Mood disorders and risk of lung cancer in the EAGLE case-control study and in the U.S. Veterans Affairs Inpatient Cohort
Capo-Ramos DE , Gao Y , Lubin JH , Check DP , Goldin LR , Pesatori AC , Consonni D , Bertazzi PA , Saxon AJ , Bergen AW , Caporaso NE , Landi MT . PLoS One 2012 7 (8) e42945 BACKGROUND: Mood disorders may affect lung cancer risk. We evaluated this hypothesis in two large studies. METHODOLOGY/PRINCIPAL FINDINGS: We examined 1,939 lung cancer cases and 2,102 controls from the Environment And Genetics in Lung cancer Etiology (EAGLE) case-control study conducted in Italy (2002-2005), and 82,945 inpatients with a lung cancer diagnosis and 3,586,299 person-years without a lung cancer diagnosis in the U.S. Veterans Affairs Inpatient Cohort (VA study), composed of veterans with a VA hospital admission (1969-1996). In EAGLE, we calculated odds ratios (ORs) and 95% confidence intervals (CI), with extensive adjustment for tobacco smoking and multiple lifestyle factors. In the VA study, we estimated lung cancer relative risks (RRs) and 95% CIs with time-dependent Poisson regression, adjusting for attained age, calendar year, hospital visits, time within the study, and related previous medical diagnoses. In EAGLE, we found decreased lung cancer risk in subjects with a personal history of mood disorders (OR: 0.59, 95% CI: 0.44-0.79, based on 121 lung cancer incident cases and 192 controls) and family history of mood disorders (OR: 0.62, 95% CI: 0.50-0.77, based on 223 lung cancer cases and 345 controls). The VA study analyses yielded similar results (RR: 0.74, 95% CI: 0.71-0.77, based on 2,304 incident lung cancer cases and 177,267 non-cancer person-years) in men with discharge diagnoses for mood disorders. History of mood disorders was associated with nicotine dependence, alcohol and substance use and psychometric scales of depressive and anxiety symptoms in controls for these studies. CONCLUSIONS/SIGNIFICANCE: The consistent finding of a relationship between mood disorders and lung cancer risk across two large studies calls for further research into the complex interplay of risk factors associated with these two widespread and debilitating diseases. Although we adjusted for smoking effects in EAGLE, residual confounding of the results by smoking cannot be ruled out. |
Prevalence of periodontitis in adults in the United States: 2009 and 2010
Eke PI , Dye BA , Wei L , Thornton-Evans GO , Genco RJ . J Dent Res 2012 91 (10) 914-20 This study estimated the prevalence, severity, and extent of periodontitis in the adult U.S. population, with data from the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES) cycle. Estimates were derived from a sample of 3,742 adults aged 30 years and older, of the civilian non-institutionalized population, having 1 or more natural teeth. Attachment loss (AL) and probing depth (PD) were measured at 6 sites per tooth on all teeth (except the third molars). Over 47% of the sample, representing 64.7 million adults, had periodontitis, distributed as 8.7%, 30.0%, and 8.5% with mild, moderate, and severe periodontitis, respectively. For adults aged 65 years and older, 64% had either moderate or severe periodontitis. Eighty-six and 40.9% had 1 or more teeth with AL ≥ 3 mm and PD ≥ 4 mm, respectively. With respect to extent of disease, 56% and 18% of the adult population had 5% or more periodontal sites with ≥ 3 mm AL and ≥ 4 mm PD, respectively. Periodontitis was highest in men, Mexican Americans, adults with less than a high school education, adults below 100% Federal Poverty Levels (FPL), and current smokers. This survey has provided direct evidence for a high burden of periodontitis in the adult U.S. population. |
Diabetes prevention: global health policy and perspectives from the ground
Bergman M , Buysschaert M , Schwarz PEH , Albright A , Narayan KMV , Yach D . Diabetes Manag (Lond) 2012 2 (4) 309-321 Type 2 diabetes and other noncommunicable diseases are a growing public health challenge globally. An estimated 285 million people, corresponding to 6.4% of the worlds adult population, has diabetes, which is expected to reach 552 million by the International Diabetes Federation in 2030. A much larger segment of the worlds population, approximating 79 million individuals in the USA alone, has prediabetes. Globally, a relatively small percentage of those with diabetes or prediabetes are diagnosed with the potential for developing chronic complications. To address this epidemic, governments, in concert with the private sector, need to set policies that promote healthy nutritional and agricultural policies, favor modifications in the environment that encourage greater physical activity and make prevention affordable for all citizens at high risk. The public health sector has the charge of translating evidence-based findings into practical, accessible and cost-effective programs and monitoring the process to continuously improve prevention initiatives. The clinical sector has the formidable challenge of screening and identifying those at high risk and referring them to accredited intervention programs. There is a need to explore additional cost-effective interventions that are customized to meet individual needs that can be offered at the community and clinical levels. Thus, all three sectors, government, public health and clinical, each have a critical role in this process and by working in a partnership, ought to create the necessary synergies essential for making substantial forays in the prevention of Type 2 diabetes. (2012 Future Medicine Ltd.) |
Reemerging Sudan Ebola virus disease in Uganda, 2011
Shoemaker T , Macneil A , Balinandi S , Campbell S , Wamala JF , McMullan LK , Downing R , Lutwama J , Mbidde E , Stroher U , Rollin PE , Nichol ST . Emerg Infect Dis 2012 18 (9) 1480-3 Two large outbreaks of Ebola hemorrhagic fever occurred in Uganda in 2000 and 2007. In May 2011, we identified a single case of Sudan Ebola virus disease in Luwero District. The establishment of a permanent in-country laboratory and cooperation between international public health entities facilitated rapid outbreak response and control activities. |
U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons, 2000 to 2008
Althoff KN , Buchacz K , Hall HI , Zhang J , Hanna DB , Rebeiro P , Gange SJ , Moore RD , Kitahata MM , Gebo KA , Martin J , Justice AC , Horberg MA , Hogg RS , Sterling TR , Cescon A , Klein MB , Thorne JE , Crane HM , Mugavero MJ , Napravnik S , Kirk GD , Jacobson LP , Brooks JT . Ann Intern Med 2012 157 (5) 325-335 BACKGROUND: The U.S. National HIV/AIDS Strategy targets for 2015 include "increasing access to care and improving health outcomes for persons living with HIV in the United States" (PLWH-US). OBJECTIVE: To demonstrate the utility of the NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) for monitoring trends in the HIV epidemic in the United States and to present trends in HIV treatment and related health outcomes. DESIGN: Trends from annual cross-sectional analyses comparing patients from pooled, multicenter, prospective, clinical HIV cohort studies with PLWH-US, as reported to national surveillance systems in 40 states. SETTING: U.S. HIV outpatient clinics. PATIENTS: HIV-infected adults with 1 or more HIV RNA plasma viral load (HIV VL) or CD4 T-lymphocyte (CD4) cell count measured in any calendar year from 1 January 2000 to 31 December 2008. MEASUREMENTS: Annual rates of antiretroviral therapy use, HIV VL, and CD4 cell count at death. RESULTS: 45,529 HIV-infected persons received care in an NA-ACCORD-participating U.S. clinical cohort from 2000 to 2008. In 2008, the 26,030 NA-ACCORD participants in care and the 655,966 PLWH-US had qualitatively similar demographic characteristics. From 2000 to 2008, the proportion of participants prescribed highly active antiretroviral therapy increased by 9 percentage points to 83% (P < 0.001), whereas the proportion with suppressed HIV VL (≤2.7 log10 copies/mL) increased by 26 percentage points to 72% (P < 0.001). Median CD4 cell count at death more than tripled to 0.209 x 109 cells/L (P < 0.001). LIMITATION: The usual limitations of observational data apply. CONCLUSION: The NA-ACCORD is the largest cohort of HIV-infected adults in clinical care in the United States that is demographically similar to PLWH-US in 2008. From 2000 to 2008, increases were observed in the percentage of prescribed HAART, the percentage who achieved a suppressed HIV VL, and the median CD4 cell count at death. PRIMARY FUNDING SOURCE: National Institutes of Health; Centers for Disease Control and Prevention; Canadian Institutes of Health Research; Canadian HIV Trials Network; and the government of British Columbia, Canada. |
Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study
Dalton T , Cegielski P , Akksilp S , Asencios L , Caoili JC , Cho SN , Erokhin VV , Ershova J , Gler MT , Kazennyy BY , Kim HJ , Kliiman K , Kurbatova E , Kvasnovsky C , Leimane V , van der Walt M , Via LE , Volchenkov GV , Yagui MA , Kang H . Lancet 2012 380 (9851) 1406-17 BACKGROUND: The prevalence of extensively drug-resistant (XDR) tuberculosis is increasing due to the expanded use of second-line drugs in people with multidrug-resistant (MDR) disease. We prospectively assessed resistance to second-line antituberculosis drugs in eight countries. METHODS: From Jan 1, 2005, to Dec 31, 2008, we enrolled consecutive adults with locally confirmed pulmonary MDR tuberculosis at the start of second-line treatment in Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea, and Thailand. Drug-susceptibility testing for study purposes was done centrally at the Centers for Disease Control and Prevention for 11 first-line and second-line drugs. We compared the results with clinical and epidemiological data to identify risk factors for resistance to second-line drugs and XDR tuberculosis. FINDINGS: Among 1278 patients, 43.7% showed resistance to at least one second-line drug, 20.0% to at least one second-line injectable drug, and 12.9% to at least one fluoroquinolone. 6.7% of patients had XDR tuberculosis (range across study sites 0.8-15.2%). Previous treatment with second-line drugs was consistently the strongest risk factor for resistance to these drugs, which increased the risk of XDR tuberculosis by more than four times. Fluoroquinolone resistance and XDR tuberculosis were more frequent in women than in men. Unemployment, alcohol abuse, and smoking were associated with resistance to second-line injectable drugs across countries. Other risk factors differed between drugs and countries. INTERPRETATION: Previous treatment with second-line drugs is a strong, consistent risk factor for resistance to these drugs, including XDR tuberculosis. Representative drug-susceptibility results could guide in-country policies for laboratory capacity and diagnostic strategies. FUNDING: US Agency for International Development, Centers for Disease Control and Prevention, National Institutes of Health/National Institute of Allergy and Infectious Diseases, and Korean Ministry of Health and Welfare. |
Effects of influenza on pregnant women and infants
Rasmussen SA , Jamieson DJ , Uyeki TM . Am J Obstet Gynecol 2012 207 S3-8 Influenza vaccination during pregnancy has been shown to decrease the risk of influenza and its complications among pregnant women and their infants up to 6 months old. To adequately assess the benefits and potential risks that are associated with the use of influenza vaccine during pregnancy, it is necessary to examine the influenza-associated complications that occur among pregnant women and their children. Pregnant women have been shown to be at increased risk for morbidity and death with influenza illness during seasonal epidemics and pandemics. Newborn infants born to mothers with influenza during pregnancy, especially mothers with severe illness, are at increased risk of adverse outcomes, such as preterm birth and low birthweight. Infants <6 months old who experience influenza virus infection have the highest rates of hospitalization and death of all children. Here we review the risks for influenza-associated complications among pregnant women and infants <6 months old. |
Etiology and incidence of viral and bacterial acute respiratory illness among older children and adults in rural western Kenya, 2007-2010
Feikin DR , Njenga MK , Bigogo G , Aura B , Aol G , Audi A , Jagero G , Muluare PO , Gikunju S , Nderitu L , Balish A , Winchell J , Schneider E , Erdman D , Oberste MS , Katz MA , Breiman RF . PLoS One 2012 7 (8) e43656 BACKGROUND: Few comprehensive data exist on disease incidence for specific etiologies of acute respiratory illness (ARI) in older children and adults in Africa. METHODOLOGY/PRINCIPAL FINDINGS: From March 1, 2007, to February 28, 2010, among a surveillance population of 21,420 persons >5 years old in rural western Kenya, we collected blood for culture and malaria smears, nasopharyngeal and oropharyngeal swabs for quantitative real-time PCR for ten viruses and three atypical bacteria, and urine for pneumococcal antigen testing on outpatients and inpatients meeting a ARI case definition (cough or difficulty breathing or chest pain and temperature >38.0 degrees C or oxygen saturation <90% or hospitalization). We also collected swabs from asymptomatic controls, from which we calculated pathogen-attributable fractions, adjusting for age, season, and HIV-status, in logistic regression. We calculated incidence by pathogen, adjusting for health-seeking for ARI and pathogen-attributable fractions. Among 3,406 ARI patients >5 years old (adjusted annual incidence 12.0 per 100 person-years), influenza A virus was the most common virus (22% overall; 11% inpatients, 27% outpatients) and Streptococcus pneumoniae was the most common bacteria (16% overall; 23% inpatients, 14% outpatients), yielding annual incidences of 2.6 and 1.7 episodes per 100 person-years, respectively. Influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human metapneumovirus were more prevalent in swabs among cases (22%, 6%, 8% and 5%, respectively) than controls. Adenovirus, parainfluenza viruses, rhinovirus/enterovirus, parechovirus, and Mycoplasma pneumoniae were not more prevalent among cases than controls. Pneumococcus and non-typhi Salmonella were more prevalent among HIV-infected adults, but prevalence of viruses was similar among HIV-infected and HIV-negative individuals. ARI incidence was highest during peak malaria season. CONCLUSIONS/SIGNFICANCE: Vaccination against influenza and pneumococcus (by potential herd immunity from childhood vaccination or of HIV-infected adults) might prevent much of the substantial ARI incidence among persons >5 years old in similar rural African settings. |
Influenza A(H1N1)pdm09 virus among healthy show pigs, United States
Gray GC , Bender JB , Bridges CB , Daly RF , Krueger WS , Male MJ , Heil GL , Friary JA , Derby RB , Cox NJ . Emerg Infect Dis 2012 18 (9) 1519-21 Within 5 months after the earliest detection of human influenza A(H1N1)pdm09 virus, we found molecular and culture evidence of the virus in healthy US show pigs. The mixing of humans and pigs at swine shows possibly could further the geographic and cross-species spread of influenza A viruses. |
Acquired resistance to second-line drugs among persons with tuberculosis in the United States
Ershova JV , Kurbatova EV , Moonan PK , Cegielski JP . Clin Infect Dis 2012 55 (12) 1600-7 BACKGROUND: Acquired resistance to second-line drugs (SLD) is a problem in treating patients with drug-resistant tuberculosis (TB) worldwide. The objectives of this study were to identify risk factors for acquired resistance (AR) to injectable SLD and fluoroquinolones in the US National TB Surveillance System, 1993-2008. METHODS: We selected cases with initial and final drug susceptibility test (DST) results reported. We defined AR as resistance at the final DST but susceptibility to the same drug at the initial DST. We analyzed AR using 2-way frequency tables and multivariable logistic regression. RESULTS: Baseline prevalence of multidrug-resistant (MDR) and extensively drug-resistant (XDR)TB was 12.6% (1864/14,770) and 0.38% (56/14,770), respectively. Of 2,274 individuals without initial resistance to injectable SLD, 49 (2.2%) acquired resistance. Of 1,141 initially susceptible to fluoroquinolones, 32 (2.8%) acquired resistance. AR to injectable SLD was associated with age group 25-44 years (adjusted Odds Ratio [aOR], 2.7; 95% confidence interval [CI], 1.2-6.3), positive HIV status (aOR, 2.5; 95% CI, 1.3-4.7), MDR at treatment initiation (aOR, 5.5; 95% CI, 2.9-10.5), and treatment with any SLD (aOR, 2.4; 95% CI,1.2-4.7). AR to fluoroquinolones was associated with MDR TB at treatment initiation (aOR, 6.5; 95% CI, 2.9-14.6). CONCLUSION: Among patients with initial and final DST reported, risk factors for AR to injectable SLD included age, positive HIV status, MDR TB and initial treatment with any SLD, while the only predictor for AR to fluoroquinolones was MDR TB at treatment initiation. Providers should consider monitoring SLD DST for MDR TB patients in the indicated subgroups. |
Antiretroviral prophylaxis for HIV prevention in heterosexual men and women
Baeten JM , Donnell D , Ndase P , Mugo NR , Campbell JD , Wangisi J , Tappero JW , Bukusi EA , Cohen CR , Katabira E , Ronald A , Tumwesigye E , Were E , Fife KH , Kiarie J , Farquhar C , John-Stewart G , Kakia A , Odoyo J , Mucunguzi A , Nakku-Joloba E , Twesigye R , Ngure K , Apaka C , Tamooh H , Gabona F , Mujugira A , Panteleeff D , Thomas KK , Kidoguchi L , Krows M , Revall J , Morrison S , Haugen H , Emmanuel-Ogier M , Ondrejcek L , Coombs RW , Frenkel L , Hendrix C , Bumpus NN , Bangsberg D , Haberer JE , Stevens WS , Lingappa JR , Celum C . N Engl J Med 2012 367 (5) 399-410 BACKGROUND: Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations. METHODS: We conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens--once-daily tenofovir (TDF), combination tenofovir-emtricitabine (TDF-FTC), or matching placebo--and followed monthly for up to 36 months. At enrollment, the HIV-1-seropositive partners were not eligible for antiretroviral therapy, according to national guidelines. All couples received standard HIV-1 treatment and prevention services. RESULTS: We enrolled 4758 couples, of whom 4747 were followed: 1584 randomly assigned to TDF, 1579 to TDF-FTC, and 1584 to placebo. For 62% of the couples followed, the HIV-1-seronegative partner was male. Among HIV-1-seropositive participants, the median CD4 count was 495 cells per cubic millimeter (interquartile range, 375 to 662). A total of 82 HIV-1 infections occurred in seronegative participants during the study, 17 in the TDF group (incidence, 0.65 per 100 person-years), 13 in the TDF-FTC group (incidence, 0.50 per 100 person-years), and 52 in the placebo group (incidence, 1.99 per 100 person-years), indicating a relative reduction of 67% in the incidence of HIV-1 with TDF (95% confidence interval [CI], 44 to 81; P<0.001) and of 75% with TDF-FTC (95% CI, 55 to 87; P<0.001). Protective effects of TDF-FTC and TDF alone against HIV-1 were not significantly different (P=0.23), and both study medications significantly reduced the HIV-1 incidence among both men and women. The rate of serious adverse events was similar across the study groups. Eight participants receiving active treatment were found to have been infected with HIV-1 at baseline, and among these eight, antiretroviral resistance developed in two during the study. CONCLUSIONS: Oral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women. (Funded by the Bill and Melinda Gates Foundation; Partners PrEP ClinicalTrials.gov number, NCT00557245.). |
Trends in national surveillance data for bat rabies in the United States: 2001-2009
Patyk K , Turmelle A , Blanton JD , Rupprecht CE . Vector Borne Zoonotic Dis 2012 12 (8) 666-73 Rabies remains an important public health concern in the United States, with most human cases associated with bat rabies virus variants. Cases of rabies virus (RV) infection in bats are widely distributed across the continental United States and elsewhere in the Americas. In this retrospective study, data on bats submitted to state laboratories for RV diagnosis between 2001 and 2009 were analyzed to investigate epidemiological trends in the United States. Season, region, and roosting habits were the primary risk factors of interest. During the study interval, more than 205,439 bats were submitted for RV diagnosis, and 6.7% of these bats were rabid. Increased odds of a submitted bat being rabid were associated with species that exhibit inconspicuous roosting habits, bats originating in the Southwest, and bats submitted for diagnosis during the fall. Periodic analysis of zoonotic disease surveillance is recommended to detect changes in trends regarding geographic distribution, seasonal fluctuations, and host associations; this is particularly necessary, as existing trends may be influenced by climate change or other emerging factors. |
Hantaan virus surveillance in small mammals at firing points 10 and 60, Yeoncheon, Gyeonggi Province, Republic of Korea
Klein TA , Kim HC , Chong ST , O'Guinn ML , Lee JS , Turell MJ , Sames WJ , Gu SH , Kang HJ , Moon S , Lee SY , Chun Y , Song JW . Vector Borne Zoonotic Dis 2012 12 (8) 674-82 We used epidemiological data and indirect fluorescent antibody tests to determine the Hantaan virus (HTNV) antibody-positive (Ab+) prevalence in small mammals captured at firing point 10 (FP-10) and firing point 60 (FP-60), Gyeonggi Province, near the demilitarized zone, Republic of Korea (ROK), from 2001 to 2005. We used these data, combined with the partial M segment amplified from HTNV recovered from lung tissues of Apodemus agrarius, to clarify the genetic diversity and phylogenetic relationships among HTNV strains in the ROK. Of the eight species of rodents and one insectivore species captured, A. agrarius accounted for 93.4% and 88.5% at FP-10 and FP-60, respectively. Only two species of rodents, A. agrarius and Micromys minutus, were HTNV Ab+. The overall HTNV Ab+ prevalence for A. agrarius captured at FP-10 and FP-60 was 23.3% (121/520) and 14.5% (94/647), respectively. The hantaviral reverse transcription-polymerase chain reaction-positive rate of Ab+ A. agrarius was 74.2% (167/215), and the phylogenetic trees, based on the 269-nucleotide G2-encoding M segment, demonstrated that HTNV strains from FP-10 and FP-60 were distantly segregated from HTNV of other geographic regions in Korea and China. These data are useful in the development of risk reduction strategies for the prevention of hantavirus infections among military personnel, especially during training or the event of hostilities, and civilian populations. |
Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda
Kigozi R , Baxi SM , Gasasira A , Sserwanga A , Kakeeto S , Nasr S , Rubahika D , Dissanayake G , Kamya MR , Filler S , Dorsey G . PLoS One 2012 7 (8) e42857 BACKGROUND: Recently the use of indoor residual spraying of insecticide (IRS) has greatly increased in Africa; however, limited data exist on the quantitative impacts of IRS on health outcomes in highly malaria endemic areas. METHODOLOGY/PRINCIPAL FINDINGS: Routine data were collected on more than 90,000 patient visits at a single health facility over a 56 month period covering five rounds of IRS using three different insecticides. Temporal associations between the timing of IRS and the probability of a patient referred for microscopy having laboratory confirmed malaria were estimated controlling for seasonality and age. Considering patients less than five years of age there was a modest decrease in the odds of malaria following the 1(st) round of IRS using DDT (OR = 0.76, p<0.001) and the 2(nd) round using alpha-cypermethrin (OR = 0.83, p = 0.002). Following rounds 3-5 using bendiocarb there was a much greater decrease in the odds of malaria (ORs 0.34, 0.16, 0.17 respectively, p<0.001 for all comparisons). Overall, the impact of IRS was less pronounced among patients 5 years or older. CONCLUSIONS/SIGNIFICANCE: IRS was associated with a reduction in malaria morbidity in an area of high transmission intensity in Uganda and the benefits appeared to be greatest after switching to a carbamate class of insecticide. |
Real-time modelling used for outbreak management during a cholera epidemic, Haiti, 2010-2011
Abrams JY , Copeland JR , Tauxe RV , Date KA , Belay ED , Mody RK , Mintz ED . Epidemiol Infect 2012 141 (6) 1-10 SUMMARY: The emergence of epidemic cholera in post-earthquake Haiti portended a public health disaster of uncertain magnitude. In order to coordinate relief efforts in an environment with limited healthcare infrastructure and stretched resources, timely and realistic projections of the extent of the cholera outbreak were crucial. Projections were shared with Government and partner organizations beginning 5 days after the first reported case and were updated using progressively more advanced methods as more surveillance data became available. The first projection estimated that 105,000 cholera cases would occur in the first year. Subsequent projections using different methods estimated up to 652,000 cases and 163,000-247,000 hospitalizations during the first year. Current surveillance data show these projections to have provided reasonable approximations of the observed epidemic. Providing the real-time projections allowed Haitian ministries and external aid organizations to better plan and implement response measures during the evolving epidemic. |
National carbon monoxide poisoning surveillance framework and recent estimates
Iqbal S , Clower JH , King M , Bell J , Yip FY . Public Health Rep 2012 127 (5) 486-96 OBJECTIVES: Unintentional, non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States. A comprehensive national CO poisoning surveillance framework is needed to obtain accurate estimates of CO poisoning burden and guide prevention efforts. This article describes the current national CO poisoning surveillance framework and reports the most recent national estimates. METHODS: We analyzed mortality data from the National Vital Statistics System multiple cause-of-death file, emergency department (ED) and hospitalization data from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample and Nationwide Inpatient Sample, hyperbaric oxygen treatment (HBOT) data from HBOT facilities, exposure data from the National Poison Data System, and CO alarm prevalence data from the American Housing Survey and the National Health Interview Survey. RESULTS: In the United States, 2,631 UNFR CO deaths occurred from 1999 to 2004, an average of 439 deaths annually. In 2007, there were 21,304 (71 per one million population) ED visits and 2,302 (eight per one million population) hospitalizations for confirmed cases of CO poisoning. In 2009, 552 patients received HBOT, and from 2000 to 2009, 68,316 UNFR CO exposures were reported to poison centers. Most nonfatal poisonings were among children (<18 years of age) and females; hospitalizations and deaths occurred more frequently among males and elderly people (>65 years of age). More poisonings occurred during winter months and in the Midwest and Northeast. CONCLUSIONS: UNFR CO poisoning poses a significant public health burden. Systematic evaluation of data sources coupled with modification and expansion of the surveillance framework might assist in developing effective prevention strategies. |
HIV screening practices in U.S. hospitals, 2009-2010
Voetsch AC , Heffelfinger JD , Yonek J , Patel P , Ethridge SF , Torres GW , Lampe MA , Branson BM . Public Health Rep 2012 127 (5) 524-31 OBJECTIVE: A 2004 national survey of hospitals showed that 23.4% of hospitals screened for HIV in at least one department, most frequently in labor and delivery departments. However, less than 2% of these hospitals screened patients in inpatient units, urgent care clinics, or emergency departments. In 2006, the Centers for Disease Control and Prevention (CDC) recommended HIV screening for all individuals 13-64 years of age in health-care settings. We determined the frequency of hospital adoption of these CDC recommendations. METHODS: We surveyed hospital infection-control personnel at a randomly selected sample of U.S. general medical and surgical hospitals in 2009-2010. RESULTS: Of the 1,476 hospitals selected for the survey, 754 (51.1%) responded to the survey; of those responding, 703 (93.2%) offered HIV tests for patients at the hospital and 206 (27.3%) screened for HIV in at least one department. Screening was most common in larger hospitals (45.7%), hospitals in large metropolitan areas (50.5%), and teaching hospitals (44.4%); it was least common in public hospitals (19.1%). By department, screening was most common in labor and delivery departments (34.6%) and substance abuse clinics (20.7%); it was least common in emergency departments (11.9%), inpatient units (9.6%), and psychiatry/mental health departments (9.4%). More than half of hospitals were not considering implementing CDC's recommendations within the next 12 months. CONCLUSIONS: Since 2004, HIV screening in hospitals increased overall and by department. However, the majority of U.S. hospitals have not adopted the CDC recommendations. |
Impact of fetal death reporting requirements on early neonatal and fetal mortality rates and racial disparities
Tyler CP , Grady SC , Grigorescu V , Luke B , Todem D , Paneth N . Public Health Rep 2012 127 (5) 507-15 OBJECTIVE: Racial disparities in infant and neonatal mortality vary substantially across the U.S. with some states experiencing wider disparities than others. Many factors are thought to contribute to these disparities, but state differences in fetal death reporting have received little attention. We examined whether such reporting requirements may explain national variation in neonatal and fetal mortality rates and racial disparities. METHODS: We used data on non-Hispanic white and non-Hispanic black infants from the U.S. 2000-2002 linked birth/infant death and fetal death records to determine the degree to which state fetal death reporting requirements explain national variation in neonatal and fetal mortality rates and racial disparities. States were grouped depending upon whether they based the lower limit for fetal death reporting on birthweight alone, gestational age alone, both birthweight and gestational age, or required reporting of all fetal deaths. Traditional methods and the fetuses-at-risk approach were used to calculate mortality rates, 95% confidence intervals, and relative and absolute racial disparity measures in these four groups. RESULTS: States with birthweight-alone fetal death thresholds substantially underreported fetal deaths at lower gestations and slightly overreported neonatal deaths at older gestations. This finding was reflected by these states having the highest neonatal mortality rates and disparities, but the lowest fetal mortality rates and disparities. CONCLUSIONS: Using birthweight alone as a reporting threshold may promote some shift of fetal deaths to newborn deaths, contributing to racial disparities in neonatal mortality. The adoption of a uniform national threshold for reporting fetal deaths could reduce systematic differences in live birth and fetal death reporting. |
Demographic shift of influenza A(H1N1)pdm09 during and after pandemic, rural India
Broor S , Sullender W , Fowler K , Gupta V , Widdowson MA , Krishnan A , Lal RB . Emerg Infect Dis 2012 18 (9) 1472-5 Population-based active surveillance in India showed higher incidence rates for influenza A(H1N1)pdm09 among children during pandemic versus postpandemic periods (345 vs. 199/1,000 person-years), whereas adults had higher rates during postpandemic versus pandemic periods (131 vs. 69/1,000 person-years). Demographic shifts as pandemics evolve should be considered in public health response planning. |
A permutation procedure to correct for confounders in case-control studies, including tests of rare variation.
Epstein MP , Duncan R , Jiang Y , Conneely KN , Allen AS , Satten GA . Am J Hum Genet 2012 91 (2) 215-23 Many case-control tests of rare variation are implemented in statistical frameworks that make correction for confounders like population stratification difficult. Simple permutation of disease status is unacceptable for resolving this issue because the replicate data sets do not have the same confounding as the original data set. These limitations make it difficult to apply rare-variant tests to samples in which confounding most likely exists, e.g., samples collected from admixed populations. To enable the use of such rare-variant methods in structured samples, as well as to facilitate permutation tests for any situation in which case-control tests require adjustment for confounding covariates, we propose to establish the significance of a rare-variant test via a modified permutation procedure. Our procedure uses Fisher's noncentral hypergeometric distribution to generate permuted data sets with the same structure present in the actual data set such that inference is valid in the presence of confounding factors. We use simulated sequence data based on coalescent models to show that our permutation strategy corrects for confounding due to population stratification that, if ignored, would otherwise inflate the size of a rare-variant test. We further illustrate the approach by using sequence data from the Dallas Heart Study of energy metabolism traits. Researchers can implement our permutation approach by using the R package BiasedUrn. |
Measuring the degree of closeness to the cancer experience: development and initial validation of the CONNection to the Experience of Cancer Scale (CONNECS)
Hawkins NA , McCarty F , Peipins LA , Rodriguez JL . Patient Educ Couns 2012 89 (2) 292-9 OBJECTIVE: To describe the development and psychometric testing of items measuring connection to the cancer experience through a close friend or relative. METHODS: Ten items assess four aspects of connection to cancer: emotional and cognitive involvement, kind and amount of shared experience, perceived similarity to the affected person, and negative change witnessed. Interviews were conducted with 2200 women close to someone with cancer. The sample was split into two samples for exploratory and confirmatory factor analysis. Sample 1 (n=1342) was used to examine the underlying structure of the items. Sample 2 (n=858) was used for CFA. Internal consistency and reliability analysis were also conducted. RESULTS: Three factors with moderate correlation were extracted: general closeness, resemblance, and cognitive processing. Results from the CFA analysis confirmed a good fit of the three-factor model (Bentler-Bonett NIF=0.973, Bentler-Bonett NNFI=0.975, RMSEA=0.040 and CFI=0.984) and all path coefficients were statistically significant. CONCLUSION: Findings provide preliminary evidence for the reliability and construct validity of the CONNECS scale in measuring individuals' connection to the cancer experience through a close friend or relative. PRACTICE IMPLICATIONS: CONNECS may be a useful tool for examining the impact of the cancer experience on risk perceptions, cancer worry, and medical decision making. |
Health risk behaviors among young adults with spina bifida
Soe MM , Swanson ME , Bolen JC , Thibadeau JK , Johnson N . Dev Med Child Neurol 2012 54 (11) 1057-64 AIM: Persons with spina bifida who adopt unhealthy lifestyles could be at increased risk of adverse health outcomes because the presence of spina bifida may magnify this risk. We estimated overall and age-specific prevalence of selected health risk behaviors (HRBs) in young people with spina bifida and examined the association between HRBs and depression. METHOD: We performed analyses on data obtained from individuals with spina bifida (n=130; mean age 23y SD 4y 5mo; 64 males, 66 females; 64% lumbosacral lesion; 77% with shunt) who participated in a population-based survey conducted by the Arkansas Spinal Cord Commission in 2005. RESULTS: Compared with national estimates, young people with spina bifida tend to eat less healthy diets, do less exercise, and engage in more sedentary activities. Respondents were less likely to use substances (alcohol, tobacco, illegal drugs), which peaked among 25 to 31 year olds. About 90% saw a doctor in the previous year. Nearly one half reported mild or major depressive symptoms. In the logistic regression analysis after controlling for potential confounders (age, sex, ethnic group, education, employment, marital status, living arrangement, level of lesion, presence of shunt, mobility, self-rated health and healthcare utilization), major depressive symptoms were associated with current alcohol drinking (adjusted odds ratio: 4.74; 95% CI 1.18-19.04). INTERPRETATION: Young adults with spina bifida exhibit unhealthy behaviors that continue into their late 20s. The findings highlight the need to increase awareness of their health risk profiles in the spina bifida community and show opportunities for mental health and health risk screening and counseling by healthcare providers. |
Health service use among the previously uninsured: is subsidized health insurance enough?
Decker SL , Doshi JA , Knaup AE , Polsky D . Health Econ 2012 21 (10) 1155-68 Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys-the National Health Interview Survey and the Health and Retirement Study-to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians but make 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented. (Copyright (c) 2011 John Wiley & Sons, Ltd.) |
Association between transfusion with human herpesvirus 8 antibody-positive blood and subsequent mortality
Hladik W , Pellett PE , Hancock J , Downing R , Gao H , Packel L , Mimbe D , Nzaro E , Mermin J . J Infect Dis 2012 206 (10) 1497-503 BACKGROUND: Human herpesvirus 8 (HHV-8) is endemic in Uganda and transmissible by blood. We evaluated mortality following transfusion of HHV-8-antibody-positive blood. METHODS: In a hospital-based observational prospective cohort study with a 6-month follow-up we examined the effect of HHV-8-antibody-positive blood on transfusion recipients surviving at least 7 days. RESULTS: Of 1,092 recipients, 471 (43.1%) were transfused with HHV-8-antibody-positive blood. Median age was 1.8 years (range, 0.1-78); 111 (10.2%) died during follow-up. After adjusting for confounders (increasing age, HIV infection, illness other than malaria, receipt of multiple transfusions), recipients of HHV-8-antibody-positive blood stored ≤4 days ("short-stored") were more likely to die than recipients of HHV-8-antibody-negative blood (adjusted hazards ratio [AHR], 1.92; 95% confidence interval [CI], 1.21-3.05; P=.01). The AHR of the effect of each additional short-stored HHV-8-antibody-positive transfusion was 1.79 (95% CI, 1.33-2.41; P=.001). Recipients of a single short-stored HHV-8-antibody-positive blood unit were twice as likely to die (AHR, 2.19; 95% CI, 1.06-4.53) as recipients of a single short-stored HHV-8-antibody-negative blood unit. CONCLUSIONS: Transfusion with short-stored HHV-8-antibody-positive blood was associated with an increased risk of death. Further research is warranted to determine if a causal pathway exists, and to verify the observed association between acute HHV-8 infection and premature mortality. |
Monitoring seasonal influenza vaccination coverage among pregnant women in the United States
Kennedy ED , Ahluwalia IB , Ding H , Lu PJ , Singleton JA , Bridges CB . Am J Obstet Gynecol 2012 207 S9-S16 This report describes surveillance systems used for assessing influenza vaccination coverage among pregnant women in the United States. Coverage estimates and factors associated with maternal vaccination are reviewed for internet panel surveys of pregnant women and the Pregnancy Risk Assessment Monitoring System (PRAMS); new estimates are reported from the Behavioral Risk Factor Surveillance System (BRFSS) and Internet panel surveys. Influenza vaccination coverage among pregnant women improved from 11% during the 2001-2002 influenza season to approximately 38% measured by BRFSS and 50% measured by Internet panel surveys during the 2010-2011 influenza season. Coverage varied by state, ranging from 26% to 68% among the states participating in PRAMS in 2009-2010. Provider recommendation increased a woman's likelihood of vaccination nearly 6-fold. Despite increases in influenza vaccination coverage among pregnant women, approximately half remain unvaccinated. Continued efforts are needed to ensure pregnant women receive recommendations and offers of vaccination from their health care providers. |
Perceptions matter: beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans
Wooten KG , Wortley PM , Singleton JA , Euler GL . Vaccine 2012 30 (48) 6927-34 BACKGROUND: Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. OBJECTIVE: To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. METHODS: Data from a national telephone survey conducted in 2004 were used for this study. Reponses for 3875 adults ≥65 years of age were analyzed using logistic regression methods. RESULTS: Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. CONCLUSIONS: Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups. |
The impact of new vaccine introduction on immunization and health systems: a review of the published literature
Hyde T , Dentz H , Wang S , Burchett H , Mounier-Jack S , Mantel C . Vaccine 2012 30 (45) 6347-58 We conducted a systematic review of the published literature to examine the impact of new vaccine introduction on countries' immunization and broader health systems. Six publication databases were searched using 104 vaccine and health system-related search terms. The search yielded 15,795 unique articles dating from December 31, 1911 to September 29, 2010. Based on review of the title and abstract, 654 (4%) of these articles were found to be potentially relevant and were referred for full review. After full review, 130 articles were found to be relevant and included in the analysis. These articles represented vaccines introduced to protect against 10 different diseases (hepatitis A, hepatitis B, Haemophilus influenzae type b disease, human papilloma virus infection, influenza, Japanese encephalitis, meningococcal meningitis, Streptococcus pneumoniae disease, rotavirus diarrhea and typhoid), in various formulations and combinations. Most reviewed articles (97 [75%]) reported experiences in high-income countries. New vaccine introduction was most efficient when the vaccine was introduced into an existing delivery platform and when introduced in combination with a vaccine already in the routine childhood immunization schedule (i.e., as a combination vaccine). New vaccine introduction did not impact coverage of vaccines already included in the routine childhood immunization schedule. The need for increased cold chain capacity was frequently reported. New vaccines facilitated the introduction and widespread use of auto-disable syringes into the immunization and the broader health systems. The importance of training and education for health care workers and social mobilization was frequently noted. There was evidence in high-income countries that new vaccine introduction was associated with reduced health-care costs. Future evaluations of new vaccine introductions should include the systematic and objective assessment of the impacts on a country's immunization system and broader health system, especially in lower-income countries. |
Involvement of endocrinologists in the 2009 to 2010 H1N1 vaccination effort
Clark SJ , Cowan AE , Wortley PM . Endocr Pract 2012 18 (4) 464-71 OBJECTIVE: To assess the level of participation of endocrinologists in the United States in the 2009 to 2010 H1N1 vaccination campaign and explore their perspectives on H1N1 vaccination. METHODS: We conducted a cross-sectional, mailed survey of a national sample of 1,991 endocrinologists in June through September 2010. The extent of the response and the survey responses are reported and analyzed. RESULTS: The overall response rate was 59%. The majority of endocrinologists strongly recommended H1N1 vaccine for children, whereas about a third did so for both nonelderly adults and seniors. Just over half (52%) of the responding endocrinologists had agreed to participate in the 2009 to 2010 H1N1 vaccine campaign and received vaccine, in comparison with 73% who offered seasonal influenza vaccine. The supply of H1N1 vaccine was a significant challenge, but otherwise endocrinologists reported few major problems with administration of H1N1 vaccine. Overall, less than half of the respondents thought that they would be "very likely" to provide vaccine in the event of a future influenza pandemic, with a much higher proportion among those endocrinologists who offered seasonal influenza vaccine and H1N1 vaccine. CONCLUSION: Although the experiences of endocrinologists who provided H1N1 vaccine were generally positive, many did not offer the vaccine and indicated that they are hesitant about providing vaccine during a future influenza pandemic. Approaches to increase their participation in future pandemics in an effort to reach persons at high risk for influenza and its complications, such as those with diabetes, should be further explored. |
Algorithm to assess causality after individual adverse events following immunizations
Halsey NA , Edwards KM , Dekker CL , Klein NP , Baxter R , Larussa P , Marchant C , Slade B , Vellozzi C . Vaccine 2012 30 (39) 5791-5798 Assessing individual reports of adverse events following immunizations (AEFI) can be challenging. Most published reviews are based on expert opinions, but the methods and logic used to arrive at these opinions are neither well described nor understood by many health care providers and scientists. We developed a standardized algorithm to assist in collecting and interpreting data, and to help assess causality after individual AEFI. Key questions that should be asked during the assessment of AEFI include: Is the diagnosis of the AEFI correct? Does clinical or laboratory evidence exist that supports possible causes for the AEFI other than the vaccine in the affected individual? Is there a known causal association between the AEFI and the vaccine? Is there strong evidence against a causal association? Is there a specific laboratory test implicating the vaccine in the pathogenesis? An algorithm can assist with addressing these questions in a standardized, transparent manner which can be tracked and reassessed if additional information becomes available. Examples in this document illustrate the process of using the algorithm to determine causality. As new epidemiologic and clinical data become available, the algorithm and guidelines will need to be modified. Feedback from users of the algorithm will be invaluable in this process. We hope that this algorithm approach can assist with educational efforts to improve the collection of key information on AEFI and provide a platform for teaching about causality assessment. |
Benefits of influenza vaccination during pregnancy for pregnant women
Jamieson DJ , Kissin DM , Bridges CB , Rasmussen SA . Am J Obstet Gynecol 2012 207 S17-20 Influenza vaccination is a cornerstone of influenza prevention efforts among pregnant women. Prior to 2005, data from studies conducted on pregnant women were limited, with much of the supporting evidence coming from influenza vaccine studies conducted among nonpregnant, age-matched populations. Since 2005, however, an increasing number of studies have demonstrated the safety and immunogenicity of influenza vaccine for pregnant women, including evidence of maternal transfer of antibody. In addition, the clinical benefit of influenza vaccination, both for the mother and infant, was demonstrated in a landmark randomized clinical trial conducted in Bangladesh. Additional randomized clinical trials with laboratory-confirmed influenza as the primary outcome are underway in countries without a current influenza vaccination program, but such trials are unlikely to be conducted in the United States or other countries that already recommend the vaccination of pregnant women. However, current evidence supports the safety and immunogenicity of inactivated influenza vaccine and its effectiveness in reducing the risk of influenza-related illness among pregnant women. |
Duration of protection of pentavalent rotavirus vaccination in Nicaragua
Patel M , Pedreira C , De Oliveira LH , Umana J , Tate J , Lopman B , Sanchez E , Reyes M , Mercado J , Gonzalez A , Perez MC , Balmaceda A , Andrus J , Parashar U . Pediatrics 2012 130 (2) e365-72 OBJECTIVE: To evaluate the duration of protection of pentavaent rotavirus vaccine (RV5) against rotavirus hospitalizations in Nicaragua, a developing country in Central America. METHODS: We conducted a case-control study at 4 hospitals from 2007 through 2010, including 1016 children hospitalized with laboratory-confirmed rotavirus diarrhea, 4930 controls with nonrotavirus diarrhea (ie, "test-negative"), and 5627 controls without diarrhea. All cases and controls were aged ≥6 months and born after August 2006. Outcomes included odds of antecedent vaccination between case-patients and controls, and effectiveness of vaccination (1 - adjusted odds ratio [OR] x 100). Duration of protection was assessed by comparing effectiveness among children aged <1 year compared with ≥1 year. RESULTS: Indicators of socioeconomic conditions and nonrotavirus vaccination (oral polio vaccine and diphtheria/tetanus/pertussis/hepatitis A/hepatitis B) for test-negative controls were more comparable to the rotavirus case-patients than nondiarrhea controls. RV5 vaccination was associated with a significantly lower risk of rotavirus hospitalization by using test-negative controls (OR: 0.55; 95% confidence interval [CI]: 0.41-0.74) and nondiarrhea controls (OR: 0.30; 95% CI: 0.22-0.40). Risk of rotavirus hospitalization was twofold lower among RV5 vaccinated children aged <1 year (OR: 0.36; 95% CI: 0.22-0.57) compared with RV5 vaccinated children aged ≥1 year (OR: 0.70; 95% CI: 0.47-1.05). CONCLUSIONS: RV5 provided good protection against severe rotavirus disease in Nicaragua during the first year of life, when most severe and fatal rotavirus disease in developing countries occurs. However, the decline in protection with age warrants monitoring of disease among older children and consideration of a booster dose evaluation at the end of infancy. |
Risk and protective factors associated with gang affiliation among high-risk youth: a public health approach
McDaniel DD . Inj Prev 2012 18 (4) 253-8 BACKGROUND: Gang violence accounted for 20% of homicides in large cities from 2002 to 2006. Preventing gang affiliation (ie, youth who either desire or have gang membership) might reduce subsequent gang activity. Previous research has focused on identifying risk factors for gang affiliation; however, little information is available on protective factors. AIM: To identify risk and protective factors to provide more direction for gang violence prevention strategies. METHODS: The author analysed cross-sectional survey data from 4131 youths in grades 7, 9, 11 and 12. Data were collected in 2004 from students in a high-risk, urban public school district. Regression analyses were conducted to assess the association between gang affiliation and alcohol and drug use, delinquency, depressed mood, suicidal ideation, peer victimisation, parental monitoring and positive reinforcement, adult, family and peer support, coping skills, and school connectedness. Analyses were controlled for sex, race/ethnicity and age. RESULTS: An estimated 7% of youths were gang affiliated. Adjusting for all factors, gang affiliation was positively associated with engaging in any delinquent behaviours (prevalence OR: 2.07; 95% CI 1.18 to 3.64), frequent alcohol use (OR: 2.62; 95% CI 1.85 to 3.72) and frequent drug use (OR: 1.95; 95% CI 1.15 to 3.29). Gang affiliation was negatively associated with moderate levels of parental monitoring (OR: 0.67; 95% CI 0.54 to 0.85) and coping skills (OR: 0.54; 95% CI 0.42 to 0.71). CONCLUSIONS: The findings suggest the potential benefit of increasing parental monitoring and coping skills and reducing delinquency, alcohol use and drug use to prevent gang affiliation. |
Sex, race/ethnicity, and context in school-associated student homicides
Kaufman JM , Hall JE , Zagura M . J Interpers Violence 2012 27 (12) 2373-90 This study assessed the importance of sex, race/ethnicity, and geographic context for incidents of school-associated student homicides between July 1, 1994 and June 30, 1999, covering 5 academic years. Using data from the Centers for Disease Control and Prevention School Associated Violent Deaths Study (n = 125 incidents), we compared percentages and medians of victim, offender, motive, and school characteristics for incidents by geographic context and race/ethnicity of the offenders. Most incidents involved urban areas (53.6%), Black and Latino offenders and victims, moderately high youth poverty, and male on male violence (77.6%) driven by disputes and gang-related motives. Suburban area incidents (31.2%) often involved offenders and victims of a different race/ethnicity (51.3%). Multiple victims and White offenders were more common in rural areas (15.2%). More than 50% of the rural incidents involved male offenders and female victims. White offender incidents more often included multiple victims and female victims while Black and Latino offenders more often included single victims of the same sex. These results emphasize the utility of an incident-based analysis of school-associated student homicides in highlighting important variations by intersections of sex, race/ethnicity, and geographic context. |
Multilocus variable-number tandem-repeat analysis of Mycoplasma pneumoniae clinical isolates from 1962 to the present: a retrospective study.
Benitez AJ , Diaz MH , Wolff BJ , Pimentel G , Njenga MK , Estevez A , Winchell JM . J Clin Microbiol 2012 50 (11) 3620-6 In this study we evaluated a recently developed multi-locus variable-number tandem-repeat (VNTR) analysis (MLVA) method for the molecular typing of Mycoplasma pneumoniae. The method is based on GeneScan analysis of five VNTR loci throughout the genome which define a specific genotype based on the number of tandem repeats within each locus. A retrospective analysis of 154 M. pneumoniae clinical isolates collected over the last 50 years and a limited (n=4) number of M. pneumoniae-positive primary specimens acquired by CDC was performed using MLVA. Eighteen distinct VNTR types were identified including two previously unidentified VNTR types. Isolates from several M. pneumoniae community outbreaks within the United States were also analyzed to examine clonality of a specific MLVA type. Observed in vitro variability of the Mpn1 VNTR locus prompted further analysis which showed multiple insertions or deletions of tandem repeats within this locus for a number of specimens and isolates. To our knowledge this is the first report showing variation within the Mpn 1 locus, thus affecting precise and reliable classification using the current MLVA typing system. The superior discriminatory capability of MLVA provides a powerful tool for greater resolution of M. pneumoniae strains and could be useful during outbreaks and epidemiological investigations. |
Genomic characterization of Listeria monocytogenes strains involved in a multistate listeriosis outbreak associated with cantaloupe in US.
Laksanalamai P , Joseph LA , Silk BJ , Burall LS , Tarr CL , Gerner-Smidt P , Datta AR . PLoS One 2012 7 (7) e42448 A multistate listeriosis outbreak associated with cantaloupe consumption was reported in the United States in September, 2011. The outbreak investigation recorded a total of 146 invasive illnesses, 30 deaths and one miscarriage. Subtyping of the outbreak associated clinical, food and environmental isolates revealed two serotypes (1/2a and 1/2b) and four pulsed-field gel electrophoresis two-enzyme pattern combinations I, II, III, and IV, including one rarely seen before this outbreak. A DNA-microarray, Listeria GeneChip(R), developed by FDA from 24 Listeria monocytogenes genome sequences, was used to further characterize a representative sample of the outbreak isolates. The microarray data (in the form of present or absent calls of specific DNA sequences) separated the isolates into two distinct groups as per their serotypes. The gene content of the outbreak-associated isolates was distinct from that of the previously-reported outbreak strains belonging to the same serotypes. Although the 1/2b outbreak associated isolates are closely related to each other, the 1/2a isolates could be further divided into two distinct genomic groups, one represented by pattern combination I strains and the other represented by highly similar pattern combinations III and IV strains. Gene content analysis of these groups revealed unique genomic sequences associated with these two 1/2a genovars. This work underscores the utility of multiple approaches, such as serotyping, PFGE and DNA microarray analysis to characterize the composition of complex polyclonal listeriosis outbreaks. |
Biomarkers in toxicology and risk assessment.
Fowler BA . Exp Suppl 2012 101 459-70 Over the last 30 years, the field of biomarkers has greatly expanded as early and specific endpoints for monitoring cellular responses to various disease states and exposures to drugs and chemical agents. They have enjoyed some success as predictors of health outcomes for a number of clinical diseases, but the application to chemical exposure risk assessments has been more limited. Biomarkers may be classified into categories of markers of exposure, effect, and susceptibility. Currently, "omics" biomarkers (i.e., genomic, proteomic, and metabolomic/metabonomic) are the major classes of biomarkers under development. These markers represent a continuum of cellular responses to drug or chemical exposures and provide linkages to mechanisms of cell injury/cell death or carcinogenic transformation. On the other hand, translation and application of these biomarkers for risk assessment has been limited due to validation and interpretation issues that need to be addressed in order for these potentially extremely valuable endpoints to reach their full potential as predictive tools for public health. This short chapter will briefly review these three "omics" biomarker classes and examine some validation/translation aspects needed in order for them to reach their full potential and acceptance as valuable tools for application to risk assessment. |
Severe hemorrhagic fever in strain 13/n guinea pigs infected with Lujo virus
Bird BH , Dodd KA , Erickson BR , Albarino CG , Chakrabarti AK , McMullan LK , Bergeron E , Stroeher U , Cannon D , Martin B , Coleman-McCray JD , Nichol ST , Spiropoulou CF . PLoS Negl Trop Dis 2012 6 (8) e1801 Lujo virus (LUJV) is a novel member of the Arenaviridae family that was first identified in 2008 after an outbreak of severe hemorrhagic fever (HF). In what was a small but rapidly progressing outbreak, this previously unknown virus was transmitted from the critically ill index patient to 4 attending healthcare workers. Four persons died during this outbreak, for a total case fatality of 80% (4/5). The suspected rodent source of the initial exposure to LUJV remains a mystery. Because of the ease of transmission, high case fatality, and novel nature of LUJV, we sought to establish an animal model of LUJV HF. Initial attempts in mice failed, but infection of inbred strain 13/N guinea pigs resulted in lethal disease. A total of 41 adult strain 13/N guinea pigs were infected with either wild-type LUJV or a full-length recombinant LUJV. Results demonstrated that strain 13/N guinea pigs provide an excellent model of severe and lethal LUJV HF that closely resembles what is known of the human disease. All infected animals experienced consistent weight loss (3-5% per day) and clinical illness characterized by ocular discharge, ruffled fur, hunched posture, and lethargy. Uniform lethality occurred by 11-16 days post-infection. All animals developed disseminated LUJV infection in various organs (liver, spleen, lung, and kidney), and leukopenia, lymphopenia, thrombocytopenia, coagulopathy, and elevated transaminase levels. Serial euthanasia studies revealed a temporal pattern of virus dissemination and increasing severity of disease, primarily targeting the liver, spleen, lungs, and lower gastrointestinal tract. Establishing an animal LUJV model is an important first step towards understanding the high pathogenicity of LUJV and developing vaccines and antiviral therapeutic drugs for this highly transmissible and lethal emerging pathogen. |
Methods for the determination of biomarkers of exposure to emerging pollutants in human specimens
Yusa V , Ye X , Calafat AM . Trends Analyt Chem 2012 38 129-142 Biomonitoring is a very useful tool for assessing human exposure to environmental pollutants. This review discusses recent methods for the quantitative measurement of biomarkers of exposure to different classes of chemicals used in personal-care products (e.g., musk fragrances, preservatives, UV filters, and insect repellents) and consumer products (e.g., organophosphate flame retardants, phthalate esters, perfluorinated compounds, and industrial phenols). The measurements are mainly taken in urine, blood, and breast milk. We also discuss the different procedures commonly used for sample-pretreatment, extraction, and clean up, and chromatographic techniques currently used to determine these compounds. Finally, we present data on the main biomarkers occurring in different human specimens. (2012 Elsevier Ltd.) |
Performance of the PointCare NOW system for CD4 counting in HIV patients based on five independent evaluations
Bergeron M , Daneau G , Ding T , Sitoe NE , Westerman LE , Stokx J , Jani IV , Coetzee LM , Scott L , De Weggheleire A , Boel L , Stevens WS , Glencross DK , Peter TF . PLoS One 2012 7 (8) e41166 INTRODUCTION: Point-of-care (POC) CD4 testing can improve access to treatment by enabling decentralization and reducing patient loss-to-follow-up. As new POC CD4 technologies become available, their performance should be assessed before widespread deployment. This study reports the findings of five independent evaluations of the PointCare NOW CD4 system. MATERIALS/METHODS: Evaluations were conducted in Southern Africa (Mozambique, South Africa) and North America (Canada, USA). 492 blood samples (55 from HIV-negative blood donors and 437 from HIV-infected patients, including 20 children aged between 12 and 59 months) were tested with both the PointCare NOW and reference flow cytometry instruments. Assessment of bias, precision and levels of clinical misclassification for absolute and percent CD4 count was conducted. RESULTS: PointCare NOW significantly overestimated CD4 absolute counts with a mean relative bias of +35.0%. Bias was greater in samples with CD4 counts below ≤350cells/microl (+51.3%) than in the CD4 >350cells/microl stratum (15.1%). Bias in CD4% had a similar trend with an overall relative mean bias of +25.6% and a larger bias for low CD4 stratum (+40.2%) than the higher CD4 stratum (+5.8%). Relative bias for CD4% in children was -6.8%. In terms of repeatability, PointCare NOW had a coefficient of variation of 11%. Using a threshold of 350cells/microl, only 47% of patients who qualified for antiretroviral therapy with reference CD4 testing, would have been eligible for treatment with PointCare NOW test results. This was 39% using a 200cells/microl threshold. Agreement with infant samples was higher, with 90% qualifying at a 25% eligibility threshold. CONCLUSION: The performance of the PointCare NOW instrument for absolute and percent CD4 enumeration was inadequate for HIV clinical management in adults. In children, the small sample size was not large enough to draw a conclusion. This study also highlights the importance of independent evaluation of new diagnostic technology platforms before deployment. |
Experimental infection of laboratory mice with two Bartonella tribocorum strains from wild Mus species: a homologous host-bacteria model system at the genus level
Colton L , Kosoy M . Parasitology 2012 140 (1) 1-8 SUMMARY: To date no experimental infection studies have been conducted in laboratory mice using Mus spp. bartonella strains. Therefore we designed a study to evaluate the in vivo infection characteristics of 2 Bartonella tribocorum strains from wild Mus spp. in laboratory mice with the aim of developing a mouse model that reproduces characteristics of naturally acquired bartonella infections in rodents. Groups of outbred CD1 female mice were subcutaneously inoculated with low doses of 2 mouse bartonella strains (10, 100, and 1000 bacteria/mouse). Blood was collected weekly for 27 weeks to evaluate bacteraemia kinetics in infected mice. Mouse urine collected during weeks 3-6 post-inoculation was also tested for viable bacteria to determine whether urine might serve as a source of bacterial transmission. Mice were susceptible to infection with both strains. Bacteraemias in mice lasted up to 25 weeks, sometimes with abacteraemic intervals, and achieved levels up to 107 cfu/ml of blood. Temporal lags in bacteraemia onset of up to 19 weeks in length were noted at different inoculum doses. No viable bacteria were detected in mouse urine. Bacteraemic mice displayed characteristics of infection similar to those observed in natural rodent hosts during longitudinal field studies. This mouse model of persistent bacteraemia should be suitable for a variety of experimental uses. |
Interspecies uncertainty in molecular responses and toxicity of mixtures
Mumtaz MM , Pohl HR . Exp Suppl 2012 101 361-79 Most of the experimental toxicity testing data for chemicals are generated through the use of laboratory animals, namely, rodents such as rats and mice or other species. Interspecies extrapolation is needed to nullify the differences between species so as to use such data for human health/risk assessment. Thus, understanding of interspecies differences is important in extrapolating the laboratory results to humans and conducting human risk assessments based on current credible scientific knowledge. Major causes of interspecies differences in anatomy and physiology, toxicokinetics, injury repair, molecular receptors, and signal transduction pathways responsible for variations in responses to toxic chemicals are outlined. In the risk assessment process, uncertainty associated with data gaps in our knowledge is reflected by application of uncertainty factors for interspecies differences. Refinement of the risk assessment methods is the ultimate goal as we strive to realistically evaluate the impact of toxic chemicals on human populations. Using specific examples from current risk assessment practice, this chapter illustrates the integration of interspecies differences in evaluation of individual chemicals and chemical mixtures. |
Cavity ring-down spectroscopy with an automated control feedback system for investigating nitrate radical surface chemistry reactions
Flemmer MM , Ham JE . Rev Sci Instrum 2012 83 (8) 085103 Nitrate radical (NO(3)) surface chemistry of indoor environments has not been well studied due to the difficulty in generating and maintaining NO(3) at low concentrations for long term exposures. This article presents the Surface Chemistry Reactant Air Delivery and Experiment System (SCRADES), a novel feedback controlled system developed to deliver nitrate radicals at specified concentrations (50-500 ppt, +/-30 ppt) and flow rates (500-2000 ml min(-1)) to a variety of indoor surfaces to initiate reaction chemistry for periods of up to 72 h. The system uses a cavity ring-down spectrometer (CRDS), with a detection limit of 1.7 ppt, to measure the concentration of NO(3) supplied to a 24 l experiment chamber. Nitrate radicals are introduced via thermal decomposition of N(2)O(5) and diluted with clean dry air until the desired concentration is achieved. Additionally, this article addresses details concerning NO(3) loss through the system, consistency of the NO(3) concentration delivered, and stability of the CRDS cavity over long exposure durations (72 h). |
Chick embryo tracheal organ: a new and effective in vitro culture model for Cryptosporidium baileyi
Zhang S , Jian F , Zhao G , Huang L , Zhang L , Ning C , Wang R , Qi M , Xiao L . Vet Parasitol 2012 188 376-81 In the present study, chick embryo tracheal organ (TOCs) was used to cultivate oocysts or sporozoites of Cryptosporidium baileyi. Approximately 5x10(4) sporozoites and oocysts mixture for group I; 5x10(5), 1x10(6), 2x10(6) purified sporozoites for group II, group III and group IV, respectively, were inoculated into respective chick embryo tracheal rings maintained in RPMI 1640 supplemented with 5% heat-inactivated FBS, and cultivated in each well of the 24-well culture plate at 40 degrees C and 5% CO(2). The tracheal rings in four experimental groups (I-IV) were successfully infected with C. baileyi, and different stages of parasites were also observed under light and electron microscopy. Parasite infection and cytological alterations were noted as early as PI 72h. The Cryptosporidium were seen attached to the edge of the tracheal epithelium, with more number of parasites in group I than that in group II, group III and group IV. The moderate nuclear swelling and chromatin margination were also detected, and the normal vertical orientation and basilar location of the nuclei of the epithelial cells were almost lost. C. baileyi that has been passed by TOCs exhibited similar immunity and molecular features with parasites before intratracheal inoculation. These results suggest that chick embryo tracheal organ is a new and effective in vitro culture model for C. baileyi and other respiratory pathogens. |
Curcumin protects against UVB-induced skin cancers in SKH-1 hairless mouse: analysis of early molecular markers in carcinogenesis
Tsai KD , Lin JC , Yang SM , Tseng MJ , Hsu JD , Lee YJ , Cherng JM . Evid Based Complement Alternat Med 2012 2012 593952 Curcumin (CUR) has been shown to possess a preventive effect against various cancers and interfere with multiple-cell signaling pathways. We evaluated the protective effects of CUR in regression of UVB-induced skin tumor formation in SKH-1 hairless mice and its underlying early molecular biomarkers associated with carcinogenesis. Mice irradiated with UVB at 180 mJ/cm(2) twice per week elicited 100% tumor incidence at 20 weeks. Topical application of CUR prior to UVB irradiation caused delay in tumor appearance, multiplicity, and size. Topical application of CUR prior to and immediately after a single UVB irradiation (180 mJ/cm(2)) resulted in a significant decrease in UVB-induced thymine dimer-positive cells, expression of proliferative cell nuclear antigen (PCNA), terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and apoptotic sunburn cells together with an increase in p53 and p21/Cip1-positive cell population in epidermis. Simultaneously, CUR also significantly inhibited NF-kappaB, cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), and nitric oxide (NO) levels. The results suggest that the protective effect of CUR against photocarcinogenesis is accompanied by downregulation of cell proliferative controls, involving thymine dimer, PCNA, apoptosis, transcription factors NF-kappaB, and of inflammatory responses involving COX-2, PGE2, and NO, while upregulation of p53 and p21/Cip1 to prevent DNA damage and facilitate DNA repair. |
Seroconversion to islet autoantibodies after enterovirus infection in early pregnancy
Resic Lindehammer S , Honkanen H , Nix WA , Oikarinen M , Lynch KF , Jonsson I , Marsal K , Oberste S , Hyoty H , Lernmark A . Viral Immunol 2012 25 (4) 254-61 Gestational enterovirus (EV) infections have been associated with an increased risk for type 1 diabetes in the offspring. We therefore analyzed non-diabetic mothers for EV exposure in early pregnancy in relation to type 1 diabetes HLA-DQ risk genotypes and seroconversion to islet autoantibodies during pregnancy. Non-diabetic mothers who had islet autoantibodies (n=365) against glutamic acid decarboxylase (GADA), islet antigen-2 autoantibodies (IA-2A), or insulin autoantibodies (IAA), in early pregnancy and at delivery were compared to islet autoantibody-negative mothers (n=1457) matched for age and sampling date. Mothers were genotyped for HLA-DQ and analyzed for both EV-RNA and EV-IgM. EV-IgM, but not EV-RNA, was detected during early pregnancy in 12% of islet autoantibody-positive mothers compared to 11% of the controls. In early pregnancy, mothers with HLA-DQ 2/2 or 2/X genotypes showed an increased risk for islet autoantibodies at delivery (OR 1.85; p=0.001). After adjusting for parity, maternal age, year of birth, and season of early pregnancy, early pregnancy EV-IgM combined with DQ2/2 or 2/X increased the risk for islet autoantibodies (OR 3.10; 95% CI 1; p=0.008). EV-IgM in early pregnancy increased the risk for islet autoantibodies at delivery in non-diabetic mothers with HLA-DQ 2/2 or 2/X type 1 diabetes risk genotypes. |
Surgeon General's Call to Action to Support Breastfeeding: significant actions in the first year
Grummer-Strawn LM . Breastfeed Med 2012 7 (5) 332-3 In January 2011, Surgeon General Regina Benjamin issued the Call to Action to Support Breastfeeding.1 In this document, she outlined 20 Action Steps to be carried out to improve the ways that breastfeeding women can be supported. The Action Steps focused on mothers and their families, communities, health care, employment, research and surveillance, and public health infrastructure. In the year since the Call to Action was issued, numerous programs have been undertaken to respond to the Call. |
A framework for elimination of perinatal transmission of HIV in the United States
Nesheim S , Taylor A , Lampe MA , Kilmarx PH , Fitz Harris L , Whitmore S , Griffith J , Thomas-Proctor M , Fenton K , Mermin J . Pediatrics 2012 130 (4) 738-44 The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age. |
Neurodegenerative causes of death among retired National Football League players
Lehman EJ , Hein MJ , Baron SL , Gersic CN . Neurology 2012 79 (19) 1970-4 OBJECTIVE: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players. METHODS: This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs). RESULTS: Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7). CONCLUSIONS: The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players. (Neurology 2012;79:1-1) |
Pulmonary and heart rate responses to wearing N95 filtering facepiece respirators
Kim JH , Benson SM , Roberge RJ . Am J Infect Control 2012 41 (1) 24-7 BACKGROUND: Filtering facepiece respirators are the most common respirator worn by US health care and industrial workers, yet little is known on the physiologic impact of wearing this protective equipment. METHODS: Twenty young, healthy subjects exercised on a treadmill at a low-moderate (5.6 km/h) work rate while wearing 4 different models of N95 filtering facepiece respirators for 1 hour each, 2 models of which were equipped with exhalation valves, while being monitored for physiologic variables. RESULTS: Compared with controls, respirator use was associated with mean 1 hour increases in heart rate (range, 5.7-10.6 beats per minute, P < .001), respiratory rate (range, 1.4-2.4 breaths per minute, P < .05), and transcutaneous carbon dioxide (range, 1.7-3.0 mm Hg, P < .001). No significant differences in oxygen saturation between controls and respirators were noted (P > .05). CONCLUSION: The pulmonary and heart rate responses to wearing a filtering facepiece respirator for 1 hour at a low-moderate work rate are relatively small and should generally be well tolerated by healthy persons. |
Saving lives for a lifetime: supporting orphans and vulnerable children impacted by HIV/AIDS
Nyberg BJ , Yates DD , Lovich R , Coulibaly-Traore D , Sherr L , Thurman TR , Sampson A , Howard B . J Acquir Immune Defic Syndr 2012 60 S127-S135 President's Emergency Plan for AIDS Relief (PEPFAR's) response to the millions of children impacted by HIV/AIDS was to designate 10% of its budget to securing their futures, making it the leading supporter of programs reaching orphan and vulnerable children (OVC) programs globally. This article describes the evolution of PEPFAR's OVC response based on programmatic lessons learned and an evergrowing understanding of the impacts of HIV/AIDS. In launching this international emergency effort and transitioning it toward sustainable local systems, PEPFAR helped establish both the technical content and the central importance of care and support for OVC as a necessary complement to biomedical efforts to end the HIV/AIDS epidemic. Critical services are reaching millions of HIV-affected children and families through vast networks of community-based responders and strengthened national systems of care. But rapid program scale-up has at times resulted in inconsistent responses, failure to match resources to properly assessed needs, and a dearth of rigorous program evaluations. Key investments should continue to be directed toward more sustainable and effective responses. These include greater attention to children's most significant developmental stages, a focus on building the resilience of families and communities, a proper balance of government and civil society investments, and more rigorous evaluation and research to ensure evidence-based programming. Even as HIV prevalence declines and medical treatment improves and expands, the impacts of HIV/AIDS on children, families, communities, economies, and societies will continue to accumulate for generations. Protecting the full potential of children-and thus of societies-requires sustained and strategic global investments aligned with experience and science. |
PEPFAR'S past and future efforts to cut costs, improve efficiency, and increase the impact of global HIV programs
Holmes CB , Blandford JM , Sangrujee N , Stewart SR , Dubois A , Smith TR , Martin JC , Gavaghan A , Ryan CA , Goosby EP . Health Aff (Millwood) 2012 31 (7) 1553-60 Amid the global economic crisis, the President's Emergency Plan for AIDS Relief (PEPFAR) and other organizations have been pressed to do more with constrained resources to meet unmet needs in the worldwide HIV/AIDS pandemic. PEPFAR has approached this challenge through the development of an Impact and Efficiency Acceleration Plan, which includes improving the collection and use of economic and financial data, increasing the efficiency of HIV/AIDS program implementation, and collaborating with governments and multilateral organizations to maximize the impact of the resources provided by the United States. For example, by linking financial data with program outputs, PEPFAR was able to help its implementing partners in Mozambique reduce mean unit expenditures for people receiving antiretroviral treatment by 45 percent, from $265 to $145 per person, between 2009 and 2011. This article describes the plan's elements, provides examples of progress and challenges to its implementation, and assesses the prospects for further improvements in efficiency and impact. |
Costs, consequences and feasibility of strategies for achieving the goals of the National HIV/AIDS Strategy in the United States: a closing window for success?
Holtgrave DR , Hall HI , Wehrmeyer L , Maulsby C . AIDS Behav 2012 16 (6) 1365-72 Three key policy questions are explored here: Is it still epidemiologically feasible to attain the incidence and transmission rate reduction goals of the U.S. National HIV/AIDS Strategy (NHAS) by 2015? If so, what costs will be incurred in necessary program expansion, and will the investment be cost-effective? Would substantial expansion of prevention services for persons living with HIV (PLWH) augment the other strategies outlined in the NHAS in terms of effectiveness and cost-effectiveness? Eight policy scenarios were constructed based on three factors (two levels each): expansion (or not) of HIV diagnostic services; assumptions regarding levels of effectiveness of HIV treatment in achieving suppressed viral load; and possible levels of expansion of prevention services for PLWH. All scenarios assumed that the NHAS goal of 85% linkage to HIV care would be fully achieved by 2015. Standard methods of economic evaluation and epidemiologic modeling were employed. Each of the eight policy scenarios was compared to a flat transmission rate comparison condition; then, key policy dyads were compared pairwise. Without expansion of diagnostic services and of prevention services for PLWH, scaling up coverage of HIV care and treatment alone in the U.S. will not achieve the incidence and transmission rate reduction goals of the NHAS. However, timely expansion of testing and prevention services for PLWH does allow for the goals to still be achieved by 2015, and does so in a highly cost-effective manner. |
"Smoking Cessation for Pregnancy and Beyond: A Virtual Clinic," an innovative web-based training for healthcare professionals
Tong VT , Dietz PM , England LJ . J Womens Health (Larchmt) 2012 21 (10) 1014-7 This article provides an overview of an interactive online training designed for healthcare professionals to hone their skills in assisting pregnant women to quit smoking and to remain quit postpartum. The curriculum teaches a best practice approach for smoking cessation, the 5A's, and is based on current clinical recommendations. The program offers five interactive case simulations and comprehensive discussions of patient visits, short lectures on relevant topics from leading experts, interviews with real patients who have quit, and a dedicated website of pertinent links and office resources. The training is accredited for up to 4.5 hours of continuing education credits. To access the training, please visit www.smokingcessationandpregnancy.org . |
Need for physician education on the benefits and risks of male circumcision in the United States
Carbery B , Zhu J , Gust DA , Chen RT , Kretsinger K , Kilmarx PH . AIDS Educ Prev 2012 24 (4) 377-87 Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult men. A self-administered, cross-sectional electronic survey of physicians was conducted in 2008. We analyzed responses from 1,500 physicians (510 family practitioners, 490 internists, 250 pediatricians, and 250 obstetricians/gynecologists). Nearly 22% (n = 327/1500) reported they did not understand the risks and benefits of newborn male circumcision well enough to counsel parents and 40.3% (n = 504/1250) reported not understanding the risks and benefits well enough to counsel adult men. A substantial minority of physicians may need additional training and/or information about current male circumcision research to feel comfortable counseling parents of newborn male infants or adult men. |
Assessment of assisted reproductive technology use questions: Pregnancy Risk Assessment Monitoring System survey, 2004
Barradas DT , Barfield WD , Wright V , D'Angelo D , Manning SE , Schieve LA . Public Health Rep 2012 127 (5) 516-23 OBJECTIVE: Women who conceive with the assistance of fertility treatments are at increased risk for multiple-gestation pregnancies and accompanying adverse pregnancy outcomes. The Pregnancy Risk Assessment Monitoring System (PRAMS) can be used to assess outcomes associated with fertility treatments, but a previous study suggested that PRAMS questions about fertility treatments overestimated use of assisted reproductive technology (ART) by 2.6 times. These PRAMS ART questions were revised in 2004. We compared prevalence estimates based on revised questions with counts from the National ART Surveillance System (NASS), the standard for describing ART prevalence. METHODS: We compared weighted PRAMS prevalence estimates of births conceived by using ART with corresponding counts from NASS for three states (Florida, Maryland, and Utah) for 2004. We also compared these data by age, parity, plurality, and infant birthweight. RESULTS: Estimated ART births determined from PRAMS totaled 3,672 (95% confidence interval 2,210, 5,134), compared with 2,939 ART births reported to NASS. PRAMS estimates and NASS counts differed by maternal age (p=0.02) and parity (p<0.01). For example, PRAMS responses from women aged ≥40 years overestimated ART use by 70% (27.9% vs. 16.5%, p<0.01). CONCLUSIONS: Revised PRAMS questions better estimate numbers of ART births than earlier PRAMS questions. PRAMS data are useful to describe behaviors and outcomes associated with ART use. |
Early adolescent romantic relationships and maternal approval among inner city Latino families
Bouris A , Guilamo-Ramos V , Jaccard J , Ballan M , Lesesne CA , Gonzalez B . AIDS Behav 2012 16 (6) 1570-83 Latino youth are at high risk for acquiring HIV during adolescence. The present study documented the nature of adolescent romantic relationships among 702 Latino eighth grade students and their mothers in the Bronx, NY. The study examined adolescent romantic relationships, the association between participation in such relationships and intentions to engage in sexual risk behavior, and maternal influences on adolescent's involvement in intimate behaviors in romantic relationships. Almost 50% of youth had been in a romantic relationship, which typically lasted 3-3.5 months. Mothers tended to approve of intimate behaviors and sexual activity in romantic relationships more so for males than females. Latino youth tended to underestimate maternal disapproval of a range of intimate behaviors, and the correlations between perceived and actual maternal approval were generally low in magnitude. Finally, maternal orientations towards their adolescent engaging in romantic relationships were associated with their child's intentions to have sexual intercourse in the future. |
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