Non-high-density lipoprotein cholesterol concentration is associated with the metabolic syndrome among US youth aged 12-19 years
Li C , Ford ES , McBride PE , Kwiterovich PO , McCrindle BW , Gidding SS . J Pediatr 2010 158 (2) 201-7 OBJECTIVE: To test the hypothesis that the concentration of non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the metabolic syndrome (MetS) in youth. STUDY DESIGN: Data on children and adolescents aged 12-19 years (n = 2734) from the cross-sectional National Health and Nutrition Examination Survey 1999-2004 were analyzed. RESULTS: Depending on the definition of MetS used, the mean non-HDL-C concentration among youth with MetS ranged from 144.2 to 155.8 mg/dL, compared with 108.8-109.1 mg/dL in those without MetS (all P < .001). The MetS prevalence ranged from 6.9% to 11.7% in youth with a non-HDL-C concentration of 120-144 mg/dL and from 21.5% to 23.4% in those with a concentration ≥145 mg/dL-both significantly higher than the prevalence of 1.9%-3.4% in youth with a concentration <120 mg/dL (all P < .001). After adjustment for potential confounders, youth with a non-HDL-C concentration ≥120 mg/dL or ≥145 mg/dL were about 3 or 4 times more likely to have MetS compared with those with a non-HDL-C <120 mg/dL or <145 mg/dL (all P < .001). CONCLUSIONS: Fasting non-HDL-C concentration was strongly associated with MetS in US youth. Our results support the use of non-HDL-C thresholds of 120 mg/dL and 145 mg/dL to indicate borderline and high MetS risk, respectively. |
Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US
Ford ES , Li C , Zhao G . J Diabetes 2010 2 (3) 180-193 BACKGROUND: Recently, a Joint Scientific Statement bridged differences between previous definitions of metabolic syndrome. Our objective was to estimate the prevalence of metabolic syndrome in a representative sample of US adults and to examine its correlates. METHODS: We analyzed data for up to 3461 participants aged >=20 years of the 2003-2006 National Health and Nutrition Examination Survey. RESULTS: Using waist circumference thresholds of >=102 cm for men and >=88 cm for women, the age-adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women. Using racial- or ethnic-specific International Diabetes Federation criteria for waist circumference, the age-adjusted prevalence of metabolic syndrome was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, peaking among those aged 60-69 years. Prevalence was lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women. In a multivariate regression model, significant independent associations were noted for age (positive), gender (men higher than women), race or ethnicity (African Americans and participants of another race lower than Whites), educational status (inverse), hypercholesterolemia (positive), concentrations of C-reactive protein (positive), leisure time physical activity (inverse), microalbuminuria (positive), and hyperinsulinemia (positive). Additional adjustment for body mass index weakened many of the associations, with educational status and microalbuminuria no longer significant contributors to the model. CONCLUSION: Metabolic syndrome continues to be highly prevalent among adults in the US. Published 2010. This article is a US Government work and is in the public domain in the USA. |
Coronary mortality declines in the U.S. between 1980 and 2000 quantifying the contributions from primary and secondary prevention
Young F , Capewell S , Ford ES , Critchley JA . Am J Prev Med 2010 39 (3) 228-34 BACKGROUND: Coronary heart disease (CHD) mortality rates in the U.S. have halved since 1980. However, CHD remains a leading cause of death. The relative importance of secondary and primary prevention in explaining falls in coronary heart disease mortality is debated. PURPOSE: The aim of this study was to quantify the primary and secondary preventive contributions to the U.S. CHD mortality fall between 1980 and 2000. METHODS: The IMPACT model was used to estimate contributions to the U.S. CHD mortality fall from risk factor declines in asymptomatic individuals (primary prevention) and in CHD patients (secondary prevention). Analyses were carried out in 2008. RESULTS: Approximately 316,100 fewer deaths were attributable to risk factor declines: 64,930 in CHD patients (21%) and 251,170 in asymptomatic individuals (79%). Smoking declines accounted for approximately 8390 fewer deaths in CHD patients and for 46,315 fewer deaths in asymptomatic people. Cholesterol falls gave approximately 22,210 fewer deaths in CHD patients and 107,300 fewer deaths in asymptomatic people. Statins accounted for approximately 16,580 fewer deaths, that is, one sixth of this mortality fall. Systolic blood pressure declines accounted for approximately 34,330 fewer deaths among CHD patients and 97,555 fewer deaths in asymptomatic individuals. Antihypertensive medications accounted for approximately 23,845 fewer deaths. CONCLUSIONS: Half of the U.S. mortality fall in coronary heart disease between 1980 and 2000 was attributable to risk factor declines, with primary prevention producing substantially larger mortality reductions than secondary. |
South Carolina tuberculosis genotype cluster investigation: a tale of substance abuse and recurrent disease
Buff AM , Moonan PK , Desai MA , McKenna TL , Harris DA , Rogers BJ , Rabley SS , Oeltmann JE . Int J Tuberc Lung Dis 2010 14 (10) 1347-1349 The South Carolina Tuberculosis (TB) Control Division ranked all the TB genotype clusters (two or more cases with matching genotypes) in the state based on the number of cases. The largest cluster, PCR00002, was investigated to determine if the cluster represented recent Mycobacterium tuberculosis transmission, and if so, to identify associated risk factors. The PCR0002 cluster, which included pediatric cases, clearly represented recent M. tuberculosis transmission. The two primary factors contributing to cluster growth were substance abuse and recurrent TB disease. Elimination of ongoing M. tuberculosis transmission in this population will require concurrent treatment for TB disease and substance abuse. |
Tuberculosis in humans and its epidemiology, diagnosis and treatment in the United States
Lobue PA , Enarson DA , Thoen TC . Int J Tuberc Lung Dis 2010 14 (10) 1226-1232 Tuberculosis (TB) is a pulmonary and systemic disease caused by Mycobacterium tuberculosis complex species. TB is spread from person to person by airborne transmission. Several factors determine the probability of transmission, including the infectiousness of the source patient and the nature of the environment where exposure occurs. This initial infection (primary TB) rapidly progresses to disease in some persons (especially children and immunocompromised persons), but resolves spontaneously in most individuals. This condition in which the organism lies dormant is known as latent TB infection (LTBI). In the United States, the diagnosis of LTBI is made with either the tuberculin skin test or an interferon-gamma release assay. LTBI is treated with isoniazid (INH; usually for 9 months) to prevent progression to TB disease. Up to 5% of immunocompetent persons will progress to TB disease at some time in the future, even decades after infection, if they are not treated for LTBI. Pulmonary TB disease is diagnosed using a combination of chest radiography and microscopic examination, culture and nucleic acid amplification testing of sputum. Treatment of drug-susceptible TB consists of at least 6 months of an INH and rifampin-containing regimen (with ethambutol and pyrazinamide for the first 2 months). In the United States, drug-resistant TB is relatively rare (approximately 1% of all patients), and is treated with an 18-24 month individualized regimen based on drug susceptibility test results. |
Uptake of regular chlamydia testing by U.S. women: a longitudinal study
Heijne JC , Tao G , Kent CK , Low N . Am J Prev Med 2010 39 (3) 243-50 BACKGROUND: Routine chlamydia screening is a recommended preventive intervention for sexually active women aged ≤25 years in the U.S. but rates of regular uptake are not known. PURPOSE: This study aimed to examine rates of annual chlamydia testing and factors associated with repeat testing in a population of U.S. women. METHODS: Women aged 15-25 years at any time from January 1, 2002, to December 31, 2006 who were enrolled in 130 commercial health plans were included. Data relating to chlamydia tests were analyzed in 2009. Chlamydia testing rates (per 100 woman-years) by age and rates of repeated annual testing were estimated. Poisson regression was used to examine the effects of age and previous testing on further chlamydia testing within the observation period. RESULTS: In total, 2,632,365 women were included. The chlamydia testing rate over the whole study period was 13.6 per 100 woman years after adjusting for age-specific sexual activity; 8.5 (95% CI=6.0, 12.3) per 100 woman-years in those aged 15 years; and 17.7 (95% CI=17.1, 18.9) in those aged 25 years. Among women enrolled for the entire 5-year study period, 25.9% had at least one test but only 0.1% had a chlamydia test every year. Women tested more than once and older women were more likely to be tested again in the observation period. CONCLUSIONS: The low rates of regular annual chlamydia testing do not comply with national recommendations and would not be expected to have a major impact on the control of chlamydia infection at the population level. |
Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study
Lichtenstein KA , Armon C , Buchacz K , Chmiel JS , Buckner K , Tedaldi EM , Wood K , Holmberg SD , Brooks JT . Clin Infect Dis 2010 51 (4) 435-47 BACKGROUND: Traditional cardiovascular disease (CVD) risk factors, human immunodeficiency virus (HIV) infection, and antiretroviral (ARV) agents have been associated with CVD events in HIV-infected patients. We investigated the association of low CD4(+) T lymphocyte cell count with incident CVD in a cohort of outpatients treated in 10 HIV specialty clinics in the United States. METHODS: We studied patients who were under observation from 1 January 2002 (baseline), categorized them according to National Cholesterol Education Program guidelines into 10-year cardiovascular risk score (10-y CVR) groups , and observed them until CVD event, death, last HIV Outpatient Study contact, or 30 September 2009. We calculated rates of incident CVD events and identified associated baseline risk factors using Cox proportional hazard models. We also performed a nested case-control study to examine the association of latest CD4(+) cell count with CVD events. RESULTS: Among 2005 patients, 148 experienced incident CVD events. CVD incidence increased steadily from 0.4 to 3.0 events per 100 person-years from lowest to highest 10-y CVR group (P < .001). In multivariable Cox analyses adjusted for 10-y CVR, CD4(+) cell count <350 cells/mm(3) was associated with incident CVD events (hazard ratio, 1.58 [95% confidence interval, 1.09-2.30], compared with >500 cells/mm(3)), suggesting an attributable risk of approximately 20%. In the multivariable case-control analyses, traditional CVD risk factors and latest CD4(+) cell count <500 cells/mm(3), but not cumulative use of ARV class or individual drugs, were associated with higher odds of experiencing CVD events. CONCLUSION: CD4(+) count <500 cells/mm(3) is an independent risk factor for incident CVD, comparable in attributable risk to several traditional CVD risk factors in the HIV Outpatient Study cohort. |
Methicillin-resistant Staphylococcus aureus colonization in HIV-infected outpatients is common and detection is enhanced by groin culture
Peters PJ , Brooks JT , Limbago B , Lowery HK , McAllister SK , Mindley R , Fosheim G , Gorwitz RJ , Guest JL , Hageman J , Fridge J , Rimland D . Epidemiol Infect 2010 139 (7) 1-11 Although high rates of clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) have been reported in HIV-infected adults, data on MRSA colonization are limited. We enrolled HIV-infected adults receiving care at the Atlanta VA Medical Center. Swabs from each participant's nares and groin were cultured with broth enrichment for S. aureus. Of 600 HIV-infected adults, 79 (13%) were colonized with MRSA and 180 (30%) with methicillin-susceptible S. aureus. MRSA pulsed-field gel electrophoresis types USA300 (n=44, 54%) and USA500/Iberian (n=29, 35%) predominated. Inclusion of groin swabs increased MRSA detection by 24% and USA300 detection by 38%. In multivariate analysis, MRSA colonization compared to no MRSA colonization was associated with a history of MRSA clinical infection, rarely or never using condoms, and contact with prisons and jails. In summary, the prevalence of MRSA colonization was high in this study of HIV-infected adults and detection of USA300 was enhanced by groin culture. |
Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis
Marks G , Gardner LI , Craw J , Crepaz N . AIDS 2010 24 (17) 2665-78 OBJECTIVE: A 'test and treat' strategy to reduce HIV transmission hinges on linking and retaining HIV patients in care to achieve the full benefit of antiretroviral therapy. We integrated empirical findings and estimated the percentage of HIV-positive persons in the United States who entered HIV medical care soon after their diagnosis; and were retained in care during specified assessment intervals. METHODS: We comprehensively searched databases and bibliographic lists to identify studies that collected data from May 1995 through 2009. Separate meta-analyses were conducted for entry into care and retention in care (having multiple HIV medical visits during specified assessment intervals) stratified by methodological variables. All analyses used random-effects models. RESULTS: Overall, 69% [95% confidence interval (CI) 66-71%, N = 53 323, 28 findings] of HIV-diagnosed persons in the United States entered HIV medical care averaged across time intervals in the studies. Seventy-two percent (95% CI 67-77%, N = 6586, 12 findings) entered care within 4 months of diagnosis. Seventy-six percent (95% CI 66-84%, N = 561, 15 findings) entered care after testing HIV-positive in emergency/urgent care departments and 67% (95% CI 64-70%, N = 52 762, 13 findings) entered care when testing was done in community locations. With respect to retention in care, 59% (95% CI 53-65%, N = 75 655, 28 findings) had multiple HIV medical care visits averaged across assessment intervals of 6 months to 3-5 years. Retention was lower during longer assessment intervals. CONCLUSION: Entry and retention in HIV medical care in the United States are moderately high. Improvement in both outcomes will increase the success of a test and treat strategy. |
Assessing the relationship between HIV infection and cervical cancer in Cote d'Ivoire: a case-control study
Adjorlolo-Johnson G , Unger ER , Boni-Ouattara E , Toure-Coulibaly K , Maurice C , Vernon SD , Sissoko M , Greenberg AE , Wiktor SZ , Chorba TL . BMC Infect Dis 2010 10 242 BACKGROUND: The association between HIV infection and invasive cervical cancer that has been reported may reflect differential prevalence of human papillomavirus (HPV) infection or uncontrolled confounding. We conducted a case-control study in a West African population to assess the relationship between HIV infection and invasive cervical cancer, taking into account HPV infection and other potential risk factors for cervical cancer. METHODS: Women with invasive cervical cancer (cases) or normal cervical cytology (controls) were recruited in a hospital-based case-control study in Abidjan, Cote d'Ivoire. Odds ratios and 95% confidence intervals (CI) were estimated in logistic regression analyses controlling for important cofactors. RESULTS: HIV infection was noted in 22/132 (16.7%) cases and 10/120 (8.3%) controls (p = 0.048). High-risk HPV infection was detected in cervical tumor samples from 89.4% of case-participants and in cervical cytology samples in 31.1% of control-participants. In logistic regression analysis, HIV infection was associated with cervical cancer in women with HPV (OR 3.4; 95% CI 1.1-10.8). Among women aged <or= 40 years, risk factors for cervical cancer were high-risk HPV infection (OR 49.3; 95% CI 8.2-295.7); parity > 2 (OR 7.0; 95% CI 1.9-25.7) and HIV infection (OR 4.5; 95% CI 1.5-13.6). Among women aged > 40 years, high-risk HPV infection (OR 23.5; 95% CI 9.1-60.6) and parity > 2 (OR 5.5; 95% CI 2.3-13.4), but association with HIV infection was not statistically significant. CONCLUSIONS: These data support the hypothesis that HIV infection is a cofactor for cervical cancer in women with HPV infection, and, as in all populations, the need for promoting cervical screening in populations with high prevalence of HIV infection. |
Barriers to intravenous penicillin use for treatment of nonmeningitis pneumococcal disease
Rosen J , Beekmann S , Polgreen P , Moore M . J Clin Microbiol 2010 48 (9) 3372-4 Infectious disease physicians were surveyed to determine whether the new penicillin breakpoint change will translate into increased penicillin use and to identify barriers to intravenous (i.v.) penicillin use for pneumococcal infections. The inconvenience of i.v. penicillin may limit its use despite a reduction in numbers of infections considered resistant. |
Anti-folate drug resistance in Africa: meta-analysis of reported dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutant genotype frequencies in African Plasmodium falciparum parasite populations
Sridaran S , McClintock SK , Syphard LM , Herman KM , Barnwell JW , Udhayakumar V . Malar J 2010 9 (1) 247 BACKGROUND: Mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes of Plasmodium falciparum are associated with resistance to anti-folate drugs, most notably sulphadoxine-pyrimethamine (SP). Molecular studies document the prevalence of these mutations in parasite populations across the African continent. However, there is no systematic review examining the collective epidemiological significance of these studies. This meta-analysis attempts to: 1) summarize genotype frequency data that are critical for molecular surveillance of anti-folate resistance and 2) identify the specific challenges facing the development of future molecular databases. METHODS: This review consists of 220 studies published prior to 2009 that report the frequency of select dhfr and dhps mutations in 31 African countries. Maps were created to summarize the location and prevalence of the highly resistant dhfr triple mutant (N51I, C59R, S108N) genotype and dhps double mutant (A437G and K540E) genotype in Africa. A hierarchical mixed effects logistic regression was used to examine the influence of various factors on reported mutant genotype frequency. These factors include: year and location of study, age and clinical status of sampled population, and reporting conventions for mixed genotype data. RESULTS: A database consisting of dhfr and dhps mutant genotype frequencies from all African studies that met selection criteria was created for this analysis. The map illustrates particularly high prevalence of both the dhfr triple and dhps double mutant genotypes along the Kenya-Tanzania border and Malawi. The regression model shows a statistically significant increase in the prevalence of both the dhfr triple and dhps double mutant genotypes in Africa. CONCLUSION: Increasing prevalence of the dhfr triple mutant and dhps double mutant genotypes in Africa are consistent with the loss of efficacy of SP for treatment of clinical malaria in most parts of this continent. Continued assessment of the effectiveness of SP for the treatment of clinical malaria and intermittent preventive treatment in pregnancy is needed. The creation of a centralized resistance data network, such as the one proposed by the WorldWide Antimalarial Resistance Network (WWARN), will become a valuable resource for planning timely actions to combat drug resistant malaria. |
Utah clinical guidelines on prescribing opioids for treatment of pain
Rolfs RT , Johnson E , Williams NJ , Sundwall DN . J Pain Palliat Care Pharmacother 2010 24 (3) 219-35 Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain were produced and made available to medical providers in March 2009. These guidelines were developed by a multidisciplinary consensus panel after a review of existing evidence-based guidelines. Common recommendations were compiled and presented to the panel for review. The guidelines consist of a set of recommendations for both acute and chronic pain. A second panel reviewed existing tools for providers and determined the need for any new tools. The final guidelines include 20 tools for providers to use in their practice. The complete version of the guidelines and the accompanying tools are available at: www.useonlyasdirected.org or www.health.utah.gov/prescription. |
Increase in unintentional medication overdose deaths Oklahoma, 1994-2006
Piercefield E , Archer P , Kemp P , Mallonee S . Am J Prev Med 2010 39 (4) 357-63 BACKGROUND: During 1999-2006, rates of unintentional drug-related deaths increased 120% in the U.S. PURPOSE: This report describes demographics and trends of unintentional medication overdose deaths among Oklahoma residents to target prevention strategies. METHODS: Oklahoma medical examiner data regarding fatal unintentional poisonings involving at least one prescription or over-the-counter medication during 1994-2006 and opioid retail sales data during 1997-2006 were analyzed during 2008-2009 to determine demographic-specific rates of overdose deaths and changes in 3-year mean death rates. RESULTS: A total of 2112 fatal unintentional medication overdoses were identified (4.7 deaths/100,000 population) involving a median of two substances/decedent. The highest fatality rates occurred among men (5.9/100,000) and people aged 35-54 years (11/100,000). Crude overdose death rates increased sevenfold during the investigation period, peaking at 11/100,000 in 2006. Death rates increased more for women (ninefold) than men (sixfold); rates among residents of rural counties increased more (eightfold) than urban county rates (sixfold). Leading drug types involved in fatalities were opioids and anxiolytics. The individual drugs contributing most frequently included methadone (31%); hydrocodone (19%); alprazolam (15%); and oxycodone (15%). During 1997-2006, Oklahoma prescription opioid sales increased fourfold. Methadone was associated with the highest number of deaths per equianalgesic dose sold (23.3), whereas hydrocodone and oxycodone had the highest increases in deaths per equianalgesic dose sold (threefold increase each). CONCLUSIONS: Unintentional medication-related deaths are increasing in Oklahoma and often involve multiple substances. Substances most frequently contributing to deaths were prescription opioid analgesics. Prevention strategies should target people aged 35-54 years and emphasize the dangers of coingesting substances and misusing prescription pain medications. |
Nuclear polyhedrosis virus as a biological control agent for Malacosoma americanum (Lepidoptera: Lasiocampidae)
Progar RA , Rinella MJ , Fekedulegn D , Butler L . J Appl Entomol 2010 134 (8) 641-646 In addition to damaging trees, the eastern tent caterpillar is implicated in early fetal loss and late-term abortion in horses. In a field study, we evaluated the potential biological control of the caterpillar using eastern tent caterpillar nuclear polyhedrosis virus (ETNPV), a naturally occurring virus that is nearly species-specific. Egg masses were hatched and second instar larvae were fed virus-inoculated foliage to propagate the virus in vivo. Then, a viral pesticide was formulated at concentrations of 10(4), 10(6) and 10(8) polyhedral inclusion bodies per ml. The pesticide was applied to foliage on which second, third and fourth instar caterpillars were feeding. When the majority of surviving larvae reached the sixth instar, colonies were collected and the surviving caterpillars counted. Mean numbers of surviving caterpillars per treatment were compared via 95% bootstrap confidence intervals. The data indicate second instar caterpillars were highly susceptible to the virus, but only at the highest concentration tested. Third instar caterpillars were also somewhat susceptible to high virus concentrations, while fourth instar caterpillars were fairly resistant. Our data provide the strongest evidence to date that ETNPV can be propagated, harvested and refined for formulation as a biological control agent for eastern tent caterpillar. Its use on this insect may be merited in circumstances where landowners and managers need to protect trees and horses. |
A comparison of aboveground and belowground populations of Culex pipiens (Diptera: Culicidae) mosquitoes in Chicago, Illinois, and New York City, New York, using microsatellites
Kothera L , Godsey M , Mutebi JP , Savage HM . J Med Entomol 2010 47 (5) 805-813 Aboveground and belowground populations of the mosquito Culex pipiens L. are traditionally classified as form pipiens and form molestus, respectively, and gene flow between forms is thought to be limited. Relatively few f. molestus populations have been found in the United States, which has hindered their study in North America. In this study, we used microsatellites to characterize a newly discovered population of f. molestus in Chicago, IL, and compared levels of genetic diversity and differentiation in aboveground and belowground populations from Chicago and New York City, NY. Levels of genetic diversity, as measured by expected heterozygosity and allelic richness, were markedly lower in both f. molestus populations. Allele frequencies were distinctly different between the two f. molestus populations, and some alleles were present in one belowground population and not the other. Pairwise FST values between populations indicated that f. molestus populations were highly divergent from each other, as well as from their associated aboveground populations. Cluster analysis suggested the most likely number of groups was three, with the four f. pipiens populations in one cluster, and each of the f. molestus populations in its own cluster. Admixture analysis detected a low number of hybrids, 8%, between forms. We also tested the efficacy of two assays purported to distinguish between the forms, the CQ11 assay and a restriction fragment-length polymorphism assay of the COI gene, and found neither assay reliable in this regard. Our findings support the hypothesis that f. molestus populations in Chicago and New York City arose from local aboveground populations. |
Urine concentrations of a tobacco-specific nitrosamine carcinogen in the U.S. population from secondhand smoke exposure
Bernert JT , Pirkle JL , Xia Y , Jain RB , Ashley DL , Sampson EJ . Cancer Epidemiol Biomarkers Prev 2010 19 (11) 2969-77 BACKGROUND: The tobacco-specific nitrosamine NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone) and its reduction product in the body, NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), are potent pulmonary carcinogens. We have measured total NNAL in the U.S. population of tobacco users and nonsmokers exposed to secondhand smoke (SHS). METHODS: We measured total urinary NNAL (free NNAL plus its glucuronides following hydrolysis) by using a sensitive and specific high-performance liquid chromatography / tandem mass spectrometry method. We calculated the percentage above the LOD, the 50th through 95th percentiles, and in some cases geometric means for groups classified by age, gender and race/ethnicity. RESULTS: Total urinary NNAL was measureable at or above its limit of detection (0.6 pg/mL) in 55% of the study participants, including 44% of nonsmokers. The population distribution of urinary NNAL included smoker and nonsmoker regions similar to the bimodal distribution of serum cotinine, and serum cotinine and total urinary NNAL were strongly correlated (r = 0.92; p<0.001). Among nonsmokers, children had significantly higher concentrations of NNAL than did adults aged ≥20 years (p < 0.001). CONCLUSIONS: Among NHANES participants, total NNAL was found at measurable levels in the urine of 44% of nonsmokers, and in 87.5% of those with substantial SHS exposure (with serum cotinine concentrations of 0.1 to 10 ng/mL). Children aged 6-11 years had the highest NNAL concentrations among all nonsmokers. IMPACT: We describe for the first time the distribution of total urinary NNAL in the entire U.S. population including both smokers and nonsmokers. NNAL was detected in 44% of all nonsmokers. |
An estimate of phthalate exposure among pregnant women living in Trujillo, Peru
Irvin EA , Calafat AM , Silva MJ , Aguilar-Villalobos M , Needham LL , Hall DB , Cassidy B , Naeher LP . Chemosphere 2010 80 (11) 1301-7 Phthalates are a group of phthalic acid esters which are used as plasticizers and additives. In laboratory animals, several phthalates are known endocrine disruptors. Several studies have described phthalate exposure in the United States and developed countries but little is known about phthalate exposure in the developing world, particularly during pregnancy. To assess exposure to six different phthalates, we measured the concentrations of nine phthalate metabolites in spot urine samples collected during the first, second, and third trimester of pregnancy from a group of 72 women living in Trujillo, Peru. Additionally, women completed questionnaires to provide demographic characteristics. Statistical analysis via linear models was used to evaluate potential differences in the concentrations of phthalate metabolites by trimester, cooking fuel type, socioeconomic status, and education. All metabolites were detected in>40% of samples analyzed, and mono-n-butyl phthalate, mono (2-ethyl-5-carboxypentyl) phthalate, and monoethyl phthalate were found in>90% of samples. Five of nine unadjusted urinary metabolites and four of nine creatinine-adjusted urinary metabolites were significantly lower in this group of pregnant women living in Peru compared to pregnant women in the US general population. |
Racial/ethnic differences in the incidence of Kawasaki Syndrome among children in Hawaii
Holman RC , Christensen KY , Belay ED , Steiner CA , Effler PV , Miyamura J , Forbes S , Schonberger LB , Melish M . Hawaii Med J 2010 69 (8) 194-197 OBJECTIVE: To describe the occurrence of Kawasaki syndrome (KS) among different racial/ethnic groups in Hawaii. METHODS: Retrospective analysis of children <18 years of age, with a focus on children <5 years of age, living in Hawaii who were hospitalized with KS using the 1996-2006 Hawaii State Inpatient Data. RESULTS: Children <5 years of age accounted for 84% of the 528 patients <18 years of age with KS. The average annual incidence among this age group was 50.4 per 100,000 children <5 years of age, ranging from 45.5 to 56.5. Asian and Pacific Islander children accounted for 92% of the children <5 years of age with KS during the study period; the average annual incidence was 62.9 per 100,000. Within this group, Japanese children had the highest incidence (210.5), followed by Native Hawaiian children (86.9), other Asian children (84.9), and Chinese children (83.2). The incidence for white children (13.7) was lower than for these racial/ethnic groups. The median age of KS admission for children <5 years of age was 21 months overall, 24 months for Japanese children, 14.5 months for Native Hawaiian children and 26.5 months for white children. CONCLUSIONS: The high average annual KS incidence for children <5 years of age in Hawaii compared to the rest of the United States population reflects an increased KS incidence among Asian and Pacific Islander children, especially Japanese children. The incidence for white children was slightly higher than or similar to that generally reported nationwide. |
Population-based monitoring of HIV drug resistance in Namibia with early warning indicators
Hong SY , Jonas A , Dumeni E , Badi A , Pereko D , Blom A , Muthiani VS , Shiningavamwe AN , Mukamba J , Andemichael G , Barbara R , Bennett DE , Jordan MR . J Acquir Immune Defic Syndr 2010 55 (4) 27-31 INTRODUCTION: HIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings, therefore, antiretroviral therapy (ART) program and site factors known to be associated with HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR. METHODS: In 2009, Namibia selected 5 World Health Organization Early Warning Indicators (EWIs) and piloted abstraction at 9 ART sites: "ART prescribing practices, patients lost to follow-up at 12 months, patient retention on first-line ART at 12 months, on-time antiretroviral drug pick-up, and antiretroviral drug-supply continuity". RESULTS: Records supported monitoring of 3 of 5 selected EWIs. Nine of 9 (100%) sites met the target of 100% initiated on appropriate first-line regimens. Eight of 9 (89%) sites met the target of ≤20% lost to follow-up, although 20.8% of ART starters (range: 4.6%-44.6%) had a period of absence without documented ART coverage of 2.3 months (range: 1.5-3.9 months). Six of 9 (67%) sites met the target of 0% switched to a second-line regimen. CONCLUSIONS: EWI monitoring directly resulted in public health action which will optimize the quality of care, specifically the strengthening of ART record systems permitting monitoring of 5 EWIs in future years and protocols for improved ART patient defaulter tracing. |
Public health surveillance for methicillin-resistant Staphylococcus aureus: comparison of methods for classifying health care- and community-associated infections
Sievert DM , Wilson ML , Wilkins MJ , Gillespie BW , Boulton ML . Am J Public Health 2010 100 (9) 1777-83 OBJECTIVES: We compared 3 methods for classifying methicillin-resistant Staphylococcus aureus (MRSA) infections as health care associated or community associated for use in public health surveillance. METHODS: We analyzed data on MRSA infections reported to the Michigan Department of Community Health from October 1, 2004, to December 31, 2005. Patient demographics, risk factors, infection information, and susceptibility were collected for 2151 cases. We classified each case by the health care risk factor, infection-type, and susceptibility pattern methods and compared the results of the 3 methods. RESULTS: Demographic, clinical, and microbiological variables yielded similar health care-associated and community-associated distributions when classified by risk factor and infection type. When 2 methods yielded the same classifications, the overall distribution was similar to classification by 3 methods. No specific combination of 2 methods was superior. CONCLUSIONS: MRSA categorization by 2 methods is more accurate than it is by a single method. The health care risk factor and infection-type methods yield comparable classification results. Accuracy is increased by using more variables; however, further research is needed to identify the optimal combination. |
Evolving with the times, the new National Toxic Substance Incidents Program
Duncan MA , Orr MF . J Med Toxicol 2010 6 (4) 461-3 ATSDR's surveillance and registries branch has a new three-part program to gather data on toxic substance incidents, the National Toxic Substance Incidents Program (NTSIP). NTSIP includes state-based surveillance of releases, a national database of chemical incidents, and incident investigations after large releases. NTSIP replaces the Hazardous Substances Emergency Events Surveillance program. Through this more comprehensive program, ATSDR is collecting data that may be used to decrease the number and severity of chemical releases and enhance preparedness, so that the health effects of future incidents are minimized. |
Racial and ethnic differences in weight management behavior by weight perception status
Dorsey RR , Eberhardt MS , Ogden CL . Ethn Dis 2010 20 (3) 244-50 OBJECTIVE: To examine racial/ethnic differences in the relationship between weight perception and weight management behaviors among overweight and obese adults. PARTICIPANTS: The study examined a nationally representative sample of 11,319 non-Hispanic White, non-Hispanic Black and Mexican American overweight and obese adults aged > or = 20 years from the 1999-2006 National Health and Nutrition Examination Survey. DESIGN: Body mass index (BMI, defined as weight in kilograms divided by height in meters squared) was used to categorize overweight (25 < or = BMI < 30) and obesity (BMI > or = 30). Measured height and weight were used to calculate BMI. Subjects reported self-perception of weight status (correct perception and misperception) and weight management behaviors over the previous 12 months (trying to lose weight, trying not to gain weight, and having a desired weight goal). Weight perception stratified logistic regression was used to model odds of weight management behavior by race/ethnicity. RESULTS: Among overweight and obese non-Hispanic White, non-Hispanic Black, and Mexican American adults, correct weight perception was positively associated with weight management behavior. In multiple logistic regression models, overweight non-Hispanic Blacks with a weight misperception were less likely to have tried to lose weight (adjusted odds ratio [aOR] = .7; 95% confidence interval [Cl] = .5,1.0) or to have tried not to gain weight (aOR = .7; 95% CI = .5,1.0) compared to overweight non-Hispanic Whites with a weight misperception. Among the obese with a misperception, non-Hispanic Blacks were less likely to desire to weigh less compared to non-Hispanic Whites (aOR = .5; 95% CI = .3,.9). CONCLUSIONS: Weight perception was associated with weight management behaviors, and this relationship varied by race/ethnicity. Weight perception may need to be addressed among overweight and obese individuals to increase appropriate weight management behaviors, particularly among minority communities. |
Travel characteristics and risk-taking attitudes in youths traveling to nonindustrialized countries
Han P , Balaban V , Marano C . J Travel Med 2010 17 (5) 316-321 BACKGROUND: International travel to developing countries is increasing with rising levels of disposable income; this trend is seen in both adults and children. Risk-taking attitude is fundamental to research on the prevention of risky health behaviors, which can be an indicator of the likelihood of experiencing illness or injury during travel. The aim of this study is to investigate whether risk-taking attitudes of youths are associated with travel characteristics and likelihood of experiencing illness or injury while traveling to nonindustrialized countries. METHODS: Data were analyzed from the 2008 YouthStyles survey, an annual mail survey gathering demographics and health knowledge, attitudes, and practices of individuals from 9 through 18 years of age. Travelers were defined as respondents who reported traveling in the last 12 months to a destination other than the United States, Canada, Europe, Japan, Australia, or New Zealand. Risk-taking attitude was measured by using a four-item Brief Sensation-Seeking Scale. All p values ≤0.05 were considered significant. RESULTS: Of 1,704 respondents, 131 (7.7%) traveled in the last 12 months. Females and those with higher household income were more likely to travel (odds ratio=1.6,1.1). Of those who traveled, 16.7% reported seeking pretravel medical care, with most visiting a family doctor for that care (84.0%). However, one-fifth of respondents reported illness and injury during travel; of these, 83.3% traveled with their parents. Males and older youths had higher mean sensation-seeking scores. Further, travelers had a higher mean sensation-seeking score than nontravelers. Those who did not seek pretravel medical care also had higher mean sensation-seeking scores (p=0.1, not significant). CONCLUSIONS: Our results show an association between risk-taking attitudes and youth travel behavior. However, adult supervision during travel and parental directives prior to travel should be taken into consideration. Communication messages should emphasize the importance of pretravel advice, target parents of children who are traveling, and be communicated through family doctors. |
Prevalence of HIV infection and prior HIV testing among young men who have sex with men. The Baltimore young men's survey
Sifakis F , Hylton JB , Flynn C , Solomon L , MacKellar DA , Valleroy LA , Celentano DD . AIDS Behav 2010 14 (4) 904-12 Data are presented from the Baltimore Young Men's Survey, a cross-sectional, venue-based sample survey of risks associated with HIV and report of a prior HIV test, conducted between 1996 and 2000, and enrolling 843 young men who have sex with men (MSM) aged 15-29 years. HIV prevalence was 12.1% overall and racial disparities in HIV prevalence were pronounced (range, 2.9% among non-Hispanic whites to 27.1% among non-Hispanic blacks). Risks independently associated with being HIV-positive were: being between 26 and 29 years of age, being non-Hispanic black or of other/mixed race, having had 20 or more lifetime male sex partners, having been diagnosed with a sexually transmitted disease (STD), and not being currently enrolled in school. The majority of participants (78.9%) reported a prior HIV test. In multivariate analysis, being older, having had five or more lifetime male sex partners, having had anal intercourse with males, reporting an STD diagnosis, and reporting recent unprotected anal sex were associated with report of a prior HIV test. Prevention efforts must address high HIV prevalence among young non-Hispanic black MSM and must make testing and effective counseling for young MSM readily available. |
Examining HIV infection among male sex workers in Bangkok, Thailand: a comparison of participants recruited at entertainment and street venues
Toledo CA , Varangrat A , Wimolsate W , Chemnasiri T , Phanuphak P , Kalayil EJ , McNicholl J , Karuchit S , Kengkarnrua K , van Griensven F . AIDS Educ Prev 2010 22 (4) 299-311 HIV prevalence and associated factors were examined among male sex workers (MSWs, N = 414) in Bangkok, Thailand. Cross-sectional venue-day-time sampling was used to collect data in entertainment and street venues. Chi-square and logistic regression were used to identify HIV risk factors. HIV prevalence was 18.8% overall, but differences were found between MSW recruited in entertainment and street venues. Significant relationships were found between several demographic, behavioral, exposure to HIV prevention, and other characteristics, and recruitment location. In multivariate analyses, being sexually attracted to men was significantly associated with HIV infection among both groups of sex workers. In addition, among street-based sex workers, not having had sex with a woman in the past 3 months, having ever had a sexually transmitted disease symptom, and not having a friend to talk to about personal problems were significantly associated with HIV infection. |
The associations of voluntary counseling and testing acceptance and the perceived likelihood of being HIV-infected among men with multiple sex partners in a South African township
Johnston L , O'Bra H , Chopra M , Mathews C , Townsend L , Sabin K , Tomlinson M , Kendall C . AIDS Behav 2010 14 (4) 922-31 This paper examines the socio-demographic factors and sexual risk behaviors (condom use, number of sexual partners, STI symptoms) associated with voluntary counselling and testing (VCT) acceptance and self-perceived risk of being HIV-infected among black men with multiple and younger sex partners in a South African township outside of Cape Town. Using respondent driven sampling, we interviewed 421 men, of whom 409 (97.3%) consented to provide a dried blood spot, 12.3% were HIVinfected (95% confidence intervals [CI.] 8.3, 16.9) and 47.2% (CI. 41.1, 53.6) accepted on site VCT. Twenty six percent (CI. 20.2, 30.7) reported having an HIV test in the past year. Few men perceived themselves as very likely to be infected with HIV (15.6%; CI. 10.4, 20.5). VCT acceptance was significantly associated with being older, married or living with a partner, having higher education, having four to six partners in the past three months and testing HIV positive. Self-perceived likelihood of being HIV infected was significantly associated with low condom use and having seven or more partners in the past three months, and testing HIV positive. These findings indicate that men correctly understand that engaging in certain HIV risk behaviors increases the likelihood of HIV-infection. However, those who perceive themselves at high risk of having HIV do not seek testing. Further investigation into the psychological and cultural barriers to reducing risky sexual behaviors and accessing VCT and other HIV services is recommended. |
Duck hunters' perceptions of risk for avian influenza, Georgia, USA
Dishman H , Stallknecht D , Cole D . Emerg Infect Dis 2010 16 (8) 1279-81 To determine duck hunters' risk for highly pathogenic avian influenza, we surveyed duck hunters in Georgia, USA, during 2007-2008, about their knowledge, attitudes, and practices. We found they engage in several practices that could expose them to the virus. Exposures and awareness were highest for those who had hunted >10 years. |
Cultural adaptation of a U.S. evidence-based parenting intervention for rural Western Kenya: From parents matter! To families matter!
Poulsen MN , Vandenhoudt H , Wyckoff SC , Obong'o CO , Ochura J , Njika G , Otwoma NJ , Miller KS . AIDS Educ Prev 2010 22 (4) 273-85 Evidence-based interventions (EBIs) are critical for effective HIV prevention, but time and resources required to develop and evaluate new interventions are limited. Alternatively, existing EBIs can be adapted for new settings if core elements remain intact. We describe the process of adapting the Parents Matter! Program, an EBI originally developed for African American parents to promote effective parent-child communication about sexual risk reduction and parenting skills, for use in rural Kenya. A systematic process was used to assess the community's needs, identify potential EBIs, identify and make adaptations, pilot-test the adapted intervention, and implement and monitor the adapted EBI. Evaluation results showed the adapted EBI retained its effectiveness, successfully increasing parent-child sexual communication and parenting skills. Our experience suggests an EBI can be successfully adapted for a new context if it is relevant to local needs, the process is led by a multidisciplinary team with community representation, and pilot-testing and early implementation are well monitored. |
Statewide HPV vaccine initiation among adolescent females in North Carolina
Reiter PL , Cates JR , McRee AL , Gottlieb SL , Shafer A , Smith JS , Brewer NT . Sex Transm Dis 2010 37 (9) 549-56 BACKGROUND: Cervical cancer incidence in the United States may be greatly reduced through widespread human papillomavirus (HPV) vaccination. We estimated the statewide level of HPV vaccine initiation among adolescent girls in North Carolina and identified correlates of vaccine initiation. METHODS: We used data from 617 parents of adolescent females from North Carolina who completed the population-based 2008 Child Health Assessment and Monitoring Program survey. Analyses used weighted multivariate logistic regression. RESULTS: Overall, 31.3% of parents reported their daughters had received at least 1 dose of HPV vaccine. Vaccine initiation was higher among daughters aged 13 to 15 years (odds ratio [OR] = 2.03, 95% CI, 1.12-3.67) or 16 to 17 years (OR = 3.21, 95% CI, 1.76-5.86) compared with those 10 to 12 years old. Additional correlates of HPV vaccine initiation included the daughter having a preventive check-up in the last 12 months (OR = 5.09, 95% CI, 2.43-10.67), having received meningococcal vaccine (OR = 2.50, 95% CI, 1.55-4.01), or being from an urban area (OR = 1.81, 95% CI, 1.02-3.21). Among parents of unvaccinated daughters, intent to vaccinate in the next year was higher among those with daughters aged 13 to 17 years. Parents of unvaccinated non-Hispanic white daughters reported lower levels of intent to vaccinate within the next year compared with parents of unvaccinated daughters of other races. CONCLUSIONS: HPV vaccine initiation in North Carolina is comparable with other US areas. Potential strategies for increasing HPV vaccination levels include reducing missed opportunities for HPV vaccination at preventive check-ups and increasing concomitant administration of HPV vaccine with other adolescent vaccines. |
Pneumococcal polysaccharide vaccination among adults aged 65 years and older, U.S., 1989-2008
Lu PJ , Pekka Nuorti J . Am J Prev Med 2010 39 (4) 287-95 BACKGROUND: The 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been recommended for all people aged ≥65 years in the U.S. since 1983; consistent surveillance for vaccine coverage has been conducted since 1989. PURPOSE: To assess PPSV23 vaccination coverage among adults aged ≥65 years in the U.S. METHODS: The data were analyzed from the 1989, 1991, 1993-1995, and 1997-2008 National Health Interview Surveys in 2009. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with receiving PPSV23 in 2008. Missed opportunities for vaccination were also assessed. RESULTS: Among people aged ≥65 years, PPSV23 coverage increased from 14.1% in 1989 to 60.1% in 2008. On average, vaccination coverage increased by 3.5% annually during 1989-2000 compared with 1.0% during 2001-2008. In 2008, coverage was significantly higher for people aged 75-84 years (68.8%), and ≥85 years (69.0%) compared with those aged 65-74 years (52.5%). Coverage was significantly higher for non-Hispanic whites (64.3%) compared with non-Hispanic blacks (44.6%) and those with Hispanic ethnicity (36.4%). Among people aged ≥65 years who reported never receiving PPSV23, 90.6% reported at least one missed opportunity. Characteristics independently associated with increased likelihood of ever receiving PPSV23 were higher age, female, non-Hispanic white race/ethnicity, not employed, higher education level, more physician visits in the past year, hospitalized within past year, having Medicare and other supplemental health insurance, and having a chronic medical condition. CONCLUSIONS: National PPSV23 coverage among people aged ≥65 years increased substantially until 2000, but the rate of increase was smaller after 2000 and coverage in 2008 remained well below the national Healthy People 2010 target of 90%. Increased efforts to avoid missed opportunities for pneumococcal vaccination are needed, especially among minority populations. |
Spirometry Longitudinal Data Analysis Software (SPIROLA) for analysis of spirometry data in workplace prevention or COPD treatment
Hnizdo E , Yan T , Hakobyan A , Enright P , Beeckman-Wagner LA , Hankinson J , Fleming J , Petsonk E . Open Med Inform J 2010 4 94-102 Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Periodic spirometry is often recommended for individuals with potential occupational exposure to respiratory hazards and in medical treatment of respiratory disease, to prevent COPD or improve treatment outcome. To achieve the full potential of spirometry monitoring in preserving lung function, it is important to maintain acceptable precision of the longitudinal measurements, apply interpretive strategies that identify individuals with abnormal test results or excessive loss of lung function in a timely manner, and use the results for intervention on respiratory disease prevention or treatment modification. We describe novel, easy-to-use visual and analytical software, Spirometry Longitudinal Data Analysis software (SPIROLA), designed to assist healthcare providers in the above aspects of spirometry monitoring. Software application in ongoing workplace spirometry-based medical monitoring programs helped to identify increased spirometry data variability due to deteriorating test quality and subsequent improvement following interventions, and helped to enhance identification of individuals with excessive decline in lung function. |
Screening and brief intervention for substance misuse among patients with traumatic brain injury
Corrigan JD , Bogner J , Hungerford DW , Schomer K . J Trauma 2010 69 (3) 722-6 BACKGROUND: Research on screening and brief interventions (SBI) for substance misuse has demonstrated efficacy in a variety of medical settings including emergency departments and trauma centers. However, SBI has not yet been evaluated for persons who incur traumatic brain injury (TBI)-a substantial patient subpopulation for whom substance-related problems are frequent. To examine whether research on SBI efficacy and effectiveness can be generalized to persons with TBI, a systematic review of the literature was conducted to analyze how TBI populations were included in previous studies and whether there was evidence of differential outcomes. METHODS: Peer-reviewed studies that investigated SBI for misuse of alcohol or other drugs, that were implemented in emergency departments or trauma centers, and that were published in English since 1985 were examined. From 174 articles initially identified, 28 studies were determined to meet inclusion criteria. RESULTS: The review revealed that research conducted on SBI for injury populations systematically neglected patients with more severe TBI and those who presented with sufficient confusion that they could not provide informed consent. CONCLUSIONS: Future effectiveness studies should examine barriers to routine clinical use of SBI and evaluate the generalizability of expected benefits to the full spectrum of injured patients. Researchers should also develop and evaluate systematic accommodations for persons with neurobehavioral impairments who would benefit from brief interventions for substance misuse. |
Developing sexual violence prevention strategies by bridging spheres of public health
Vivolo AM , Holland KM , Teten AL , Holt MK . J Womens Health (Larchmt) 2010 19 (10) 1811-4 Sexual violence (SV) is a significant public health problem with multiple negative physical and emotional sequelae for both victims and perpetrators. Despite substantial research and program activity over the past 20 years, there are few programs with demonstrated effectiveness in preventing SV. As a result, the field may benefit from considering effective approaches used with other risk behaviors that share risk factors with SV. The Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) has taken several steps to identify and understand the breadth of risk factors for sexual violence and to delineate the implications of these factors in the development of effective prevention strategies. This report from CDC will highlight several risk factors that, although not traditionally included in SV prevention efforts, may be important areas on which to focus and may ultimately prevent youth from embarking on trajectories resulting in SV perpetration. |
Macaque proteome response to highly pathogenic avian influenza and 1918 reassortant influenza virus infections
Brown JN , Palermo RE , Baskin CR , Gritsenko M , Sabourin PJ , Long JP , Sabourin CL , Bielefeldt-Ohmann H , Garcia-Sastre A , Albrecht R , Tumpey TM , Jacobs JM , Smith RD , Katze MG . J Virol 2010 84 (22) 12058-68 The host proteome response and molecular mechanisms that drive disease in vivo during infection by a human isolate of the highly pathogenic avian influenza (HPAI) and 1918 pandemic influenza virus remains poorly understood. This study presents a comprehensive characterization of the proteome response in cynomolgus macaque (Macaca fascicularis) lung tissue over 7 days of infection with HPAI (most virulent), a reassortant virus containing 1918 hemagglutinin (HA) and neuraminidase (NA) surface proteins (intermediate virulence), or a human seasonal strain (least virulent). A high sensitivity two-dimensional LC-MS/MS strategy and functional network analysis were implemented to gain insight into response pathways activated in macaques during influenza infection. A macaque protein database was assembled and used in the identification of 35,239 unique peptide sequences corresponding to approximately 4,259 proteins. Quantitative analysis identified an increase in expression of 400 proteins during viral infection. The abundance levels of a subset of these 400 proteins produced strong correlations with disease progression observed in the macaques, distinguishing a "core" response to viral infection from a "high" response specific to severe disease. Proteome expression profiles revealed distinct temporal response kinetics between viral strains, with HPAI inducing the most rapid response. While proteins involved in immune response, metabolism, and transport were increased rapidly in the lung by HPAI, the other viruses produced a delayed response, characterized by an increase in proteins involved in oxidative phosphorylation, RNA processing, and translation. Proteomic results were integrated with previous genomic and pathologic analysis to characterize the dynamic nature of the influenza viral infection process. |
Multilocus sequence typing identifies evidence for recombination and two distinct lineages within Corynebacterium diphtheriae
Bolt F , Cassiday P , Tondella ML , Dezoysa A , Efstratiou A , Sing A , Zasada A , Bernard K , Guiso N , Badell E , Rosso ML , Baldwin A , Dowson C . J Clin Microbiol 2010 48 (11) 4177-85 We describe the development of a multilocus sequence typing (MLST) scheme for Corynebacterium diphtheriae, the causative agent of the potentially fatal upper respiratory disease, diphtheria. Global changes in diphtheria epidemiology are highlighted by the recent epidemic in the Former Soviet Union (FSU) and also by the emergence of non-toxigenic strains causing atypical disease. Although numerous techniques have been developed to characterise C. diphtheriae their use is hindered by limited portability and, in some instances, poor reproducibility. 150 isolates from 18 countries and encompassing a period of 50 years were analysed by MLST. Strain discrimination was in accordance with previous ribotyping data, and clonal complexes associated with disease outbreaks were clearly identified by MLST. The data produced are portable, reproducible and unambiguous. The MLST scheme described provides a valuable tool for monitoring and characterising endemic and epidemic C. diphtheriae strains. Furthermore, multilocus sequence analysis of the nucleotide data reveals two distinct lineages within the population of C. diphtheriae examined, one of which is composed exclusively of biotype belfanti isolates, the other of multiple biotypes. |
P4 peptide therapy rescues aged mice from fatal pneumococcal sepsis
Rajam G , Bangert M , Hammons GM , Melnick N , Carlone GM , Sampson JS , Ades EW . Clin Vaccine Immunol 2010 17 (11) 1823-4 Many studies suggest that with aging, immune capabilities gradually diminish, leading to a decrease in antibody production, cytokines, and various effector cells (1-4). In this study, we examined the effects of an immune-enhancing peptide on aged mice. P4, a 28-amino-acid cationic peptide derived from pneumococcal surface adhesin A (PsaA), is a eukaryotic cellular activator (10). Previously, we demonstrated that the cellular activation properties of P4 can be utilized to rescue severely ill young mice from fatal pneumococcal infection in the presence of pathogen-specific antibodies and active complement (8, 12). While P4 therapy was used to rescue young Swiss Webster mice (6 to 10 weeks old), we questioned its effectiveness in aged mice (11 and 15 months old). | Intranasal inoculation of mice with Streptococcus pneumoniae WU2 (serotype 3) and P4 therapy were done using protocols previously described, with minor modifications (12). Eleven-month-old BALB/c (n = 20) and 15-month-old Swiss Webster mice (n = 20) were infected intranasally with S. pneumoniae WU2 (∼2.1 × 107 cells/mouse). Mice were monitored and visually scored twice daily for moribund characteristics as previously described (12). At 48 h postchallenge, 80% (16/20) were moribund. Moribund mice were divided into a control (n = 8) and a treatment group (n = 8). Two doses of P4 therapy with pathogen-specific antibody (intravenous immunoglobulin [IVIG]; Gamunex, Telecris, NC) and P4 were administered intravenously (postinfection) in the treatment group. Treated and untreated animals were monitored for 166 h, and the data computed for significant differences among various groups using a t test for paired samples for the means (MS Excel 2007). |
Proceedings of the Modeling Evidence in HPV Pre-Conference Workshop in Malmo, Sweden, May 9-10, 2009
Craig BM , Brisson M , Chesson H , Giuliano AR , Jit M . Clin Ther 2010 32 (8) 1546-64 BACKGROUND: Prominent published and active human papillomavirus (HPV) modelers from around the world were invited to participate in the inaugural Modeling Evidence in HPV (MEHPV) Pre-Conference Workshop on May 9-10, 2009, in Malmo, Sweden. The workshop took place directly before the 25th International Papillomavirus Conference. OBJECTIVES: The aim of the workshop was to develop an international network of investigators engaged in HPV modeling and to facilitate open discussion about the structure and parameterization of models, as well as other methodologic concerns. METHODS: Thirty-four participants from more than a dozen countries and a variety of settings, representing the authors or coauthors of 82% of the HPV modeling literature, exchanged ideas on fundamental questions in the field. These proceedings, based on the 217-page transcript, were assembled by the Scientific Committee to summarize the ideas of workshop participants in a deidentified, readable fashion. They represent the work and recorded opinions of session participants and do not constitute the official positions of participants as a whole or individually, the Scientific Committee, or any sponsoring organization or entity. RESULTS: In charting a path forward, 3 topics emerged as most pressing: best practices for HPV modeling, comparative modeling, and modeling in developing countries. CONCLUSION: This summary of the proceedings of the preconference workshop on HPV modeling characterizes many of the prominent contemporary issues in the field. |
Quantification of cyanuric acid residue in human urine using high performance liquid chromatography-tandem mass spectrometry
Panuwet P , Wade EL , Nguyen JV , Montesano MA , Needham LL , Barr DB . J Chromatogr B Analyt Technol Biomed Life Sci 2010 878 (28) 2916-22 Concern has increased about the resulting health effects of exposure to melamine and its metabolic contaminant, cyanuric acid, after infants in China were fed baby formula milk products contaminated with these compounds. We have developed a selective and sensitive analytical method to quantify the amount of cyanuric acid in human urine. The sample preparation involved extracting free-form cyanuric acid in human urine using anion exchange solid phase extraction. Cyanuric acid was separated from its urinary matrix components on the polymeric strong anion exchange analytical column; the analysis was performed by high performance liquid chromatography-tandem mass spectrometry using negative mode electrospray ionization interface. Quantification was performed using isotope dilution calibration covering the concentration range of 1.00-200ng/mL. The limit of detection was 0.60ng/mL and the relative standard deviations were 2.8-10.5% across the calibration range. The relative recovery of cyanuric acid was 100-104%. Our method is suitable to detect urinary concentrations of cyanuric acid caused by either environmental exposures or emerging poisoning events. |
FKS mutations and elevated echinocandin MIC values among Candida glabrata isolates from US population-based surveillance
Zimbeck AJ , Iqbal N , Ahlquist AM , Farley MM , Harrison LH , Chiller T , Lockhart SR . Antimicrob Agents Chemother 2010 54 (12) 5042-7 Candida glabrata is the second leading cause of candidemia in the United States. Its high resistance to triazole antifungal drugs has led to the increased use of the echinocandin class of antifungal agents for primary therapy of these infections. We monitored C. glabrata bloodstream isolates from a population-based surveillance for elevated echinocandin MIC values (MIC ≥0.25 mug/ml). From the 490 C. glabrata isolates that were screened, we identified 16 isolates with an elevated MIC value (2.9% of isolates from Atlanta and 2.0% of isolates from Baltimore) to one or more of the echinocandin drugs caspofungin, anidulafungin or micafungin. All the isolates with elevated MIC values had a mutation in the previously identified hotspot 1 of either glucan synthase FKS1 (n=2) or FKS2 (n=14) genes. No mutations were detected in hotspot 2 of either FKS1 or FKS2. The predominant mutation was FKS2 serine 663 to proline (S663P), found in 10 of the isolates with elevated echinocandin MICs. Two of the mutations, R631G in FKS1 and R665G in FKS2 have not been previously reported for C. glabrata. Multilocus sequence typing indicated that the predominance of the S663P mutation was not due to the clonal spread of a single sequence type. With a rising number of echinocandin therapy failures reported, it is important to continue to monitor rates of elevated echinocandin MIC values and the associated mutations. |
Identification of an atypical strain of Toxoplasma gondii as the cause of a waterborne outbreak of toxoplasmosis in Santa Isabel do Ivai, Brazil
Vaudaux JD , Muccioli C , James ER , Silveira C , Magargal SL , Jung C , Dubey JP , Jones JL , Doymaz MZ , Bruckner DA , Belfort Jr R , Holland GN , Grigg ME . J Infect Dis 2010 202 (8) 1226-33 Multilocus DNA sequencing has identified a nonarchetypal strain of Toxoplasma gondii as the causal agent of a waterborne outbreak in Brazil in 2001. The strain, isolated from a water supply epidemiologically linked to the outbreak, was virulent to mice, and it has previously been identified as BrI. Using a serologic assay that detects strain-specific antibodies, we found that 13 (65%) of 20 individuals who were immunoglobulin (Ig) M positive during the outbreak possessed the same serotype as mice infected with the purported epidemic strain. The remaining 7 individuals, plus additional IgM-negative, IgG-positive individuals, possessed 1 of 4 novel serotypes, the most common of which matched the serotype of mice infected with strains isolated from chickens foraging near the outbreak site. The latter strains likely reflect the genetic diversity of T. gondii circulating in highly endemic regions of Brazil. The serotyping assay proved a useful tool for identification of specific individuals infected with the outbreak agent. |
Maternal body mass index as a risk factor for craniosynostosis
Boulet SL , Rasmussen SA , Honein MA . Am J Med Genet A 2010 152A (11) 2895-7 Craniosynostosis is a birth defect characterized by the premature fusion of one or more cranial sutures and often results in an abnormal head shape [Muenke and Wilkie, 2001; Kabbani and Raghuveer, 2004]. The etiology of craniosynostosis is heterogeneous and the condition can occur as an isolated defect, as one of multiple major unrelated defects, or as part of a syndrome [Aleck, 2004; Kabbani and Raghuveer, 2004]. Isolated and syndromic craniosynostosis can involve either a single type of suture (simple) or more than one type of suture (complex). Population-based estimates of the birth prevalence of craniosynostosis range from approximately 3 to 5 per 10,000 livebirths [Cohen, 2000; Boulet et al., 2008]. | Maternal obesity has been found to be associated with certain types of birth defects, including neural tube defects and congenital heart defects [Watkins et al., 2003; Waller et al., 2007; Stothard et al., 2009; Gilboa et al., 2010]. Findings from a recent analysis using data from the National Birth Defects Prevention Study (NBDPS) to assess the association between maternal body mass index (BMI) and a spectrum of structural birth defects suggested a modest association between prepregnancy overweight maternal status and infant craniosynostosis [Waller et al., 2007]. However, variations in risk according to the type of suture involved were not evaluated in the Waller et al. analysis and might be an important factor, given that some risk factors have been found to differ by the type of suture [Boulet et al., 2008]. |
Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism
Price CS , Thompson WW , Goodson B , Weintraub ES , Croen LA , Hinrichsen VL , Marcy M , Robertson A , Eriksen E , Lewis E , Bernal P , Shay D , Davis RL , Destefano F . Pediatrics 2010 126 (4) 656-64 OBJECTIVE: Exposure to thimerosal, a mercury-containing preservative that is used in vaccines and immunoglobulin preparations, has been hypothesized to be associated with increased risk of autism spectrum disorder (ASD). This study was designed to examine relationships between prenatal and infant ethylmercury exposure from thimerosal-containing vaccines and/or immunoglobulin preparations and ASD and 2 ASD subcategories: autistic disorder (AD) and ASD with regression. METHODS: A case-control study was conducted in 3 managed care organizations (MCOs) of 256 children with ASD and 752 controls matched by birth year, gender, and MCO. ASD diagnoses were validated through standardized in-person evaluations. Exposure to thimerosal in vaccines and immunoglobulin preparations was determined from electronic immunization registries, medical charts, and parent interviews. Information on potential confounding factors was obtained from the interviews and medical charts. We used conditional logistic regression to assess associations between ASD, AD, and ASD with regression and exposure to ethylmercury during prenatal, birth-to-1 month, birth-to-7-month, and birth-to-20-month periods. RESULTS: There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83-1.51) for prenatal exposure, 0.88 (0.62-1.26) for exposure from birth to 1 month, 0.60 (0.36-0.99) for exposure from birth to 7 months, and 0.60 (0.32-0.97) for exposure from birth to 20 months. CONCLUSIONS: In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of ASDs. |
Case records of the Massachusetts General Hospital. Case 25-2010. A 24-year-old woman with abdominal pain and shock
Klempner MS , Talbot EA , Lee SI , Zaki S , Ferraro MJ . N Engl J Med 2010 363 (8) 766-77 Dr. Franklin W. Huang (Medicine): A 24-year-old woman was transferred to this hospital because of abdominal pain, vomiting, ascites, and shock. | The patient had been well until 9 days before admission, when fatigue, fevers, headache, and diffuse body aches developed, followed by a productive cough and vague pain in the abdomen and lower back. Three days before admission, nausea and vomiting developed, and oral intake decreased. Late in the evening of the next day, she was admitted to another hospital. | On evaluation, she appeared tired and restless; the blood pressure was 98/58 mm Hg, the pulse 122 beats per minute, the temperature 36.7°C, and the respiratory rate 22 breaths per minute. The abdomen was distended and diffusely tender, with normal bowel sounds; the remainder of the examination was normal. A rapid test for influenza was negative; other laboratory-test results are shown in Table 1. Intravenous crystalloid fluids were administered. During the next 3 hours, her abdominal pain increased (she rated it as 8 on a scale of 1 to 10, where 10 is the most severe), with increased abdominal distention and tenderness; ketorolac tromethamine was administered. A nasogastric tube was inserted, after which the hypotension worsened. She was admitted to the intensive care unit at the other hospital. Specimens of blood were sent for culture, and a central venous catheter was inserted; intravenous fluids and ertapenem were administered. Results on transthoracic echocardiography were normal. Computed tomography (CT) of the abdomen and pelvis after the administration of intravenous contrast material showed a large amount of ascites, no bowel dilatation, and concentric wall thickening of a long segment of the distal small bowel. Numerous slightly enlarged, avidly enhancing lymph nodes were present at the root of the small-bowel mesentery and in the retroperitoneum. Exploratory laparotomy revealed ascites (3 liters), which was drained; nodular, hemorrhagic lesions in the mesentery; and two areas of necrotic small bowel. Biopsy specimens were obtained from the mesenteric lesions, and the necrotic bowel and appendix were resected. Gram-positive rods, thought to be contaminants, grew after less than 15 hours of incubation from two of two blood-culture bottles containing blood obtained on admission. Cultures of the ascites remained sterile. |
In situ estimation of roof rock strength using sonic logging
Oyler DC , Mark C , Molinda GM . Int J Coal Geol 2010 83 (4) 484-490 Sonic travel time logging of exploration boreholes is routinely used in Australia to obtain estimates of coal mine roof rock strength. Because sonic velocity logs are relatively inexpensive and easy to obtain during exploration, the technique has provided Australian underground coal mines with an abundance of rock strength data for use in all aspects of ground control design. However, the technique depends upon reliable correlations between the uniaxial compressive strength (UCS) and the sonic velocity. This paper describes research recently conducted by NIOSH aimed at developing a correlation for use by the U.S. mining industry. From two coreholes in Illinois, two from Pennsylvania, and one each from Colorado, western Kentucky and southern West Virginia, sonic velocity logs were compared with UCS values derived from Point Load tests for a broad range of coal measure rock types. For the entire data set, the relationship between UCS and sonic travel time is expressed by an exponential equation relating the UCS in psi to the travel time of the P-wave in s/ft. The coefficient of determination or R-squared for this equation is 0.72, indicating that a relatively high reliability can be achieved with this technique. The strength estimates obtained from the correlation equation may be used to help design roof support systems. The paper also addresses the steps that are necessary to ensure that high-quality sonic logs are obtained for use in estimating UCS. 2010. |
The potential impact of light emitting diode lighting on reducing mining injuries during operation and maintenance of lighting systems
Yenchek MR , Sammarco JJ . Saf Sci 2010 48 (10) 1380-1386 Research by the US National Institute for Occupational Safety and Health (NIOSH) indicates that light emitting diodes (LEDs) can be used to enhance safety by improving a miner's ability to see mining hazards and reducing glare. This paper investigates if LEDs provide another benefit by reducing miner exposure to hazards during maintenance and operation of LED lighting. LEDs could provide useful lives up to 50 times longer than incandescent lighting commonly used in mining and could enable design changes to reduce certain hazards. The mining accident records compiled by the Mine Safety and Health Administration (MSHA) were examined to determine the extent and nature of accidents involving the maintenance and operation of mine luminaries. A total of 140 relevant accident records were found for the years 2002-2006. These incidents resulted in 3668 days lost from work with an additional 925 days of restricted activity. The injury narratives were studied to determine if the implementation of LED-based luminaries could reduce injury severity and frequency. The greatest near-term potential impacts appear to be related to reducing maintenance and cap lamp redesign. Longer term (5 years), low-power and lightweight auxiliary LED lighting for surface mines could also have potential impact for improving safety. |
Fantastic voyage and opportunities of engineered nanomaterials: what are the potential risks of occupational exposures?
Kagan VE , Shi J , Feng W , Shvedova AA , Fadeel B . J Occup Environ Med 2010 52 (9) 943-946 Be precise. A lack of precision is dangerous when the margin of error is small. | Donald Rumsfeld (US Secretary of Defense) | In his legendary lecture at Caltech 50 years ago, Richard P. Feynman, introducing a new concept of nano-sized materials, noted: “.... a point that is most important is that it would have an enormous number of technical applications. What I want to talk about is the problem of manipulating and controlling things on a small scale.” This prediction turned out to be a prophecy, and today we appreciate that quantum properties strongly affect physical and chemical properties of nanoscale objects, conferring electrical, optical, and magnetic features not present in materials at a larger scale. Based on this, devices enormously smaller than before have been created, which may have a potentially huge impact on engineering, chemistry, medicine, and computer technology. Not surprisingly, nanodevices have already found different applications as diagnostic and therapeutic tools in biomedicine and in numerous consumer products. The applications in biomedicine range from novel approaches to the design of artificial organs and tissues for replacement therapies to nanorobotic biosensors, diagnostic devices, and miniscule vehicles for targeted drug delivery.1 Different types of nanoparticles are being considered, including carbon-based structures, such as carbon nanotubes, carbon nanocapsules, and fullerenes, or spherical lipid-based liposomes, which are already in use for numerous applications in drug delivery and in cosmetic products. Other types of nanomaterials envisioned for biomedical and other applications are based on metals and their oxides as well as ceramics. Nanotechnology industry is projected to exceed $1 trillion by 2015.2 |
Trend and prevalence estimates based on the 2008 physical activity guidelines for Americans
Carlson SA , Fulton JE , Schoenborn CA , Loustalot F . Am J Prev Med 2010 39 (4) 305-13 BACKGROUND: According to the 2008 Physical Activity Guidelines for Americans, adults need to engage in at least 150 minutes/week of moderate-intensity activity or its equivalent (defined as aerobically active) to obtain substantial health benefits and more than 300 minutes/week (defined as highly active) to obtain more extensive health benefits. In addition to aerobic activity, the 2008 Guidelines recommend that adults participate in muscle-strengthening activities on 2 or more days/week. PURPOSE: This study examined the prevalence and trends of meeting the activity criteria defined by the 2008 Guidelines among U.S. adults. METHODS: Prevalence and trends of participation in leisure-time physical activity were estimated from the 1998-2008 National Health Interview Survey (analyzed in 2010). RESULTS: In 2008, 43.5% of U.S. adults were aerobically active, 28.4% were highly active, 21.9% met the muscle-strengthening guideline, and 18.2% both met the muscle-strengthening guideline and were aerobically active. The likelihood of meeting each of these four activity criteria was similar and were associated with being male, being younger, being non-Hispanic white, having higher levels of education, and having a lower BMI. Trends over time were also similar for each part of the 2008 Guidelines, with the prevalence of participation exhibiting a small but significant increase when comparing 1998 to 2008 (difference ranging from 2.4 to 4.2 percentage points). CONCLUSIONS: Little progress has been made during the past 10 years in increasing physical activity levels in the U.S. There is much room for improvement in achieving recommended levels of physical activity among Americans, particularly among relatively inactive subgroups. |
Comparing physical activity patterns of hypertensive and nonhypertensive US adults
Churilla JR , Ford ES . Am J Hypertens 2010 23 (9) 987-93 BACKGROUND: Nonpharmacologic management of hypertension is an important strategy in treating people with hypertension, but little is known about patterns of physical activity among such people. We compared patterns of physical activity of adults with and without hypertension in the United States using the most recent guidelines for physical activity. METHODS: We used data from 391,017 adults aged > or =18 years from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and physical activity categories based on 2008 Department of Health and Human Services (DHHS) guidelines. All information was self-reported. RESULTS: The age-adjusted prevalence of hypertension was 27.2%, whereas the age-adjusted prevalence of meeting DHHS recommendations was 60.2% among participants with hypertension and 66.9% among participants without hypertension. After adjusting for age, gender, race or ethnicity, education, body mass index (BMI), smoking status, and histories of diabetes and cardiovascular disease (CVD), the odds ratio (OR) for meeting DHHS recommendations among participants with hypertension was 0.85 (95% confidence interval (CI) 0.82, 0.88) compared with those who did not have hypertension. CONCLUSIONS: Although the majority of adults with hypertension are currently meeting national guidelines for physical activity, they are less active overall than adults who do not have hypertension. |
Progression through puberty in girls enrolled in a contemporary British cohort
Christensen KY , Maisonet M , Rubin C , Holmes A , Flanders WD , Heron J , Ness A , Drews-Botsch C , Dominguez C , McGeehin MA , Marcus M . J Adolesc Health 2010 47 (3) 282-9 PURPOSE: Patterns of pubertal development reflect underlying endocrine function and exposures, and could affect future health outcomes. We used data from a longitudinal cohort to describe factors associated with breast and pubic hair stage and estimate average duration of puberty. METHODS: Data from the Avon Longitudinal Study of Parents and Children were used to describe timing and duration of pubertal development in girls. Self-reported Tanner stage of breast and pubic hair and menarche status were collected from ages 8-14 through mailed questionnaires. Factors associated with breast and pubic hair stage were identified using ordinal probit models. Age at entry into breast and pubic hair stages, and duration of puberty were estimated using interval-censored parametric survival analysis. RESULTS: Among the 3,938 participants, being overweight or obese, of non-white race, being the firstborn, and younger maternal age at menarche were associated with more advanced breast and pubic hair stages. Having an overweight or obese mother was associated with more advanced breast stages. Time spent in breast stages 2 and 3 was longer (1.5 years) than time spent in pubic hair stages 2 and 3 (1 year). The average age at menarche was 12.9 (95% CI, 12.8-12.9) years, and average duration of puberty (time from initiation of puberty to menarche) was 2.7 years. CONCLUSIONS: Girls in Avon Longitudinal Study of Parents and Children had a slightly longer duration of puberty compared to an earlier British cohort study. Various maternal and child characteristics were associated with breast and pubic hair stage, including both child and maternal body mass. |
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