The public's perceptions about cognitive health and Alzheimer's disease among the U.S. population: a national review
Anderson LA , Day KL , Beard RL , Reed PS , Wu B . Gerontologist 2009 49 S3-11 The present review assesses the public's perceptions about cognitive health and Alzheimer's disease among adults in the United States. We searched the published literature and Internet, and contacted experts in the field to locate surveys assessing the public's perceptions about cognition. We found 10 eligible surveys and abstracted data concerning the public's knowledge, beliefs, concerns, and sources of information. Most of the surveys were conducted in the 2000s and focused on Alzheimer's disease rather then cognitive health. Based on the findings from the surveys, most adults were found to be aware of Alzheimer's disease but lacked specific information about the disease and its treatments. Most respondents did not perceive themselves as being very knowledgeable about Alzheimer's disease. Although we could classify the findings into several overarching domains, such as knowledge, we found considerable variability among surveys in the questions asked. Additional work is needed to understand the public's perceptions about cognitive health. Moreover, we also lack studies that help us understand perceptions about cognition across diverse demographic and cultural groups. Only by addressing these gaps can we develop targeted and effective strategies to enhance knowledge and beliefs about cognitive impairment and health. |
Trend analysis of diagnosed diabetes prevalence among American Indian/Alaska native young adults--United States, 1994-2007
Roberts H , Jiles R , Mokdad A , Beckles G , Rios-Burrows N . Ethn Dis 2009 19 (3) 276-9 OBJECTIVE: In this study, we build on the previous findings of increased diabetes prevalence among American Indian/Alaska Native (AI/AN) young adults, by studying the rate at which annual prevalence estimates of diagnosed diabetes increased from 1994 to 2007. DESIGN AND SETTING: For this study, BRFSS data for 1994-2007 from the 50 states, District of Columbia, Puerto Rico, Guam, and the Virgin Islands were analyzed. PARTICIPANTS: Only non-institutionalized adults aged 18 years and older were eligible to participate in the Behavioral Risk Factor Surveillance System survey. MAIN OUTCOME MEASURES: To examine the existence and strength of a trend, we analyzed plots and Spearman's rank correlation coefficients of annual prevalence estimates for each group of young adults. Mantel-Haenszel tests were employed to study the relationship of diagnosed diabetes prevalence and race (AI/ AN, non-Hispanic White), while controlling for the time periods 1994-2000 and 2001-2007. To quantify increases in the disparity of diagnosed diabetes prevalence and race (AI/ AN, non-Hispanic White), odds risk ratio estimates were employed to approximate corresponding prevalence ratio estimates for the time periods 1994-2000 and 2001-2007. RESULTS: Employing Spearman's test for trend resulted in observing, during 1994-2007, statistically significant increasing trends in the annual prevalence estimates of diagnosed diabetes among AI/AN and non-Hispanic White young adults. AI/AN young adults, on average, were 1.7 (95% CI; [1.12, 2.63]) times more likely than non-Hispanic White young adults to be diagnosed with diabetes during 1994-2000 and 2.5 (95% CI; [1.93, 3.32]) times more likely during 2001-2007. CONCLUSION: The findings in this study suggests that the disparity in the estimated prevalence of diagnosed diabetes between AI/AN and NHW young adults widened steadily from 2001 to 2007. |
Characterizing extreme values of body mass index for age by using the 2000 Centers for Disease Control and Prevention growth charts
Flegal KM , Wei R , Ogden CL , Freedman DS , Johnson CL , Curtin LR . Am J Clin Nutr 2009 90 (5) 1314-20 BACKGROUND: The 2000 Centers for Disease Control and Prevention (CDC) growth charts included lambda-mu-sigma (LMS) parameters intended to calculate smoothed percentiles from only the 3rd to the 97th percentile. OBJECTIVE: The objective was to evaluate different approaches to describing more extreme values of BMI-for-age by using simple functions of the CDC growth charts. DESIGN: Empirical data for the 99th and the 1st percentiles of body mass index (BMI)-for-age were calculated from the data set used to construct the growth charts and were compared with estimates extrapolated from the CDC-supplied LMS parameters and to various functions of other smoothed percentiles. A set of reestimated LMS parameters that incorporated a smoothed 99th percentile were also evaluated. RESULTS: Extreme percentiles extrapolated from the CDC-supplied LMS parameters did not match well to the empirical data for the 99th percentile. A better fit to the empirical data was obtained by using 120% of the smoothed 95th percentile. The empirical first percentile was reasonably well approximated by extrapolations from the LMS values. The reestimated LMS parameters had several drawbacks and no clear advantages. CONCLUSIONS: Several approximations can be used to describe extreme high values of BMI-for-age with the use of the CDC growth charts. Extrapolation from the CDC-supplied LMS parameters does not provide a good fit to the empirical 99th percentile values. Simple approximations to high values as percentages of the existing smoothed percentiles have some practical advantages over imputation of very high percentiles. The expression of high BMI values as a percentage of the 95th percentile can provide a flexible approach to describing and tracking heavier children. |
Nasopharyngeal carriage of Streptococcus pneumoniae in Navajo and White Mountain Apache children before the introduction of pneumococcal conjugate vaccine
Millar EV , O'Brien KL , Zell ER , Bronsdon MA , Reid R , Santosham M . Pediatr Infect Dis J 2009 28 (8) 711-6 BACKGROUND: Infants and children are frequently colonized with pneumococcus. Recent nasopharyngeal acquisition of pneumococcus is thought to precede disease episodes. The increased risk of pneumococcal disease among Navajo and White Mountain Apache populations has been documented. Little is known about the dynamics of pneumococcal carriage in these populations. METHODS: A group randomized, controlled trial of 7-valent conjugate pneumococcal vaccine (PnCRM7, Wyeth) was conducted on the Navajo and Apache reservations. A nasopharyngeal (NP) carriage study was nested in the trial to evaluate the impact of PnCRM7 on carriage. Children <6 years of age had NP swabs collected at enrollment and at 6 and 12 months following enrollment. We analyzed carriage data from children in control vaccine randomized communities to describe the epidemiology of pneumococcal carriage. RESULTS: Of the 410 participants enrolled, 92% were colonized with pneumococcus at least once during the course of the study. Sixty-three percent of NP specimens were positive for pneumococcus. The most common serotypes were 6A, 6B, nontypable, 23F, 14, 19F, 19A, and 9V. Thirty-eight percent of isolates were vaccine serotypes. Age <2 years, male sex, daycare attendance, and having a sibling colonized with pneumococcus were associated with an increased risk of carriage. CONCLUSIONS: The high carriage prevalence among Navajo and Apache children reflects an intense exposure to pneumococcus. The lack of modifiable risk factors for carriage highlights the importance of preventive strategies for disease control. |
Recommendations from a research consultation to address intervention strategies for HIV/AIDS prevention focused on African Americans
Purcell DW , McCree DH . Am J Public Health 2009 99 (11) 1937-40 Despite substantial federal resources spent on HIV prevention, research, treatment, and care, as well as the availability and dissemination of evidence-based behavioral interventions, the disparate impact of HIV on African Americans continues.In October 2007, 3 federal agencies convened 20 HIV/AIDS prevention researchers and care providers for a research consultation to focus on new intervention strategies and current effective intervention strategies that should be more widely disseminated to address the HIV/AIDS epidemic among African Americans. The consultants focused on 2 areas: (1) potential directions for HIV prevention interventions, defined to include behavioral, community, testing, service delivery, structural, biomedical, and other interventions; and (2) improved research methods and agency procedures to better support prevention research focused on African American communities. |
Spread of Cryptococcus gattii into Pacific Northwest region of the United States
Datta K , Bartlett KH , Baer R , Byrnes E , Galanis E , Heitman J , Hoang L , Leslie MJ , MacDougall L , Magill SS , Morshed MG , Marr KA , Cryptococcus gattii Working Group of the Pacific Northwest , Chiller T . Emerg Infect Dis 2009 15 (8) 1185-91 Cryptococcus gattii has emerged as a human and animal pathogen in the Pacific Northwest. First recognized on Vancouver Island, British Columbia, Canada, it now involves mainland British Columbia, and Washington and Oregon in the United States. In Canada, the incidence of disease has been one of the highest worldwide. In the United States, lack of cryptococcal species identification and case surveillance limit our knowledge of C. gattii epidemiology. Infections in the Pacific Northwest are caused by multiple genotypes, but the major strain is genetically novel and may have emerged recently in association with unique mating or environmental changes. C. gattii disease affects immunocompromised and immunocompetent persons, causing substantial illness and death. Successful management requires an aggressive medical and surgical approach and consideration of potentially variable antifungal drug susceptibilities. We summarize the study results of a group of investigators and review current knowledge with the goal of increasing awareness and highlighting areas where further knowledge is required. |
Adenovirus gastroenteritis in Hungary, 2003-2006
Banyai K , Kisfali P , Bogdan A , Martella V , Melegh B , Erdman D , Szucs G . Eur J Clin Microbiol Infect Dis 2009 28 (8) 997-9 The incidence and type distribution of enteric human adenoviruses (HAds) among diarrheic children in south-western Hungary was investigated from 2003 through 2006. Laboratory studies were conducted using commercial antigen detection tests (latex agglutination or immunochromatography), polymerase chain reaction (PCR) amplification, single-strand conformation polymorphism, and sequencing and phylogenetic analysis of a conservative region of the HAd hexon gene. The overall rate of HAd infection in childhood gastroenteritis cases during the 4-year study was 8.1%, with a gradual decrease in detection rates from 11.7% in 2003 to 5.7% in 2006. Molecular studies of a subset of HAd-positive samples found that enteric HAd type 40 strains were identified only in 2003 and 2004, while HAd type 41 strains were identified throughout the 4-year study. Higher detection rates of non-enteric HAds was documented during the first half of the study period when latex agglutination was used in our laboratory for detection. Our study suggests that the choice of diagnostic method may profoundly influence the epidemiologic picture and disease burden attributed to enteric HAd infections. |
Avian influenza virus A (H5N1), detected through routine surveillance, in child, Bangladesh
Brooks WA , Alamgir AS , Sultana R , Islam MS , Rahman M , Fry AM , Shu B , Lindstrom S , Nahar K , Goswami D , Haider MS , Nahar S , Butler E , Hancock K , Donis RO , Davis CT , Zaman RU , Luby SP , Uyeki TM . Emerg Infect Dis 2009 15 (8) 1311-3 We identified avian influenza virus A (H5N1) infection in a child in Bangladesh in 2008 by routine influenza surveillance. The virus was of the same clade and phylogenetic subgroup as that circulating among poultry during the period. This case illustrates the value of routine surveillance for detection of novel influenza virus. |
Early clinical features of dengue infection in Puerto Rico
Ramos MM , Tomashek KM , Arguello DF , Luxemburger C , Quinones L , Lang J , Munoz-Jordan JL . Trans R Soc Trop Med Hyg 2009 103 (9) 878-84 Early diagnosis of dengue is challenging because the initial symptoms are often non-specific, viraemia may be below detectable levels and serological tests confirm dengue late in the course of illness. Identifying dengue early in the clinical course could be useful in reducing dengue virus transmission in a community. This study analyzed data from 145 laboratory-positive and 293 laboratory-negative dengue cases in Puerto Rico to define the early clinical features of dengue infection in children and adults and to identify the clinical features that predict a laboratory-positive dengue infection. Among children, rash and age were independently associated with laboratory-positive dengue infection. Rash in the absence of cough had a positive predictive value of 100% and a negative predictive value of 82.4% as a paediatric dengue screen. Among adults, eye pain, diarrhoea and absence of upper respiratory symptoms were independently associated with laboratory-positive dengue infection. No useful early predictors of dengue infection among adults were found. Using clinical features may promote earlier identification of a subset of paediatric dengue patients in Puerto Rico. Laboratory confirmation is still necessary for the accurate diagnosis of dengue infection. |
The epidemiology of hepatitis A virus infections in four Pacific Island nations, 1995-2008
Fischer GE , Thompson N , Chaves SS , Bower W , Goldstein S , Armstrong G , Williams I , Bialek S . Trans R Soc Trop Med Hyg 2009 103 (9) 906-10 Historically, hepatitis A virus (HAV) has been highly prevalent in developing countries, with most infections occurring during childhood, when they are likely to be asymptomatic. Shifts in the acquisition of infection from childhood to adulthood, when clinical hepatitis is more likely, may leave populations vulnerable to large outbreaks. We conducted cross-sectional serosurveys from 1995 to 2008 in four Pacific Island nations to determine the proportion of people previously infected with HAV by measuring antibodies to HAV (anti-HAV). In American Samoa, 0.0% of 4- to 6-year-olds (95% CI 0.0-3.7) were anti-HAV positive. In Chuuk, FSM, 8.6% of 2- to 6-year-olds (95% CI 5.7-11.5) were anti-HAV positive compared with 98.3% of individuals > or =16 years old (95% CI 96.6-100). In Pohnpei, FSM, 0.8% of 2- to 9-year-olds (95% CI 0.0-1.6) were anti-HAV positive compared with 95.1% of > or =16 year-olds (95% CI 92.2-98.0). In RMI, 85.7% (95% CI 81.9-89.5) of 4- to 9-year-olds were anti-HAV positive. In Palau, 0.7% of 7- to 8-year-olds were anti-HAV positive (95% CI 0.0-1.8). The low HAV seroprevalence among children in American Samoa, FSM and Palau may indicate a vulnerability to hepatitis A morbidity among these populations. These data will be useful for evaluating the need for hepatitis A surveillance and vaccination programs. |
HIV among injecting drug users: current epidemiology, biologic markers, respondent-driven sampling, and supervised-injection facilities
Des Jarlais DC , Arasteh K , Semaan S , Wood E . Curr Opin HIV AIDS 2009 4 (4) 308-13 PURPOSE OF REVIEW: To describe recent research done primarily during the past 12 months (i.e., primarily in 2008) on the epidemiology of HIV infection among injecting drug users (IDUs). RECENT FINDINGS: Major research developments include a global assessment of HIV infection among IDUs and evidence of a transition from epidemics concentrated among IDUs to generalized, heterosexual epidemics in eastern Europe and Asia. Intervention research also includes several studies of supervised-injecting facilities. Methodological research includes respondent-driven sampling and the use of hepatitis C virus and herpes simplex virus-2 as biomarkers for injecting and sexual risk. SUMMARY: There have been important advances in research during the past year, but HIV infection continues to spread rapidly across many areas of the world among IDUs and their nondrug-using sex partners. |
Invasive group B streptococcal disease in the elderly, Minnesota, USA, 2003-2007
Kothari NJ , Morin CA , Glennen A , Jackson D , Harper J , Schrag SJ , Lynfield R . Emerg Infect Dis 2009 15 (8) 1279-81 In Minnesota, incidence of invasive group B streptococcal disease was 3 times greater in older adults in long-term care facilities than in older adults in community settings (67.7/100,000 vs. 21.4/100,000) during 2003-2007. The overall case-fatality rate was 6.8%, and concurrent conditions were common among both groups. |
Brief report of community ownership of local coalitions: community members' perspectives
Cox PJ . J Community Psychol 2009 37 (6) 789-94 Although community ownership has been described as critical to the long-term effectiveness of local coalitions, a lack of consensus exists regarding what community ownership is and what exactly is being owned. This exploratory study examined community ownership of coalitions that address domestic violence from the perspective of community members who initiated and operated these coalitions. Qualitative data collection methods included interviews, observations, and archival review of coalition records. Findings expand current conceptualizations of what community ownership is and how it develops. Results may inform future research regarding how community ownership affects the effectiveness of a coalition's programs and how researchers and government agencies partner with coalitions to address health problems. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract). |
Effectiveness of multicomponent programs with community mobilization for reducing alcohol-impaired driving
Shults RA , Elder RW , Nichols JL , Sleet DA , Compton R , Chattopadhyay SK , Task Force on Community Preventive Services . Am J Prev Med 2009 37 (4) 360-71 A systematic review was conducted to determine the effectiveness and economic efficiency of multicomponent programs with community mobilization for reducing alcohol-impaired driving. The review was conducted for the Guide to Community Preventive Services (Community Guide). Six studies of programs qualified for the review. Programs addressed a wide range of alcohol-related concerns in addition to alcohol-impaired driving. The programs used various crash-related outcomes to measure their effectiveness. Two studies examined fatal crashes and reported declines of 9% and 42%; one study examined injury crashes and reported a decline of 10%; another study examined crashes among young drivers aged 16-20 years and reported a decline of 45%; and one study examined single-vehicle late-night and weekend crashes among young male drivers and reported no change. The sixth study examined injury crashes among underage drivers and reported small net reductions. Because the actual numbers of crashes were not reported, percentage change could not be calculated. According to Community Guide rules of evidence, the studies reviewed here provided strong evidence that carefully planned, well-executed multicomponent programs, when implemented in conjunction with community mobilization efforts, are effective in reducing alcohol-related crashes. Three studies reported economic evidence that suggests that such programs produce cost savings. The multicomponent programs generally included a combination of efforts to limit access to alcohol (particularly among youth), responsible beverage service training, sobriety checkpoints or other well-defined enforcement efforts, public education, and media advocacy designed to gain the support of both policymakers and the general public for reducing alcohol-impaired driving. |
Viability of commercially available bleach for water treatment in developing countries
Lantagne DS . Am J Public Health 2009 99 (11) 1975-8 Treating household water with low-cost, widely available commercial bleach is recommended by some organizations to improve water quality and reduce disease in developing countries. I analyzed the chlorine concentration of 32 bleaches from 12 developing countries; the average error between advertised and measured concentration was 35% (range = -45%-100%; standard deviation = 40%). Because of disparities between advertised and actual concentration, the use of commercial bleach for water treatment in developing countries is not recommended without ongoing quality control testing. |
Climate change and human health
Luber G , Prudent N . Trans Am Clin Climatol Assoc 2009 120 113-7 Climate change science points to an increase in sea surface temperature, increases in the severity of extreme weather events, declining air quality, and destabilizing natural systems due to increases in greenhouse gas emissions. The direct and indirect health results of such a global imbalance include excessive heat-related illnesses, vector- and waterborne diseases, increased exposure to environmental toxins, exacerbation of cardiovascular and respiratory diseases due to declining air quality, and mental health stress among others. Vulnerability to these health effects will increase as elderly and urban populations increase and are less able to adapt to climate change. In addition, the level of vulnerability to certain health impacts will vary by location. As a result, strategies to address climate change must include health as a strategic component on a regional level. The co-benefits of improving health while addressing climate change will improve public health infrastructure today, while mitigating the negative consequences of a changing climate for future generations. |
Human health consequences of use of antimicrobial agents in aquaculture
Heuer OE , Kruse H , Grave K , Collignon P , Karunasagar I , Angulo FJ . Clin Infect Dis 2009 49 (8) 1248-53 Intensive use of antimicrobial agents in aquaculture provides a selective pressure creating reservoirs of drug-resistant bacteria and transferable resistance genes in fish pathogens and other bacteria in the aquatic environment. From these reservoirs, resistance genes may disseminate by horizontal gene transfer and reach human pathogens, or drug-resistant pathogens from the aquatic environment may reach humans directly. Horizontal gene transfer may occur in the aquaculture environment, in the food chain, or in the human intestinal tract. Among the antimicrobial agents commonly used in aquaculture, several are classified by the World Health Organisation as critically important for use in humans. Occurrence of resistance to these antimicrobial agents in human pathogens severely limits the therapeutic options in human infections. Considering the rapid growth and importance of aquaculture industry in many regions of the world and the widespread, intensive, and often unregulated use of antimicrobial agents in this area of animal production, efforts are needed to prevent development and spread of antimicrobial resistance in aquaculture to reduce the risk to human health. |
Improving environmental assessments during foodborne outbreaks
Selman CA . J Environ Health 2009 72 (2) 46-7 Although an investigation of an outbreak can be initiated quickly, an outbreak | may be over by the time public health | officials know of its existence (e.g., a local | church supper outbreak). An outbreak can | also occur via a contaminated ingredient moving in interstate commerce and affect persons | in multiple states. The complexity of these | events and the myriad avenues of response | required are well known within the public | health community, as is the importance of a | strong public health team approach to meeting | the challenges. But once an outbreak is over, | how do environmental health (EH) service | programs prevent similar future outbreaks? |
Strategy to enhance influenza surveillance worldwide
Ortiz JR , Sotomayor V , Uez OC , Oliva O , Bettels D , McCarron M , Bresee JS , Mounts AW . Emerg Infect Dis 2009 15 (8) 1271-8 The emergence of a novel strain of influenza virus A (H1N1) in April 2009 focused attention on influenza surveillance capabilities worldwide. In consultations before the 2009 outbreak of influenza subtype H1N1, the World Health Organization had concluded that the world was unprepared to respond to an influenza pandemic, due in part to inadequate global surveillance and response capacity. We describe a sentinel surveillance system that could enhance the quality of influenza epidemiologic and laboratory data and strengthen a country's capacity for seasonal, novel, and pandemic influenza detection and prevention. Such a system would 1) provide data for a better understanding of the epidemiology and extent of seasonal influenza, 2) provide a platform for the study of other acute febrile respiratory illnesses, 3) provide virus isolates for the development of vaccines, 4) inform local pandemic planning and vaccine policy, 5) monitor influenza epidemics and pandemics, and 6) provide infrastructure for an early warning system for outbreaks of new virus subtypes. |
Tsunami-related injury in Aceh Province, Indonesia
Doocy S , Robinson C , Moodie C , Burnham G . Glob Public Health 2009 4 (2) 205-14 The Asian tsunami, of December 2004, caused widespread loss of life. A series of surveys were conducted to assess tsunami-related mortality and injury, risk factors, care seeking and injury outcomes. Three surveys of tsunami-affected populations, in seven districts of Aceh province, were conducted between March and August 2005. Surveys employed a two-stage cluster design and probability proportional to size sampling methods. Overall, 17.7% (95% confidence interval (CI)=16.8-18.6) of the population was reported as dead/missing1 and 8.5% (95% CI=7.9-9.2) had been injured. Odds of mortality were 1.41% (95% CI=1.27-1.58) times greater in females than in males; risk of injury was opposite, with an odds of injury of 0.81 (95% CI=0.61-0.96) for females in comparison to males. Mortality was greatest among the oldest and young population sub-groups, and injuries were most prevalent among middle-aged populations (20-49). An estimated 25,572 people were injured and 3682 (1.2%) suffered lasting disabilities. While mortality was particularly elevated among females and among the youngest and oldest age groups, injury rates were the greatest among males and the working-age population, suggesting that those are more likely to survive the tsunami were also more likely to be injured. |
Advances and future directions in HIV surveillance in low- and middle-income countries
Diaz T , Garcia-Calleja JM , Ghys PD , Sabin K . Curr Opin HIV AIDS 2009 4 (4) 253-9 PURPOSE OF REVIEW: To present recent advances in HIV/AIDS surveillance methods in low- and middle-income countries. RECENT FINDINGS: From 2001 to 2008, 30 low- and middle-income countries implemented national population-based surveys with HIV testing. Antenatal clinic HIV sentinel surveillance sites in sub-Saharan Africa increased from just over 1000 in 2003-2004 to almost 2500 in 2005-2006, becoming more representative of rural areas. Between 2003 and 2007, at least 122 behavioral surveys in low- and middle-income countries used respondent-driven sampling for surveillance among high-risk populations, although many countries with concentrated epidemics continue to have major sentinel surveillance gaps. Improvements have been made in modeling estimates of number of persons HIV infected, and systems are now in place to measure HIV drug resistance. However, the reliable monitoring of trends and the measuring of HIV incidence, morbidity, and mortality is still a challenge. SUMMARY: In the past 5 years, there have been substantial improvements in the quantity and quality of HIV surveillance studies, especially in the countries with high prevalence. Further efforts should be made in countries that lack fully implemented surveillance systems to improve HIV incidence, morbidity, and mortality surveillance and to use data more effectively. |
Creating a nationally representative sample of patients from trauma centers
Goble S , Neal M , Clark DE , Nathens AB , Annest JL , Faul M , Sattin RW , Li L , Levy PS , Mann NC , Guice K , Cassidy LD , Fildes JJ . J Trauma 2009 67 (3) 637-42; discussion 642-4 BACKGROUND: The National Trauma Data Bank (NTDB) was developed as a convenience sample of registry data from contributing trauma centers (TCs), thus, inferences about trauma patients may not be valid at the national level. The NTDB National Sample was created to obtain nationally representative estimates of trauma patients treated in the US level I and II TCs. METHODS: Level I and II TCs in the Trauma Information Exchange Program were identified and a random stratified sample of 100 TCs was selected. The probability-proportional-to-size method was used to select TCs and sample weights were calculated. National Sample Program estimates from 2003 to 2006 were compared with raw NTDB data, and to a subset of TCs in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a population-based dataset drawn from community hospitals. RESULTS: Weighted estimates from the NTDB National Sample range from 484,000 (2004) to 608,000 (2006) trauma incidents. Crude NTDB data over-represented the proportion of younger patients (0 years-14 years) compared with the NTDB National Sample, which does not include children's hospitals. Few TCs in Trauma Information Exchange Program are included in Healthcare Cost and Utilization Project Nationwide Inpatient Sample, but estimates based on this subset indicate a higher percentage of older patients (age 65 year or older, 23.98% versus 17.85%), lower percentage male patients, and a lower percentage of motor vehicle accidents compared with NTDB National Sample. CONCLUSION: Although nationally representative data regarding trauma patients are available in other population-based samples, they do not represent TCs patients and lack the specificity of National Sample Program data, which contains detailed information on injury mechanisms, diagnoses, and hospital treatment. |
Challenges of translating genetic tests into clinical and public health practice.
Rogowski WH , Grosse SD , Khoury MJ . Nat Rev Genet 2009 10 (7) 489-95 Research in genetics and genomics has led to an expanding list of molecular genetic tests, which are increasingly entering health care systems. However, the evidence surrounding the benefits and harms of these tests is frequently weak. Here we present the main challenges to the successful translation of new research findings about genotype-phenotype associations into clinical practice. We discuss the means to achieve an accelerated translation research agenda that is conducted in a reasonable, fair and efficient manner. |
The global epidemic of HIV infection among men who have sex with men
van Griensven F , de Lind van Wijngaarden JW , Baral S , Grulich A . Curr Opin HIV AIDS 2009 4 (4) 300-7 PURPOSE OF REVIEW: In the last few years, there have been reports of new, newly identified and resurging epidemics of HIV infection among men who have sex with men (MSM). This article reviews and summarizes the global epidemic of HIV infection among MSM. RECENT FINDINGS: In the Western world, the increase in notifications of new HIV infections among MSM is continuing. Steep increases in reports of new HIV diagnoses among MSM were also seen in the developed economies of East Asia. In the developing world, epidemiologic studies have now established the presence of MSM populations in Africa, China and Russia and a high HIV prevalence among them. High and increasing HIV prevalence was also reported from South and Southeast Asia, and Latin America and the Caribbean. SUMMARY: HIV continues to spread among MSM on a global level. Current prevention efforts have been unable to contain or reduce HIV transmission in this population. Additional behavioral and biomedical interventions are urgently needed. |
Global epidemiology of HIV
Kilmarx PH . Curr Opin HIV AIDS 2009 4 (4) 240-6 PURPOSE OF REVIEW: To provide an update on the epidemiology of HIV worldwide and by region, along with an overview of recent HIV epidemiological research. RECENT FINDINGS: The global prevalence of HIV-1 has stabilized at 0.8%, with 33 million people living with HIV/AIDS, 2.7 million new infections, and 2.0 million AIDS deaths in 2007. Heterosexual spread in the general population is the main mode of transmission in sub-Saharan Africa, which remains the most heavily affected region, with 67% of the global burden. Male-male sex, injection drug use, and sex work are the predominant risk factors in most other regions. Infection rates are declining in some regions, including some of the most heavily affected countries in Africa, but climbing elsewhere such as in eastern Europe and central Asia. Recent HIV epidemiologic research findings include new insights into the role of HIV viral load, co-infection with sexually transmitted infections, male circumcision, antiretroviral treatment, serosorting, and superinfection in HIV transmission and prevention. SUMMARY: The global prevalence of HIV has stabilized in this decade, but with important regional differences in trends and modes of transmission. Prevention and treatment programs have an expanding impact in preventing HIV infection and AIDS deaths. |
Risk behaviors and psychosocial stressors in the New York City House Ball community: A comparison of men and transgender women who have sex with men
Sanchez T , Finlayson T , Murrill C , Guilin V , Dean L . AIDS Behav 2009 14 (2) 351-8 The New York City House Ball community consists of social networks of racial/ethnic minority gay, lesbian or bisexual men and women, and transgender persons. HIV seroprevalence and interview data were obtained from a sample of community members to identify statistical differences in HIV prevalence, risk behavior, and psychosocial stressors between men who have sex with men (MSM) and transgender women. Of 301 MSM and 60 transgender women, 20% were HIV-infected and 73% were unaware of their infection, but rates did not differ by gender. Risk behavior and stressors were common in both groups, but transgender women were more likely to report exchange sex, stigmatization, and stressful life events. High rates of risk behavior and HIV in this special community warrant relevant HIV testing and prevention services. Transgender women in the community may be at even greater risk for HIV infection due to behaviors compounded by substantial psychosocial stressors. |
"Someone naughty for tonight": sex partner recruitment venues and associated STI risk
Aral SO , Manhart LE . Sex Transm Infect 2009 85 (4) 239-40 Patterns of sex partner recruitment are diverse; have changed over the past few decades; are associated with rates of formation and dissolution of sex partnerships, and may be associated with differential risk for acquiring sexually transmitted infections (STIs) and HIV infection. During earlier times, people met sex partners at work, school and church; in the neighbourhood; through friends and acquaintances; or on the street and/or in the brothel, massage parlour, etc.1 More recently, under the influence of technological developments, formation of new social ties has become faster and more diverse; hundreds of meet-ups are announced in local areas every week. Formation of sexual ties followed a similar pattern. Recruitment of sex partners through personal ads in newspapers,2 which was a relatively new mode of meeting partners in the late 1980s and early 1990s, has mostly been replaced by internet-based searches. In January 2009, a Google search based on the words “find sex partner on web” yielded 1 050 000 results; options included “local moms looking for younger men”, “one night stand” and “find a naughty partner for tonight”. | In theory, to the extent that a particular partner recruitment approach results in: (1) faster formation of new ties; (2) greater likelihood that infected individuals hook-up with uninfected individuals; and (3) greater numbers of individuals participating in sex-partner recruitment, holding everything else constant, it would be associated with faster spread of infection in the population. At the individual level, a particular sex-partner recruitment approach would be associated with a higher risk of STI acquisition if it increases the likelihood of “hooking-up” with an infected partner. Infection status of individuals is difficult to ascertain; therefore, we use high risk behaviours as proxies for infection status. Thus, if partners one is likely to meet through a particular recruitment venue tend to engage in other high-risk behaviours, one would expect that recruitment venue to be associated with high risk of STI acquisition for the individual. In reality, everything else is not held constant; there are interdependencies among rates of partnership formation, probability of infected individuals having sex with uninfected individuals, and numbers of individuals participating in sex-partner recruitment; furthermore, most changes carry with them unintended and unanticipated consequences. Hence, it is important to conduct empirical studies of partner recruitment patterns and their association with rate of spread of infection in the population and infection acquisition risk for the individual. |
Health-risk correlates of video-game playing among adults
Weaver JB 3rd , Mays D , Sargent Weaver S , Kannenberg W , Hopkins GL , Eroglu D , Bernhardt JM . Am J Prev Med 2009 37 (4) 299-305 BACKGROUND: Although considerable research suggests that health-risk factors vary as a function of video-game playing among young people, direct evidence of such linkages among adults is lacking. PURPOSE: The goal of this study was to distinguish adult video-game players from nonplayers on the basis of personal and environmental factors. It was hypothesized that adults who play video games, compared to nonplayers, would evidence poorer perceptions of their health, greater reliance on Internet-facilitated social support, more extensive media use, and higher BMI. It was further hypothesized that different patterns of linkages between video-game playing and health-risk factors would emerge by gender. METHODS: A cross-sectional, Internet-based survey was conducted in 2006 with a sample of adults from the Seattle-Tacoma area (n=562), examining health risks; media use behaviors and perceptions, including those related to video-game playing; and demographics. Statistical analyses conducted in 2008 to compare video-game players and nonplayers included bivariate descriptive statistics, stepwise discriminant analysis, and ANOVA. RESULTS: A total of 45.1% of respondents reported playing video games. Female video-game players reported greater depression (M=1.57) and poorer health status (M=3.90) than female nonplayers (depression, M=1.13; health status, M=3.57). Male video-game players reported higher BMI (M=5.31) and more Internet use time (M=2.55) than male nonplayers (BMI, M=5.19; Internet use, M=2.36). The only determinant common to female and male video-game players was greater reliance on the Internet for social support. CONCLUSIONS: A number of determinants distinguished video-game players from nonplayers, and these factors differed substantially between men and women. The data illustrate the need for further research among adults to clarify how to use digital opportunities more effectively to promote health and prevent disease. |
The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review
Anderson LM , Quinn TA , Glanz K , Ramirez G , Kahwati LC , Johnson DB , Buchanan LR , Archer WR , Chattopadhyay S , Kalra GP , Katz DL , Task Force on Community Preventive Services . Am J Prev Med 2009 37 (4) 340-57 This report presents the results of a systematic review of the effectiveness of worksite nutrition and physical activity programs to promote healthy weight among employees. These results form the basis for the recommendation by the Task Force on Community Preventive Services on the use of these interventions. Weight-related outcomes, including weight in pounds or kilograms, BMI, and percentage body fat were used to assess effectiveness of these programs. This review found that worksite nutrition and physical activity programs achieve modest improvements in employee weight status at the 6-12-month follow-up. A pooled effect estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based on six RCTs. The findings appear to be applicable to both male and female employees, across a range of worksite settings. Most of the studies combined informational and behavioral strategies to influence diet and physical activity; fewer studies modified the work environment (e.g., cafeteria, exercise facilities) to promote healthy choices. Information about other effects, barriers to implementation, cost and cost effectiveness of interventions, and research gaps are also presented in this article. The findings of this systematic review can help inform decisions of employers, planners, researchers, and other public health decision makers. |
Factors associated with parent-child communication about HIV/AIDS in the United States and Kenya: A cross-cultural comparison
Poulsen MN , Miller KS , Lin C , Fasula A , Vandenhoudt H , Wyckoff SC , Ochura J , Obong'o CO , Forehand R . AIDS Behav 2009 14 (5) 1083-94 This study explored parent-child communication about HIV/AIDS among two populations disproportionately affected by HIV. Similar computer-assisted surveys were completed by parents of pre-teens, including 1,115 African American parents of 9-12-year-old children in southeastern US and 403 parents of 10-12-year-old children in Nyanza Province, Kenya. Multivariate analyses identified factors associated with parental report of ever talking to their child about HIV/AIDS. Twenty-nine percent of US parents and 40% in Kenya had never talked to their pre-teen about HIV/AIDS. In both countries, communication was more likely if parents perceived their child to be ready to learn about sex topics, had gotten information to educate their child about sex, and had greater sexual communication responsiveness (skill, comfort, and confidence communicating about sexuality). Programs are needed that help parents assess children's readiness to learn about sexual issues; access accurate information about adolescent sexual risks; and acquire the responsiveness needed to discuss sexual issues, including HIV/AIDS. |
Prioritization of pandemic influenza vaccine: rationale and strategy for decision making
Schwartz B , Orenstein WA . Curr Top Microbiol Immunol 2009 333 495-507 Few catastrophes can compare with the global impact of a severe influenza pandemic. The 1918-1919 pandemic was associated with more than 500,000 deaths in the USA and an estimated 20-40 million deaths worldwide, though some place the global total much higher. In an era when infectious disease mortality had been steadily decreasing, the 1918-1919 pandemic caused a large spike in overall population mortality, temporarily reversing decades of progress. The US Department of Health and Human Services, extrapolating from the 1918-1919 pandemic to the current US population size and demographics, has estimated that a comparable pandemic today would result in almost two million deaths.Vaccination is an important component of a pandemic response. Public health measures such as reduction of close contacts with others, improved hygiene, and respiratory protection with facemasks or respirators can reduce the risk of exposure and illness (Germann et al. 2006; Ferguson et al. 2006), but would not reduce susceptibility among the population. Prophylaxis with antiviral medications also may prevent illness but depends on the availability of large antiviral drug stockpiles and also does not provide long-term immunity. By contrast, immunization with a well-matched pandemic vaccine would provide active immunity and represent the most durable pandemic response. However, given current timelines for the development of a pandemic influenza vaccine and its production capacity, vaccine is likely not to be available in sufficient quantities to protect the entire population before pandemic outbreaks occur, and thus potentially limited stocks may need to be prioritized. This chapter reviews information on influenza vaccine production capacity, describes approaches used in the USA to set priorities for vaccination in the setting of limited supply, and presents a proposed strategy for prioritization. |
Risk of medically attended local reactions following diphtheria toxoid containing vaccines in adolescents and young adults: a Vaccine Safety Datalink study
Jackson LA , Yu O , Nelson J , Belongia EA , Hambidge SJ , Baxter R , Naleway A , Nordin J , Baggs J , Iskander J . Vaccine 2009 27 (36) 4912-6 Three vaccines currently recommended for adolescents (Tdap, Td, and MCV4 meningococcal conjugate vaccine) contain diphtheria toxoid. While the safety of individual diphtheria toxoid containing vaccines has been evaluated, less is known regarding the safety of administration of two or more of these vaccines, either concomitantly or sequentially. This study evaluated the risk of medically attended local reactions in adolescents and young adults with varying patterns of receipt of diphtheria toxoid containing vaccines. In general the risk of medically attended local reactions was low and did not differ with concomitant or sequential administration of diphtheria toxoid containing vaccines. |
Seasonal influenza vaccines
Fiore AE , Bridges CB , Cox NJ . Curr Top Microbiol Immunol 2009 333 43-82 Influenza vaccines are the mainstay of efforts to reduce the substantial health burden from seasonal influenza. Inactivated influenza vaccines have been available since the 1940s and are administered via intramuscular injection. Inactivated vaccines can be given to anyone six months of age or older. Live attenuated, cold-adapted influenza vaccines (LAIV) were developed in the 1960s but were not licensed in the United States until 2003, and are administered via nasal spray. Both vaccines are trivalent preparations grown in eggs and do not contain adjuvants. LAIV is licensed for use in the United States for healthy nonpregnant persons 2-49 years of age.Influenza vaccination induces antibodies primarily against the major surface glycoproteins hemagglutinin (HA) and neuraminidase (NA); antibodies directed against the HA are most important for protection against illness. The immune response peaks at 2-4 weeks after one dose in primed individuals. In previously unvaccinated children <9 years of age, two doses of influenza vaccine are recommended, as some children in this age group have limited or no prior infections from circulating types and subtypes of seasonal influenza. These children require both an initial priming dose and a subsequent booster dose of vaccine to mount a protective antibody response.The most common adverse events associated with inactivated vaccines are sore arm and redness at the injection site; systemic symptoms such as fever or malaise are less commonly reported. Guillian-Barre Syndrome (GBS) was identified among approximately 1 per 100,000 recipients of the 1976 swine influenza vaccine. The risk of influenza vaccine-associated GBS from seasonal influenza vaccine is thought to be at most approximately 1-2 cases per 1 million vaccinees, based on a few studies that have found an association; other studies have found no association.The most common adverse events associated with LAIV are nasal congestion, headache, myalgias or fever. Studies of the safety of LAIV among young children suggest an increased risk of wheezing in some young children, and the vaccine is not recommended for children younger than 2 years old, ages 2-4 old with a history of recurrent wheezing or reactive airways disease, or older persons who have any medical condition that confers an increased risk of influenza-related complications.The effectiveness of influenza vaccines is related predominantly to the age and immune competence of the vaccinee and the antigenic relatedness of vaccine strains to circulating strains. Vaccine effectiveness in preventing laboratory-confirmed influenza illness when the vaccine strains are well matched to circulating strains is 70-90% in randomized, placebo-controlled trials conducted among children and young healthy adults, but is lower among elderly or immunocompromised persons. In years with a suboptimal match, vaccine benefit is likely to be lower, although the vaccine can still provide substantial benefit, especially against more severe outcomes. Live, attenuated influenza vaccines have been most extensively studied among children, and have been shown to be more effective than inactivated vaccines in several randomized controlled trials among young children.Influenza vaccination is recommended in the United States for all children six months or older, all adults 50 years or older, all persons with chronic medical conditions, and pregnant women, and contacts of these persons, including healthcare workers. The global disease burden of influenza is substantial, and the World Health Organization has indicated that member states should evaluate the cost-effectiveness of introducing influenza vaccination into national immunization programs. More research is needed to develop more effective seasonal influenza vaccines that provide long-lasting immunity and broad protection against strains that differ antigenically from vaccine viruses. |
Generation and characterization of candidate vaccine viruses for prepandemic influenza vaccines
O'Neill E , Donis RO . Curr Top Microbiol Immunol 2009 333 83-108 Vaccination will be a critical public health intervention to mitigate the next influenza pandemic. Its effectiveness will depend on preparedness at multiple levels, from the laboratory bench to the population. Here we describe a global approach to ensure that appropriate candidate vaccine viruses are produced, evaluated, and made available to vaccine manufacturers in a timely fashion. This is an integrated activity involving global virologic and epidemiologic surveillance, genetic and antigenic characterization of influenza viruses, pandemic risk assessments, selection of appropriate virus strains for vaccines, production of reassortant viruses by reverse genetics, and finally, analysis of their safety and growth characteristics prior to distribution. These procedures must comply with national and international regulations governing vaccine and environmental safety. |
Immunosenescence and influenza vaccine efficacy
Sambhara S , McElhaney JE . Curr Top Microbiol Immunol 2009 333 413-29 A number of protective immune functions decline with age along with physiological and anatomical changes, contributing to the increased susceptibility of older adults to infectious diseases and suboptimal protective immune responses to vaccination. Influenza vaccination is the most cost-effective strategy to prevent complications from influenza viral infections; however, the immunogenicity and effectiveness of currently licensed vaccines in the United States is about 30-50% in preventing complications arising from influenza and preventing death from all causes during winter months in older adults. Hence, it is crucial to understand the molecular mechanisms that lead to immune dysfunction as a function of age so that appropriate strategies can be developed to enhance the disease resistance and immunogenicity of preventive vaccines, including influenza vaccines, for the older adult population. |
Ocular infection of mice with influenza A (H7) viruses: a site of primary replication and spread to the respiratory tract
Belser JA , Wadford DA , Xu J , Katz JM , Tumpey TM . J Virol 2009 83 (14) 7075-84 Avian H7 influenza viruses have been responsible for poultry outbreaks worldwide and have resulted in numerous cases of human infection in recent years. The high rate of conjunctivitis associated with avian H7 subtype virus infections may represent a portal of entry for avian influenza viruses and highlights the need to better understand the apparent ocular tropism observed in humans. To study this, mice were inoculated by the ocular route with viruses of multiple subtypes and degrees of virulence. We found that in contrast to human (H3N2 and H1N1) viruses, H7N7 viruses isolated from The Netherlands in 2003 and H7N3 viruses isolated from British Columbia, Canada, in 2004, two subtypes that were highly virulent for poultry, replicated to a significant titer in the mouse eye. Remarkably, an H7N7 virus, as well as some avian H5N1 viruses, spread systemically following ocular inoculation, including to the brain, resulting in morbidity and mortality of mice. This correlated with efficient replication of highly pathogenic H7 and H5 subtypes in murine corneal epithelial sheets (ex vivo) and primary human corneal epithelial cells (in vitro). Influenza viruses were labeled to identify the virus attachment site in the mouse cornea. Although we found abundant H7 virus attachment to corneal epithelial tissue, this did not account for the differences in virus replication as multiple subtypes were able to attach to these cells. These findings demonstrate that avian influenza viruses within H7 and H5 subtypes are capable of using the eye as a portal of entry. |
Pre-treatment syphilis titers: distribution and evaluation of their use to distinguish early from late latent syphilis and to prioritize contact investigations
Samoff E , Koumans EH , Gibson JJ , Ross M , Markowitz LE . Sex Transm Dis 2009 36 (12) 789-93 BACKGROUND: Treatment, contact investigation, and reporting decisions for syphilis cases are based on the stage of disease. Because of limitations of current staging protocols, the rapid plasma reagin (RPR) titer has been proposed as an alternative priority marker for contact investigation. METHODS: We describe the RPR titers and stages for 10,021 syphilis cases reported between 1997 and 1999 in Columbia, South Carolina; Houston, Texas; and Jackson, Mississippi. We constructed receiver operating characteristic curves (ROC curves) to compare titer and stage. We calculated the number of infected contacts to evaluate the use of titer to prioritize contact investigation. RESULTS: RPR titers differed by stage, with 67% of primary, 95% of secondary, 78% of early latent, and 41% of late latent and unknown duration having titers >1:8; however, there was considerable overlap in titer distributions. The ROC curve based on titer values demonstrated good agreement between titer and latent stage. Prioritization by titer (≥1:8) of latent cases would result in a similar number of cases interviewed and contacts located as stage prioritization, although different cases are prioritized. CONCLUSION: Titer distributions meaningfully but imperfectly distinguish populations with different stages. Recent analyses and anecdotal reports indicate the difficulty and inconsistency of staging latent syphilis. Over time, titer could provide a more objective and reliable historical record of syphilis trends. Titer may be a useful alternative or adjunct to stage in prioritizing latent syphilis cases for investigation. |
Preexposure to repeated low doses of zymosan increases the susceptibility to pulmonary infection in rats
Young SH , Antonini JM , Roberts JR . Exp Lung Res 2009 35 (7) 570-90 Chronic exposure to low levels of mold has been reported to increase susceptibility to respiratory infections. In the current study, the authors investigate the lungs' ability to clear an infection after repeated low-dose zymosan exposure. Exposure was conducted at a zymosan dose of 0.6 mg/kg body weight (bw) of rat, for a total of 4 doses, via intratracheal instillation during a 2 week period. Treated animals were allowed to recover for 1 week before pulmonary inoculation with Listeria monocytogenes. Bacterial clearance was determined by measuring colony-forming units cultured from the left lungs on days 3, 5, and 7 post bacteria infection. Bronchoalveolar lavage (BAL) was performed on the right lungs to recover phagocytes and BAL fluid to measure lung injury and the inflammatory cytokines. In contrast to the authors' previously published study that showed a single high dose (2.5 mg/kg bw) of zymosan prior to infection accelerated bacteria clearance, the repeated low-dose zymosan suppressed bacteria clearance from the lungs early after infection and induced higher lung injury and inflammation compared to control. The innate immune response was downregulated and a Th2 immune response was preferentially induced rather than a Th1 response, the latter being more effective toward the resolution of a L. monocytogenes infection. |
Reproducibility of serologic assays for influenza virus A (H5N1)
Stephenson I , Heath A , Major D , Newman RW , Hoschler K , Junzi W , Katz JM , Weir JP , Zambon MC , Wood JM . Emerg Infect Dis 2009 15 (8) 1252-9 Hemagglutination-inhibition (HI) and neutralization are used to evaluate vaccines against influenza virus A (H5N1); however, poor standardization leads to interlaboratory variation of results. A candidate antibody standard (07/150) was prepared from pooled plasma of persons given clade 1 A/Vietnam/1194/2004 vaccine. To test human and sheep antiserum, 15 laboratories used HI and neutralization and reassortant A/Vietnam/1194/2004, A/turkey/Turkey/1/2005 (clade 2.2), and A/Anhui/1/2005 (clade 2.3.4) viruses. Interlaboratory variation was observed for both assays, but when titers were expressed relative to 07/150, overall percentage geometric coefficient of variation for A/Vietnam/1194/2004 was reduced from 125% to 61% for HI and from 183% to 81% for neutralization. Lack of reduced variability to clade 2 antigens suggested the need for clade-specific standards. Sheep antiserum as a standard did not reliably reduce variability. The World Health Organization has established 07/150 as an international standard for antibody to clade 1 subtype H5 and has an assigned potency of 1,000 IU/ampoule. |
RIG-I activation inhibits ebolavirus replication
Spiropoulou CF , Ranjan P , Pearce MB , Sealy TK , Albarino CG , Gangappa S , Fujita T , Rollin PE , Nichol ST , Ksiazek TG , Sambhara S . Virology 2009 392 (1) 11-5 Hemorrhagic fever viruses are associated with rapidly progressing severe disease with high case fatality, making them of public health and biothreat importance. Effective antivirals are not available for most of the members of this diverse group of viruses. A broad spectrum strategy for antiviral development would be very advantageous. Perhaps the most challenging target would be the highly immunosuppressive filoviruses, ebolavirus and marburgvirus, associated with aerosol infectivity and case fatalities in the 80-90% range. Here we report that activation of evolutionarily conserved cytosolic viral nucleic acid sensor, RIG-I can cause severe inhibition of ebolavirus replication. These findings indicate that RIG-I-based therapies may provide an attractive approach for antivirals against Ebola hemorrhagic fever, and possibly other HF viruses. |
Size Distributions of 0.5 to 20 μm Aerodynamic Diameter Lead-Containing Particles from Aerosol Sampler Walls and Filters
Lee T , Chisholm WP , Slaven JE , Harper M . Aerosol Sci Technol 2009 43 (10) 1042-50 The study presented here investigates the number weighted particle size distributions of aerosols generated in the laboratory from lead oxide and lead sulfide dusts and sampled by Institute of Occupational Medicine (IOM) and closed face cassette (CFC) samplers as determined by scanning electron microscopy (SEM). The wall deposits and filter deposits from each sampler were characterized separately. A Mann-Whitney statistical analysis revealed that differences in the number weighted distributions of particles captured by the filter and the wall were not significant over the size range ( up to 20 mu m aerodynamic equivalent diameter) present in these laboratory-generated aerosols. Furthermore, for these samples it was not possible to distinguish an absolute difference between the IOM and CFC filter catches. By comparing direct measurements of aerodynamic equivalent diameter (AED) made by an Aerodynamic Particle Sizer (APS) to AEDs calculated from SEM images, empirical shape factors for lead oxide and lead sulfide were determined. To validate this approach APS and SEM measurements of the AED of 2 mu m and 6 mu m physical diameter monodisperse glass and polystyrene microspheres were made. Using the shape factors of spheres and the known densities of these materials, it was found that the SEM determinations of AED agreed with the APS results. To demonstrate the reliability of the redeposition method of sample preparation, lead sulfide and lead oxide aerosols were briefly sampled by IOM samplers such that sufficient particles were collected for SEM examination directly on the filter but not so many that particles were likely to touch or overlap. Half of each filter was analyzed in the SEM directly; the other half was ultrasonically |
Comparison of nucleic acid extraction methods for the detection of Mycoplasma pneumoniae
Thurman KA , Cowart KC , Winchell JM . Diagn Microbiol Infect Dis 2009 65 (4) 435-8 Four nucleic acid extraction procedures (2 automated and 2 manual) were compared for their efficiency at isolating Mycoplasma pneumoniae DNA. Oropharyngeal swabs from healthy volunteers were spiked with varying amounts of M. pneumoniae, extracted, and tested using real-time polymerase chain reaction. Our data indicate that both automated extraction methods consistently outperform the manual procedures. |
Detection of high levels of European bat lyssavirus type-1 viral RNA in the thyroid gland of experimentally-infected eptesicus fuscus bats
Fooks AR , Johnson N , Muller T , Vos A , Mansfield K , Hicks D , Nunez A , Freuling C , Neubert L , Kaipf I , Denzinger A , Franka R , Rupprecht CE . Zoonoses Public Health 2009 56 270-7 Two common bat lyssavirus species have been identified in many European countries: European bat lyssavirus type-1 and -2 (EBLV-1 and EBLV-2). Only limited knowledge on the susceptibility of the natural EBLV-hosts, insectivorous bats, to lyssavirus infection is available. Our study was undertaken to evaluate the susceptibility and pathology associated with an EBLV-1 infection in Eptesicus fuscus following different routes of virus inoculation including intracranial (n = 6), intramuscular (n = 14), oral (n = 7) and intranasal (n = 7). Blood and saliva samples were collected from all bats on a monthly basis. Four bats inoculated intracranially developed rabies with a mean of 11 days to death, whilst seven bats inoculated intramuscularly developed rabies, with an extended incubation period prior to death. We did not observe any mortality in the oral (p.o.) or intranasal (i.n.) groups and both groups had detectable levels of virus neutralizing antibodies (data not shown). Virus shedding was demonstrated in the saliva by virus isolation and the detection of viral RNA in ill bats, particularly immediately prior to the development of disease. In addition, the presence of virus and viral RNA was detected in the thyroid gland in bats challenged experimentally with EBLV-1, which exceeded that detected in all other extra-neural tissue. The significance of detecting EBLV-1 in the thyroid gland of rabid bats is not well understood. We speculate that the infection of the thyroid gland may cause subacute thyroiditis, a transient form of thyroiditis causing hyperthyroidism, resulting in changes in adrenocortical activity that could lead to hormonal dysfunction, thereby distinguishing the clinical presentation of rabies in the rabid host. |
Development and characterization of reference materials for MTHFR, SERPINA1, RET, BRCA1, and BRCA2 genetic testing
Barker SD , Bale S , Booker J , Buller A , Das S , Friedman K , Godwin AK , Grody WW , Highsmith E , Kant JA , Lyon E , Mao R , Monaghan KG , Payne DA , Pratt VM , Schrijver I , Shrimpton AE , Spector E , Telatar M , Toji L , Weck K , Zehnbauer B , Kalman LV . J Mol Diagn 2009 11 (6) 553-61 Well-characterized reference materials (RMs) are integral in maintaining clinical laboratory quality assurance for genetic testing. These RMs can be used for quality control, monitoring of test performance, test validation, and proficiency testing of DNA-based genetic tests. To address the need for such materials, the Centers for Disease Control and Prevention established the Genetic Testing Reference Material Coordination Program (GeT-RM), which works with the genetics community to improve public availability of characterized RMs for genetic testing. To date, the GeT-RM program has coordinated the characterization of publicly available genomic DNA RMs for a number of disorders, including cystic fibrosis, Huntington disease, fragile X, and several genetic conditions with relatively high prevalence in the Ashkenazi Jewish population. Genotypic information about a number of other cell lines has been collected and is also available. The present study includes the development and commutability/genotype characterization of 10 DNA samples for clinically relevant mutations or sequence variants in the following genes: MTHFR; SERPINA1; RET; BRCA1; and BRCA2. DNA samples were analyzed by 19 clinical genetic laboratories using a variety of assays and technology platforms. Concordance was 100% for all samples, with no differences observed between laboratories using different methods. All DNA samples are available from Coriell Cell Repositories and characterization information can be found on the GeT-RM website. |
Practice of feeding premasticated food to infants: a potential risk factor for HIV transmission
Gaur AH , Dominguez KL , Kalish ML , Rivera-Hernandez D , Donohoe M , Brooks JT , Mitchell CD . Pediatrics 2009 124 (2) 658-66 OBJECTIVES: Although some caregivers are known to premasticate food for infants, usually during the weaning period, HIV transmission has not been linked to this practice. We describe 3 cases of HIV transmission in the United States possibly related to this practice. PATIENTS AND METHODS: Three cases of HIV infection were diagnosed in children at ages 9, 15, and 39 months; clinical symptomatology prompted the testing. A thorough investigation to rule out alternative modes of transmission was conducted. In addition, phylogenetic comparisons of virus from cases and suspected sources were performed by using the C2V3C3 or gp41 region of env and the p17 coding region of gag. RESULTS: In 2 cases, the mothers were known to be infected with HIV, had not breastfed their children, and perinatal transmission of HIV had previously been ruled out following US HIV testing guidelines. In the third case, a great aunt who helped care for the child was infected with HIV, but the child's mother was not. All 3 children were fed food on multiple occasions that had been premasticated by a care provider infected with HIV; in 2 cases concurrent oral bleeding in the premasticating adult was described. Phylogenetic analyses supported the epidemiologic conclusion that the children were infected through exposure to premasticated food from a caregiver infected with HIV in 2 of the 3 cases. CONCLUSIONS: The reported cases provide compelling evidence linking premastication to HIV infection, a route of transmission not previously reported that has important global implications including being a possible explanation for some of the reported cases of "late" HIV transmission in infants, so far attributed to breastfeeding. Until the risk of premastication and modifying factors (eg, periodontal disease) are better understood, we recommend that health care providers routinely query children's caregivers and expecting parents who are infected with HIV or at risk of HIV infection about this feeding practice and direct them to safer, locally available, feeding options. |
Antiepileptic drug use in women of childbearing age
Meador KJ , Penovich P , Baker GA , Pennell PB , Bromfield E , Pack A , Liporace JD , Sam M , Kalayjian LA , Thurman DJ , Moore E , Loring DW , NEAD Study Group . Epilepsy Behav 2009 15 (3) 339-43 Research on antiepileptic drug (AED) teratogenesis has demonstrated an increased risk for valproate. The impact of these findings on current AED prescribing patterns for women of childbearing age with epilepsy is uncertain. The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study is an ongoing prospective multicenter observational investigation that enrolled pregnant women with epilepsy on the most common AED monotherapies from October 1999 to February 2004 (carbamazepine, lamotrigine, valproate, and phenytoin). A 2007 survey of AED use in women of childbearing age at eight NEAD centers found a total of 932 women of childbearing age with epilepsy (6% taking no AED, 53% monotherapy, 41% polytherapy). The most common monotherapies were lamotrigine or levetiracetam. Since 2004, prescriptions of carbamazepine, phenytoin, and valproate have decreased, whereas those for levetiracetam have increased. Except for the top two AED monotherapies, there were marked differences in other monotherapies and in polytherapies between U.S. and UK centers. Future investigations are needed to examine reasons for drug choice. |
Development of sizing structure for fall arrest harness design
Hsiao H , Friess M , Bradtmiller B , Rohlf FJ . Ergonomics 2009 52 (9) 1128-43 Updated harness designs are needed to accommodate diverse populations in the current workforce. This paper determined an improved fall-arrest harness sizing scheme and strap-length configurations for harness design. A 3-D elliptic Fourier analysis (EFA) procedure with 123 coefficients was developed to quantify torso-shape effect on harness fit, based on 3-D data of 108 women and 108 men. The EFA coefficients were then applied to 600 representative body scans from a national database of 2382 participants to establish an improved sizing system. Study outcomes suggested a more upward back D-ring location for women than current unisex designs to accommodate female torso form and mitigate their fit problem. Results also suggested an improved system of three sizes for women and three sizes for men. New harness sizing charts for women and men were proposed accordingly. Using the most current 3-D whole-body digital scanning technology, this study assembled data from a US workforce to establish an improved fall-arrest harness sizing system and strap configurations for men and women. The information is useful for new generation harness designs to reduce the risk of worker injury. |
Evaluation of COSHH essentials: methylene chloride, isopropanol, and acetone exposures in a small printing plant
Lee EG , Harper M , Bowen RB , Slaven J . Ann Occup Hyg 2009 53 (5) 463-74 The current study evaluated the Control of Substances Hazardous to Health (COSHH) Essentials model for short-term task-based exposures and full-shift exposures using measured concentrations of three volatile organic chemicals at a small printing plant. A total of 188 exposure measurements of isopropanol and 187 measurements of acetone were collected and each measurement took approximately 60 min. Historically, collected time-weighted average concentrations (seven results) were evaluated for methylene chloride. The COSHH Essentials model recommended general ventilation control for both isopropanol and acetone. There was good agreement between the task-based exposure measurements and the COSHH Essentials predicted exposure range (PER) for cleaning and print preparation with isopropanol and for cleaning with acetone. For the other tasks and for full-shift exposures, agreement between the exposure measurements and the PER was either moderate or poor. However, for both isopropanol and acetone, our findings suggested that the COSHH Essentials model worked reasonably well because the probabilities of short-term exposure measurements exceeding short-term occupational exposure limits (OELs) or full-shift exposures exceeding the corresponding full-shift OELs were <0.05 under the recommended control strategy. For methylene chloride, the COSHH Essentials recommended containment control but a follow-up study was not able to be performed because it had already been replaced with a less hazardous substance (acetone). This was considered a more acceptable alternative to increasing the level of control. |
Induction of aneuploidy by single-walled carbon nanotubes
Sargent LM , Shvedova AA , Hubbs AF , Salisbury JL , Benkovic SA , Kashon ML , Lowry DT , Murray AR , Kisin ER , Friend S , McKinstry KT , Battelli L , Reynolds SH . Environ Mol Mutagen 2009 50 (8) 708-17 Engineered carbon nanotubes are newly emerging manufactured particles with potential applications in electronics, computers, aerospace, and medicine. The low density and small size of these biologically persistent particles makes respiratory exposures to workers likely during the production or use of commercial products. The narrow diameter and great length of single-walled carbon nanotubes (SWCNT) suggest the potential to interact with critical biological structures. To examine the potential of nanotubes to induce genetic damage in normal lung cells, cultured primary and immortalized human airway epithelial cells were exposed to SWCNT or a positive control, vanadium pentoxide. After 24 hr of exposure to either SWCNT or vanadium pentoxide, fragmented centrosomes, multiple mitotic spindle poles, anaphase bridges, and aneuploid chromosome number were observed. Confocal microscopy demonstrated nanotubes within the nucleus that were in association with cellular and mitotic tubulin as well as the chromatin. Our results are the first to report disruption of the mitotic spindle by SWCNT. The nanotube bundles are similar to the size of microtubules that form the mitotic spindle and may be incorporated into the mitotic spindle apparatus. Environ. Mol. Mutagen., 2009. Published 2009 Wiley-Liss, Inc. |
Pneumoconiosis among underground bituminous coal miners in the United States: is silicosis becoming more frequent?
Laney AS , Petsonk EL , Attfield MD . Occup Environ Med 2009 67 (10) 652-6 OBJECTIVES: Epidemiologic reports since 2000 have documented increased prevalence and rapid progression of pneumoconiosis among underground coal miners in the United States. To investigate a possible role of silica exposure in the increase, we examined chest x-rays (CXRs) for specific abnormalities (r-type small opacities) known to be associated with silicosis lung pathology. METHODS: Underground coal miners are offered CXRs every 5 years. Abnormalities consistent with pneumoconiosis are recorded by National Institute for Occupational Safety and Health (NIOSH) B Readers using the International Labour Office Classification of Radiographs of Pneumoconioses. CXRs from 1980-2008 of 90,973 participating miners were studied, focusing on reporting of r-type opacities (small rounded opacities 3-10 mm in diameter). Log binomial regression was used to calculate prevalence ratios adjusted for miner age and profusion category. RESULTS: Among miners from Kentucky, Virginia, and West Virginia, the proportion of radiographs showing r-type opacities increased in the 1990s (PR=2.5; 95% CI=1.7-3.7) and after 1999 (PR=4.1; 95% CI=3.0-5.6), compared to the 1980s (adjusted for profusion category and miner age). The prevalence of progressive massive fibrosis in 2000-2008 was also elevated compared to the 1980's (PR=4.4; 95% CI=3.1-6.3) and 1990's (PR=3.8; 95% CI=2.1-6.8) in miners from Kentucky, Virginia, and West Virginia. CONCLUSIONS: The increasing prevalence of pneumoconiosis over the past decade and the change in the epidemiology and disease profile documented in this and other recent studies imply that U.S. coal miners are being exposed to excessive amounts of respirable crystalline silica. |
The prescribed amount of physical activity in randomized clinical trials in older adults
Kruger J , Buchner DM , Prohaska TR . Gerontologist 2009 49 S100-7 PURPOSE: Over the past two decades, a consensus has formed that increasing physical activity and reducing sedentary behavior in older adults are important for physical and cognitive health. Although there is strong evidence that regular physical activity can prevent or delay the onset of many chronic diseases, a major concern is ensuring that older adults take part in adequate levels of physical activity. DESIGN AND METHODS: This article describes the amount of physical activity prescribed between 1980 and 2005 to sedentary older adults enrolled in randomized controlled trials (RCTs) using MEDLINE, Health and Psychological Instruments, EBM Reviews, CINAHL, ERIC, PsychInfo, and Social Science Abstracts with the key words "exercise," "physical activity," and "older adult." More than 13,502 research abstracts were reviewed, and 160 RCTs 12 weeks or more in duration with documented outcomes of physical activity were synthesized. RESULTS: The average prescribed dose of aerobic activity provided by interventions for older adults was less than the recommended amount of 150 min or more per week of moderate-intensity physical activity. In interpreting the results of RCTs, there is an insufficient body of evidence on the relationship between physical activity and cognitive health. However, studies indicated that moderate-intensity physical activity had a positive effect on cognitive health. IMPLICATIONS: Given the broad consensus of a dose-response relationship between aerobic activity and a variety of health outcomes, the RCT literature appears to have underestimated the benefit of physical activity for previously sedentary older adults because the prescribed dosages are not consistent with those recommended. |
Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study
Steinberg M , Leoutsakos JM , Podewils LJ , Lyketsos CG . Int J Geriatr Psychiatry 2009 24 (7) 680-5 OBJECTIVE: To determine the feasibility and efficacy of a home-based exercise intervention program to improve the functional performance of patients with Alzheimer's Disease (AD). METHODS: Twenty-seven home-dwelling patients with AD were randomized to either an exercise intervention program delivered by their caregivers or a home safety assessment control. Measures of functional performance (primary), cognition, neuropsychiatric symptoms, quality of life and caregiver burden (secondary) were obtained at baseline and at 6 and 12 weeks following randomization. For each outcome measure, intent-to-treat analyses using linear random effects models were performed. Feasibility and adverse events were also assessed. RESULTS: Adherence to the exercise program was good. On the primary outcomes (functional performance) patients in the exercise group demonstrated a trend for improved performance on measures of hand function and lower extremity strength. On secondary outcome measures, trends toward worse depression and lower quality of life ratings were noted. CONCLUSIONS: The physical exercise intervention developed for the study, delivered by caregivers to home-dwelling patients with AD, was feasible and was associated with a trend for improved functional performance in this group of frail patients. Given the limited efficacy to date of pharmacotherapies for AD, further study of exercise intervention, in a variety of care setting, is warranted. |
Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing--invited commentary
Budnitz DS . Arch Intern Med 2009 169 (14) 1332-4 In 2006, nearly 20% of adults 65 years or older in the United States took at least 10 medications, nearly 60% took 5 or more medications, and over 90% took at least 1 medication a week.1 In 2007, total Medicare spending on outpatient prescription drugs (part D) increased 17.5% to $47.6 billion.2 The number of drugs used by older adults will likely further increase owing to an aging population, the development of new prescription medications, the transition of prescription medications to over-the-counter availability, and the increasing use of drugs for chemoprevention. | Physicians and pharmacists, health services researchers and pharmacologists, policy makers, and payers have been struggling to improve the safety and effectiveness of prescribing for older adults for decades. Most of this effort has focused on identifying medications that might be associated with elevated risks and reduced benefits in older adults and reducing the use of these medications. In 1991, Beers et al3 introduced criteria to help researchers evaluate prescribing quality in nursing homes (hereinafter, Beers criteria). In 2001, Zhan et al4 published a subset of the criteria by Beers et al for evaluating prescribing quality in outpatient populations (hereinafter, Zhan criteria). Other measures of potentially inappropriate medication use in older adults have been used in Canada, and new measures have recently been developed specifically for French and Irish populations.5 |
Introduction to the special issue on promoting cognitive health in diverse populations of older adults
Anderson L , Logsdon RG , Hochhalter AK , Sharkey JR . Gerontologist 2009 49 S1-2 This special issue of The Gerontologist, “Promoting Cognitive Health in Diverse Populations of Older Adults,” is devoted to cognitive health, a major factor in ensuring quality of life and preserving independence. Cognitive health has been identified as a priority area for aging and public health through national efforts such as the National Institutes of Health's Cognitive and Emotional Health Project (Hendrie et al., 2006) and the Centers for Disease Control and Prevention's (CDC) Healthy Brain Initiative (Anderson & McConnell, 2007). This increased recognition also aligns with growing awareness of the significant health, social, and economic burden associated with cognitive impairments; rising concerns and fears about potential loss of cognitive functions with age; and increasing demands of family and professional caregivers. As the readers of The Gerontologist are well aware, the U.S. population as a whole is aging at an unprecedented rate, and with that change comes an increasing incidence of cognitive impairments, such as Alzheimer's disease and other dementias (Administration on Aging, 2005). Alzheimer's disease is now the sixth leading cause of death among U.S. adults aged 18 years or older and the fifth leading cause of death among those aged 65 years or older (Heron, Hoyert, Xu, Scott, & Tejada-Vera, 2008). |
'Learn the signs. Act early': A campaign to help every child reach his or her full potential
Daniel KL , Prue C , Taylor MK , Thomas J , Scales M . Public Health 2009 123 e11-6 OBJECTIVE: To examine the application of a social marketing approach to increase the early identification and treatment of autism and other developmental disorders. STUDY DESIGN: The intervention used formative research, behaviour change theory and traditional social marketing techniques to develop a campaign targeting parents, healthcare professionals and early educators to increase awareness of autism and other developmental delays, and to prompt action if a developmental delay was suspected. METHOD: Using social marketing principles, the Centers for Disease Control and Prevention applied baseline research with the target audiences to understand the barriers and motivators to behaviour change, which included a lack of knowledge and resources (barriers), along with a willingness to learn and do more (motivators). Focus group testing of potential campaign concepts led to one particular approach and accompanying images, which together increased perceived severity of the problem and encouraged taking action. The audience research also helped to shape the marketing mix (product, price, place and promotion). RESULTS: Three-year follow-up research in this case study indicates a significant change in parent target behaviours, particularly among parents aware of the campaign, and substantially more healthcare professionals believe that they have the resources to educate parents about monitoring their child's cognitive, social and physical development. Qualitative results from early educators and childcare professional associations have been positive about products developed for daycare settings. CONCLUSION: The application of social marketing principles, behavior change theory and audience research was an effective approach to changing behaviours in this case. Understanding what the target audiences want and need, looking beyond parents to engage healthcare professionals and early educators, and engaging many strategic partners to extend the reach of the message helped campaign planners to develop a campaign that resonated with the target audiences and, importantly, moved them towards action. |
Driving after binge drinking
Naimi TS , Nelson DE , Brewer RD . Am J Prev Med 2009 37 (4) 314-20 BACKGROUND: Although binge drinking is strongly associated with alcohol-impaired driving, little is known about the prevalence of or risk factors for driving after binge drinking. PURPOSE: The purpose of this study was to assess the prevalence of, and risk factors for, driving during or shortly after a specific binge drinking episode. METHODS: The data were analyzed in 2007 and 2008 from 14,085 adults from 13 states in 2003 and 14 states in 2004 who reported binge drinking and answered an additional series of questions about binge drinking behaviors as part of the Behavioral Risk Factor Surveillance System survey. Binge drinking was defined as the consumption of five or more drinks during a drinking occasion. RESULTS: Overall, 11.9% of binge drinkers drove during or within 2 hours of their most recent binge drinking episode. Those drinking in licensed establishments (bars, clubs, and restaurants) accounted for 54.3% of these driving episodes. Significant independent risk factors for driving after binge drinking included male gender (AOR = 1.75); being aged 35-54 or > or = 55 years compared to 18-34 years (AOR = 1.58 and 2.37, respectively); and drinking in bars or clubs compared to drinking in the respondent's home (AOR = 7.81). Drivers who drank most of their alcohol in licensed establishments consumed an average of 8.1 drinks, and 25.7% of them consumed > or = 10 drinks. CONCLUSIONS: Because binge drinking and subsequent driving were common in establishments licensed to sell alcohol, and because licensing is conditional on responsible beverage service practices (i.e., not selling to intoxicated people), efforts to prevent impaired driving should focus on enforcing responsible beverage service in licensed establishments. |
The efficacy of HIV/STI behavioral interventions for african american females in the United States: A meta-analysis
Crepaz N , Marshall KJ , Aupont LW , Jacobs ED , Mizuno Y , Kay LS , Jones P , McCree DH , O'Leary A . Am J Public Health 2009 99 (11) 2069-78 OBJECTIVES: We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy. METHODS: We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression. RESULTS: Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR]=0.63; 95% confidence interval [CI]=0.54, 0.75; n=11239; Cochrane Q32=84.73; P<.001) and sexually transmitted infections (STIs; OR=0.81; 95% CI=0.67, 0.98; n=8760; Cochrane Q16=22.77; P=.12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills. CONCLUSIONS: Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population. |
Exploring the mental health of black men who have sex with men
Graham LF , Braithwaite K , Spikes P , Stephens CF , Edu UF . Community Ment Health J 2009 45 (4) 272-84 Current research indicates that black men who have sex with men (MSM) are disproportionately burdened by depressive distress and anxiety disorders as compared to their white gay and heterosexual counterparts. This study utilizes focus groups to qualitatively explore issues surrounding the mental health status of this population in an attempt to shed light on potential influencing and determinant factors. Twenty-two self-identified black, or multi-racial including black, MSM residing in Atlanta, Georgia participated in two focus groups--11 subjects each, respectively. Categories that emerged from data analysis include: knowledge/experiences, attitudes/beliefs, societal action/behavior, identity development, relationship functionality, and mental health status. Overarching themes for each category were delineated. |
The Hispanic mortality advantage and ethnic misclassification on US death certificates
Arias E , Eschbach K , Schauman WS , Backlund EL , Sorlie PD . Am J Public Health 2009 100 S171-7 OBJECTIVES: We tested the data artifact hypothesis regarding the Hispanic mortality advantage by investigating whether and to what degree this advantage is explained by Hispanic origin misclassification on US death certificates. METHODS: We used the National Longitudinal Mortality Study, which links Current Population Survey records to death certificates for 1979 through 1998, to estimate the sensitivity, specificity, and net ascertainment of Hispanic ethnicity on death certificates compared with survey classifications. Using national vital statistics mortality data, we estimated Hispanic age-specific and age-adjusted death rates, which were uncorrected and corrected for death certificate misclassification, and produced death rate ratios comparing the Hispanic with the non-Hispanic White population. RESULTS: Hispanic origin reporting on death certificates in the United States is reasonably good. The net ascertainment of Hispanic origin is just 5% higher on survey records than on death certificates. Corrected age-adjusted death rates for Hispanics are lower than those for the non-Hispanic White population by close to 20%. CONCLUSIONS: The Hispanic mortality paradox is not explained by an incongruence between ethnic classification in vital registration and population data systems. |
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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