Using social network analysis to assess mentorship and collaboration in a public health network
Petrescu-Prahova M , Belza B , Leith K , Allen P , Coe NB , Anderson LA . Prev Chronic Dis 2015 12 E130 INTRODUCTION: Addressing chronic disease burden requires the creation of collaborative networks to promote systemic changes and engage stakeholders. Although many such networks exist, they are rarely assessed with tools that account for their complexity. This study examined the structure of mentorship and collaboration relationships among members of the Healthy Aging Research Network (HAN) using social network analysis (SNA). METHODS: We invited 97 HAN members and partners to complete an online social network survey that included closed-ended questions about HAN-specific mentorship and collaboration during the previous 12 months. Collaboration was measured by examining the activity of the network on 6 types of products: published articles, in-progress manuscripts, grant applications, tools, research projects, and presentations. We computed network-level measures such as density, number of components, and centralization to assess the cohesiveness of the network. RESULTS: Sixty-three respondents completed the survey (response rate, 65%). Responses, which included information about collaboration with nonrespondents, suggested that 74% of HAN members were connected through mentorship ties and that all 97 members were connected through at least one form of collaboration. Mentorship and collaboration ties were present both within and across boundaries of HAN member organizations. CONCLUSION: SNA of public health collaborative networks provides understanding about the structure of relationships that are formed as a result of participation in network activities. This approach may offer members and funders a way to assess the impact of such networks that goes beyond simply measuring products and participation at the individual level. |
Age at asthma onset and asthma self-management education among adults in the United States
Mirabelli MC , Beavers SF , Shepler SH , Chatterjee AB . J Asthma 2015 52 (9) 1-7 OBJECTIVE: Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. METHODS: Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. RESULTS: Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. CONCLUSIONS: Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset. |
Molecular Detection and Characterization of Mycoplasma pneumoniae Among Patients Hospitalized With Community-Acquired Pneumonia in the United States.
Diaz MH , Benitez AJ , Cross KE , Hicks LA , Kutty P , Bramley AM , Chappell JD , Hymas W , Patel A , Qi C , Williams DJ , Arnold SR , Ampofo K , Self WH , Grijalva CG , Anderson EJ , McCullers JA , Pavia AT , Wunderink RG , Edwards KM , Jain S , Winchell JM . Open Forum Infect Dis 2015 2 (3) ofv106 BACKGROUND: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). The molecular characteristics of M pneumoniae detected in patients hospitalized with CAP in the United States are poorly described. METHODS: We performed molecular characterization of M pneumoniae in nasopharyngeal/oropharyngeal swabs from children and adults hospitalized with CAP in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, including P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide susceptibility genotyping. RESULTS: Of 216 M pneumoniae polymerase chain reaction-positive specimens, 40 (18.5%) were obtained from adults and 176 (81.5%) from children. P1 type distribution differed between adults (64% type 1 and 36% type 2) and children (84% type 1, 13% type 2, and 3% variant) (P < .05) and among sites (P < .01). Significant differences in the proportions of MLVA types 4/5/7/2 and 3/5/6/2 were also observed by age group (P < .01) and site (P < .01). A macrolide-resistant genotype was identified in 7 (3.5%) specimens, 5 of which were from patients who had recently received macrolide therapy. No significant differences in clinical characteristics were identified among patients with various strain types or between macrolide-resistant and -sensitive M pneumoniae infections. CONCLUSIONS: The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but there were differences between children and adults and among sites. Macrolide resistance was rare. Differences in strain types did not appear to be associated with differences in clinical outcomes. Whole genome sequencing of M pneumoniae may help identify better ways to characterize strains. |
Staphylococcus aureus colonization and strain type at various body sites among patients with a closed abscess and uninfected controls at U.S. emergency departments
Albrecht VS , Limbago BM , Moran GJ , Krishnadasan A , Gorwitz RJ , McDougal LK , Talan DA . J Clin Microbiol 2015 53 (11) 3478-84 INTRODUCTION: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a prevalent cause of skin and soft tissue infections (SSTI), but the association between CA-MRSA colonization and infection remains uncertain. We studied the carriage frequency at several body sites and the diversity of S. aureus strains from patients with and without SSTI. MATERIALS AND METHODS: Case-subjects with a closed skin abscess (i.e., without drainage) and matched control subjects without a skin infection (N=147 each) presenting to 10 U.S. emergency departments were cultured at the nares, throat, rectum, and groin using broth enrichment; wounds were cultured from abscess cases. Methicillin resistance testing and spa typing were performed for all S. aureus isolates. RESULTS: S. aureus was found in 85/147 (57.8%) of abscesses; 49 were MRSA, 36 were MSSA. MRSA colonization was more common among cases (59/147; 40.1%) than controls (27/147; 18.4%) overall (p<0.001), and at each body site; no differences were observed for MSSA. S. aureus-infected subjects were usually (75/85) colonized with the infecting strain; among MRSA-infected subjects this was most common in the groin. The CC8 lineage accounted for most of both infecting and colonizing isolates, although more than 16 distinct strains were identified. Nearly all MRSA infections were inferred as USA300. There was more diversity among colonizing than infecting isolates, and among those isolated from controls versus cases. CONCLUSIONS: CC8 S. aureus is a common colonizer of persons with and without skin infections. Detection of S. aureus colonization, and especially MRSA, may be enhanced by extra-nasal site culture. |
Technical assistance needs for successful implementation of couples HIV testing and counseling (CHTC) intervention for male couples at US HIV testing sites
Stephenson R , Grabbe KL , Sidibe T , McWilliams A , Sullivan PS . AIDS Behav 2015 20 (4) 841-7 The African couples HIV testing and counseling (CHTC) model, which focuses on heterosexual couples, was adapted for same-sex male couples in the US. This paper presents the results of a follow-up survey conducted with representatives of the agencies that received CHTC training. The paper aims to understand the post-training implementation and identify critical technical assistance gaps. There are clear needs for continual learning opportunities, focused on the key skills required for CHTC, and for resources aimed at tackling agency-level concerns about service provision and integration. Central to this is the need for implementation science research that can identify the messages that are effective in encouraging couples to utilize CHTC and test models of service integration. |
Using a multi-test algorithm to improve the positive predictive value of rapid HIV testing and linkage to HIV care in non-clinical HIV test sites
Delaney KP , Rurangirwa J , Facente S , Dowling T , Janson M , Knoble T , Vu A , Hu YW , Kerndt P , King J , Scheer S . J Acquir Immune Defic Syndr 2015 71 (1) 78-86 BACKGROUND: Use of a rapid HIV testing algorithm (RTA) in which all tests are conducted within one client appointment could eliminate off-site confirmatory testing and reduce the number of persons not receiving confirmed results. METHODS: An RTA was implemented in 9 sites in Los Angeles and San Francisco; results of testing at these sites were compared with 23 sites conducting rapid HIV testing with off-site confirmation. RTA clients with reactive results on >1 rapid test were considered HIV+ and immediately referred for HIV care. The positive predictive value (PPV) of a single rapid HIV test and the RTA were calculated compared to laboratory-based confirmatory testing. A Poisson risk-regression model was used to assess the effect of the RTA on the proportion of HIV+ persons linked to HIV care within 90 days of a reactive rapid test. RESULTS: The PPV of the RTA was 100% compared to 86.4% for a single rapid test. The time between testing and receipt of RTA results was on average 8 days shorter than laboratory-based confirmatory testing. For risk groups other than MSM, the RTA increased the probability of being in care within 90 days compared to standard testing practice. CONCLUSIONS: The RTA increased the PPV of rapid testing to 100%, giving providers, clients, and HIV counselors timely information about a client's HIV-positive serostatus. Use of an RTA could reduce loss to follow-up between testing positive and confirmation, and increase the proportion of HIV-infected persons receiving HIV care. |
Limited access to new hepatitis C virus treatment under state Medicaid programs
Canary LA , Klevens RM , Holmberg SD . Ann Intern Med 2015 163 (3) 226-8 The burden of fatal liver disease is increasing in the estimated 3.2 million adults chronically infected with hepatitis C virus (HCV) in the United States (1–3). Sofosbuvir (Sovaldi, Gilead Sciences), which was approved by the U.S. Food and Drug Administration in December 2013, is a new oral HCV treatment that, when combined with other therapies, has a therapeutic efficacy (cure) greater than 90% across the 4 major HCV genotypes, limited adverse effects, and a shorter treatment window (usually 12 weeks) than its interferon-based predecessors (4). However, this drug currently retails at $84 000 per patient, forcing many payers to ration this lifesaving treatment. As such, Medicaid programs, which cover approximately 25% of patients with HCV infection who are hospitalized but have limited budgets, face the challenge of deciding who should receive new, costly treatments (4, 5). | To understand policies that might affect patient access to new HCV therapies, we obtained preferred drug lists and prior authorization criteria from state Medicaid fee-for-service program Web sites and, when these were unavailable, elicited feedback from Medicaid programs through direct communication. We compared the guidelines used by state Medicaid programs with those published by the Infectious Diseases Society of America (IDSA) and the American Association for the Study of Liver Diseases (AASLD) (www.hcvguidelines.org). On the basis of data collected from May through November 2014, Medicaid programs in 31 states had designated sofosbuvir a "nonpreferred" drug, the prescription of which requires that clinicians provide evidence of medical necessity as defined by state-specific laws. Seventeen states applied a "preferred" designation, and although demonstrated medical necessity is not necessarily required in these states, all but 2 required clinicians to seek "prior authorization" for sofosbuvir prescription (Table ). |
Measles in our time: the US experience
Schuchat A . Future Virol 2015 10 (7) 809-812 For a viral illness first described a thousand years ago, vaccine-preventable for 50 years, and eliminated from the USA in 2000, the interest associated with measles in 2015 is notable [1–4]. Most virologists only dream of a solution as successful as live-attenuated measles vaccine, with 97% two-dose efficacy and literally billions ‘served.’ Success can breed complacency, skepticism or even attack. All these reactions play a role in the current US experience with measles. The dynamics involved with recent US measles outbreaks may have more to do with cultural attitudes and consumer behavior than with R0 and airborne transmission. | From 4 January to 10 April 2015, 159 people were reported to have measles in the USA [1]. Seventy percent of cases are part of an outbreak associated with Disney amusement parks in Southern California. Eighteen states and the District of Columbia have identified measles cases so far this year, with multiple genotypes (B3, D4, D8, D9 and H1) detected. Based on available information, 45% of the reported cases occurred in people who were never vaccinated (68 of 155 US residents), while more than a third (60 or 38%) had unknown vaccination status. Of those who had not been vaccinated, 29 (43%) were unvaccinated because of personal, philosophical or parental beliefs, while 26 (35%) were too young to receive the vaccine. Cases with links back to the Disney parks occurred in seven states, Mexico and Canada. In 2015, smaller outbreaks unrelated to the amusement parks have involved a childcare center in Illinois, extended family in Washington State, and community exposures in Nevada. |
Progress toward poliomyelitis eradication - Nigeria, January 2014-July 2015
Etsano A , Gunnala R , Shuaib F , Damisa E , Mkanda P , Ticha JM , Banda R , Korir C , Chevez AE , Enemaku O , Corkum M , Davis LB , Nganda GW , Burns CC , Wassilak SG , Vertefeuille JF . MMWR Morb Mortal Wkly Rep 2015 64 (32) 878-882 Since the 1988 launch of global poliomyelitis eradication efforts, four of the six World Health Organization (WHO) regions have been certified polio-free. Nigeria is one of only three countries, along with Afghanistan and Pakistan, where transmission of wild poliovirus (WPV) has never been interrupted. During 2003-2013, northern Nigeria served as a reservoir for WPV reintroduction into 26 previously polio-free countries. In 2012, the Nigerian government launched a national polio eradication emergency plan to intensify efforts to interrupt WPV transmission. This report describes polio eradication activities and progress in Nigeria during January 2014-July 2015 and updates previous reports. No WPV cases have been reported to date in 2015, compared with a total of six cases reported during 2014. Onset of paralysis in the latest reported WPV type 1 (WPV1) case was July 24, 2014. Only one case of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been reported to date in 2015, compared with 20 cVDPV2 cases during the same period in 2014. Pending final laboratory testing of 218 remaining specimens of 16,617 specimens collected since January 2015, Nigeria could be removed from the WHO list of polio-endemic countries in September 2015. Major remaining challenges to the national polio eradication program include sustaining political support and program funding in the absence of active WPV transmission, maintaining high levels of population immunity in hard-to-reach areas, and accessing children in security-compromised areas of the northeastern states. |
High burden of HIV infection and risk behaviors among female sex workers in three main urban areas of Mozambique
Augusto AD , Young PW , Horth RZ , Inguane C , Sathane I , Ngale K , Benedetti M , Cummings B , Botao CF , Baltazar CA , Frank H , Fagan J , Fisher Raymond H , McFarland W . AIDS Behav 2015 20 (4) 799-810 This is the first integrated biological and behavioral survey among female sex workers (FSW) in Mozambique. Using respondent-driven sampling, 400, 411 and 429 FSW were enrolled respectively in Maputo, Beira and Nampula in 2011-2012. Estimates were produced using RDSAT 7.1. HIV prevalence was 31.2, 23.6, and 17.8 % in each location respectively. Among HIV-positive FSW, 48.1, 79.8 and 89.6 % in each city, were unaware of their serostatus. Condom use at last sex with a client was 85.8, 73.4 and 62.8 % among FSW, respectively. HIV was associated with current age, age of first sex for money, low educational level, and having had a genital ulcer in the last 6 months. Results suggest the urgent need to increase behavioral and structural interventions in this key population. |
Identify, isolate, inform: background and considerations for Ebola virus disease preparedness in U.S. ambulatory care settings
Chea N , Perz JF , Srinivasan A , Laufer AS , Pollack LA . Am J Infect Control 2015 43 (11) 1244-5 Public health activities to identify and monitor persons at risk for Ebola virus disease in the United States include directing persons at risk to assessment facilities that are prepared to safely evaluate for Ebola virus disease. Although it is unlikely that a person with Ebola virus disease will unexpectedly present to a nonemergency ambulatory care facility, the Centers for Disease Control and Prevention have provided guidance for this setting that can be summarized as identify, isolate, and inform. |
Active tracing and monitoring of contacts associated with the first cluster of Ebola in the United States
Chung WM , Smith JC , Weil LM , Hughes SM , Joyner SN , Hall EM , Ritch J , Srinath D , Goodman E , Chevalier MS , Epstein L , Hunter JC , Kallen AJ , Karwowski MP , Kuhar DT , Smith C , Petersen LR , Mahon BE , Lakey DL , Schrag SJ . Ann Intern Med 2015 163 (3) 164-73 BACKGROUND: Following hospitalization of the first patient with Ebola virus disease diagnosed in the United States on 28 September 2014, contact tracing methods for Ebola were implemented. OBJECTIVE: To identify, risk-stratify, and monitor contacts of patients with Ebola. DESIGN: Descriptive investigation. SETTING: Dallas County, Texas, September to November 2014. PARTICIPANTS: Contacts of symptomatic patients with Ebola. MEASUREMENTS: Contact identification, exposure risk classification, symptom development, and Ebola. RESULTS: The investigation identified 179 contacts, 139 of whom were contacts of the index patient. Of 112 health care personnel (HCP) contacts of the index case, 22 (20%) had known unprotected exposures and 37 (30%) did not have known unprotected exposures but interacted with a patient or contaminated environment on multiple days. Transmission was confirmed in 2 HCP who had substantial interaction with the patient while wearing personal protective equipment. These HCP had 40 additional contacts. Of 20 community contacts of the index patient or the 2 HCP, 4 had high-risk exposures. Movement restrictions were extended to all 179 contacts; 7 contacts were quarantined. Seven percent (14 of 179) of contacts (1 community contact and 13 health care contacts) were evaluated for Ebola during the monitoring period. LIMITATION: Data cannot be used to infer whether in-person direct active monitoring is superior to active monitoring alone for early detection of symptomatic contacts. CONCLUSION: Contact tracing and monitoring approaches for Ebola were adapted to account for the evolving understanding of risks for unrecognized HCP transmission. HCP contacts in the United States without known unprotected exposures should be considered as having a low (but not zero) risk for Ebola and should be actively monitored for symptoms. Core challenges of contact tracing for high-consequence communicable diseases included rapid comprehensive contact identification, large-scale direct active monitoring of contacts, large-scale application of movement restrictions, and necessity of humanitarian support services to meet nonclinical needs of contacts. PRIMARY FUNDING SOURCE: None. |
Contact lens wearer demographics and risk behaviors for contact lens-related eye infections - United States, 2014
Cope JR , Collier SA , Rao MM , Chalmers R , Mitchell GL , Richdale K , Wagner H , Kinoshita BT , Lam DY , Sorbara L , Zimmerman A , Yoder JS , Beach MJ . MMWR Morb Mortal Wkly Rep 2015 64 (32) 865-870 Contact lenses provide safe and effective vision correction for many Americans. However, contact lens wearers risk infection if they fail to wear, clean, disinfect, and store their contact lenses as directed. Over the past decade, CDC has investigated several multistate outbreaks of serious eye infections among contact lens wearers, including Acanthamoeba keratitis. Each investigation identified frequent contact lens hygiene-related risk behaviors among patients. To guide prevention efforts, a population-based survey was used to estimate the number of contact lens wearers aged ≥18 years in the United States. A separate online survey of contact lens wearers assessed the prevalence of contact lens hygiene-related risk behaviors. Approximately 99% of wearers reported at least one contact lens hygiene risk behavior. Nearly one third of contact lens wearers reported having experienced a previous contact lens-related red or painful eye requiring a doctor's visit. An estimated 40.9 million U.S. adults wear contact lenses, and many could be at risk for serious eye infections because of poor contact lens wear and care behaviors. These findings have informed the creation of targeted prevention messages aimed at contact lens wearers such as keeping all water away from contact lenses, discarding used disinfecting solution from the case and cleaning with fresh solution each day, and replacing their contact lens case every 3 months. |
Diversity and persistence of Salmonella enterica strains in rural landscapes in the southeastern United States
Maurer JJ , Martin G , Hernandez S , Cheng Y , Gerner-Smidt P , Hise KB , Tobin D'Angelo M , Cole D , Sanchez S , Madden M , Valeika S , Presotto A , Lipp EK . PLoS One 2015 10 (7) e0128937 Salmonellosis cases in the in the United States show distinct geographical trends, with the southeast reporting among the highest rates of illness. In the state of Georgia, USA, non-outbreak associated salmonellosis is especially high in the southern low-lying coastal plain. Here we examined the distribution of Salmonella enterica in environmental waters and associated wildlife in two distinct watersheds, one in the Atlantic Coastal Plain (a high case rate rural area) physiographic province and one in the Piedmont (a lower case rate rural area). Salmonella were isolated from the two regions and compared for serovar and strain diversity, as well as distribution, between the two study areas, using both a retrospective and prospective design. Thirty-seven unique serovars and 204 unique strain types were identified by pulsed-field gel electrophoresis (PFGE). Salmonella serovars Braenderup, Give, Hartford, and Muenchen were dominant in both watersheds. Two serovars, specifically S. Muenchen and S. Rubislaw, were consistently isolated from both systems, including water and small mammals. Conversely, 24 serovars tended to be site-specific (64.8%, n = 37). Compared to the other Salmonella serovars isolated from these sites, S. Muenchen and S. Rubislaw exhibited significant genetic diversity. Among a subset of PFGE patterns, approximately half of the environmental strain types matched entries in the USA PulseNet database of human cases. Ninety percent of S. Muenchen strains from the Little River basin (the high case rate area) matched PFGE entries in PulseNet compared to 33.33% of S. Muenchen strains from the North Oconee River region (the lower case rate area). Underlying the diversity and turnover of Salmonella strains observed for these two watersheds is the persistence of specific Salmonella serovars and strain types that may be adapted to these watersheds and landscapes. |
Meteorologically Driven Simulations of Dengue Epidemics in San Juan, PR.
Morin CW , Monaghan AJ , Hayden MH , Barrera R , Ernst K . PLoS Negl Trop Dis 2015 9 (8) e0004002 Meteorological factors influence dengue virus ecology by modulating vector mosquito population dynamics, viral replication, and transmission. Dynamic modeling techniques can be used to examine how interactions among meteorological variables, vectors and the dengue virus influence transmission. We developed a dengue fever simulation model by coupling a dynamic simulation model for Aedes aegypti, the primary mosquito vector for dengue, with a basic epidemiological Susceptible-Exposed-Infectious-Recovered (SEIR) model. Employing a Monte Carlo approach, we simulated dengue transmission during the period of 2010-2013 in San Juan, PR, where dengue fever is endemic. The results of 9600 simulations using varied model parameters were evaluated by statistical comparison (r2) with surveillance data of dengue cases reported to the Centers for Disease Control and Prevention. To identify the most influential parameters associated with dengue virus transmission for each period the top 1% of best-fit model simulations were retained and compared. Using the top simulations, dengue cases were simulated well for 2010 (r2 = 0.90, p = 0.03), 2011 (r2 = 0.83, p = 0.05), and 2012 (r2 = 0.94, p = 0.01); however, simulations were weaker for 2013 (r2 = 0.25, p = 0.25) and the entire four-year period (r2 = 0.44, p = 0.002). Analysis of parameter values from retained simulations revealed that rain dependent container habitats were more prevalent in best-fitting simulations during the wetter 2010 and 2011 years, while human managed (i.e. manually filled) container habitats were more prevalent in best-fitting simulations during the drier 2012 and 2013 years. The simulations further indicate that rainfall strongly modulates the timing of dengue (e.g., epidemics occurred earlier during rainy years) while temperature modulates the annual number of dengue fever cases. Our results suggest that meteorological factors have a time-variable influence on dengue transmission relative to other important environmental and human factors. |
Lead poisoning and anemia associated with use of Ayurvedic medications purchased on the internet - Wisconsin, 2015
Meiman J , Thiboldeaux R , Anderson H . MMWR Morb Mortal Wkly Rep 2015 64 (32) 883 On April 30, 2015, the Wisconsin Division of Public Health (WDPH) was notified by a local health department of an elevated blood lead level (BLL) in a female patient aged 64 years. All Wisconsin laboratories are required to provide BLL testing results performed on any state resident to WDPH, and WDPH and local health departments are statutorily mandated to investigate any single BLL ≥20 microg/dL or BLLs that are persistently ≥15 microg/dL. Review of medical records revealed that the patient had developed progressive fatigue and shortness of breath during a period of multiple weeks that prompted inpatient medical evaluation. Hemoglobin level was 8.3 g/dL (normal range for age and sex of patient = 12.5-15.0 g/dL), and peripheral blood smear showed normochromic, normocytic red blood cells with basophilic stippling. A BLL was obtained and found to be 85.8 microg/dL. Urine toxic metals tests revealed mercury and aluminum levels in the normal range. Combined methylated and inorganic urine arsenic levels were slightly elevated at 53.3 microg/L (normal = <18.9 microg/L). The patient was discharged for outpatient lead chelation therapy with oral meso-2,3-dimercaptosuccinic acid. |
CDC Grand Rounds: getting smart about antibiotics
Demirjian A , Sanchez GV , Finkelstein JA , Ling SM , Srinivasan A , Pollack LA , Hicks LA , Iskander JK . MMWR Morb Mortal Wkly Rep 2015 64 (32) 871-873 Each year in the United States, approximately two million persons become infected with antibiotic-resistant bacteria, at least 23,000 persons die as a direct result of these infections, and many more die from conditions complicated by a resistant infection. Antibiotic-resistant infections contribute to poor health outcomes, higher health care costs, and use of more toxic treatments. Although emerging resistance mechanisms are being identified and resistant infections are on the rise, new antibiotic development has slowed considerably. |
The rise and decline in Salmonella enterica serovar Enteritidis outbreaks attributed to egg-containing foods in the United States, 1973-2009
Wright AP , Richardson L , Mahon BE , Rothenberg R , Cole DJ . Epidemiol Infect 2015 144 (4) 1-10 Salmonella enterica causes an estimated 1 million domestically acquired foodborne illnesses annually. Salmonella enterica serovar Enteritidis (SE) is among the top three serovars of reported cases of Salmonella. We examined trends in SE foodborne outbreaks from 1973 to 2009 using Joinpoint and Poisson regression. The annual number of SE outbreaks increased sharply in the 1970s and 1980s but declined significantly after 1990. Over the study period, SE outbreaks were most frequently attributed to foods containing eggs. The average rate of SE outbreaks attributed to egg-containing foods reported by states began to decline significantly after 1990, and the proportion of SE outbreaks attributed to egg-containing foods began declining after 1997. Our results suggest that interventions initiated in the 1990s to decrease SE contamination of shell eggs may have been integral to preventing SE outbreaks. |
Risk factors for Vibrio parahaemolyticus infection in a southern coastal region of China
Liao Y , Li Y , Wu S , Mou J , Xu Z , Cui R , Klena JD , Shi X , Lu Y , Qiu Y , Lin Y , Xie X , Ma H , Li Z , Yu H , Varma JK , Ran L , Hu Q , Cheng J . Foodborne Pathog Dis 2015 12 (11) 881-6 OBJECTIVES: The objectives of the study were to identify dietary and medical risk factors for Vibrio parahaemolyticus (VP) infection in the coastal city Shenzhen in China. METHODS: In April-October 2012, we conducted a case-control study in two hospitals in Shenzhen, China. Laboratory-confirmed VP cases (N = 83) were matched on age, sex, and other social factors to healthy controls (N = 249). Subjects were interviewed using a questionnaire on medical history; contact with seawater; clinical symptoms and outcome; travel history over the past week; and dietary history 3 days prior to onset. Laboratory tests were used to culture, serotype, and genotype VP strains. We used logistic regression to calculate the odds ratios for the association of VP infection with potential risk factors. RESULTS: In multivariate analysis, VP infection was associated with having pre-existing chronic disease (adjusted odds ratio [aOR], 6.0; 95% confidence interval [CI], 1.5-23.7), eating undercooked seafood (aOR, 8.0; 95% CI, 1.3-50.4), eating undercooked meat (aOR, 29.1; 95% CI, 3.0-278.2), eating food from a street food vendor (aOR, 7.6; 95% CI, 3.3-17.6), and eating vegetable salad (aOR, 12.1; 95% CI, 5.2-28.2). CONCLUSIONS: Eating raw (undercooked) seafood and meat is an important source of VP infection among the study population. Cross-contamination of VP in other food (e.g., vegetables and undercooked meat) likely plays a more important role. Intervention should be taken to lower the risks of cross-contamination with undercooked seafood/meat, especially targeted at people with low income, transient workers, and people with medical risk factors. |
Increase in multistate foodborne disease outbreaks - United States, 1973-2010
Nguyen VD , Bennett SD , Mungai E , Gieraltowski L , Hise K , Gould LH . Foodborne Pathog Dis 2015 12 (11) 867-72 INTRODUCTION: Changes in food production and distribution have increased opportunities for foods contaminated early in the supply chain to be distributed widely, increasing the possibility of multistate outbreaks. In recent decades, surveillance systems for foodborne disease have been improved, allowing officials to more effectively identify related cases and to trace and identify an outbreak's source. MATERIALS AND METHODS: We reviewed multistate foodborne disease outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1973-2010. We calculated the percentage of multistate foodborne disease outbreaks relative to all foodborne disease outbreaks and described characteristics of multistate outbreaks, including the etiologic agents and implicated foods. RESULTS: Multistate outbreaks accounted for 234 (0.8%) of 27,755 foodborne disease outbreaks, 24,003 (3%) of 700,600 outbreak-associated illnesses, 2839 (10%) of 29,756 outbreak-associated hospitalizations, and 99 (16%) of 628 outbreak-associated deaths. The median annual number of multistate outbreaks increased from 2.5 during 1973-1980 to 13.5 during 2001-2010; the number of multistate outbreak-associated illnesses, hospitalizations, and deaths also increased. Most multistate outbreaks were caused by Salmonella (47%) and Shiga toxin-producing Escherichia coli (26%). Foods most commonly implicated were beef (22%), fruits (13%), and leafy vegetables (13%). CONCLUSIONS: The number of identified and reported multistate foodborne disease outbreaks has increased. Improvements in detection, investigation, and reporting of foodborne disease outbreaks help explain the increasing number of reported multistate outbreaks and the increasing percentage of outbreaks that were multistate. Knowing the etiologic agents and foods responsible for multistate outbreaks can help to identify sources of food contamination so that the safety of the food supply can be improved. |
Mycobacterium tuberculosis pncA polymorphisms that do not confer pyrazinamide resistance at a breakpoint concentration of 100 µg/ml in MGIT.
Whitfield MG , Warren RM , Streicher EM , Sampson SL , Sirgel FA , van Helden PD , Mercante A , Willby M , Hughes K , Birkness K , Morlock G , van Rie A , Posey JE . J Clin Microbiol 2015 Sequencing of the Mycobacterium tuberculosis pncA gene allows for pyrazinamide susceptibility testing. We summarize data on pncA polymorphisms which do not confer resistance at a susceptibility breakpoint of 100 mug/ml pyrazinamide in MGIT within a cohort of isolates from South Africa and the US Centre for Disease Control. |
Diagnosing Balamuthia mandrillaris Encephalitis With Metagenomic Deep Sequencing.
Wilson MR , Shanbhag NM , Reid MJ , Singhal NS , Gelfand JM , Sample HA , Benkli B , O'Donovan B , Ali IK , Keating MK , Dunnebacke TH , Wood MD , Bollen A , DeRisi JL . Ann Neurol 2015 78 (5) 722-30 OBJECTIVE: Identification of a particular cause of meningoencephalitis can be challenging due to the myriad bacteria, viruses, fungi, and parasites that can produce overlapping clinical phenotypes, frequently delaying diagnosis and therapy. Metagenomic deep sequencing (MDS) approaches to infectious disease diagnostics are known for their ability to identify unusual or novel viruses and thus are well suited for investigating possible etiologies of meningoencephalitis. METHODS: We present the case of a 74 year-old woman with endophthalmitis followed by meningoencephalitis. MDS of her cerebrospinal fluid (CSF) was performed to identify an infectious agent. RESULTS: Sequences aligning to Balamuthia mandrillaris ribosomal RNA genes were identified in the CSF via MDS. Polymerase chain reaction (PCR) subsequently confirmed the presence of B. mandrillaris in CSF, brain tissue, and vitreous fluid from the patient's infected eye. B. mandrillaris serology and immunohistochemistry for free-living amoebas on the brain biopsy tissue were positive. INTERPRETATION: The diagnosis was made using MDS after the patient had been hospitalized for several weeks and subjected to costly and invasive testing. MDS a powerful diagnostic tool with the potential for rapid and unbiased pathogen identification leading to early therapeutic targeting. |
Genetic Analysis and Species Specific Amplification of the Artemisinin Resistance-Associated Kelch Propeller Domain in P. falciparum and P. vivax.
Talundzic E , Chenet SM , Goldman IF , Patel DS , Nelson JA , Plucinski MM , Barnwell JW , Udhayakumar V . PLoS One 2015 10 (8) e0136099 Plasmodium falciparum resistance to artemisinin has emerged in the Greater Mekong Subregion and now poses a threat to malaria control and prevention. Recent work has identified mutations in the kelch propeller domain of the P. falciparum K13 gene to be associated artemisinin resistance as defined by delayed parasite clearance and ex vivo ring stage survival assays. Species specific primers for the two most prevalent human malaria species, P. falciparum and P. vivax, were designed and tested on multiple parasite isolates including human, rodent, and non- humans primate Plasmodium species. The new protocol described here using the species specific primers only amplified their respective species, P. falciparum and P. vivax, and did not cross react with any of the other human malaria Plasmodium species. We provide an improved species specific PCR and sequencing protocol that could be effectively used in areas where both P. falciparum and P. vivax are circulating. To design this improved protocol, the kelch gene was analyzed and compared among different species of Plasmodium. The kelch propeller domain was found to be highly conserved across the mammalian Plasmodium species. |
Game, set, match for factor VIII mismatch?
Miller CH . Blood 2015 126 (7) 829-30 In this issue of Blood, Gunasekera et al provide evidence that the high rate of factor VIII (FVIII) inhibitors seen in black hemophilia A (HA) patients is not due to a mismatch between the structure of treatment products and FVIII genotypes common in blacks. |
Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000-12.
Iqbal S , Shi J , Seib K , Lewis P , Moro PL , Woo EJ , Shimabukuro T , Orenstein WA . Lancet Infect Dis 2015 15 (10) 1175-1182 BACKGROUND: Safety data from countries with experience in the use of inactivated poliovirus vaccine (IPV) are important for the global polio eradication strategy to introduce IPV into the immunisation schedules of all countries. In the USA, IPV has been included in the routine immunisation schedule since 1997. We aimed to analyse adverse events after IPV administration reported to the US Vaccine Adverse Event Reporting System (VAERS). METHODS: We analysed all VAERS data associated with IPV submitted between Jan 1, 2000, and Dec 31, 2012, either as individual or as combination vaccines, for all age and sex groups. We analysed the number and event type (non-serious, non-fatal serious, and death reports) of individual reports, and explored the most commonly coded event terms to describe the adverse event. We classified death reports according to previously published body-system categories (respiratory, cardiovascular, neurological, gastrointestinal, other infectious, and other non-infectious) and reviewed death reports to identify the cause of death. We classified sudden infant death syndrome as a separate cause of death considering previous concerns about sudden infant syndrome after vaccines. We used empirical Bayesian data mining methods to identify disproportionate reporting of adverse events for IPV compared with other vaccines. Additional VAERS data from 1991 to 2000 were analysed to compare the safety profiles of IPV and oral poliovirus vaccine (OPV). FINDINGS: Of the 41 792 adverse event reports submitted, 39 568 (95%) were for children younger than 7 years. 38 381 of the reports for children in this age group (97%) were for simultaneous vaccination with IPV and other vaccines (most commonly pneumococcal and acellular pertussis vaccines), whereas standalone IPV vaccines accounted for 0.5% of all reports. 34 880 reports were for non-serious events (88%), 3905 reports were for non-fatal serious events (10%), and 783 reports were death reports (2%). Injection-site erythema was the most commonly coded term for non-serious events (29%), and pyrexia for non-fatal serious events (38%). Most deaths (96%) were in children aged 12 months or younger; most (52%) had sudden infant death syndrome as the reported cause of death. The safely profiles of combined IPV and whole-cell pertussis vaccines, OPV and whole-cell pertussis vaccines, and OPV and acellular pertussis vaccines were similar. We noted no indication of disproportionate reporting of adverse events after immunisation with IPV-containing vaccines compared with other vaccines between 1990 and 2013. INTERPRETATION: Fairly few adverse events were reported for the more than 250 million IPV doses distributed between 2000 and 2012. Sudden infant death syndrome reports after IPV were consistent with reporting patterns for other vaccines. No new or unexpected vaccine safety problems were identified for fatal, non-fatal serious, and non-serious reports in this assessment of adverse events after IPV. FUNDING: None. |
Improved immunogenicity of individual influenza vaccine components delivered with a novel dissolving microneedle patch stable at room temperature
Vassilieva EV , Kalluri H , McAllister D , Taherbhai MT , Esser ES , Pewin WP , Pulit-Penaloza JA , Prausnitz MR , Compans RW , Skountzou I . Drug Deliv Transl Res 2015 5 (4) 360-71 Prevention of seasonal influenza epidemics and pandemics relies on widespread vaccination coverage to induce protective immunity. In addition to a good antigenic match with the circulating viruses, the effectiveness of individual strains represented in the trivalent vaccines depends on their immunogenicity. In this study, we evaluated the immunogenicity of H1N1, H3N2, and B seasonal influenza virus vaccine strains delivered individually with a novel dissolving microneedle patch and the stability of this formulation during storage at 25 degrees C. Our data demonstrate that all strains retained their antigenic activity after incorporation in the dissolving patches as measured by single radial diffusion (SRID) assay and immune responses to vaccination in BALB/c mice. After a single immunization, all three antigens delivered with microneedle patches induced superior neutralizing antibody titers compared to intramuscular immunization. Cutaneous antigen delivery was especially beneficial for the less immunogenic B strain. Mice immunized with dissolving microneedle patches encapsulating influenza A/Brisbane/59/07 (H1N1) vaccine were fully protected against lethal challenge by homologous mouse-adapted influenza virus. All vaccine components retained activity during storage at room temperature for at least 3 months as measured in vitro by SRID assay and in vivo by mouse immunization studies. Our data demonstrate that dissolving microneedle patches are a promising advance for influenza cutaneous vaccination due to improved immune responses using less immunogenic influenza antigens and enhanced stability. |
Incidence of medically attended influenza infection and cases averted by vaccination, 2011/2012 and 2012/2013 influenza seasons
Jackson ML , Jackson LA , Kieke B , McClure D , Gaglani M , Murthy K , Malosh R , Monto A , Zimmerman RK , Foppa IM , Flannery B , Thompson MG . Vaccine 2015 33 (39) 5181-7 BACKGROUND: We estimated the burden of outpatient influenza and cases prevented by vaccination during the 2011/2012 and 2012/2013 influenza seasons using data from the United States Influenza Vaccine Effectiveness (US Flu VE) Network. METHODS: We defined source populations of persons who could seek care for acute respiratory illness (ARI) at each of the five US Flu VE Network sites. We identified all members of the source population who were tested for influenza during US Flu VE influenza surveillance. Each influenza-positive subject received a sampling weight based on the proportion of source population members who were tested for influenza, stratified by site, age, and other factors. We used the sampling weights to estimate the cumulative incidence of medically attended influenza in the source populations. We estimated cases averted by vaccination using estimates of cumulative incidence, vaccine coverage, and vaccine effectiveness. RESULTS: Cumulative incidence of medically attended influenza ranged from 0.8% to 2.8% across sites during 2011/2012 and from 2.6% to 6.5% during the 2012/2013 season. Stratified by age, incidence ranged from 1.2% among adults 50 years of age and older in 2011/2012 to 10.9% among children 6 months to 8 years of age in 2012/2013. Cases averted by vaccination ranged from 4 to 41 per 1000 vaccinees, depending on the study site and year. CONCLUSIONS: The incidence of medically attended influenza varies greatly by year and even by geographic region within the same year. The number of cases averted by vaccination varies greatly based on overall incidence and on vaccine coverage. |
Intussusception after monovalent rotavirus vaccine - United States, Vaccine Adverse Event Reporting System (VAERS), 2008-2014
Haber P , Parashar UD , Haber M , DeStefano F . Vaccine 2015 33 (38) 4873-7 BACKGROUND: In 2006 and 2008, two new rotavirus vaccines (RotaTeq [RV5] and Rotarix [RV1]) were introduced in the United States. US data on intussusception have been mostly related to RV5, with limited data on RV1. METHODS: We assessed intussusception events following RV1 reported to the Vaccine Adverse Event Reporting System (VAERS), a US national passive surveillance system, during February 2008-December 2014. We conducted a self-controlled risk interval analysis using Poisson regression to estimate the daily reporting ratio (DRR) of intussusception after the first 2 doses of RV1 comparing average daily reports 3-6 versus 0-2 days after vaccination. We calculated the excess risk of intussusception per 100,000 vaccinations based on DRRs and background rates of intussusception. Sensitivity analyses were conducted to assess effects of differential reporting completeness and inaccuracy of baseline rates. RESULTS: VAERS received 108 confirmed insusceptible reports after RV1. A significant clustering was observed on days 3-8 after does1 (p=0.001) and days 2-7 after dose 2 (p=0.001). The DRR comparing the 3-6 day and the 0-2 day periods after RV1 dose 1 was 7.5 (95% CI=2.3, 24.6), translating to an excess risk of 1.6 (95% CI=0.3, 5.8) per 100,000 vaccinations. The DRR was elevated but not significant after dose 2 (2.4 [95% CI=0.8,7.5]). The excess risk ranged from 1.2 to 2.8 per 100,000 in sensitivity analysis. CONCLUSIONS: We observed a significant increased risk of intussusception 3-6 days after dose 1 of RV1. The estimated small number of intussusception cases attributable to RV1 is outweighed by the benefits of rotavirus vaccination. |
A structured approach to recording AIDS-defining illnesses in Kenya: a SNOMED CT based solution
Oluoch T , de Keizer N , Langat P , Alaska I , Ochieng K , Okeyo N , Kwaro D , Cornet R . J Biomed Inform 2015 56 387-94 INTRODUCTION: Several studies conducted in sub-Saharan Africa (SSA) have shown that routine clinical data in HIV clinics often have errors. Lack of structured and coded documentation of diagnosis of AIDS defining illnesses (ADIs) can compromise data quality and decisions made on clinical care. METHODS: We used a structured framework to derive a reference set of concepts and terms used to describe ADIs. The four sources used were: (i) CDC/Accenture list of opportunistic infections, (ii) SNOMED Clinical Terms (SNOMED CT), (iii) Focus Group Discussion (FGD) among clinicians and nurses attending to patients at a referral provincial hospital in western Kenya, and (iv) chart abstraction from the Maternal Child Health (MCH) and HIV clinics at the same hospital. Using the January 2014 release of SNOMED CT, concepts were retrieved that matched terms abstracted from approach iii & iv, and the content coverage assessed. Post-coordination matching was applied when needed. RESULTS: The final reference set had 1054 unique ADI concepts which were described by 1860 unique terms. Content coverage of SNOMED CT was high (99.9% with pre-coordinated concepts; 100% with post-coordination). The resulting reference set for ADIs was implemented as the interface terminology on OpenMRS data entry forms. CONCLUSION: Different sources demonstrate complementarity in the collection of concepts and terms for an interface terminology. SNOMED CT provides a high coverage in the domain of ADIs. Further work is needed to evaluate the effect of the interface terminology on data quality and quality of care. |
It's not as simple as it sounds: problems and solutions in accessing and using administrative child welfare data for evaluating the impact of early childhood interventions
Green BL , Ayoub C , Bartlett JD , Furrer C , Von Ende A , Chazan-Cohen R , Klevens J , Nygren P . Child Youth Serv Rev 2015 57 40-49 In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children's involvement with the child welfare system from birth through age eleven. We provide "lessons learned" for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research. |
CKD as a model for improving chronic disease care through electronic health records
Drawz PE , Archdeacon P , McDonald CJ , Powe NR , Smith KA , Norton J , Williams DE , Patel UD , Narva A . Clin J Am Soc Nephrol 2015 10 (8) 1488-99 Electronic health records have the potential to improve the care of patients with chronic medical conditions. CKD provides a unique opportunity to show this potential: the disease is common in the United States, there is significant room to improve CKD detection and management, CKD and its related conditions are defined primarily by objective laboratory data, CKD care requires collaboration by a diverse team of health care professionals, and improved access to CKD-related data would enable identification of a group of patients at high risk for multiple adverse outcomes. However, to realize the potential for improvement in CKD-related care, electronic health records will need to provide optimal functionality for providers and patients and interoperability across multiple health care settings. The goal of the National Kidney Disease Education Program Health Information Technology Working Group is to enable and support the widespread interoperability of data related to kidney health among health care software applications to optimize CKD detection and management. Over the course of the last 2 years, group members met to identify general strategies for using electronic health records to improve care for patients with CKD. This paper discusses these strategies and provides general goals for appropriate incorporation of CKD-related data into electronic health records and corresponding design features that may facilitate (1) optimal care of individual patients with CKD through improved access to clinical information and decision support, (2) clinical quality improvement through enhanced population management capabilities, (3) CKD surveillance to improve public health through wider availability of population-level CKD data, and (4) research to improve CKD management practices through efficiencies in study recruitment and data collection. Although these strategies may be most effectively applied in the setting of CKD, because it is primarily defined by laboratory abnormalities and therefore, an ideal computable electronic health record phenotype, they may also apply to other chronic diseases. |
Texting while driving as impulsive choice: a behavioral economic analysis
Hayashi Y , Russo CT , Wirth O . Accid Anal Prev 2015 83 182-189 The goal of the present study was to examine the utility of a behavioral economic analysis to investigate the role of delay discounting in texting while driving. A sample of 147 college students completed a survey to assess how frequently they send and read text messages while driving. Based on this information, students were assigned to one of two groups: 19 students who frequently text while driving and 19 matched-control students who infrequently text while driving but were similar in gender, age, years of education, and years driving. The groups were compared on the extent to which they discounted, or devalued, delayed hypothetical monetary rewards using a delay-discounting task. In this task, students made repeated choices between $1000 available after a delay (ranging from 1 week to 10 years) and an equal or lesser amount of money available immediately. The results show that the students who frequently text while driving discounted delayed rewards at a greater rate than the matched control students. The study supports the conclusions that texting while driving is fundamentally an impulsive choice made by drivers, and that a behavioral economic approach may be a useful research tool for investigating the decision-making processes underlying risky behaviors. |
Getting everyone to buckle up on every trip: what more can be done?
Baldwin GT , Houry D . Ann Intern Med 2015 163 (3) 234-5 The Centers for Disease Control and Prevention (CDC) focuses on preventing illness, injury, disability, and death. To spotlight attention and focus activity, CDC Director Dr. Thomas Frieden has identified 7 public health “winnable battles.” These battles address public health issues in which judicious action and implementation of evidence-based and scalable interventions would have an immediate positive effect. | The prevention of motor vehicle injuries is a winnable battle, in part, because of the life-saving potential of seat belts and our opportunity to increase their use. The CDC aims to prevent deaths and injuries from motor vehicle crashes by focusing on modifiable behaviors through coordinated, sustained, and complementary actions with the U.S. Department of Transportation, especially the National Highway Traffic Safety Administration. | The most effective intervention to reduce injury of motor vehicle occupants in a crash is simple: Wear a seat belt. Seat belts reduce the risk for fatal injuries by approximately 45% and serious injuries by approximately 50% when worn in a motor vehicle crash (1). Seat belts are a critical and cross-cutting secondary prevention strategy. They protect persons regardless of who is at fault or the root cause of the crash, including those involved in crashes that result from the negligence of alcohol-impaired drivers and from distracted driving. Seat belts have saved the lives of 300 000 Americans since 1975, including more than 12 500 Americans in 2013 alone (1, 2). In that same year, approximately 2800 more Americans would be alive today if all unrestrained passenger vehicle occupants aged 5 years or older involved in a fatal crash had buckled up (2). |
High rates of homicide in a rural South African population (2000-2008): findings from a population-based cohort study
Otieno G , Marinda E , Bärnighausen T , Tanser F . Popul Health Metr 2015 13 (20) 20 BACKGROUND: South Africa has continued to receive increasing attention due to unprecedented high levels of violence. Homicide-related violence accounts for a significant proportion of unnatural deaths and contributes significantly to loss of years of expected life. We investigated levels and factors associated with homicide-related deaths and identify communities with excessively high homicide risk in a typical rural South African population. METHOD: Data drawn from verbal autopsies conducted on all deaths recorded during annual demographic and health surveillance in KwaZulu Natal, South Africa were used to derive the cumulative probability of death from homicide over a nine-year period (2000-2008). Weibull regression methods were used to investigate factors associated with homicide deaths. A Kulldorff spatial scan statistic was used to identify spatial clusters of homicide-related deaths. RESULTS: With 536 homicide-related deaths, and a median seven years of follow-up, the study found an overall homicide incidence rate of 66 deaths per 100, 000 person-years of observation (PYOs) (95 % CI 60-72) for the period under study. Death related to the use of firearms was the leading reported method of homicide (65 %) and most deaths occurred over weekends (43 %). Homicides are the second-most common cause of death in men aged 25-34 after HIV-related deaths (including TB) in this community, at 210 deaths per 100,000 PYOs, and was highest among 55-64 year old women, at 78 deaths per 100,000 PYOs. Residency status, age, socioeconomic status, and highest education level attained independently predicted the risk of homicide death. The spatial distribution of homicide deaths was not homogenous and the study identified two clear geographical clusters with significantly elevated homicide risk. CONCLUSION: The high rates of homicide observed in this typical rural South African population - particularly among men - underscore the need for urgent interventions to reduce this tragic and theoretically preventable loss of life in this population and similar South African settings. |
MyD88 mediates in vivo effector functions of alveolar macrophages in acute lung inflammatory responses to carbon nanotube exposure
Frank EA , Birch ME , Yadav JS . Toxicol Appl Pharmacol 2015 288 (3) 322-9 Carbon nanotubes (CNTs) are rapidly emerging as high-priority occupational toxicants. CNT powders contain fibrous particles that aerosolize readily in places of manufacture and handling, posing an inhalation risk for workers. Studies using animal models indicate that lung exposure to CNTs causes prolonged inflammatory responses and diffuse alveolar injury. The mechanisms governing CNT-induced lung inflammation are not fully understood but have been suggested to involve alveolar macrophages (AMs). In the current study, we sought to systematically assess the effector role of AMs in vivo in the induction of lung inflammatory responses to CNT exposures and investigate their cell type-specific mechanisms. Multi-wall CNTs characterized for various physicochemical attributes were used as the CNT type. Using an AM-specific depletion and repopulation approach in a mouse model, we unambiguously demonstrated that AMs are major effector cells necessary for the in vivo elaboration of CNT-induced lung inflammation. We further investigated in vitro AM responses and identified molecular targets which proved critical to pro-inflammatory responses in this model, namely MyD88 as well as MAPKs and Ca2+/CamKII. We further demonstrated that MyD88 inhibition in donor AMs abrogated their capacity to reconstitute CNT-induced inflammation when adoptively transferred into AM-depleted mice. Taken together, this is the first in vivo demonstration that AMs act as critical effector cell types in CNT-induced lung inflammation and that MyD88 is required for this in vivo effector function. AMs and their cell type-specific mechanisms may therefore represent potential targets for future therapeutic intervention of CNT-related lung injury. |
Increased dietary salt intake does not influence influenza A virus-induced disease severity in mice
Amoah S , Cao W , Ranjan P , Greer P , Shieh WJ , Zaki SR , Katz JM , Sambhara S , Gangappa S . Viral Immunol 2015 28 (9) 532-7 Influenza viruses are pathogens of significant public health importance. The influence of nutritional status on severity of disease has become increasingly recognized. In particular, high dietary salt intake has been linked to cardiovascular disease, but the effects on infectious diseases have not been studied. This study investigated the impact on influenza-induced morbidity and mortality in mice fed isocaloric diets containing 10-fold increments of sodium by altering the salt levels. Following infection, despite higher levels of IFN-gamma cytokine in the lung as well as virus-neutralizing antibody in the serum of mice fed the lowest salt level, the amounts of dietary salt intake had no substantial impact on the disease severity or the ability to respond immunologically to the infection. |
Inhibition of melanogenesis by yeast extracts from cultivations of recombinant pichia pastoris catalyzing ortho-hydroxylation of flavonoids
Chang TS , Beezhold D , Gao J . Curr Pharm Biotechnol 2015 16 (12) 1085-93 The inhibition of melanogenesis by yeast extracts from cultivations of recombinant Pichia pastoris catalyzing ortho-hydroxylation of flavonoids was investigated. The recombinant yeast harbored a fusion gene composed of the CYP57B3 gene from Aspergillus oryzae and a cytochrome reductase gene from Saccharomyces cerevisiae. Ten flavonoids belonging to flavones, flavonols, flavanones, flavanols, and isoflavones were evaluated for biotransformation by the recombinant strain. The results showed that five flavonoids, including the flavone apigenin, the flavanones naringenin and liquiritigenin, and the isoflavones daidzein and genistein, could be biotransformed. The yeast extracts from the five biotransformation fermentations were then evaluated for inhibitory activity on melanogenesis in cultured mouse B16 melanoma cells. Three yeast extracts from biotransformation fermentation feeding with daidzein, genistein, or apigenin showed inhibitory activity on melanogenesis in the B16 cells, while the extract from genistein biotransformation exhibited the highest activity. The yeast extract from genistein biotransformation also showed inhibitory activity on cellular tyrosinase activity in the B16 cells. The present study shows a CYP with multiple flavonoid substrates for the first time and highlights the usage of yeast extracts from cultivations of the recombinant yeast catalyzing flavonoids' biotransformation in the development of skin-whitening agents. |
Investigations into the immunotoxicity and allergic potential induced by topical application of N-Butylbenzenesulfonamide (NBBS) in a murine model
Marrocco A , Meade BJ , Long CM , Lukomska E , Marshall NB , Anderson SE . J Toxicol Environ Health A 2015 78 (17) 1-11 N-Butylbenzene sulfonamide (NBBS) is a commonly used plasticizer found in numerous products. Due to its extensive use, lack of adequate toxicological data, and suspicion of toxicity based on the presence of structural alerts, it was nominated to the National Toxicology Program for comprehensive toxicological testing. The purpose of this study was to evaluate the potential for hypersensitivity and immune suppression following dermal exposure to NBBS using a murine model. NBBS tested negative in a combined irritancy/local lymph node assay (LLNA), classifying it as nonirritating and nonsensitizing. To estimate the immunosuppressive potential of NBBS, assays that assessed immunotoxicity were performed, including the immumnoglobulin (Ig) M response to T-cell-dependent antigen sheep red blood cells (SRBC), using the plaque-forming cell (PFC) assay and immune cell phenotyping. After a 28-d treatment with NBBS, mice exposed to the lowest concentration (25% NBBS) showed a significant increase in IgM-producing B cells in the spleen. No marked changes were identified in immune cell markers in the lymph node. In contrast to body weight, a significant elevation in kidney and liver weight was observed following dermal exposure to all concentrations of NBBS. These results demonstrate that dermal exposure to NBBS, other than liver and kidney toxicity, did not apparently induce immunotoxicity in a murine model. |
Comparison of simulated workplace protection factors offered by N95 and P100 filtering facepiece and elastomeric half-mask respirators against particles of 10 to 400 nm
He X , Vo E , Horvatin M , Liu Y , Bergman M , Zhuang Z . J Nanotechnol Mater Sci 2015 2 (2) 1-6 This study compared the simulated workplace protection factors (SWPFs) between NIOSH-approved N95 respirators and P100 respirators, including two models of filtering facepiece respirator (FFR) and two models of elastomeric half-mask respirator (EHR), against sodium chloride particles (NaCl) in a range of 10 to 400 nm. Twenty-five human test subjects performed modified OSHA fit test exercises in a controlled laboratory environment with the N95 respirators (two FFR models and two EHR models) and the P100 respirators (two FFRs and two EHRs). Two Scanning Mobility Particle Sizers (SMPS) were used to measure aerosol concentrations (in the 10-400 nm size range) inside (Cin) and outside (Cout) of the respirator, simultaneously. SWPF was calculated as the ratio of Cout to Cin. The SWPF values obtained from the N95 respirators were then compared to those of the P100 respirators. SWPFs were found to be significantly different (P<0.05) between N95 and P100 class respirators. The 10th, 25th, 50th, 75th and 90th percentiles of the SWPFs for the N95 respirators were much lower than those for the P100 models. The N95 respirators had 5th percentiles of the SWPFs > 10. In contrast, the P100 class was able to generate 5th percentiles SWPFs > 100. No significant difference was found in the SWPFs when tested against nano-size (10 to 100 nm) and large-size (100 to 400 nm) particles. Overall, the findings suggest that the two FFRs and two EHRs with P100 class filters provide better performance than those with N95 filters against particles from 10 to 400 nm, supporting current OSHA and NIOSH recommendations. |
Development of a pefloxacin disk diffusion method for detection of fluoroquinolone-resistant Salmonella enterica
Skov R , Matuschek E , Sjolund-Karlsson M , Ahman J , Petersen A , Stegger M , Torpdahl M , Kahlmeter G . J Clin Microbiol 2015 53 (11) 3411-7 Fluoroquinolones are among the drugs of choice for treatment of salmonella infections. However, fluroquinolone resistance is increasing in salmonella due to chromosomal mutations in the quinolone resistance-determining region (QRDR) of the topoisomerase genes gyrA, gyrB, parC and parE and/or plasmid-mediated quinolone resistance (PMQR) mechanisms including qnr variants, aac(6' )-Ib-cr, qepA and oqxAB. Some of these cause only subtle increases of the MIC i.e, MICs ranging from 0.12 - 0.25 mg/L for ciprofloxacin (just above the wild type MIC of ≤0.06 mg/L). These isolates are difficult to detect with standard ciprofloxacin disk diffusion, and plasmid mediated resistance such as qnr are often not detected by the nalidixic acid screen test. We evaluated 16 quinolone/fluoroquinolone disks for their ability to detect low-level resistant Salmonella non-typhi isolates. A total of 153 Salmonella isolates characterized for the presence (N=104) or absence (N=49) of gyrA/parC topoisomerase mutations, qnrA, qnrB, qnrD, qnrS, aac(6' )-lb-cr or qepA genes were investigated. All isolates were MIC tested by broth micro-dilution against ciprofloxacin, levofloxacin and ofloxacin and by disk diffusion using EUCAST/CLSI methodology. MIC determination correctly categorized all isolates as either wildtype (MICs ≤0.06 mg/L and absence of resistance genes) or non-wildtype (MIC >0.06 mg/L and presence of a resistance gene). Disk diffusion using these antibiotics and nalidixic acid failed to detect some low-level resistant isolates whereas the pefloxacin 5 mug disk correctly identified all resistant isolates. However, pefloxacin will not detect isolates having aac(6' )-Ib-cr as the only resistance determinant. The pefloxacin disk assay was approved and implemented by EUCAST(2014) and CLSI(2015). |
Early breastfeeding problems mediate the negative association between maternal obesity and exclusive breastfeeding at 1 and 2 months postpartum
O'Sullivan EJ , Perrine CG , Rasmussen KM . J Nutr 2015 145 (10) 2369-78 BACKGROUND: Compared with normal-weight women, women with obesity experience poorer breastfeeding outcomes. Successful breastfeeding among women with obesity is important for achieving national breastfeeding goals. OBJECTIVES: The objectives were to determine whether the negative association between obesity and any or exclusive breastfeeding at 1 and 2 mo postpartum is mediated through breastfeeding problems that occur in the first 2 wk postpartum and if this association differs by parity. METHODS: Mothers (1151 normal-weight and 580 obese) in the Infant Feeding Practices Study II provided information on sociodemographic and psychosocial characteristics, body mass index, and breastfeeding outcomes. At 1 mo postpartum, participants reported the breastfeeding problems they experienced in the first 2 wk postpartum from a predefined list of 17 options. We used factor analysis to condense these problems into 4 explanatory variables; continuous factor scores were computed for use in further analyses. We used maximum likelihood logistic regression to assess mediation of the association between obesity and breastfeeding outcomes through early breastfeeding problems. RESULTS: No significant effect of obesity was found on any breastfeeding at 1 or 2 mo. At 1 mo postpartum, for both primiparous and multiparous women, there was a significant direct effect of obesity on exclusive breastfeeding and a significant indirect effect of obesity through early breastfeeding problems related to the explanatory mediating variable "Insufficient Milk" (throughout the remainder of the Abstract, this factor will be denoted by upper case notation). At 2 mo postpartum both the direct effect of obesity and the indirect effect through Insufficient Milk were significant in primiparous women but only the indirect effect remained significant in multiparous women. CONCLUSIONS: Early problems related to Insufficient Milk may partially explain the association between obesity and poor exclusive breastfeeding outcomes. Women who are obese, particularly those reporting breastfeeding problems that grouped in the Insufficient Milk factor in the early postpartum period, may benefit from additional breastfeeding support. |
A Case Study of Michigan's Breastfeeding Initiative: The Role of Coalitions in Community-Based Breastfeeding Support
Hudson IJ , Rutledge G , Roberts Ayers D . J Hum Lact 2015 31 (4) 611-3 The Michigan Department of Community Health (MDCH) funded 9 local breastfeeding coalitions to implement breastfeeding support groups and to develop breastfeeding resources for mothers and health professionals. The authors conducted qualitative analyses of reports, success stories, and MDCH grantees' interview responses (via follow-up call with 3 coalitions) to assess key barriers, facilitators, and lessons learned for coalitions implementing breastfeeding support groups. Coalitions noted implementation barriers related to their organizational structure and to recruiting mothers and finding meeting locations. Facilitators to implementing breastfeeding support groups included referrals, expertise, resources, and incentives. The following themes emerged from the reports analysis regarding how to implement breastfeeding support groups: "meet moms where they are," build community partnerships, and leverage in-kind and financial resources to sustain breastfeeding support groups. |
Congenital heart defects and receipt of special education services
Riehle-Colarusso T , Autry A , Razzaghi H , Boyle CA , Mahle WT , Van Naarden Braun K , Correa A . Pediatrics 2015 136 (3) 496-504 BACKGROUND: We investigated the prevalence of receipt of special education services among children with congenital heart defects (CHDs) compared with children without birth defects. METHODS: Children born from 1982 to 2004 in metropolitan Atlanta with CHDs (n = 3744) were identified from a population-based birth defect surveillance program; children without birth defects (n = 860 715) were identified from birth certificates. Cohorts were linked to special education files for the 1992-2012 school years to identify special education services. Children with noncardiac defects or genetic syndromes were excluded; children with CHDs were classified by presence or absence of critical CHDs (ie, CHDs requiring intervention by age one year). We evaluated the prevalence of receipt of special education services and prevalence rate ratios using children without birth defects as a reference. RESULTS: Compared with children without birth defects, children with CHDs were 50% more likely to receive special education services overall (adjusted prevalence rate ratio [aPRR] = 1.5; 95% confidence interval [CI]: 1.4-1.7). Specifically, they had higher prevalence of several special education categories including: intellectual disability (aPRR = 3.8; 95% CI: 2.8-5.1), sensory impairment (aPRR = 3.0; 95% CI: 1.8-5.0), other health impairment (aPRR = 2.8; 95% CI: 2.2-3.5), significant developmental delay (aPRR = 1.9; 95% CI: 1.3-2.8), and specific learning disability (aPRR = 1.4; 95% CI: 1.1-1.7). For most special education services, the excess prevalence did not vary by presence of critical CHDs. CONCLUSIONS: Children with CHDs received special education services more often than children without birth defects. These findings highlight the need for special education services and the importance of developmental screening for all children with CHDs. |
Exposure to welding fumes and lower airway infection with Streptococcus pneumoniae
Suri R , Periselneris J , Lanone S , Zeidler-Erdely PC , Melton G , Palmer KT , Andujar P , Antonini JM , Cohignac V , Erdely A , Jose RJ , Mudway I , Brown J , Grigg J . J Allergy Clin Immunol 2015 137 (2) 527-534 e7 BACKGROUND: Welders are at increased risk of pneumococcal pneumonia. The mechanism for this association is not known. The capacity of pneumococci to adhere to and infect lower airway cells is mediated by host-expressed platelet-activating factor receptor (PAFR). OBJECTIVE: We sought to assess the effect of mild steel welding fumes (MS-WF) on PAFR-dependent pneumococcal adhesion and infection to human airway cells in vitro and on pneumococcal airway infection in a mouse model. METHODS: The oxidative potential of MS-WF was assessed by their capacity to reduce antioxidants in vitro. Pneumococcal adhesion and infection of A549, BEAS-2B, and primary human bronchial airway cells were assessed by means of quantitative bacterial culture and expressed as colony-forming units (CFU). After intranasal instillation of MS-WF, mice were infected with Streptococcus pneumoniae, and bronchoalveolar lavage fluid (BALF) and lung CFU values were determined. PAFR protein levels were assessed by using immunofluorescence and immunohistochemistry, and PAFR mRNA expression was assessed by using quantitative PCR. PAFR was blocked by CV-3988, and oxidative stress was attenuated by N-acetylcysteine. RESULTS: MS-WF exhibited high oxidative potential. In A549 and BEAS-2B cells MS-WF increased pneumococcal adhesion and infection and PAFR protein expression. Both CV-3988 and N-acetylcysteine reduced MS-WF-stimulated pneumococcal adhesion and infection of airway cells. MS-WF increased mouse lung PAFR mRNA expression and increased BALF and lung pneumococcal CFU values. In MS-WF-exposed mice CV-3988 reduced BALF CFU values. CONCLUSIONS: Hypersusceptibility of welders to pneumococcal pneumonia is in part mediated by the capacity of welding fumes to increase PAFR-dependent pneumococcal adhesion and infection of lower airway cells. |
Effect of ground control mesh on dust sampling and explosion mitigation
Alexander DW , Chasko LL . Min Eng 2015 67 (7) 111-117 Researchers from the National Institute for Occupational Safety and Health's Office of Mine Safety and Health Research conducted an assessment of the effects that ground control mesh might have on rock and float coal dust distribution in a coal mine. The increased use of mesh to control roof and rib spall introduces additional elevated surfaces on which rock or coal dust can collect. It is possible to increase the potential for dust explosion propagation if any float coal dust is not adequately inerted. In addition, the mesh may interfere with the collection of representative dust samples when using the pan-and-brush sampling method developed by the U.S. Bureau of Mines and used by the Mine Safety and Health Administration for band sampling. This study estimates the additional coal or rock dust that could accumulate on mesh and develops a means to collect representative dust samples from meshed entries. |
The use of intermittent preventive treatment in pregnancy and insecticide-treated bed nets for malaria prevention by women of child-bearing age in eight districts in Malawi
Mwandama D , Gutman J , Wolkon A , Luka M , Jafali J , Ali D , Mathanga DP , Skarbinski J . Malar J 2015 14 316 BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated bed nets (ITNs) can reduce the morbidity and mortality associated with malaria in pregnancy. Although the coverage for both IPTp and ITN use have been described in Malawi, the analysis of factors associated with IPTp receipt and ITN use is lacking. This analysis was conducted to assess IPTp and ITN use and predictors of use by women of child-bearing age (WOCBA). METHODS: A two-stage cluster-sample cross-sectional survey was conducted April 16-30, 2009 in eight districts across Malawi. Information on receipt of two or more doses of IPTp, ITN ownership, and ITN use the night before the survey was collected. Multivariate logistic regression was used to assess predictors of IPTp and ITN use. RESULTS: Data were collected from 7407 households containing 6985 WOCBA and 3213 recently pregnant women (women who reported a completed pregnancy in the 2 years before the survey). Most recently pregnant women (96 %) had at least one antenatal care (ANC) clinic visit; 91 % reported receiving at least one dose of IPTp, and 72 % reported receiving two or more doses of IPTp. Women in Phalombe, Rumphi, and Lilongwe were more likely to receive two doses of IPTp than those in Blantyre [adjusted odds ratio (aOR) 2.5 (95 % CI 1.5-4.5), 2.5 (95 % CI 1.5-4.3), and 2.0 (95 % CI 1.2-3.1), respectively]. Educated women were more likely to have received IPTp compared to women with no education [aOR 1.6 (95 % CI 1.0-2.6) for those who completed primary school, aOR1.9 (95 % CI 1.1-3.3) for some secondary school, and aOR 4.1 (95 % CI 1.9-8.7) for completed secondary school or above], and women in the poorest socioeconomic status quintile were less likely to receive IPTp than those in the least poor quintile [aOR 0.68 (95 % CI 0.48-0.97)]. In all, 53 % of WOCBA used an ITN the previous night. Women in Nkhotkhota and Phalombe were less likely to have slept under an ITN the previous night compared to those in Blantyre [aOR 0.52 (95 % CI 0.39-0.69) and aOR 0.67 (95 % CI 0.47-0.95), respectively]. In addition, age [aOR 0.61 (95 % CI 0.45-0.83) for women 15-19 years old], and either being currently pregnant [aOR 1.5 (95 % CI 1.2-2.0)] or having been pregnant in the previous 2 years [aOR 2.4, (95 % CI 2.1-2.8)] were associated with ITN use. CONCLUSION: In Malawi in 2009, IPTp and ITN use in WOCBA fell short of national and international goals. Adoption of new guidelines encouraging administration of IPTp at every scheduled ANC visit might increase IPTp use. Increasing health promotion activities to encourage earlier attendance at ANC clinics and create demand for IPTp and ITNs might improve overall IPTp and ITN use. |
Evaluation of the informed consent process of a multicenter tuberculosis treatment trial
Chapman KN , Pevzner E , Mangan JM , Breese P , Lamunu D , Shrestha-Kuwahara R , Nakibali JG , Goldberg SV . AJOB Empir Bioeth 2015 6 (4) 31-43 BACKGROUND: Ethical principles obligate researchers to maximize study participants’ comprehension during the informed consent process for clinical trials. A pilot evaluation of the consent process was conducted during an international clinical trial of treatment for pulmonary tuberculosis to assess the feasibility of conducting an evaluation in a larger population and to guide these future efforts. METHODS: Study staff administered an informed consent assessment tool (ICAT) to a convenience sample of trial participants, measuring comprehension of consent components as derived from the Common Rule and FDA Title 21 Part 50, and satisfaction with the process. Participating site staff completed a consent process questionnaire about consent practices at their respective sites and provided improvement recommendations. ICAT scores and corresponding practices were compared where both were completed. RESULTS: ICATs (n = 54) were submitted from one site in Spain (n = 10), one in Uganda (n = 30), and five in the United States (n = 14). Participants were primarily male (76%), born in Africa (n = 31, 57%), and had a median age of 27 years (interquartile range [IQR]: 24–42). Median ICAT scores were 80% (IQR: 67–93) for comprehension and 89% (IQR: 78–100) for satisfaction. Ugandan participants scored higher than participants from other sites on comprehension (87% vs. 64%) and satisfaction (100% vs. 78%). Staff from 14 sites completed consent process questionnaires. Median ICAT scores for comprehension and satisfaction were higher at sites that utilized visual aids. Practice recommendations included shorter forms, simpler documents, and supplementary materials. CONCLUSIONS: Participants achieved high levels (≥80%) of comprehension and satisfaction with their current consent processes. Higher ICAT scores at one site suggest an additional evaluation may identify approaches to improve comprehension and satisfaction in future trials. Through this pilot evaluation, complexities and challenges were identified in obtaining consent in a large, international multicenter trial and provided insights for a more robust assessment of the consent process in future trials. |
Combined hormonal contraceptive use among women with known dyslipidemias: a systematic review of critical safety outcomes
Dragoman M , Curtis KM , Gaffield ME . Contraception 2015 94 (3) 280-7 CONTEXT: Dyslipidaemias represent a spectrum of lipid disorders that are important risk factors for cardiovascular disease. In addition, elevated triglycerides are known to be associated with pancreatitis. Though less clear, it is possible that dyslipidaemias may also contribute to risk for venous thromboembolism. Ethinyl estradiol and progestogen, contained within combined hormonal contraception, are known to impact lipid metabolism. OBJECTIVE: To evaluate from the literature whether use of combined hormonal contraception (CHC), including combined oral contraception pills (COC), transdermal patch, vaginal ring, or injectables, modifies the relative risk of acute myocardial infarction (MI), stroke, venous thromboembolism (VTE) or pancreatitis among women with known dyslipidaemias and to determine if existing lipid abnormalities worsen with CHC use. METHODS: PubMed and the Cochrane Library databases were searched for all articles in all languages published between inception and September 2014 relevant to dyslipidaemia, CHC use, and serious adverse events (MI, stroke, VTE or pancreatitis). The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force. RESULTS: From 306 articles identified by our search strategy, 3 articles met inclusion criteria. In a poor quality case-control study, women with hypercholesterolemia but no COC use had an increased risk of myocardial infarction (adjusted odds ratio [adj OR] 3.3, 95% confidence interval [CI] 1.6-6.8), as did women who used COCs but did not have hypercholesterolemia (adj OR 2.0, 95% CI 1.4-2.8), compared with non-COC users without hypercholesterolemia; women with both COC use and hypercholesterolemia had an adjusted OR of 24.7 (95% CI 5.6-108.5) compared with women with neither risk factor. A poor quality cohort study examined COC users and reported that women with dyslipidaemia had increased risk for VTE (crude RR 1.39, 95% CI 1.04-1.85) and transient ischemic attacks (TIA) and or cerebrovascular accidents (CVA) (RR: 1.76, 95% CI 1.51 - 2.06) compared to those without dyslipidaemia. Another poor quality cohort study provided direct evidence on changes in lipid levels among COC users with dyslipidaemia. A minority of women with elevated total cholesterol or triglyceride levels at baseline showed normal results (25% and 28%, respectively) after 6cycles of COC use. No evidence regarding risks associated with use of other CHC methods were identified. No evidence was identified for the outcome of pancreatitis. CONCLUSION: Limited data from poor quality observational studies suggest that women with known dyslipidaemias using CHC may be at increased risk for MI and may experience a minimal increase in risk for CVA or VTE. No evidence was identified on risk for pancreatitis in this context. The impact of CHC exposure on the status of lipid abnormalities over time, an intermediate marker for disease, is also unclear. Given the significant limitations of this body of evidence, the importance of access to effective contraception and theoretical concerns raised about the use of CHCs by women with known dyslipidaemias, additional rigorous studies are needed to best estimate true associations. Contraceptive decision-making should include consideration of both the known and theoretical risks of a given CHC method, safety and acceptability of alternative contraceptive methods, and risks associated with unintended pregnancy. |
Tobacco use screening and counseling during hospital outpatient visits among US adults, 2005-2010
Jamal A , Dube SR , King BA . Prev Chronic Dis 2015 12 E132 INTRODUCTION: Physicians and health care providers play an important role in educating their patients about the health risks of tobacco use and in providing effective cessation interventions. Little is known about these practices in hospital outpatient settings. The objective of the study was to assess the prevalence, correlates, and trends of tobacco use screening and cessation assistance offered to US adults during their hospital outpatient clinic visits. METHODS: Data for aggregated hospital outpatient visits among patients aged 18 years or older (N = 148,727) from the 2005-2010 National Hospital Ambulatory Medical Care Survey were analyzed. Tobacco use screening was defined as documentation of screening for either current tobacco use (cigarettes, cigars, snuff, or chewing tobacco) or no current use on the patient record form. Tobacco cessation assistance was defined as documentation of either tobacco counseling or cessation medications. RESULTS: Tobacco use screening was reported for 63.0% (estimated 271 million visits) of hospital outpatient visits, and cessation assistance was reported for 24.5% (estimated 17.1 million visits) of visits among current tobacco users. From 2005 through 2010, tobacco use screening (P for trend = .06) and cessation assistance (P for trend = .17) did not change significantly. CONCLUSION: From 2005 through 2010, more than one-third of hospital outpatient visits had no screening for tobacco use, and among current tobacco users, only 1 in 4 received any cessation assistance. Health care providers should consistently identify and document their patients' tobacco use status and provide them with appropriate tobacco cessation assistance. Opportunities also exist to expand the coverage for tobacco cessation. |
Toking, vaping, and eating for health or fun: marijuana use patterns in adults, U.S., 2014
Schauer GL , King BA , Bunnell RE , Promoff G , McAfee TA . Am J Prev Med 2015 50 (1) 1-8 INTRODUCTION: Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults. METHODS: Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression. RESULTS: Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use. CONCLUSION: Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning. |
Quitline use and outcomes among callers with and without mental health conditions: a 7-month follow-up evaluation in three states
Vickerman KA , Schauer GL , Malarcher AM , Zhang L , Mowery P , Nash CM . Biomed Res Int 2015 2015 817298 OBJECTIVES: To examine abstinence outcomes among tobacco users with and without a reported mental health condition (MHC) who enrolled in state tobacco quitline programs. METHODS: Data were analyzed from a 7-month follow-up survey (response rate: 41% [3,132/7,459]) of three state-funded telephone quitline programs in the United States that assessed seven self-reported MHCs at quitline registration. We examined 30-day point prevalence tobacco quit rates for callers with any MHC versus none. Data were weighted to adjust for response bias and oversampling. Multivariable logistic regression was used to examine cessation outcomes. RESULTS: Overall, 45.8% of respondents reported ≥1 MHC; 57.4% of those reporting a MHC reported ≥2 MHCs. The unadjusted quit rate for callers with any MHC was lower than for callers with no MHC (22.0% versus 31.0%, P < 0.001). After adjusting for demographics, nicotine dependence, and program engagement, callers reporting ≥1 MHC were less likely to be abstinent at follow-up (adjusted OR = 0.63, 95% CI = 0.51-0.78, P < 0.001). CONCLUSIONS: More intensive or tailored quitline programs may need to be developed among callers with MHCs as their quit rates appear to be lower than callers without MHCs. |
Electron microscopic analysis of surface inorganic substances on oral and combustible tobacco products
Halstead MM , Watson CH , Pappas RS . J Anal Toxicol 2015 39 (9) 698-701 Although quantitative trace toxic metal analyses have been performed on tobacco products, little has been published on inorganic particulate constituents on and inside the products. We analyzed these constituents using scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS). The nature of SEM-EDS instrumentation makes it an ideal choice for inorganic particulate analyses and yields relevant information to potential exposures during consumption of oral tobacco products, and possibly as a consequence of smoking. Aluminum silicates, silica and calcium compounds were common inorganic particulate constituents of tobacco products. Aluminum silicates and silica from soil were found on external leaf surfaces. Phytolithic silica, found in the lumen of the plant leaf, is of biogenic origin. Calcium oxalate was also apparently of biogenic origin. Small mineral deposits on tobacco could have health implications. Minerals found on the surfaces of smokeless tobacco products could possibly abrade the oral mucosa and contribute to the oral inflammatory responses observed with smokeless tobacco product use. If micron and sub-micron size calcium particles on cigarette filler were transported in mainstream smoke, they could potentially induce a pulmonary irritant inflammation when inhaled. The transport of aluminum silicate and silica in smoke could potentially also contribute to chronic inflammatory disease. |
Alcohol production, prevention strategies, and inmate knowledge about the risk for botulism from pruno consumption in a correctional facility - Arizona, 2013
Adams LE , Yasmin S , Briggs G , Redden K , Silvas S , Anderson S , Weiss J , Tsang CA , Henke E , Francies J , Herrick K , Lira R , Livar E , Thompson G , Sunenshine R , Robinson BF , Bisgard KM , Komatsu KK . J Correct Health Care 2015 21 (4) 335-42 During July to November 2012, two botulism outbreaks (12 cases total) occurred in one all-male prison; both were associated with illicitly brewed alcohol (pruno) consumption. Inmate surveys were conducted to evaluate and develop prevention and education strategies. Qualitative surveys with open-ended questions were performed among inmates from rooms where outbreaks occurred to learn about pruno consumption. Quantitative surveys assessed knowledge gained after the outbreaks and preferred information sources. For the quantitative surveys, 250 inmates were randomly selected by bed from across the correctional facility and 164 inmates were interviewed. Only 24% of inmates reported any botulism knowledge before the outbreaks and education outreach, whereas 73% reported knowledge after the outbreaks (p < .01). Preferred information sources included handouts/fliers (52%) and the prison television channel (32%). |
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