Screen time, cardiorespiratory fitness and adiposity among school-age children from Monteria, Colombia
Arango CM , Parra DC , Gomez LF , Lema L , Lobelo F , Ekelund U . J Sci Med Sport 2014 17 (5) 491-5 OBJECTIVES: To explore the association between electronic media exposure (television viewing time, personal computer/video game use, total screen time), and waist circumference and body mass index, and study whether this association is independent of cardiorespiratory fitness, in a representative sample of adolescents from Monteria, Colombia. DESIGN: Cross-sectional study analyzing data from 546 students aged 11-18 years, from fourteen randomly selected schools. Z-scores for WC and BMI were calculated. METHODS: The physical activity module of the Global School Health Survey 2007 was used to determine EME, and the shuttle run test was used to assess CRF. Linear regression models adjusted by age, school location, physical activity level, type of institution (public or private), consumption of sweetened beverages, fast food, and fried food were used. RESULTS: Among boys, independently of cardiorespiratory fitness, high television viewing time (≥2h/day) (beta=+0.22; p<0.02), was positively associated with waist circumference. High total screen time (>3h/day) was positively associated with waist circumference (beta=+0.34; p<0.01), and body mass index (beta=+0.39; p<0.01). Among girls, sedentary behavior was not associated with adiposity, but cardiorespiratory fitness (beta=-0.04; p<0.02) was negatively associated with body mass index. CONCLUSIONS: These findings support the evidence on the negative impact of excessive electronic media exposure and low cardiorespiratory fitness, and highlight the need for interventions and prevention strategies. |
Noninfectious disease among the Bhutanese refugee population at a United States urban clinic
Kumar GS , Varma S , Saenger MS , Burleson M , Kohrt BA , Cantey P . J Immigr Minor Health 2014 16 (5) 922-5 A large number of Bhutanese are currently being resettled to the United States. A high prevalence of noninfectious diseases has been noted in some refugee groups, but data on the Bhutanese refugee population are lacking. A retrospective, chart review study was conducted to determine proportion of noninfectious disease among ethnically Nepali Bhutanese refugees (n = 66) seen at the Grady Refugee Clinic (GRC). GRC disease proportions included the following: 52 % of the patients were overweight/obese (n = 34), 23 % were hypertensive (n = 15), 12 % had vitamin B12 deficiency (n = 8), 15 % had depression (n = 10), and 14 % had diabetes (n = 9). Nine (90 %) patients with depression had chronic disease compared to 30 (54 %) of the patients without depression. The study found a substantial burden of chronic disease, micronutrient deficiency, and depression in the GRC. Further research is needed to accurately describe the disease burden in refugee populations and to evaluate pre-resettlement disease prevention strategies to provide a framework for future public health interventions. |
Prevalence and incidence of systemic lupus erythematosus in a population-based registry of American Indian and Alaska Native people, 2007-2009
Ferucci ED , Johnston JM , Gaddy JR , Sumner L , Posever JO , Choromanski TL , Gordon C , Lim SS , Helmick CG . Arthritis Rheumatol 2014 66 (9) 2494-502 OBJECTIVE: Few studies have investigated the epidemiology of systemic lupus erythematosus (SLE) in American Indian and Alaska Native populations. The objective of this study was to determine the prevalence and incidence of SLE in the Indian Health Service (IHS) active clinical population in 3 regions of the US. METHODS: For this population-based registry within the IHS, the denominator consisted of individuals in the IHS active clinical population in 2007, 2008, and/or 2009 and residing in a community in 1 of 3 specified regions. Potential SLE cases were identified based on the presence of a diagnostic code for SLE or related disorder in the IHS National Data Warehouse. Detailed medical record abstraction was performed for each potential case. The primary case definition was documentation in the medical record of ≥4 of the revised American College of Rheumatology criteria for the classification of SLE. Prevalence was calculated for 2007, and the mean annual incidence was calculated for the years 2007 through 2009. RESULTS: The age-adjusted prevalence and incidence of SLE according to the primary definition were 178 per 100,000 person-years (95% confidence interval [95% CI] 157-200) and 7.4 per 100,000 person-years (95% CI 5.1-10.4). Among women, the age-adjusted prevalence was 271, and the age-adjusted incidence was 10.4. The prevalence was highest in women ages 50-59 years and in the Phoenix Area IHS. CONCLUSION: The first population-based lupus registry in the US American Indian and Alaska Native population has demonstrated that the prevalence and incidence of SLE are high. Our estimates are as high as or higher than the rates reported in the US black population. |
Age adjustment of diabetes prevalence: use of 2010 US Census data 2010
Li C , Ford ES , Zhao G , Wen XJ , Gotway CA . J Diabetes 2014 6 (5) 451-61 BACKGROUND: There is a growing interest in using the 2010 US Census data for age adjustment after the Census data are officially released. This report discusses the rationale, procedures, demonstrations, and caveats of age adjustment using the 2010 US Census data. METHODS: Empirical data from the Behavioral Risk Factor Surveillance System and the 2010 US Census age composition were used in demonstrations of computing the age-adjusted prevalence of diagnosed diabetes by race/ethnicity, across various geographic regions, and over time. RESULTS: The use of the 2010 US Census data yielded higher age-adjusted prevalence of diagnosed diabetes than using the 2000 projected US population data. The differences persisted across geographic regions, among racial/ethnic groups, and over time. Sixteen age compositions were generated to facilitate the use of the 2010 Census data in age adjustment. The SAS survey procedures and SUDAAN software programs yielded similar age-adjusted prevalence estimates of diagnosed diabetes. CONCLUSIONS: Using the 2010 US Census data tends to yield a higher age-adjusted measure than using the 2000 projected US population data. Consistent use of a standard population and age composition is recommended once they are chosen for age adjustment. |
Does knowing one's elevated glycemic status make a difference in macronutrient intake?
Bardenheier BH , Cogswell ME , Gregg EW , Williams DE , Zhang Z , Geiss LS . Diabetes Care 2014 37 (12) 3143-9 OBJECTIVE: To determine whether macronutrient intake differs by awareness of glycemic status among people with diabetes and prediabetes. RESEARCH DESIGN AND METHODS: We used 24-h dietary recall and other data from 3,725 nonpregnant adults with diabetes or prediabetes aged ≥20 years from the morning fasting sample of the 2005-2010 National Health and Nutrition Examination Surveys. Diabetes and prediabetes awareness were self-reported; those unaware of diabetes and prediabetes were defined by fasting plasma glucose (FPG) ≥126 mg/dL or HbA1c ≥6.5% and FPG 100-125 mg/dL or HbA1c of 5.7%-6.4%, respectively. Components of nutrient intake on a given day assessed were total calories, sugar, carbohydrates, fiber, protein, fat, and total cholesterol, stratified by sex and glycemic status awareness. Estimates of nutrient intake were adjusted for age, race/ethnicity, education level, BMI, smoking status, and family history of diabetes. RESULTS: Men with diagnosed diabetes consumed less sugar (mean 86.8 vs. 116.8 g) and carbohydrates (mean 235.0 vs. 262.1 g) and more protein (mean 92.3 vs. 89.7 g) than men with undiagnosed diabetes. Similarly, women with diagnosed diabetes consumed less sugar (mean 79.1 vs. 95.7 g) and more protein (mean 67.4 vs. 56.6 g) than women with undiagnosed diabetes. No significant differences in macronutrient intake were found by awareness of prediabetes. All participants, regardless of sex or glycemic status, consumed on average less than the American Diabetes Association recommendations for fiber intake (i.e., 14 g/1,000 kcal) and slightly more saturated fat than recommended (>10% of total kilocalories). CONCLUSIONS: Screening and subsequent knowledge of glycemic status may favorably affect some dietary patterns for people with diabetes. |
Molecular surveillance of rotavirus infection in Bangui, Central African Republic, October 2011-September 2013.
Banga-Mingo V , Waku-Kouomou D , Gody JC , Esona MD , Yetimbi JF , Mbary-Daba R , Dahl BA , Dimanche L , Koyazegbe TD , Tricou V , Cavallaro KF , Guifara G , Bowen MD , Gouandjika-Vasilache I . Infect Genet Evol 2014 28 476-9 BACKGROUND: The World Health Organization (WHO) recommends the introduction of rotavirus vaccine in the immunization program of all countries. In the Central African Republic (CAR), sentinel surveillance for rotavirus gastroenteritis was established in 2011 by the Ministry of Health, with the support of the Surveillance en Afrique Centrale Project (SURVAC). The purpose of this study was to assess the burden of rotavirus gastroenteritis and to identify rotavirus strains circulating in CAR before the introduction of rotavirus vaccine planned for this year, 2014. METHODS: One sentinel site and one laboratory at the national level were designated by the CAR Ministry of Health to participate in this surveillance system. Stool samples were collected from children who met the WHO rotavirus gastroenteritis case definition (WHO, 2006). The samples were first screened for group A rotavirus antigen by enzyme immunoassay (EIA), and genotyping assays performed using a multiplex reverse transcriptase PCR (RT-PCR) technique. RESULTS: Between October 2011 and September 2013, 438 stool samples were collected and analyzed for detection of rotavirus antigen; 206 (47%) were positive. Among the 160 (78%) that could be genotyped, G2P[6] was the predominant strain (47%) followed by G1P[8] (25%) and G2P[4] (13%). CONCLUSIONS: Almost half of stool samples obtained from children hospitalized with gastroenteritis were positive for rotavirus. These baseline rotavirus surveillance data will be useful to health authorities considering rotavirus vaccine introduction and for evaluating the efficacy of rotavirus vaccine once it is introduced into the routine immunization system. |
Genomic epidemiology of Salmonella enterica serotype Enteritidis based on population structure of prevalent lineages.
Deng X , Desai PT , den Bakker HC , Mikoleit M , Tolar B , Trees E , Hendriksen RS , Frye JG , Porwollik S , Weimer BC , Wiedmann M , Weinstock GM , Fields PI , McClelland M . Emerg Infect Dis 2014 20 (9) 1481-9 Salmonella enterica serotype Enteritidis is one of the most commonly reported causes of human salmonellosis. Its low genetic diversity, measured by fingerprinting methods, has made subtyping a challenge. We used whole-genome sequencing to characterize 125 S. enterica Enteritidis and 3 S. enterica serotype Nitra strains. Single-nucleotide polymorphisms were filtered to identify 4,887 reliable loci that distinguished all isolates from each other. Our whole-genome single-nucleotide polymorphism typing approach was robust for S. enterica Enteritidis subtyping with combined data for different strains from 2 different sequencing platforms. Five major genetic lineages were recognized, which revealed possible patterns of geographic and epidemiologic distribution. Analyses on the population dynamics and evolutionary history estimated that major lineages emerged during the 17th-18th centuries and diversified during the 1920s and 1950s. |
Identification of molecular markers associated with alteration of receptor-binding specificity in a novel genotype of highly pathogenic avian influenza A(H5N1) viruses detected in Cambodia in 2013.
Rith S , Davis CT , Duong V , Sar B , Horm SV , Chin S , Ly S , Laurent D , Richner B , Oboho I , Jang Y , Davis W , Thor S , Balish A , Iuliano AD , Sorn S , Holl D , Sok T , Seng H , Tarantola A , Tsuyuoka R , Parry A , Chea N , Allal L , Kitsutani P , Warren D , Prouty M , Horwood P , Widdowson MA , Lindstrom S , Villanueva J , Donis R , Cox N , Buchy P . J Virol 2014 88 (23) 13897-909 Human infections with influenza A(H5N1) virus in Cambodia increased sharply during 2013. Molecular characterization of viruses detected in clinical specimens from human cases revealed the presence of mutations associated with alteration of receptor-binding specificity (K189R, Q222L) and respiratory droplet transmission in ferrets (N220K with Q222L). Discovery of quasispecies at position 222 (Q/L), in addition to absence of the mutations in poultry/environmental samples, suggested the mutations occurred during human infection and did not transmit further. |
Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis
Dharmadhikari AS , Mphahlele M , Venter K , Stoltz A , Mathebula R , Masotla T , van der Walt M , Pagano M , Jensen P , Nardell E . Int J Tuberc Lung Dis 2014 18 (9) 1019-25 BACKGROUND: Effective treatment for drug-susceptible tuberculosis (TB) rapidly renders patients non-infectious, long before conversion of sputum acid-fast smear or culture to negative. Multidrug-resistant TB (MDR-TB) patients on treatment are currently assumed to remain infectious for months. While the resources required for prolonged hospitalization are a barrier to the scale-up of MDR-TB treatment, the safety of community treatment is clear. OBJECTIVES: To estimate the impact of treatment on infectiousness among MDR-TB patients. METHODS: A series of five human-to-guinea pig TB transmission studies was conducted to test various interventions for infection control. Guinea pigs in adjacent chambers were exposed to exhaust air from a hospital ward occupied by mostly sputum smear- and culture-positive MDR-TB patients. The guinea pigs then underwent tuberculin skin testing for infection. Only the control groups of guinea pigs from each study (no interventions used) provide the data for this analysis. The number of guinea pigs infected in each study is reported and correlated with Mycobacterium tuberculosis drug susceptibility relative to treatment. RESULTS: Despite exposure to presumably infectious MDR-TB patients, infection percentages among guinea pigs ranged from 1% to 77% in the five experiments conducted. In one experiment in which guinea pigs were exposed to 27 MDR-TB patients newly started on effective treatment for 3 months, there was minimal transmission. In four other experiments with greater transmission, guinea pigs had been exposed to patients with unsuspected extensively drug-resistant tuberculosis who were not on effective treatment. CONCLUSIONS: In this model, effective treatment appears to render MDR-TB patients rapidly non-infectious. Further prospective studies on this subject are needed. |
Risk factors for HCV infection among young adults in rural New York who inject prescription opioid analgesics
Zibbell JE , Hart-Malloy R , Barry J , Fan L , Flanigan C . Am J Public Health 2014 104 (11) e1-e7 OBJECTIVES: We investigated a cluster of new hepatitis C cases in rural New York among a cohort of young people who inject drugs (PWID) and misuse prescription opioid analgesics (POA). METHODS: We recruited a purposive sample of PWID from Cortland County for an in-person survey and HCV rapid antibody test (March-July 2012). We examined sociodemographics, drugs currently injected, and lifetime and recent injection behaviors to ascertain associations with HCV antibody (anti-HCV) positivity. RESULTS: Of 123 PWID, 76 (61.8%) were younger than 30 years, and 100 (81.3%) received HCV rapid testing. Of those tested, 34 (34.0%) were positive. Participants who reported injecting POA in the past 12 months were 5 times more likely to be anti-HCV positive than those who injected drugs other than POA, and participants who reported sharing injection equipment in the past 12 months were roughly 4 times more likely to be anti-HCV positive than those who did not. CONCLUSIONS: Our analysis suggests people injecting POA may be at higher risk for HCV infection than people who inject heroin or other drugs but not POA. |
Severe respiratory illness associated with enterovirus D68 - Missouri and Illinois, 2014
Midgley CM , Jackson MA , Selvarangan R , Turabelidze G , Obringer E , Johnson D , Giles BL , Patel A , Echols F , Oberste MS , Nix WA , Watson JT , Gerber SI . MMWR Morb Mortal Wkly Rep 2014 63 (36) 798-9 On August 19, 2014, CDC was notified by Children's Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5-19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children's Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68 (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing. |
Viability of Leptospira isolates from a human outbreak in Thailand in various water types, pH, and temperature conditions
Stoddard RA , Bui D , Haberling DL , Wuthiekanun V , Thaipadungpanit J , Hoffmaster AR . Am J Trop Med Hyg 2014 91 (5) 1020-2 Leptospira spp. isolated from patients during a multiyear outbreak in Thailand were genotyped using multilocus sequence typing and a majority were identified as ST34, especially in earlier years. We tested whether ST34 isolates were better adapted to survive in various pH levels, temperatures, and water sources. Motility and growth were monitored over a 12-week period. Early year ST34 isolates did not appear to have a significant fitness advantage over non-ST34, however, this may have been because a majority of the isolates survived to the termination of the study, with the exception being at high temperature (37 degrees C) and/or basic pH (8.65). Failure to detect a significant fitness advantage of ST34 may be a result of the length of the study or the small sample size. Lengthening the study and looking at virulence and maintenance in the host could yield additional information about this outbreak. |
What obstetrician-gynecologists should know about Ebola: a perspective from the Centers for Disease Control and Prevention
Jamieson DJ , Uyeki TM , Callaghan WM , Meaney-Delman D , Rasmussen SA . Obstet Gynecol 2014 124 (5) 1005-1010 West Africa is currently in the midst of the largest Ebola outbreak in history. Although there have been no Ebola virus disease cases identified in the United States, two U.S. health care workers with Ebola virus disease were medically evacuated from Liberia to the United States in early August 2014. The Centers for Disease Control and Prevention has been working closely with other U.S. government agencies and international and nongovernmental partners for several months to respond to this global crisis. Limited evidence suggests that pregnant women are at increased risk for severe illness and death when infected with Ebola virus, but there is no evidence to suggest that pregnant women are more susceptible to Ebola virus disease. In addition, pregnant women with Ebola virus disease appear to be at an increased risk for spontaneous abortion and pregnancy-associated hemorrhage. Neonates born to mothers with Ebola virus disease have not survived. Although it is very unlikely that obstetrician-gynecologists (ob-gyns) in the United States will diagnose or treat a patient with Ebola virus disease, it is important that all health care providers are prepared to evaluate and care for these patients. Specifically, U.S. health care providers, including ob-gyns, should ask patients about recent travel and should know the signs and symptoms of Ebola virus disease and what to do if assessing a patient with compatible illness. This article provides general background information on Ebola and specifically addresses what is known about Ebola virus disease in pregnancy and the implications for practicing ob-gyns in the United States. |
Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females
Steiner RJ , Swartzendruber AL , Rose E , DiClemente RJ . Sex Transm Dis 2014 41 (10) 601-4 Among 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population. |
Partner meeting place is significantly associated with gonorrhea and chlamydia in adolescents participating in a large high school sexually transmitted disease screening program
Lewis FM , Newman DR , Anschuetz GL , Mettey A , Asbel L , Salmon ME . Sex Transm Dis 2014 41 (10) 605-10 BACKGROUND: From 2003 to 2012, the Philadelphia High School STD Screening Program screened 126,053 students, identifying 8089 Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) infections. We examined sociodemographic and behavioral factors associated with CT/GC diagnoses among a sample of this high-risk population. METHODS: Standardized interviews were given to infected students receiving in-school CT/GC treatment (2009-2012) and to uninfected students calling for results (2011-2012). Sex-stratified multivariable logistic models were created to examine factors independently associated with a CT/GC diagnosis. A simple risk index was developed using variables significant on multivariable analysis. RESULTS: A total of 1489 positive and 318 negative students were interviewed. Independent factors associated with a GC/CT diagnosis among females were black race (adjusted odds ratio [AOR], 2.27; confidence interval, 1.12-4.58), history of arrest (AOR, 2.26; 1.22-4.21), higher partner number (AOR, 1.75; 1.05-2.91), meeting partners in own neighborhood (AOR, 1.92; 1.29-2.86), and meeting partners in venues other than own school, neighborhood, or through friends ("all other"; AOR, 9.44; 3.70-24.09). For males, factors included early sexual debut (AOR, 1.99; 1.21-3.26) and meeting partners at "all other" venues (AOR, 2.76; 1.2-6.4); meeting through friends was protective (AOR, 0.63; 0.41-0.96). Meeting partners at own school was protective for both sexes (males: AOR, 0.33; 0.20-0.55; females: AOR, 0.65; 0.44-0.96). CONCLUSIONS: Although factors associated with a GC/CT infection differed between males and females in our sample, partner meeting place was associated with infection for both sexes. School-based screening programs could use this information to target high-risk students for effective interventions. |
Passive surveillance for azole-resistant Aspergillus fumigatus, United States, 2011-2013
Pham CD , Reiss E , Hagen F , Meis JF , Lockhart SR . Emerg Infect Dis 2014 20 (9) 1498-503 Emergence of Aspergillus fumigatus strains containing mutations that lead to azole resistance has become a serious public health threat in many countries. Nucleotide polymorphisms leading to amino acid substitutions in the lanosterol demethylase gene (cyp51A) are associated with reduced susceptibility to azole drugs. The most widely recognized mutation is a lysine to histidine substitution at aa 98 (L98H) and a duplication of the untranscribed promoter region, together known as TR34/L98H. This mechanism of resistance has been reported in Europe, Asia, and the Middle East, and is associated with resistance to all azole drugs and subsequent treatment failures. To determine whether isolates with this mutation are spreading into the United States, we conducted a passive surveillance-based study of 1,026 clinical isolates of A. fumigatus from 22 US states during 2011-2013. No isolates harboring the TR34/L98H mutation were detected, and MICs of itraconazole were generally low. |
Positive Transitions (POST): evaluation of an HIV prevention intervention for HIV-positive persons releasing from correctional facilities
MacGowan RJ , Lifshay J , Mizuno Y , Johnson WD , McCormick L , Zack B . AIDS Behav 2014 19 (6) 1061-9 People with HIV who are released from custody frequently do not maintain the viral suppression and other health benefits achieved while incarcerated. This study was conducted to provide preliminary evidence of efficacy of an intervention to reduce HIV risk behaviors and increase use of HIV medical services following release from custody. People with HIV were recruited from San Francisco County jails, San Quentin State Prison and the California Medical Facility (Vacaville, CA), and randomly assigned to the "standard of care" or POST intervention. POST consisted of 4 sessions pre-release and 2 sessions post-release, focusing on HIV prevention and access to care. Behavioral data were obtained for the 3 months before incarceration and 3 months after release. Although POST participants reported a statistically significant increase in receiving health care at HIV clinics (62.5-84.4 %), there were no significant differences between the POST and control participants with respect to any primary outcomes. |
Efficacy of an adapted HIV and sexually transmitted infection prevention intervention for incarcerated women: a randomized controlled trial
Fogel CI , Crandell JL , Neevel AM , Parker SD , Carry M , White BL , Fasula AM , Herbst JH , Gelaude DJ . Am J Public Health 2014 105 (4) e1-e8 OBJECTIVES: We tested the efficacy of an adapted evidence-based HIV-sexually transmitted infection (STI) behavioral intervention (Providing Opportunities for Women's Empowerment, Risk-Reduction, and Relationships, or POWER) among incarcerated women. METHODS: We conducted a randomized trial with 521 women aged 18 to 60 years in 2 correctional facilities in North Carolina in 2010 and 2011. Intervention participants attended 8 POWER sessions; control participants received a single standard-of-care STI prevention session. We followed up at 3 and 6 months after release. We examined intervention efficacy with mixed-effects models. RESULTS: POWER participants reported fewer male sexual partners than did control participants at 3 months, although this finding did not reach statistical significance; at 6 months they reported significantly less vaginal intercourse without a condom outside of a monogamous relationship and more condom use with a main male partner. POWER participants also reported significantly fewer condom barriers, and greater HIV knowledge, health-protective communication, and tangible social support. The intervention had no significant effects on incident STIs. CONCLUSIONS: POWER is a behavioral intervention with potential to reduce risk of acquiring or transmitting HIV and STIs among incarcerated women returning to their communities. |
Encephalitis caused by pathogens transmitted through organ transplants, United States, 2002-2013
Basavaraju SV , Kuehnert MJ , Zaki SR , Sejvar JJ . Emerg Infect Dis 2014 20 (9) 1443-51 The cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies. During 2002-2013, the US Centers for Disease Control and Prevention investigated several encephalitis clusters among transplant recipients. Cases were caused by infections from transplant-transmitted pathogens: West Nile virus, rabies virus, lymphocytic choriomeningitis virus, and Balamuthia mandrillaris amebae. In many of the clusters, identification of the cause was complicated by delayed diagnosis due to the rarity of the disease, geographic distance separating transplant recipients, and lack of prompt recognition and reporting systems. Establishment of surveillance systems to detect illness among organ recipients, including communication among transplant center physicians, organ procurement organizations, and public health authorities, may enable the rapid discovery and investigation of infectious encephalitis clusters. These transplant-transmitted pathogen clusters highlight the need for greater awareness among clinicians, pathologists, and public health workers, of emerging infectious agents causing encephalitis among organ recipients. |
Evaluation of gonorrhea test of cure at 1 week in a Los Angeles community-based clinic serving men who have sex with men
Beymer MR , Llata E , Stirland AM , Weinstock HS , Wigen CL , Guerry SL , Mejia E , Bolan RK . Sex Transm Dis 2014 41 (10) 595-600 BACKGROUND: Because of the decreasing susceptibility of Neisseria gonorrhoeae to cephalosporin therapy, the Centers for Disease Control and Prevention recommends test of cure (TOC) 1 week after gonorrhea (GC) treatment if therapies other than ceftriaxone are used. In addition, the Centers for Disease Control and Prevention asks clinicians, particularly those caring for men who have sex with men (MSM) on the west coast, to consider retesting all MSM at 1 week. However, it is unclear if this is acceptable to providers and patients or if nucleic acid amplification tests (NAATs) are useful for TOC at 7 days. METHODS: Between January and July 2012, MSM with GC were advised to return 1 week after treatment for TOC using NAAT. A multivariate logistic regression model was used to determine demographic and behavioral differences between MSM who returned for follow-up and MSM who did not. RESULTS: Of 737 men with GC, 194 (26.3%) returned between 3 and 21 days of treatment. Individuals who returned were more likely to have no GC history (P = 0.0001) and to report no initial symptoms (P = 0.02) when compared with individuals who did not return for TOC. Of those who returned, 0% of urethral samples, 7.4% of rectal samples, and 5.3% of pharyngeal samples were NAAT positive at TOC. CONCLUSIONS: Although TOC may be an important strategy in reducing complications and the spread of GC, low return rates may make implementation challenging. If implemented, extra efforts should be considered to enhance return rates among individuals with a history of GC. If TOCs are recommended at 1 week and NAATs are used, the interpretation of positive results, particularly those from extragenital sites, may be difficult. |
Family cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013
Abroug F , Slim A , Ouanes-Besbes L , Kacem MA , Dachraoui F , Ouanes I , Lu X , Tao Y , Paden C , Caidi H , Miao C , Al-Hajri MM , Zorraga M , Ghaouar W , BenSalah A , Gerber SI . Emerg Infect Dis 2014 20 (9) 1527-30 In 2013 in Tunisia, 3 persons in 1 family were infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The index case-patient's respiratory tract samples were negative for MERS-CoV by reverse transcription PCR, but diagnosis was retrospectively confirmed by PCR of serum. Sequences clustered with those from Saudi Arabia and United Arab Emirates. |
Impact of awareness drives and community-based active tuberculosis case finding in Odisha, India
Parija D , Patra TK , Kumar AM , Swain BK , Satyanarayana S , Sreenivas A , Chadha VK , Moonan PK , Oeltmann JE . Int J Tuberc Lung Dis 2014 18 (9) 1105-7 India's Revised National Tuberculosis Control programme employs passive case detection. The new sputum smear-positive case detection rate is less than 70% in Odisha State. During April-June 2012, active case finding (ACF) was conducted through awareness drives and field-based tuberculosis (TB) screening in select communities with the lowest case detection rates. During the campaign, 240 sputum smear-positive TB cases were detected. The number of smear-positive cases detected increased by 11% relative to April-June 2011 in intervention communities compared to an 0.8% increase in non-intervention communities. ACF brought TB services closer to the community and increased TB case detection. |
In vitro selection of mutants of Neisseria gonorrhoeae with elevated MIC values and increased resistance to cephalosporins
Johnson SR , Grad Y , Ganakammal SR , Burroughs M , Frace M , Lipsitch M , Weil R , Trees D . Antimicrob Agents Chemother 2014 58 (11) 6986-9 Strains of Neisseria gonorrhoeae with mosaic penA genes bearing novel point mutations in penA have been isolated from ceftriaxone treatment failures. Such isolates exhibit significantly higher MIC values to third generation cephalosporins. Here we report the in vitro isolation two mutants with elevated MICs to cephalosporins. The first possesses a point mutation in the transpeptidase region of the mosaic penA gene, and the second contains an insertion mutation in pilQ. |
Incidence of Cronobacter spp. infections, United States, 2003-2009
Patrick ME , Mahon BE , Greene SA , Rounds J , Cronquist A , Wymore K , Boothe E , Lathrop S , Palmer A , Bowen A . Emerg Infect Dis 2014 20 (9) 1536-9 During 2003-2009, we identified 544 cases of Cronobacter spp. infection from 6 US states. The highest percentage of invasive infections occurred among children <5 years of age; urine isolates predominated among adults. Rates of invasive infections among infants approximate earlier estimates. Overall incidence of 0.66 cases/100,000 population was higher than anticipated. |
Increase in anti-tuberculosis drug resistance in Botswana: results from the fourth National Drug Resistance Survey
Menzies HJ , Moalosi G , Anisimova V , Gammino V , Sentle C , Bachhuber MA , Bile E , Radisowa K , Kachuwaire O , Basotli J , Maribe T , Makombe R , Shepherd J , Kim B , Samandari T , El-Halabi S , Chirenda J , Cain KP . Int J Tuberc Lung Dis 2014 18 (9) 1026-33 SETTING: Although approximately 0.5 million cases of multidrug-resistant tuberculosis (MDR-TB) occur globally each year, surveillance data are limited. Botswana is one of the few high TB burden countries to have carried out multiple anti-tuberculosis drug resistance surveys (in 1995-1996, 1999 and 2002). OBJECTIVE: In 2007-2008, we conducted the fourth national survey of anti-tuberculosis drug resistance in Botswana to assess anti-tuberculosis drug resistance, including trends over time. In the previous survey, 0.8% (95% CI 0.4-1.5) of new patients and 10.4% (95%CI 5.6-17.3) of previously treated patients had MDR-TB. DESIGN: During the survey period, eligible specimens from all new sputum-smear positive TB patients and from all TB patients with history of previous anti-tuberculosis treatment underwent mycobacterial culture and anti-tuberculosis drug susceptibility testing (DST). RESULTS: Of 924 new TB patients and 137 with previous anti-tuberculosis treatment with DST results, respectively 23 (2.5%, 95% CI 1.6-3.7) and 9 (6.6%, 95% CI 3.3-11.7) had MDR-TB. The proportion of new TB patients with MDR-TB has tripled in Botswana since the previous survey. CONCLUSION: Combatting drug-resistant TB will require the scale-up of MDR-TB diagnosis and treatment to prevent the transmission of MDR-TB and strengthening of general TB control to prevent the emergence of resistance. |
The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS
Abara WE , Smith L , Zhang S , Fairchild AJ , Heiman HJ , Rust G . Am J Public Health 2014 104 (11) e1-e7 OBJECTIVES: We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). METHODS: We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). RESULTS: Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. CONCLUSIONS: Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA. |
Assessment of varicella surveillance and outbreak control practices - United States, 2012
Lopez AS , Lichtenstein M , Schmid SD , Bialek S . MMWR Morb Mortal Wkly Rep 2014 63 (36) 785-8 Case-based varicella (chickenpox) surveillance is important for monitoring the impact of the varicella vaccination program. In 2002, the Council of State and Territorial Epidemiologists (CSTE) recommended that all states move toward case-based varicella surveillance by 2005; in 2003, varicella was made nationally notifiable. To ease the transition to case-based reporting, CSTE and CDC recommended starting with sentinel site or outbreak surveillance and then moving to statewide case-based surveillance when feasible. To gauge progress in varicella surveillance, in 2012 CDC and CSTE developed a survey for assessing varicella surveillance practices, which CSTE administered to all states and the District of Columbia (DC). As of 2012, varicella was reportable in 44 (86.3%) of the 51 jurisdictions surveyed, of which 37 (84.1%) conduct statewide case-based surveillance. Of the 38 jurisdictions conducting statewide or sentinel site varicella case-based surveillance, more than 84% reported collecting information on age, sex, and race/ethnicity (all 97.4%), vaccination status (94.7%), outbreak association (86.8%), and disease severity (84.2%). Nineteen (43.2%) of the 44 jurisdictions where reporting was mandated transmitted varicella-specific data to CDC using Health Level 7 (HL7) messaging. Currently, HL7 messaging is the only mechanism available for states to send varicella-specific data to CDC. Although public health agencies have made much progress to strengthen varicella surveillance throughout the United States, strategies are needed to facilitate transmission of varicella-specific data to CDC from all jurisdictions, using HL7 messaging, and to increase the number of jurisdictions collecting the varicella-specific data necessary to monitor varicella epidemiology and the impact of the vaccination program nationally. |
Bacillus anthracis
Henry R . Emerg Infect Dis 2014 20 (9) 1463 A large, gram-positive, rod (bacillus), Bacillus anthracis is the causative agent of anthrax (Greek for “coal”), named for the black lesions of cutaneous anthrax. In 1850, Rayer and Davaine discovered the rods in the blood of anthrax-infected sheep, setting the stage for Koch to link the disease to the bacterium in 1876, after he performed a series of experiments that fulfilled what came to be known as Koch’s postulates. This was among the first times a microorganism was conclusively linked with a specific disease. |
Challenges with controlling varicella in prison settings: experience of California, 2010 to 2011
Leung J , Lopez AS , Tootell E , Baumrind N , Mohle-Boetani J , Leistikow B , Harriman KH , Preas CP , Cosentino G , Bialek SR , Marin M . J Correct Health Care 2014 20 (4) 292-301 This article describes the epidemiology of varicella in one state prison in California during 2010 and 2011, control measures implemented, and associated costs. Eleven varicella cases were reported, of which nine were associated with two outbreaks. One outbreak consisted of three cases and the second consisted of six cases with two generations of spread. Among exposed inmates serologically tested, 98% (643/656) were varicella-zoster virus seropositive. The outbreaks resulted in > 1,000 inmates exposed, 444 staff exposures, and > $160,000 in costs. The authors documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary to manage cases and outbreaks. |
Chlamydia screening among females aged 15-21 years - multiple data sources, United States, 1999-2010
Hoover KW , Leichliter JS , Torrone EA , Loosier PS , Gift TL , Tao G . MMWR Suppl 2014 63 (2) 80-8 Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Chlamydia is the most commonly reported notifiable disease in the United States, with 1.4 million cases reported in 2012. Chlamydia is usually asymptomatic in both men and women, and as a result, infections often are undiagnosed. Approximately 3 million new infections are estimated to occur each year. Among sexually active females aged 14-19 years, chlamydia prevalence has been estimated to be 6.8%. In a recent study involving approximately 1 million tests conducted among both privately insured and Medicaid-insured females aged 15-21 years, chlamydia positivity ranged from 6.9% to 10.7% among those with chlamydial symptoms and from 6.1% to 9.6% among those who were asymptomatic. |
Chlamydia screening and positivity in juvenile detention centers, United States, 2009-2011
Satterwhite CL , Newman D , Collins D , Torrone E . Women Health 2014 54 (8) 712-25 An estimated 2.9 million new chlamydia infections occur in the United States each year. Among women, chlamydia can lead to serious adverse outcomes, including pelvic inflammatory disease and infertility. Chlamydia prevalence is highest among females aged 15-19 years. Despite long-standing recommendations directed at young, sexually active females, screening remains sub-optimal. Juvenile detention centers (JDCs) are uniquely situated to screen and treat high-risk adolescents. From 2009-2011, performance measure data on chlamydia screening coverage (proportion of eligible females screened) and positivity (proportion of females tested who were positive) were available from 126 geographically-dispersed JDCs in the United States. These facilities reported screening 55.2% of females entering the facilities (149,923), with a facility-specific median of 66.4% (range: 0%-100%). Almost half (44.4%) of facilities had screening coverage levels of 75%-100%. This screening resulted in the detection of 12,305 chlamydial infections, for an overall positivity of 14.7% (facility-specific median=14.9%, range: 0%-36.9%). In linear regression analysis, chlamydia positivity was inversely associated with screening coverage: as coverage increased, positivity decreased. The burden of chlamydia in JDCs is substantial; facilities should continue to deliver recommended chlamydia screening and treatment to females and identify mechanisms to increase coverage. |
Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation
Nygren BL , Blackstock AJ , Mintz ED . Am J Trop Med Hyg 2014 91 (5) 1023-8 We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation. |
Current epidemiology of Candida infection
Lockhart SR . Clin Microbiol Newsl 2014 36 (17) 131-136 Candidemia and candidiasis are among the most frequent healthcare care-associated infections and lead to significant morbidity and mortality. The predominant species causing candidemia remains Candida albicans, but it has declined from the majority species to causing less than 50% of U.S. cases. Increasing proportions of infections are being caused by C. glabrata, which now causes almost 30% of U.S. cases, as well as C. parapsilosis and other non-C. albicans species. Outside the United States, the predominant species is dependent upon the region. Pediatric candidemia rates are declining in the U.S., but the cause of this decline has not been fully elucidated. While overall resistance to antifungal agents has remained low among Candida species, there is some concern for echinocandin resistance, as well as multidrug resistance, in C. glabrata. Although some aspects of candidemia and candidiasis have remained constant, rates, species, and susceptibility are in a constant state of flux. |
Are safety net sexually transmitted disease clinical and preventive services still needed in a changing health care system?
Cramer R , Leichliter JS , Gift TL . Sex Transm Dis 2014 41 (10) 628-30 Aprimary goal of the Affordable Care Act (ACA) is to increase access to health care, particularly among the uninsured. Reforms under the ACA will therefore likely impact access to sexually transmitted disease (STD) services, including services for the underinsured or uninsured (safety net services). We raise considerations related to the provision of safety net STD services that have resulted from the US Supreme Court's 2012 decision that upheld much of the ACA while striking down portions of the law that resulted in states deciding whether to expand Medicaid. Furthermore, we highlight the complex and unique role that safety net providers have traditionally played in STD prevention. |
Serological evidence of Batai virus infections, bovines, Northern Italy, 2011
Lambert AJ , Huhtamo E , Di Fatta T , De Andrea M , Borella A , Vapalahti O , Kosoy O , Ravanini P . Vector Borne Zoonotic Dis 2014 14 (9) 688-9 Batai virus (BATV) was identified in mosquitoes in the Caltignaga region of Novarra, northern Italy in 2009. Here, we report the identification of antibodies to BATV in serum samples that were taken from healthy bovines in that region in 2011. BATV has been associated with a mild febrile human illness and identified as the likely parental segment donor in a reassortment event that resulted in the generation of the virulent progeny, Ngari virus. The possible veterinary disease associations of BATV are unknown. The presence of antibodies to BATV in bovine populations confirms local transmission in northern Italy. Given its likely role as a segment donor, an understanding of the geographic and host distributions of BATV is of veterinary and human public health interest. |
Predicting the mosquito species and vertebrate species involved in the theoretical transmission of Rift Valley fever virus in the United States
Golnar AJ , Turell MJ , LaBeaud AD , Kading RC , Hamer GL . PLoS Negl Trop Dis 2014 8 (9) e3163 Rift Valley fever virus (RVFV) is a mosquito-borne virus in the family Bunyaviridiae that has spread throughout continental Africa to Madagascar and the Arabian Peninsula. The establishment of RVFV in North America would have serious consequences for human and animal health in addition to a significant economic impact on the livestock industry. Published and unpublished data on RVFV vector competence, vertebrate host competence, and mosquito feeding patterns from the United States were combined to quantitatively implicate mosquito vectors and vertebrate hosts that may be important to RVFV transmission in the United States. A viremia-vector competence relationship based on published mosquito transmission studies was used to calculate a vertebrate host competence index which was then combined with mosquito blood feeding patterns to approximate the vector and vertebrate amplification fraction, defined as the relative contribution of the mosquito or vertebrate host to pathogen transmission. Results implicate several Aedes spp. mosquitoes and vertebrates in the order Artiodactyla as important hosts for RVFV transmission in the U.S. Moreover, this study identifies critical gaps in knowledge which would be necessary to complete a comprehensive analysis identifying the different contributions of mosquitoes and vertebrates to potential RVFV transmission in the U.S. Future research should focus on (1) the dose-dependent relationship between viremic exposure and the subsequent infectiousness of key mosquito species, (2) evaluation of vertebrate host competence for RVFV among North American mammal species, with particular emphasis on the order Artiodactyla, and (3) identification of areas with a high risk for RVFV introduction so data on local vector and host populations can help generate geographically appropriate amplification fraction estimates. |
Behavioural responses of females of two anopheline mosquito species to human-occupied, insecticide-treated and untreated bed nets
Sutcliffe JF , Yin S . Malar J 2014 13 294 BACKGROUND: Insecticide-treated bed nets (ITNs), used extensively to reduce human exposure to malaria, work through physical and chemical means to block or deter host-seeking mosquitoes. Despite the importance of ITNs, very little is known about how host-seeking mosquitoes behave around occupied bed nets. As a result, evidence-based evaluations of the effects of physical damage on bed net effectiveness are not possible and there is a dearth of knowledge on which to base ITN design. METHODS: The dispersion of colony-raised female Anopheles gambiae and Anopheles albimanus was observed in 2-hr laboratory experiments in which up to 200 mosquitoes were released inside a mosquito-proof 3 m x 3 m tent housing a bed net arrayed with 18 30 cm x 30 cm sticky screen squares on the sides, ends and roof. Numbers of mosquitoes caught on the sticky squares were interpreted as the 'mosquito pressure' on that part of the net. RESULTS: Presence of a human subject in the bed net significantly increased total mosquito pressure on the net for both species and significantly re-oriented An. gambiae to the roof of the net. Anopheles albimanus pressure was greatest on the bed net roof in both host-present and no-host conditions. The effects of different human subjects in the bed net, of different ambient conditions (dry, cool conditions vs warm, humid conditions) and of bed net treatment (deltamethrin-treated or no insecticide) on mosquito pressure patterns were tested for both species. Species-specific pressure patterns did not vary greatly as a result of any of these factors though some differences were noted that may be due the size of the different human subjects. CONCLUSIONS: As a result of the interaction between host-seeking responses and the convective plume from the net occupant, species-specific mosquito pressure patterns manifest more or less predictably on the bed net. This has implications for bed net design and suggests that current methods of assessing damaged bed nets, which do not take damage location into account, should be modified. |
Mortality study of civilian employees exposed to contaminated drinking water at USMC Base Camp Lejeune: a retrospective cohort study
Bove FJ , Ruckart PZ , Maslia M , Larson TC . Environ Health 2014 13 68 BACKGROUND: Two drinking water systems at U.S. Marine Corps Base Camp Lejeune, North Carolina were contaminated with solvents during 1950s-1985. METHODS: We conducted a retrospective cohort mortality study of 4,647 civilian, full-time workers employed at Camp Lejeune during 1973-1985 and potentially exposed to contaminated drinking water. We selected a comparison cohort of 4,690 Camp Pendleton workers employed during 1973-1985 and unexposed to contaminated drinking water. Mortality follow-up period was 1979-2008. Cause-specific standardized mortality ratios utilized U.S. age-, sex-, race-, and calendar period-specific mortality rates as reference. We used survival analysis to compare mortality rates between Camp Lejeune and Camp Pendleton workers and assess the effects of estimated cumulative contaminant exposures within the Camp Lejeune cohort. Ground water contaminant fate/transport and distribution system models provided monthly estimated contaminant levels in drinking water serving workplaces at Camp Lejeune. The confidence interval (CI) indicated precision of effect estimates. RESULTS: Compared to Camp Pendleton, Camp Lejeune workers had mortality hazard ratios (HRs) >1.50 for kidney cancer (HR = 1.92, 95% CI: 0.58, 6.34), leukemias (HR = 1.59, 95% CI: 0.66, 3.84), multiple myeloma (HR = 1.84, 95% CI: 0.45, 7.58), rectal cancer (HR = 1.65, 95% CI: 0.36, 7.44), oral cavity cancers (HR = 1.93, 95% CI: 0.34, 10.81), and Parkinson's disease (HR = 3.13, 95% CI: 0.76, 12.81). Within the Camp Lejeune cohort, monotonic exposure-response relationships were observed for leukemia and vinyl chloride and PCE, with mortality HRs at the high exposure category of 1.72 (95% CI: 0.33, 8.83) and 1.82 (95% CI: 0.36, 9.32), respectively. Cumulative exposures were above the median for most deaths from cancers of the kidney, esophagus, rectum, prostate, and Parkinson's disease, but small numbers precluded evaluation of exposure-response relationships. CONCLUSION: The study found elevated HRs in the Camp Lejeune cohort for several causes of death including cancers of the kidney, rectum, oral cavity, leukemias, multiple myeloma, and Parkinson's disease. Only 14% of the Camp Lejeune cohort died by end of follow-up, producing small numbers of cause-specific deaths and wide CIs. Additional follow-up would be necessary to comprehensively assess drinking water exposure effects at the base. |
Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study.
Collier MG , Khudyakov YE , Selvage D , Adams-Cameron M , Epson E , Cronquist A , Jervis RH , Lamba K , Kimura AC , Sowadsky R , Hassan R , Park SY , Garza E , Elliott AJ , Rotstein DS , Beal J , Kuntz T , Lance SE , Dreisch R , Wise ME , Nelson NP , Suryaprasad A , Drobeniuc J , Holmberg SD , Xu F . Lancet Infect Dis 2014 14 (10) 976-81 BACKGROUND: In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated the source of the outbreak and assessed the public health measures used. METHODS: We interviewed patients, obtained their shopping information, and did genetic analysis of hepatitis A virus recovered from patients' serum and stool samples. We tested products for the virus and traced supply chains. FINDINGS: Of 165 patients identified from ten states, 69 (42%) were admitted to hospital, two developed fulminant hepatitis, and one needed a liver transplant; none died. Illness onset occurred from March 31 to Aug 12, 2013. The median age of patients was 47 years (IQR 35-58) and 91 (55%) were women. 153 patients (93%) reported consuming product B from retailer A. 40 patients (24%) had product B in their freezers, and 113 (68%) bought it according to data from retailer A. Hepatitis A virus genotype IB, uncommon in the Americas, was recovered from specimens from 117 people with hepatitis A virus illness. Pomegranate arils that were imported from Turkey-where genotype IB is common-were identified in product B. No hepatitis A virus was detected in product B. INTERPRETATION: Imported frozen pomegranate arils were identified as the vehicle early in the investigation by combining epidemiology-with data from several sources-genetic analysis of patient samples, and product tracing. Product B was removed from store shelves, the public were warned not to eat product B, product recalls took place, and postexposure prophylaxis with both hepatitis A virus vaccine and immunoglobulin was provided. Our findings show that modern public health actions can help rapidly detect and control hepatitis A virus illness caused by imported food. Our findings show that postexposure prophylaxis can successfully prevent hepatitis A illness when a specific product is identified. Imported food products combined with waning immunity in some adult populations might make this type of intervention necessary in the future. |
Factors contributing to decline in foodborne disease outbreak reports, United States
Imanishi M , Manikonda K , Murthy BP , Gould LH . Emerg Infect Dis 2014 20 (9) 1551-3 The number of foodborne disease outbreaks reported in the United States declined substantially in 2009, when the surveillance system transitioned from reporting only foodborne disease outbreaks to reporting all enteric disease outbreaks. A 2013 survey found that some outbreaks that would have been previously reported as foodborne are now reported as having other transmission modes. |
Gaps in food safety professionals' knowledge about noroviruses
Kosa KM , Cates SC , Hall AJ , Brophy JE , Fraser A . J Food Prot 2014 77 (8) 1336-41 Noroviruses (NoVs) are the most common etiologic agents of endemic and epidemic foodborne disease in the United States. Food safety professionals play an important role in protecting the public from foodborne illness. A survey of food safety professionals (n = 314) was conducted to characterize their knowledge of NoVs and to identify gaps in this knowledge. To recruit individuals, 25 professional organizations promoted the survey via their Web sites, newsletters, and/or e-mail distribution lists. The survey used true or false and open-ended questions to assess knowledge about NoVs, including attribution, transmission, and prevention and control strategies, including food handling practices. The online survey was available from mid-October 2012 to mid-January 2013. Of the 314 respondents, 66.2% correctly identified NoVs as one of the three most common causes of foodborne disease in the United States. Only 5.4% of respondents correctly identified the three most common settings for NoV infections, and 65.0% of respondents had the misperception that cruise ships are one of the three most common settings. Seventeen respondents (5.4%) answered all 20 true-or-false questions correctly, 33 respondents (10.5%) answered at least 19 of the 20 questions correctly, and 186 respondents (65.0%) answered at least 15 of the 20 questions correctly (i.e., a score of 75% or higher). The content domain in which respondents had the most incorrect answers was food handling practices. Thirty-eight percent of respondents incorrectly responded that it is safe for restaurant workers infected with NoVs to handle packaged food, food equipment, and utensils. About half of respondents did not know the recommended sanitizing solution for eliminating NoVs from a contaminated surface. The survey findings identified several important gaps in food safety professionals' knowledge of NoVs. The study results will inform the development of a Web-based educational module on NoVs to improve efforts to prevent the spread of NoVs in retail and institutional food establishments. |
Knowledge, attitudes, and practices among border crossers during temporary enforcement of a formal entry requirement for Mexican-style soft cheeses, 2009
Nguyen AV , Cohen NJ , Gao H , Fishbein DB , Keir J , Ocana JM , Senini L , Flores A , Waterman SH . J Food Prot 2014 77 (9) 1571-8 Mexican-style soft cheese known as queso fresco (QF), which is often unpasteurized, has been implicated in outbreaks of foodborne illness in the United States. The U.S. Food and Drug Administration (FDA) exercises discretion in enforcement of noncommercial importation of cheese. To test control measures aimed at decreasing unlawful QF importation, in 2009 the FDA temporarily enforced a requirement for formal commercial entry for all cheeses over 5 lb (2.3 kg) at the San Diego-Tijuana border. Enforcement was combined with educational outreach. Border crossers importing cheese and those not importing cheese were surveyed at the beginning and end of the temporary enforcement period. Data collected included participant demographic information, knowledge of QF-associated health risks, and attitudes and practices regarding QF consumption and importation. We surveyed 306 importers and 381 nonimporters. Compared with nonimporters, importers had a lower level of knowledge regarding QF-associated health risks (P < 0.0001). Border crossers carrying cheese were more likely to have less education, be U.S. or dual residents, consume QF more frequently, and cross the border less often. Importation and consumption of unpasteurized QF remained prevalent among border crossers during the temporary enforcement period, and the level of knowledge regarding QF-associated risks remained low among these crossers. More vigorous, sustained messaging targeted at high-risk groups is needed to change behaviors. Definition and consistent enforcement of limits will likely be needed to reduce QF importation and the risk of QF-associated diseases along the U.S.-Mexico border; however, public health benefits will need to be balanced against the cost of enforcement. |
Novel method to characterize CYP21A2 in Florida patients with congenital adrenal hyperplasia and commercially available cell lines.
Greene CN , Cordovado SK , Turner DP , Keong LM , Shulman D , Mueller PW . Mol Genet Metab Rep 2014 1 312-323 Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder and affects approximately 1 in 15,000 births in the United States. CAH is one of the disorders included on the Newborn Screening (NBS) Recommended Uniform Screening Panel. The commonly used immunological NBS test is associated with a high false positive rate and there is interest in developing second-tier assays to increase screening specificity. Approximately 90% of the classic forms of CAH, salt-wasting and simple virilizing, are due to mutations in the CYP21A2 gene. These include single nucleotide changes, insertions, deletions, as well as chimeric genes involving CYP21A2 and its highly homologous pseudogene CYP21A1P. A novel loci-specific PCR approach was developed to individually amplify the CYP21A2 gene, the nearby CYP21A1P pseudogene, as well as any 30 kb deletion and gene conversion mutations, if present, as single separate amplicons. Using commercially available CAH positive specimens and 14 families with an affected CAH proband, the single long-range amplicon approach demonstrated higher specificity as compared to previously published methods. |
National human papillomavirus vaccination coverage among adolescents aged 13-17 years - National Immunization Survey - Teen, United States, 2011
Curtis CR , Dorell C , Yankey D , Jeyarajah J , Chesson H , Saraiya M , Gold R , Dunne EF , Stokley S . MMWR Suppl 2014 63 (2) 61-70 Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. An estimated 14 million persons are newly infected with HPV each year; approximately half of new HPV infections occur among persons aged 15-24 years. Although the majority of HPV infections are asymptomatic and resolve, persistent infections can cause disease, including cancers. No cure exists for HPV infection; treatments can be directed only at HPV-associated lesions (e.g., warts, precancerous lesions, and cancers). Annual costs of cervical cancer screening and treatment of HPV-associated health outcomes have been estimated at $8 billion (in 2010 U.S. dollars). Almost all cervical cancers and many vaginal, vulvar, anal, penile, and oropharyngeal cancers are attributable to persistent, oncogenic HPV infections. In 2009, approximately 35,000 HPV-associated cancers were reported in the United States. Of these, 39% occurred in males. |
Norovirus vaccine against experimental human GII.4 virus illness: a challenge study in healthy adults
Bernstein DI , Atmar RL , Lyon GM , Treanor JJ , Chen WH , Jiang X , Vinje J , Gregoricus N , Frenck RW Jr , Moe CL , Al-Ibrahim MS , Barrett J , Ferreira J , Estes MK , Graham DY , Goodwin R , Borkowski A , Clemens R , Mendelman PM . J Infect Dis 2014 211 (6) 870-8 BACKGROUND: Vaccines against norovirus, the leading cause of acute gastroenteritis, should protect against medically significant illness and reduce transmission. METHODS: In this randomised, double-blind, placebo-controlled trial, 18-50 year-olds received two injections of placebo or norovirus GI.1/GII.4 bivalent VLP vaccine with MPL and alum. Participants were challenged as inpatients with GII.4 virus (4400 RT-PCR units), and monitored for illness and infection. RESULTS: Per-protocol, 27/50 (54.0%) vaccinees and 30/48 (62.5%) controls were infected. Using predefined illness and infection definitions, vaccination did not meet the primary endpoint, but self-reported cases of severe (0 vaccinees vs 8.3% controls, p=0.054), moderate or greater (6.0% vs 18.8%, p=0.068), and mild or greater severity of vomiting and/or diarrhea (20.0% vs 37.5%, p=0.074) were less frequent. Vaccination also reduced the modified Vesikari score from from 7.3 to 4.5 (p=0.002). Difficulties encountered were low norovirus disease rate, and inability to define illness by RT-qPCR or further antibody rise in vaccinees due to high vaccine-induced titers. By day 10, 11/49 (22.4%) vaccinees were shedding virus compared with 17/47 (36.2%) placebo recipients (p=0.179). CONCLUSIONS: Bivalent norovirus VLP vaccine reduced norovirus related vomiting and/or diarrhea; field efficacy studies are planned. |
Preparing for human papillomavirus vaccine introduction in Kenya: implications from focus-group and interview discussions with caregivers and opinion leaders in western Kenya
Friedman AL , Oruko KO , Habel MA , Ford J , Kinsey J , Odhiambo F , Phillips-Howard PA , Wang SA , Collins T , Laserson KF , Dunne EF . BMC Public Health 2014 14 855 BACKGROUND: Cervical cancer claims the lives of 275,000 women each year; most of these deaths occur in low-or middle-income countries. In Kenya, cervical cancer is the leading cause of cancer-related mortality among women of reproductive age. Kenya's Ministry of Public Health and Sanitation has developed a comprehensive strategy to prevent cervical cancer, which includes plans for vaccinating preteen girls against human papillomavirus (HPV) by 2015. To identify HPV vaccine communication and mobilization needs, this research sought to understand HPV vaccine-related perceptions and concerns of male and female caregivers and community leaders in four rural communities of western Kenya. METHODS: We conducted five focus groups with caregivers (n = 56) and 12 key-informant interviews with opinion leaders to explore cervical cancer-related knowledge, attitudes and beliefs, as well as acceptability of HPV vaccination for 9-12 year-old girls. Four researchers independently reviewed the data and developed codes based on questions in interview guides and topics that emerged organically, before comparing and reconciling results through a group consensus process. RESULTS: Cervical cancer was not commonly recognized, though it was understood generally in terms of its symptoms. By association with cancer and genital/reproductive organs, cervical cancer was feared and stigmatized. Overall acceptability of a vaccine that prevents cervical cancer was high, so long as it was endorsed by trusted agencies and communities were sensitized first. Some concerns emerged related to vaccine safety (e.g., impact on fertility), program intent, and health equity. CONCLUSION: For successful vaccine introduction in Kenya, there is a need for communication and mobilization efforts to raise cervical cancer awareness; prompt demand for vaccination; address health equity concerns and stigma; and minimize potential resistance. Visible endorsement by government leaders and community influencers can provide reassurance of the vaccine's safety, efficacy and benefits for girls and communities. Involvement of community leadership, parents and champions may also be critical for combatting stigma and making cervical cancer relevant to Kenyan communities. These findings underscore the need for adequate planning and resources for information, education and communication prior to vaccine introduction. Specific recommendations for communication and social-marketing strategies are made. |
Qualitative evaluation of Rhode Island's healthcare worker influenza vaccination regulations
Lindley MC , Dube D , Kalayil EJ , Kim H , Paiva K , Raymond P . Vaccine 2014 32 (45) 5962-6 OBJECTIVE: To evaluate Rhode Island's revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread. DESIGN: Semi-structured telephone interviews conducted in a random sample of healthcare facilities. SETTING: Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers. PARTICIPANTS: Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations. METHODS: Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented. RESULTS: Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities' ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations. CONCLUSIONS: Overall, facilities successfully implemented the revised HCW regulations during the 2012-2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island's healthcare facilities. |
Antigenic analyses of highly pathogenic avian influenza A viruses
Donis RO . Curr Top Microbiol Immunol 2014 385 403-40 In response to the ongoing threat to animal and human health posed by HPAI endemic in poultry, Asia (H5N1) and North America (H7N3) have revived efforts to reduce pandemic risk by disease control at the source and improved pandemic vaccines. Discovery of conserved neutralization epitopes in the HA, which mediate broad protection within and across HA subtypes have changed the paradigm of "broadly reactive" or "universal" vaccine design. Development of such vaccines would benefit from comparative antigenic analysis of viruses with increasing divergence within (and between) HA subtypes. A review of recent work to define the antigenic properties of HPAI viruses revealed data generated through an array of experimental approaches. This information has supported diagnostics and vaccine development for animal and human health. Further harmonization of analytical methods is needed to determine the antigenic relationships among multiple lineages of rapidly evolving HPAI viruses. |
Pediatricians' self-reported knowledge, attitudes, and practices about child passenger safety
Zonfrillo MR , Sauber-Schatz EK , Hoffman BD , Durbin DR . J Pediatr 2014 165 (5) 1040-5 e1-2 OBJECTIVE: To evaluate pediatricians' self-reported knowledge, attitudes, and dissemination practices regarding the new American Academy of Pediatrics' (AAP) child passenger safety (CPS) policy recommendations. STUDY DESIGN: A cross-sectional survey was distributed to pediatric primary care physicians via AAP e-mail distribution lists. Knowledge, attitudes, and practices related to current AAP CPS recommendations and the revised policy statement were ascertained. RESULTS: There were 718 respondents from 3497 physicians with active e-mail addresses, resulting in a 20.5% response rate, of which 533 were eligible based on the initial survey question. All 6 CPS knowledge and scenario-based items were answered correctly by 52.9% of the sample; these respondents were identified as the "high knowledge" group. Pediatricians with high knowledge were more likely to be female (P < .001), to have completed a pediatrics residency (vs medicine-pediatrics) (P = .03), and have a child between 4 and 7 years of age (P = .001). CPS information was distributed more frequently at routine health visits for patients 0-2 years of age vs those 4-12 years of age. Those with high knowledge were less likely to report several specific barriers to dissemination of CPS information, more likely to allot adequate time and discuss CPS with parents, and had greater confidence for topics related to all CPS topics. CONCLUSIONS: Although CPS knowledge is generally high among respondents, gaps in knowledge still exist. Knowledge is associated with attitudes, practices, barriers, and facilitators of CPS guideline dissemination. These results identify opportunities to increase knowledge and implement strategies to routinely disseminate CPS information in the primary care setting. |
Improving national data systems for surveillance of suicide-related events
Ikeda R , Hedegaard H , Crosby AE , Regina Seider R , Warner W , Data and Surveillance Task Force of the National Action Alliance for Suicide Prevention . Am J Prev Med 2014 47 S122-9 BACKGROUND: Describing the characteristics and patterns of suicidal behavior is an essential component in developing successful prevention efforts. The Data and Surveillance Task Force (DSTF) of the National Action Alliance for Suicide Prevention was charged with making recommendations for improving national data systems for public health surveillance of suicide-related problems, including suicidal thoughts, suicide attempts, and deaths due to suicide. PURPOSE: Data from the national systems can be used to draw attention to the magnitude of the problem and are useful for establishing national health priorities. National data can also be used to examine differences in rates across groups (e.g., sex, racial/ethnic, and age groups) and geographic regions, and are useful in identifying patterns in the mechanism of suicide, including those that rarely occur. METHODS: Using evaluation criteria from the CDC, WHO, and the U.S.A.-based Safe States Alliance, the DSTF reviewed 28 national data systems for feasibility of use in the surveillance of suicidal behavior, including deaths, nonfatal attempts, and suicidal thoughts. The review criteria included attributes such as the aspects of the suicide-related spectrum (e.g., thoughts, attempts, deaths) covered by the system; how the data are collected (e.g., census, sample, survey, administrative data files, self-report, reporting by care providers); and the strengths and limitations of the survey or data system. RESULTS: The DSTF identified common strengths and challenges among the data systems based on the underlying data source (e.g., death records, healthcare provider records, population-based surveys, health insurance claims). From these findings, the DSTF proposed several recommendations for improving existing data systems, such as using standard language and definitions, adding new variables to existing surveys, expanding the geographic scope of surveys to include areas where data are not currently collected, oversampling of underrepresented groups, and improving the completeness and quality of information on death certificates. CONCLUSIONS: Some of the DSTF recommendations are potentially achievable in the short term (<1-3 years) within existing data systems, whereas others involve more extensive changes and will require longer-term efforts (4-10 years). Implementing these recommendations would assist in the development of a national coordinated program of fatal and nonfatal suicide surveillance to facilitate evidence-based action to reduce the incidence of suicide and suicidal behavior in all populations. |
Genetic correlational analysis reveals no association between MPP+ and the severity of striatal dopaminergic damage following MPTP treatment in BXD mouse strains.
Jones BC , O'Callaghan JP , Lu L , Williams RW , Alam G , Miller DB . Neurotoxicol Teratol 2014 45 91-2 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is a pro-neurotoxicant that must be metabolized to 1-methyl-4-phenylpyridinium (MPP+) and taken up into striatal dopaminergic neurons to produce neurodegeneration. Recently, we showed wide genetic variability in MPTP-associated neuronal damage in a panel of recombinant inbred mouse strains. Here we examined the amount of MPP+ produced in the striatum in the same strains of inbred BXD mice. This allowed us to determine if the differences in the dopaminergic neurotoxicity and associated astrogliosis among the BXD mouse strains were due to differential metabolism of MPTP to MPP+. Using the same BXD mouse strains examined previously (Jones et al., 2013) we found that the extent of the striatal damage produced following MPTP treatment is not correlated quantitatively with the production of MPP+ in the striatum. Our findings also extend those of others regarding strain differences in MPTP-induced dopaminergic neurotoxicity. Importantly, our finding suggests that additional factors influence the neurodegenerative response other than the presence and amount of the toxicant at the target site. |
Tissue tropism, pathology and pathogenesis of enterovirus infection
Muehlenbachs A , Bhatnagar J , Zaki SR . J Pathol 2014 235 (2) 217-28 Enteroviruses are very common and cause infections with a diverse array of clinical features. Enteroviruses are most frequently considered by practicing pathologists in cases of aseptic meningitis, encephalitis, myocarditis, and disseminated infections in neonates and infants. Congenital infections have been reported, and transplacental transmission is thought to occur. Although skin biopsies during hand foot and mouth disease are infrequently obtained, characteristic dermatopathological findings can be seen. Enteroviruses have been implicated in lower respiratory tract infections. This review will highlight histopathological features of enterovirus infection and discuss diagnostic modalities for formalin-fixed paraffin-embedded tissues and their associated pitfalls. Immunohistochemistry can detect enterovirus antigen within cells of affected tissues, however assays can be non-specific and detect other viruses. Molecular methods are increasingly relied upon, but due to the high frequency of asymptomatic enteroviral infections, clinical-pathological correlation is needed to determine significance. Of note, diagnostic assays on central nervous system or cardiac tissues from immunocompetent patients with prolonged disease courses are most often negative. Histopathological, immunohistochemical and molecular studies performed on clinical specimens also provide insight into enteroviral tissue tropism and pathogenesis. |
Worker health and safety practices in research facilities using nonhuman primates, North America
Lankau EW , Turner PV , Mullan RJ , Galland GG . Emerg Infect Dis 2014 20 (9) 1589-90 Since 1975, federal quarantine regulations (1) have restricted nonhuman primate importation to scientific, educational, or exhibition purposes to limit risks for disease introduction (1,2). Infectious diseases resulting from importation of nonhuman primates need to be prevented to ensure that colonies of these animals are available for research and to protect persons working with them from exposure to established and emerging zoonotic diseases (2,3). | Most imported nonhuman primates are bred for research and undergo standard screening and conditioning before shipment, which substantially reduce importation-associated health risks (4). However, many zoonotic agents can be difficult to exclude from even meticulously controlled breeding facilities (3,5). Nonhuman primates are commonly imported from regions with a high prevalence of potentially zoonotic diseases, such as tuberculosis and meliodosis, in humans and animals. Diagnosing tuberculosis in nonhuman primates can be difficult; inadvertent colony and human exposures can occur through undiagnosed cases (6). Similarly, Burkholderia pseudomallei, the causative agent of meliodosis, can be carried asymptomatically for extended periods before illness onset, posing a persistent exposure risk for persons working with imported nonhuman primates from regions to which meliodosis is endemic (7). Finally, nonhuman primates are host to potentially zoonotic viruses, such as simian foamy virus, which has unknown pathogenic potential in infected persons (8), and Macacine herpesvirus 1, which causes severe, often fatal, neurologic disease in humans exposed to macaques with asymptomatic infection (9). |
Lung epithelial cells resist influenza A infection by inducing the expression of cytochrome c oxidase VIC which is modulated by miRNA 4276
Othumpangat S , Noti JD , Beezhold DH . Virology 2014 468-470c 256-264 Influenza virus infection induces several changes in host miRNA profile, host cell death and tissue damage. Cytochrome c is a regulator of the intrinsic apoptotic pathway and is altered during viral infections. Within the first 3h of infection with influenza virus, significant down-regulation of hsa-miRNA-4276 (miRNA-4276) is followed by a 2-fold increase in cytochrome c oxidase VIC (COX6C) mRNA was found to occur in human alveolar and bronchial epithelial cells. Expression of caspase-9 also increased within the first 3h of infection, but subsequently decreased. Modulation of miR-4276 using mimic and inhibitor oligonucleotides showed significant down-regulation or up-regulation, respectively, of COX6C expression. Our data suggests that on initial exposure to influenza virus, host cells upregulate COX6C mRNA expression through silencing miR-4276 and repressed viral replication by inducing the apoptotic protein caspase-9. Taken together, these data suggest that miR-4276 may be an important regulator of the early stages of infection by influenza. |
In vivo processing of ceria nanoparticles inside liver: impact on free-radical scavenging activity and oxidative stress
Graham UM , Tseng MT , Jasinski JB , Yokel RA , Unrine JM , Davis BH , Dozier AK , Hardas SS , Sultana R , Grulke EA , Butterfield DA . Chempluschem 2014 79 (8) 1083-1088 The cytotoxicity of ceria ultimately lies in its electronic structure, which is defined by the crystal structure, composition, and size. Despite previous studies focused on ceria uptake, distribution, biopersistance, and cellular effects, little is known about its chemical and structural stability and solubility once sequestered inside the liver. Mechanisms will be presented that elucidate the in vivo transformation in the liver. In vivo processed ceria reveals a particle-size effect towards the formation of ultrafines, which represent a second generation of ceria. A measurable change in the valence reduction of the second-generation ceria can be linked to an increased free-radical scavenging potential. The in vivo processing of the ceria nanoparticles in the liver occurs in temporal relation to the brain cellular and protein clearance responses that stem from the ceria uptake. This information is critical to establish a possible link between cellular processes and the observed in vivo transformation of ceria. The temporal linkage between the reversal of the pro-oxidant effect (brain) and ceria transformation (liver) suggests a cause-effect relationship. |
Depot-medroxyprogesterone acetate does not reduce the prophylactic efficacy of emtricitabine and tenofovir disoproxil fumarate in macaques
Radzio J , Hanley K , Mitchell J , Ellis S , Deyounks F , Jenkins L , Heneine W , Garcia-Lerma JG . J Acquir Immune Defic Syndr 2014 67 (4) 365-9 Concerns that the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) may increase the risk of HIV acquisition in women led to questions on whether DMPA could reduce efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention. We used a macaque model to investigate the impact of prolonged DMPA on PrEP with FTC/TDF. Twelve pigtail macaques treated with DMPA were exposed vaginally to SHIV once a week for up to 5 months and received either placebo (n=6) or FTC/TDF (n=6). All control macaques were infected while the PrEP-treated animals remained protected (p=0.0007). This model suggests that women using DMPA will fully benefit from PrEP. |
Rationale for periodic reporting on the use of selected clinical preventive services to improve the health of infants, children, and adolescents - United States
Yeung LF , Shapira SK , Coates RJ , Shaw FE , Moore CA , Boyle CA , Thacker SB . MMWR Suppl 2014 63 (2) 3-13 This supplement is the second of a series of periodic reports from a CDC initiative to monitor and report on the use of a set of selected clinical preventive services in the U.S. population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services can result in substantial reductions in the burden of illness, death, and disability and lower treatment costs. This supplement focuses on services to improve the health of U.S. infants, children, and adolescents. The majority of clinical preventive services for infants, children, and adolescents are provided by the health-care sector. Public health agencies play important roles in increasing the use of these services by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use. Recent health-reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to improve use of preventive services. This supplement, which follows a previous report on adult services, provides baseline information on the use of a set of selected clinical preventive services to improve the health of infants, children, and adolescents before implementation of these recent initiatives and discusses opportunities to increase the use of such services. This information can help public health practitioners, in collaboration with other stakeholders that have key roles in improving infant, child, and adolescent health (e.g., parents or guardians and their employers, health plans, health professionals, schools, child care facilities, community groups, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders. |
Screening for developmental delays among young children - National Survey of Children's Health, United States, 2007
Rice CE , Naarden Braun KV , Kogan MD , Smith C , Kavanagh L , Strickland B , Blumberg SJ . MMWR Suppl 2014 63 (2) 27-35 Early childhood development typically follows a trajectory of achieving physical, cognitive, communication, social-emotional, and self-help milestones within a specified age range. Although most children reach these milestones within a similar range, others exhibit mild to severe developmental delays that indicate potential developmental disabilities. Developmental disabilities are a group of conditions caused by an impairment in one or more developmental domains (e.g., physical, learning, communication, behavior, or self-help). Developmental disabilities can become evident during the prenatal period through age 22 years, affect day-to-day functioning, and usually are lifelong. Approximately 15% of children aged 3-17 years in 2008 were estimated to have developmental disabilities of varying severity, such as language or learning disorders, intellectual disabilities, cerebral palsy, seizures, hearing loss, blindness, autism spectrum disorder (ASD), or other developmental delays. |
Survey of obstetrician-gynecologists in the United States about toxoplasmosis: 2012 update
Davis SM , Anderson BL , Schulkin J , Jones K , Eng JV , Jones JL . Arch Gynecol Obstet 2014 291 (3) 545-55 PURPOSE: Toxoplasmosis, caused by the parasite Toxoplasma gondii, can have serious impacts on fetal development in the setting of acute maternal primary infection. The American College of Obstetricians and Gynecologists (ACOG) sought to determine current knowledge, practices, opinions, and educational preferences regarding T. gondii infection in pregnancy among ACOG members practicing prenatal care. METHODS: ACOG sent a survey to 1,056 members chosen by stratified random sampling from membership lists, including 370 participants and 686 non-participants in the Collaborative Ambulatory Research Network (CARN). Mailings were sent up to four times to nonresponders. RESULTS: Survey minimum response rates were 40.3 % (CARN) and 19.7 % (non-CARN); response rates adjusted for imputed non-eligibility were 59.7 % (CARN) and 22.6 % (non-CARN). Among providers, 80.2 % had diagnosed no acute maternal T. gondii infections in the past 5 years, 12.7 % correctly identified the screening role of the Toxoplasma avidity test, 42.6 % performed serologic T. gondii screening for at least some asymptomatic pregnant women, and 62.1 % of those who so did used appropriate approaches. Providers in the northeastern United States were 2.02 times more likely to routinely screen than those in the west (p = 0.025) and female providers were 1.48 times more likely than male providers (p = 0.047). The potential educational interventions considered useful by the most practitioners were updated ACOG guidelines on screening (81.4 %) and management (71.7 %) for acute T. gondii infection in pregnancy. CONCLUSIONS: ACOG members would benefit from educational efforts targeted at risk factor counseling and screening approaches. |
Use of clinical preventive services in infants, children, and adolescents
Boyle CA , Perrin JM , Moyer VA . JAMA 2014 312 (15) 1509-10 At each stage from birth to young adulthood, the use of clinical preventive services (CPSs) provides an opportunity to intervene early to improve outcomes for many costly and complex conditions and to modify important disease-defining risk factors.1 A number of important provisions of the Affordable Care Act (ACA) will provide impetus to improve the use of CPSs, in particular, the provision that such services are now covered without cost sharing.2 | The Centers for Disease Control and Prevention (CDC) has collected baseline data and reported detailed information on a select set of CPSs for children to serve as a benchmark to measure change following ACA implementation.3 | The selected CPSs were identified by the CDC because they represent important public health issues for which CPSs exist, the service was underused before ACA implementation, and national data (largely parent and self-report or provider office-based surveys) were available to establish a baseline (defined as prior to 2012). Other important CPSs for children were not included in the report because of the lack of national data to track the clinical service (eg, screening for body mass index was considered, but surveillance data on screening in clinical care were not available), or the utilization of the CPS was already at high levels (eg, many infant immunizations). Not all of the CPSs included in the CDC report have a US Preventive Services Task Force (USPSTF) grade A or B or a comparable evidence review process recommendation (eg, Advisory Committee on Immunization Practices); but all, with the exception of dental visits and preventive services by dentists, like dental sealants, are now covered under the ACA.3 |
Use of dental care and effective preventive services in preventing tooth decay among U.S. children and adolescents - Medical Expenditure Panel Survey, United States, 2003-2009 and National Health and Nutrition Examination Survey, United States, 2005-2010
Griffin SO , Barker LK , Wei L , Li CH , Albuquerque MS , Gooch BF . MMWR Suppl 2014 63 (2) 54-60 Tooth decay is one of the most common chronic conditions among children. Approximately 23% of children aged 2-11 years have at least one primary tooth with untreated decay and 20% of adolescents aged 12-19 years have at least one permanent tooth with untreated decay. Tooth decay, if left untreated, can cause pain and infection, and can lead to problems with eating, speaking, and learning. Risk factors for tooth decay include recent history of cavities, low fluoride exposure, and living in a low-income household. Prevalence of untreated decay in primary or permanent teeth among children from lower-income households is more than twice that among children from higher-income households. Prevalence of untreated tooth decay is also higher among Mexican-American children and non-Hispanic black children than among white non-Hispanic children. By age 15, approximately 60% of all adolescents will have experienced tooth decay. An estimated 51.7 million school hours are missed annually by school-aged children because of a dental problem or visit. |
Use of selected clinical preventive services to improve the health of infants, children, and adolescents - United States, 1999-2011. Foreword.
Frieden TR . MMWR Suppl 2014 63 (2) 1-2 CDC has a long history of monitoring the use of clinical preventive services to provide public health agencies, health-care providers, health-care organizations, and their partners with information needed to plan and implement programs that increase use of these services and improve the health of the U.S. population. Increased use of clinical preventive services could improve the health of infants, children, and adolescents and promote healthy lifestyles that will enable them to achieve their full potential. The Affordable Care Act (ACA) expands insurance coverage, consumer protections, and access to care for the U.S. population and places a greater emphasis on prevention. Through implementation of ACA, new opportunities exist to promote and improve use of these valuable and vital services. This supplement provides a baseline assessment of the use of key services before ACA implementation. |
Vision screening among children aged 6 years - Medical Expenditure Panel Survey, United States, 2009-2010
Kemper AR , Crews JE , Strickland B , Saaddine JB . MMWR Suppl 2014 63 (2) 43-6 Amblyopia or lazy eye is an important cause of monocular blindness and is associated with a 2.6 fold increase in the risk for bilateral visual impairment in adults. However, amblyopia can usually be prevented through early detection and treatment. Treatment focuses on correcting the underlying cause of amblyopia (e.g., strabismus or unequal refractive error) and promoting the use of the amblyogenic eye (e.g., through patching of the other eye). Effectiveness of treatment decreases with age and is less successful after age 12 years. The overall prevalence of amblyopia among children aged 6 months to 6 years is 1% to 2%. In addition, the prevalence of amblyogenic risk factors among children in this age range is approximately 3%. Because amblyopia can usually be prevented with early intervention, preschool vision screening for the prevention of amblyopia is considered cost-effective. |
Vital Signs: sodium intake among U.S. school-aged children - 2009-2010
Cogswell ME , Yuan K , Gunn JP , Gillespie C , Sliwa S , Galuska DA , Barrett J , Hirschman J , Moshfegh AJ , Rhodes D , Ahuja J , Pehrsson P , Merritt R , Bowman BA . MMWR Morb Mortal Wkly Rep 2014 63 (36) 789-97 BACKGROUND: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. METHODS: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010. RESULTS: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%). IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals. |
Lead screening and prevalence of blood lead levels in children aged 1-2 years - Child Blood Lead Surveillance System, United States, 2002-2010 and National Health and Nutrition Examination Survey, United States, 1999-2010
Raymond J , Wheeler W , Brown MJ . MMWR Suppl 2014 63 (2) 36-42 Lead poisoning in children is preventable. However, in 2010, a total of 34 U.S. states and the District of Columbia (DC) identified approximately 24,000 children aged <6 years with blood lead levels (BLLs) ≥10 microg/dL and approximately 243,000 children aged <6 years with BLLs ≥5 microg/dL, the upper reference range value established in 2012 for follow-up blood lead testing in children aged 0-6 years. Permanent neurologic damage and behavior disorders have been associated with lead exposure even at detectable BLLs <5 microg/dL. |
Nutritional status of refugee children entering DeKalb County, Georgia
Shah AY , Suchdev PS , Mitchell T , Shetty S , Warner C , Oladele A , Reines S . J Immigr Minor Health 2014 16 (5) 959-67 This study determines the nutritional status among refugee children entering one of the largest resettlement counties in the United States and identifies differences between incoming populations. Medical records of all newly arriving pediatric refugees (0-18 years) entering DeKalb County, Georgia between October 2010 and July 2011 were reviewed. Refugee children were grouped as African, Bhutanese, or Burmese (resettling from either Thailand or Malaysia) for comparative analysis. Approximately one in five refugees were anemic or malnourished, while a quarter had stool parasites, and nearly half had dental caries. African refugees had the highest anemia but the lowest underweight prevalence (p < 0.05). Compared to Burmese resettling from Malaysia, Burmese children from Thailand had a higher prevalence of anemia, underweight, and stool parasites (p < 0.05). Clinicians should use CDC medical screening guidelines for newly arriving pediatric refugees, as well as ensure proper nutritional support and follow-up care. |
Prenatal breastfeeding counseling - Pregnancy Risk Assessment Monitoring System, United States, 2010
Lind JN , Ahluwalia IB , Perrine CG , Li R , Harrison L , Grummer-Strawn LM . MMWR Suppl 2014 63 (2) 14-9 Breastfeeding is a highly effective preventive measure a mother can take after birth to protect the health of her infant, as well as her own. Immunologic and antiinflammatory properties of breast milk protect against numerous illnesses and diseases in children. Benefits of breastfeeding for infants include a lower risk for ear infections, atopic dermatitis, lower respiratory tract infections, sudden infant death syndrome (SIDS), necrotizing enterocolitis (NEC) in preterm infants, type 2 diabetes, asthma, and childhood obesity. For mothers, benefits of breastfeeding include a lower risk for breast cancer and ovarian cancer. Increasing rates of breastfeeding and therefore its health benefits might lower health-care costs. A recent study found that if higher rates of mothers complied with medical recommendations for breastfeeding, an estimated $2.2 billion in additional direct medical costs would be saved annually in the United States. |
Early hearing detection and intervention among infants - Hearing Screening and Follow-up Survey, United States, 2005-2006 and 2009-2010
Gaffney M , Eichwald J , Gaffney C , Alam S . MMWR Suppl 2014 63 (2) 20-6 Two to three infants per 1,000 live births are born deaf or hard of hearing. When left undetected, a hearing loss can delay a child's speech and language development. Approximately 40% of young adults with hearing loss identified during childhood reported experiencing at least one limitation in daily functioning. A total of 41 states, Guam, and the District of Columbia have passed statutes or regulatory guidance related to the identification of deaf and hard of hearing infants. All U.S. jurisdictions also have now established Early Hearing Detection and Intervention (EHDI) programs. These programs represent an evidence-based public health approach that connects public health and clinical preventive services to address the needs of infants who are deaf and hard of hearing. With support from public health agencies at both the jurisdictional and federal levels, EHDI programs help ensure that infants are screened for hearing loss and receive recommended follow-up through active tracking, surveillance, and coordination with clinical service providers and families. |
An evidence review of gender-integrated interventions in reproductive and maternal-child health
Kraft JM , Wilkins KG , Morales GJ , Widyono M , Middlestadt SE . J Health Commun 2014 19 Suppl 1 122-41 Evidence-based behavior change interventions addressing gender dynamics must be identified and disseminated to improve child health outcomes. Interventions were identified from systematic searches of the published literature and a web-based search (Google and implementer's websites). Studies were eligible if an intervention addressed gender dynamics (i.e., norms, unequal access to resources), measured relevant behavioral outcomes (e.g., family planning, antenatal care, nutrition), used at least a moderate evaluation design, and were implemented in low- or middle-income countries. Of the 23 interventions identified, 22 addressed reproductive and maternal-child health behaviors (e.g., birth spacing, antenatal care, breastfeeding) that improve child health. Eight interventions were accommodating (i.e., acknowledged, but did not seek to change gender dynamics), and 15 were transformative (i.e., sought to change gender dynamics). The majority of evaluations (n = 12), including interventions that engaged men and women to modify gender norms, had mixed effects. Evidence was most compelling for empowerment approaches (i.e., participatory action for maternal-child health; increase educational and economic resources, and modify norms to reduce child marriage). Two empowerment approaches had sufficient evidence to warrant scaling-up. Research is needed to assess promising approaches, particularly those that engage men and women to modify gender norms around communication and decision making between spouses. |
Hospitalization cost per case of neonatal herpes simplex virus infection from claims data
Owusu-Edusei K Jr , Flagg EW , Gift TL . J Pediatr Nurs 2014 30 (2) 346-52 The purpose of this study was to estimate the average excess inpatient cost of neonatal herpes simplex virus (NHSV) infection from 2005 to 2009 insurance claims data. The estimated adjusted average excess inpatient cost for neonate admissions with HSV diagnosis and >7days of hospitalization was $40,044 [95% confidence interval (CI), $33,529-$47,775]. When disaggregated by the days of admission, cost estimates were: 8-13days, $23,918 [CI, $19,490-$29,282]; 14-21days, $44,358 [CI, $34,654-$56,673]; >21days, $68,916 [CI, $49,905-$94,967]). Although these estimates are not representative of the entire US, they can inform future economic evaluation studies on NHSV interventions. |
Hypertension screening in children and adolescents - National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and Medical Expenditure Panel Survey, United States, 2007-2010
George MG , Tong X , Wigington C , Gillespie C , Hong Y . MMWR Suppl 2014 63 (2) 47-53 Hypertension and prehypertension have been increasing among children and adolescents since the 1990s. During 2003-2006, among children and adolescents aged 8-17 years, the prevalence of prehypertension was approximately 14% in boys and approximately 6% in girls, and the prevalence of hypertension was estimated to be 3%-4% in various studies. During 1997-2006, hospitalization rates for children and adolescents with a diagnosis of hypertension doubled, from approximately 18 cases per 100,000 pediatric hospital discharges in 1997 to approximately 35 cases per 100,000 in 2006. Among children and adolescents with hypertension, as many as one in three has target organ damage, especially left ventricular hypertrophy. Accumulating evidence supports the theory that elevated blood pressure levels in adolescence are a precursor of elevated blood pressure in adulthood, making it important to identify elevated blood pressure in childhood. An analysis of the National Childhood Blood Pressure database found that 14% of adolescents with prehypertension developed elevated blood pressure within 2 years. |
Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell
Latzman RD , Shishido Y , Latzman NE , Elkin TD , Majumdar S . Pediatr Blood Cancer 2014 61 (10) 1822-7 BACKGROUND: To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD). PROCEDURES: Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year. RESULTS: ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency. CONCLUSIONS: Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment. |
Barriers to care for children with orofacial clefts in North Carolina
Cassell CH , Strassle P , Mendez DD , Lee KA , Krohmer A , Meyer RE , Strauss RP . Birth Defects Res A Clin Mol Teratol 2014 100 (11) 837-47 BACKGROUND: Little is known about the barriers faced by families of children with birth defects in obtaining healthcare. We examined reported perceived barriers to care and satisfaction with care among mothers of children with orofacial clefts. METHODS: In 2006, a validated barriers to care mail/phone survey was administered in North Carolina to all resident mothers of children with orofacial clefts born between 2001 and 2004. Potential participants were identified using the North Carolina Birth Defects Monitoring Program, an active, state-wide, population-based birth defects registry. Five barriers to care subscales were examined: pragmatics, skills, marginalization, expectations, and knowledge/beliefs. Descriptive and bivariate analyses were conducted using chi-square and Fisher's exact tests. Results were stratified by cleft type and presence of other birth defects. RESULTS: Of 475 eligible participants, 51.6% (n = 245) responded. The six most commonly reported perceived barriers to care were all part of the pragmatics subscale: having to take time off work (45.3%); long waits in the waiting rooms (37.6%); taking care of household responsibilities (29.7%); meeting other family members' needs (29.5%); waiting too many days for appointments (27.0%); and cost (25.0%). Most respondents (72.3%, 175/242) felt "very satisfied" with their child's cleft care. CONCLUSION: Although most participants reported being satisfied with their child's care, many perceived barriers to care were identified. Due to the limited understanding and paucity of research on barriers to care for children with birth defects, including orofacial clefts, additional research on barriers to care and factors associated with them are needed. . |
Cancer incidence rates and trends among children and adolescents in the United States, 2001-2009
Siegel DA , King J , Tai E , Buchanan N , Ajani UA , Li J . Pediatrics 2014 134 (4) e945-55 OBJECTIVES: Cancer continues to be the leading disease-related cause of death among children and adolescents in the United States. More current information is needed to describe recent cancer trends and identify demographic and geographic variations. METHODS: We analyzed data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results statewide registries representing 94.2% of the US population to identify cancers diagnosed among persons aged 0 to 19 years during 2001-2009. Age-adjusted rates and annual percentage change for trends were calculated. Data were stratified by age, gender, race, ethnicity, and geography. RESULTS: We identified 120 137 childhood and adolescent cancer cases during 2001-2009 with an age-adjusted incidence rate of 171.01 per million. The overall rate of all cancers combined remained stable over time (annual percent change [APC], 0.3%; 95% confidence interval [CI], -0.1 to 0.7). There was an increase in the overall cancer trend among African American children and adolescents (APC, 1.3%; 95% CI, 0.2 to 2.5). An increasing trend for thyroid cancer was observed among both genders (APC, 4.9%; 95% CI, 3.2 to 6.6) and specifically among adolescents and those in the Northeast, South, and West regions of the United States. Renal carcinoma incidence was increasing significantly overall (APC, 5.4%; 95% CI, 2.8 to 8.1). Extracranial and extragonadal germ cell tumors and melanoma were both significantly decreasing. CONCLUSIONS: This study reports the novel finding that renal carcinoma rates are increasing among children and adolescents. This study confirms that thyroid cancer rates are increasing and further describes rising cancer rates among African Americans. |
Community socioeconomic disadvantage and the survival of infants with congenital heart defects
Kucik JE , Nembhard WN , Donohue P , Devine O , Wang Y , Minkovitz CS , Burke T . Am J Public Health 2014 104 (11) e1-e8 OBJECTIVES: We examined the association between survival of infants with severe congenital heart defects (CHDs) and community-level indicators of socioeconomic status. METHODS: We identified infants born to residents of Arizona, New Jersey, New York, and Texas between 1999 and 2007 with selected CHDs from 4 population-based, statewide birth defect surveillance programs. We linked data to the 2000 US Census to obtain 11 census tract-level socioeconomic indicators. We estimated survival probabilities and hazard ratios adjusted for individual characteristics. RESULTS: We observed differences in infant survival for 8 community socioeconomic indicators (P < .05). The greatest mortality risk was associated with residing in communities in the most disadvantaged deciles for poverty (adjusted hazard ratio [AHR] = 1.49; 95% confidence interval [CI] = 1.11, 1.99), education (AHR = 1.51; 95% CI = 1.16, 1.96), and operator or laborer occupations (AHR = 1.54; 95% CI = 1.16, 1.96). Survival decreased with increasing numbers of indicators that were in the most disadvantaged decile. Community-level mortality risk persisted when we adjusted for individual-level characteristics. CONCLUSIONS: The increased mortality risk among infants with CHDs living in socioeconomically deprived communities might indicate barriers to quality and timely care at which public health interventions might be targeted. |
Conclusions and future directions for periodic reporting on the use of selected clinical preventive services to improve the health of infants, children, and adolescents - United States
Yeung LF , Coates RJ , Seeff L , Monroe JA , Lu MC , Boyle CA . MMWR Suppl 2014 63 (2) 99-107 The findings described in this supplement can help improve collaboration among public health and other stakeholders who influence infant, child, and adolescent health (e.g., parents or guardians and their employers, health plans, health professionals, schools, child care facilities, community groups, and voluntary associations) to increase the use of selected clinical preventive services among U.S. infants, children, and adolescents. Increased use can substantially reduce illness and long-term disability and improve health and quality of life. This supplement underscores that the use of the clinical preventive services among U.S. infants, children, and adolescents is not optimal and is variable, ranging from <10% to approximately 85%, depending on the particular service. Use was particularly low for developmental screening and receipt of dental preventive services in young children, and for human papillomavirus (HPV) vaccination and tobacco cessation assistance, including counseling, in adolescents; however, opportunities exist to improve use of all of these services. Children and adolescents with no insurance and those with no usual source of health care (if available for analysis) were the groups least likely to have used the services. Use among the uninsured ranged from 1-39 percentage points below the general population averages, suggesting that improvements in insurance coverage that will result from the implementation of health-care reform are likely to increase use of these clinical preventive services. In 2012, a total of 4.9 million children (6.6% of children) were uninsured at the time of interview, and approximately 15% of eligible children in the United States are not enrolled in Medicaid and Children's Health Insurance Program (CHIP) programs. In addition, although opportunities exist for greater insurance coverage and for use of recommended clinical preventive services under the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152, together referred to as the Affordable Care Act [ACA]), a survey among the uninsured found a low level of awareness of the Health Insurance Marketplace (or Health Insurance Exchange) that can be used by families to acquire insurance or Medicaid coverage. The survey highlights the importance of focused efforts by governmental health agencies and other stakeholders to enroll uninsured children and adolescents in health plans. Also, although use of clinical preventive services in insured populations was greater than among the uninsured, use among the insured was generally <85%, and often much less. Therefore, having health insurance coverage alone might not be sufficient to optimize use of clinical preventive services, and additional measures to improve use probably will be necessary. |
Outstanding student research: Li et al on investigating the placement of green carts to improve access to healthful foods in food deserts
Posner SF . Prev Chronic Dis 2014 11 E157 Each year since 2011 Preventing Chronic Disease (PCD) has issued a special call for student papers for our Student Research Paper Contest. This year PCD received 67 submissions from students throughout the world. We are very excited to recognize Kathleen Li and colleagues as the winners of the 2014 contest for their paper entitled “Evaluation of the Placement of Mobile Fruit and Vegetable Vendors to Alleviate Food Deserts in New York City” (1). Ms Li is currently a medical student at the University of California, San Francisco, School of Medicine, and she conducted the study described in her paper with Dr Carol Horowitz and colleagues at the Icahn School of Medicine at Mount Sinai’s Department of Health Evidence and Policy. | In their paper Ms Li and colleagues described their investigation of how the placement of mobile fruit and vegetable vendors affects access to fresh fruit and vegetables in areas that have been designated food deserts. Evidence suggests that people in neighborhoods with access to supermarkets are more likely to have healthier diets and lower levels of obesity than those in food deserts (2). A substantial investment in promotion of mobile fruit and vegetable vendors in the past several years has been at least partially effective in increasing access in areas that lack retail outlets with healthful selections (3–5). The strategic placement of these vendors has been central to the New York City licensing program. In addition to placement, efforts have been made to facilitate the vendor acceptance of Electronic Benefit Transfer (EBT) cards from the Supplemental Nutrition Assistance Program and other assistance programs. |
Study methodology prevents interpretation of findings in workers involved in Gulf oil spill cleanup activities
Piacentino J , Silver S , Bernard B , DeBord DG , Funk R , Decker J . Am J Med 2014 127 (9) e25-6 We read with interest a recent report by D'Andrea and Reddy1 describing differences in hematologic and hepatic blood profiles among a cohort of workers involved in Gulf oil spill cleanup activities relative to an unexposed cohort. They report that cleanup workers had lower average levels of platelets, blood urea nitrogen, and creatinine, and higher levels of hemoglobin, hematocrit, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase. The authors also postulate that “the oil spill exposure appears to play a role in the development of hematologic and hepatic toxicity.” The relation of these findings to exposures associated with cleanup activities cannot be interpreted given the current study design, lack of exposure history, and laboratory analysis. | With regard to the study design, we have concerns about both the validity and generalizability of the results. Blood chemistries from workers participating in cleanup activities along the coast of Louisiana for 3 months or longer are compared to a cohort of randomly selected patients visiting a clinic for a wellness checkup, located 100 miles away from the Gulf coast of Louisiana. Additional selection and exclusion criteria, such as employment history, demographic and lifestyle characteristics, and medical history are not included. This recruitment design provides little assurance that the 2 groups come from the same base population or that cleanup workers chosen for this study are representative of the broader group of cleanup workers. The use of a well-characterized control group, such as workers with similar demographic, lifestyle, and medical characteristics, without exposure to cleanup activities, or an appropriately matched external referent group of subjects selected from the National Health and Nutrition Examination Survey cohort would have been preferable.2 |
Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Atherosclerosis (MESA)
Fujishiro K , Diez Roux AV , Landsbergis P , Kaufman JD , Korcarz CE , Stein JH . Occup Environ Med 2014 72 (10) 690-8 OBJECTIVES: The role of occupation in the development of cardiovascular disease (CVD) remains a topic of research because few studies have examined longitudinal associations, and because occupation can be an indicator of socioeconomic position (SEP) and a proxy for hazard exposure. This study examines associations of occupational category as an SEP marker and selected occupational exposures with progression of the subclinical carotid artery disease. METHODS: A community-based, multiethnic sample (n=3109, mean age=60.2) provided subclinical CVD measures at least twice at three data collection points (mean follow-up=9.4 years). After accounting for demographic characteristics, SEP, and traditional CVD risk factors, we modelled common carotid intima-media thickness, carotid plaque scores, and carotid plaque shadowing as a function of occupational category, physical hazard exposure, physical activity on the job, interpersonal stress, job control and job demands. These job characteristics were derived from the Occupational Resource Network (O*NET). Random coefficient models were used to account for repeated measures and time-varying covariates. RESULTS: There were a few statistically significant associations at baseline. After all covariates were included in the model, men in management, office/sales, service and blue-collar jobs had 28-44% higher plaque scores than professionals at baseline (p=0.001). Physically hazardous jobs were positively associated with plaque scores among women (p=0.014). However, there were no significant longitudinal associations between any of the occupational characteristics and any of the subclinical CVD measures. CONCLUSIONS: There was little evidence that the occupational characteristics examined in this study accelerated the progression of subclinical CVD. |
Occupational radon exposure and lung cancer mortality: estimating intervention effects using the parametric g-formula
Edwards JK , McGrath LJ , Buckley JP , Schubauer-Berigan MK , Cole SR , Richardson DB . Epidemiology 2014 25 (6) 829-34 BACKGROUND: Traditional regression analysis techniques used to estimate associations between occupational radon exposure and lung cancer focus on estimating the effect of cumulative radon exposure on lung cancer. In contrast, public health interventions are typically based on regulating radon concentration rather than workers' cumulative exposure. Estimating the effect of cumulative occupational exposure on lung cancer may be difficult in situations vulnerable to the healthy worker survivor bias. METHODS: Workers in the Colorado Plateau Uranium Miners cohort (n = 4,134) entered the study between 1950 and 1964 and were followed for lung cancer mortality through 2005. We use the parametric g-formula to compare the observed lung cancer mortality to the potential lung cancer mortality had each of 3 policies to limit monthly radon exposure been in place throughout follow-up. RESULTS: There were 617 lung cancer deaths over 135,275 person-years of follow-up. With no intervention on radon exposure, estimated lung cancer mortality by age 90 was 16%. Lung cancer mortality was reduced for all interventions considered, and larger reductions in lung cancer mortality were seen for interventions with lower monthly radon exposure limits. The most stringent guideline, the Mine Safety and Health Administration standard of 0.33 working-level months, reduced lung cancer mortality from 16% to 10% (risk ratio = 0.67 [95% confidence interval = 0.61 to 0.73]). CONCLUSIONS: This work illustrates the utility of the parametric g-formula for estimating the effects of policies regarding occupational exposures, particularly in situations vulnerable to the healthy worker survivor bias. |
The effect of tungstate nanoparticles on reactive oxygen species and cytotoxicity in raw 264.7 mouse monocyte macrophage cells
Dunnick KM , Badding MA , Schwegler-Berry D , Patete JM , Koenigsmann C , Wong SS , Leonard SS . J Toxicol Environ Health A 2014 77 (20) 1251-68 Due to their unique size, surface area, and chemical characteristics, nanoparticles' use in consumer products has increased. However, the toxicity of nanoparticle (NP) exposure during the manufacturing process has not been fully assessed. Tungstate NP are used in numerous products, including but not limited to scintillator detectors and fluorescent lighting. As with many NP, no apparent toxicity studies have been completed with tungstate NP. The hypothesis that tungstate NP in vitro exposure results in reactive oxygen species (ROS) formation and cytotoxicity was examined. Differences in toxicity based on tungstate NP size, shape (sphere vs. wire), and chemical characteristics were determined. RAW 264.7 mouse monocyte macrophages were exposed to tungstate NP, and ROS formation was assessed via electron spin resonance (ESR), and several assays including hydrogen peroxide, intracellular ROS, and Comet. Results showed ROS production induced by tungstate nanowire exposure, but this exposure did not result in oxidative DNA damage. Nanospheres showed neither ROS nor DNA damage following cellular exposure. Cells were exposed over 72 h to assess cytotoxicity using an MTT (tetrazolium compound) assay. Results showed that differences in cell death between wires and spheres occurred at 24 h but were minimal at both 48 and 72 h. The present results indicate that tungstate nanowires are more reactive and produce cell death within 24 h of exposure, whereas nanospheres are less reactive and did not produce cell death. Results suggest that differences in shape may affect reactivity. However, regardless of the differences in reactivity, in general both shapes produced mild ROS and resulted in minimal cell death at 48 and 72 h in RAW 264.7 cells. |
Fall prevention research and practice: a total worker safety approach
Hsiao H . Ind Health 2014 52 (5) 381-92 Slips, trips, and falls (STF) represent a serious hazard to workers and occupants in many industries, homes, and communities. Often, the cause of a STF incident is multifactorial, encompassing human, environmental, and task risk factors. A STF-related disability can greatly diminish the occupational capability and quality of life of individuals in both the workplace and the home. Countering STF hazards and risks both on and off the job and on all aspects of control measures is a "total worker safety" matter, a challenging yet tangible undertaking. As the federal organization responsible for conducting research for the prevention of work-related injuries in the United States, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research on STF controls for some decades. Many NIOSH research outcomes have been utilized for STF prevention in workplaces, with potential for prevention in homes as well. This paper summarizes the concept of total worker safety for STF control, NIOSH priority research goals, major activities, and accomplishments, and some emerging issues on STF. The strategic planning process for the NIOSH research goals and some identified research focuses are applicable to the development and implementation of global STF research goals. |
Application of a model for delivering occupational safety and health to smaller businesses: case studies from the US
Cunningham T , Sinclair R . Saf Sci 2014 71 (100) 213-225 Smaller firms are the majority in every industry in the US, and they endure a greater burden of occupational injuries, illnesses, and fatalities than larger firms. Smaller firms often lack the necessary resources for effective occupational safety and health activities, and many require external assistance with safety and health programming. Based on previous work by researchers in Europe and New Zealand, NIOSH researchers developed for occupational safety and health intervention in small businesses. This model was evaluated with several intermediary organizations. Four case studies which describe efforts to reach small businesses with occupational safety and health assistance include the following: trenching safety training for construction, basic compliance and hazard recognition for general industry, expanded safety and health training for restaurants, and fall prevention and respirator training for boat repair contractors. Successful efforts included participation by the initiator among the intermediaries'; planning activities, alignment of small business needs with intermediary offerings, continued monitoring of intermediary activities by the initiator, and strong leadership for occupational safety and health among intermediaries. Common challenges were a lack of resources among intermediaries, lack of opportunities for in-person meetings between intermediaries and the initiator, and balancing the exchanges in the initiator-intermediary-small business relationships. The model offers some encouragement that initiator organizations can contribute to sustainable OSH assistance for small firms, but they must depend on intermediaries who have compatible interests in smaller businesses and they must work to understand the small business social system. |
A biomechanical assessment of hand/arm force with pneumatic nail gun actuation systems
Lowe Brian D , Albers James , Hudock Stephen D . Int J Ind Ergon 2014 44 (5) 715-722 A biomechanical model is presented to estimate user hand/arm force exertion with two pneumatic nail gun trigger systems. The sequential actuation trigger (SAT) is safer than the contact actuation trigger (CAT) but increases the user's exertion of force because the trigger must be actuated after the safety tip is held pressed against the workpiece. Time integrated hand force was calculated for a single user based on direct measurement of nail gun tip force against the workpiece (tip contact) and from estimated force to support the tool weight during transfer between nails and during idle holding. The model shows that hand/arm force increases when nailing with the SAT (relative to CAT) and with a vertically-oriented workpiece (relative to horizontal). Expressed per nail fired, the user exerted 0.13Ns (horizontal orientation) and 2.88Ns (vertical orientation) integrated hand force during tip contact with CAT compared to 26.15Ns (horizontal) and 46.08Ns (vertical) with SAT. Depending upon idle holding duration, integrated hand force during tip contact was estimated to have been 1-3% of 48-132Ns total hand force with CAT and 21-44% of 83-167Ns total hand force with SAT (average of horizontal and vertical orientations). Based on standard time allowances from work measurement systems it is proposed that efficient application of hand force during tip contact with SAT can reduce this contribution to 6-15% of 55-139Ns total hand force. The model is useful for considering differences in hand/arm force exertion between the SAT and CAT systems. RELEVANCE TO INDUSTRY: This paper presents a model of hand/arm force associated with two types of pneumatic nail gun actuation (trigger) systems. The model clarifies differences in user force exertion with the sequential actuation and contact actuation triggers to inform nail gun trigger selection decisions. |
Comparison of measured and self-reported anthropometric information among firefighters: implications and applications
Hsiao H , Weaver D , Hsiao J , Whitestone J , Kau TY , Whisler R , Ferri R . Ergonomics 2014 57 (12) 1-12 This study evaluated the accuracy of self-reported body weight and height compared to measured values among firefighters and identified factors associated with reporting error. A total of 863 male and 88 female firefighters in four US regions participated in the study. The results showed that both men and women underestimated their body weight ( - 0.4 +/- 4.1, - 1.1 +/- 3.6 kg) and overestimated their height (29 +/- 18 , 17 +/- 16 mm). Women underestimated more than men on weight (p = 0.022) and men overestimated more than women on height (p < 0.001). Reporting errors on weight were increased with overweight status (p < 0.001) and were disproportionate among subgroups. About 27% men and 24% women had reporting errors on weight greater than +/- 2.2 kg, and 59% men and 28% women had reporting errors on height greater than 25 mm. Practitioner Summary: This study along with literature revealed that the self-reported approach is not a sustainable option for anthropometric surveys, even for gathering data from physically active professional groups, such as firefighters, who presumably are knowledgeable of their body dimensions. Self-reported anthropometric information is undependable in important population subgroups. |
Cytotoxicity and characterization of particles collected from an indium-tin oxide production facility
Badding MA , Stefaniak AB , Fix NR , Cummings KJ , Leonard SS . J Toxicol Environ Health A 2014 77 (20) 1193-209 Occupational exposure to indium compound particles has recently been associated with lung disease among workers in the indium-tin oxide (ITO) industry. Previous studies suggested that excessive alveolar surfactant and reactive oxygen species (ROS) may play a role in the development of pulmonary lesions following exposure to indium compounds. However, toxicity at the cellular level has not been comprehensively evaluated. Thus, the aim of this study was to assess which, if any, compounds encountered during ITO production are toxic to cultured cells and ultimately contribute to the pathogenesis of indium lung disease. The compounds used in this study were collected from eight different processing stages at an ITO production facility. Enhanced dark field imaging showed 5 of the compounds significantly associated with cells within 1 h, suggesting that cellular reactions to the compound particles may be occurring rapidly. To examine the potential cytotoxic effects of these associations, ROS generation, cell viability, and apoptosis were evaluated following exposures in RAW 264.7 mouse monocyte macrophage and BEAS-2B human bronchial epithelial cell lines. Both exhibited reduced viability with exposures, while apoptosis only occurred in RAW 264.7 cells. Our results suggested that excessive ROS production is likely not the predominant mechanism underlying indium-induced lung disease. However, the effects on cell viability reveal that several of the compounds are cytotoxic, and therefore, exposures need to be carefully monitored in the industrial setting. |
Ring-screening to control endemic transmission of Taenia solium
O'Neal SE , Moyano LM , Ayvar V , Rodriguez S , Gavidia C , Wilkins PP , Gilman RH , Garcia HH , Gonzalez AE . PLoS Negl Trop Dis 2014 8 (9) e3125 BACKGROUND: Taenia solium is a major cause of preventable epilepsy in developing nations. Screening and treatment of human intestinal stage infection (taeniasis) within high-risk foci may reduce transmission and prevent epilepsy by limiting human exposure to infective eggs. We piloted a ring-strategy that involves screening and treatment for taeniasis among households located nearby pigs heavily-infected with the larval stage (cysticercosis). These pigs mark areas of increased transmission and can be identified by tongue examination. METHODOLOGY: We selected two villages in northern Peru for a controlled prospective interventional cohort pilot study. In the intervention village (1,058 residents) we examined the tongues of all pigs every 4 months for nodules characteristic of cysticercosis. We then screened all residents living within 100-meters of any tongue-positive pig using enzyme-linked immunosorbent assay to detect Taenia antigens in stool. Residents with taeniasis were treated with niclosamide. In both the intervention and control (753 residents) we measured incidence of exposure by sampling the pig population every 4 months for serum antibodies against cysticercosis using enzyme-linked immunoelectrotransfer blot. PRINCIPAL FINDINGS: Baseline seroincidence among pigs born during the study was 22.6 cases per 100 pigs per-month (95% confidence interval [CI] 17.0-30.0) in the intervention and 18.1 (95% CI 12.7-25.9) in the control. After one year we observed a 41% reduction in seroincidence in the intervention village compared to baseline (incidence rate ratio 0.59, 95% CI 0.41-0.87) while the seroincidence in the control village remained unchanged. At study end, the prevalence of taeniasis was nearly 4 times lower in the intervention than in the control (prevalence ratio 0.28, 95% CI 0.08-0.91). CONCLUSIONS/SIGNIFICANCE: Ring-screening reduced transmission of T. solium in this pilot study and may provide an effective and practical approach for regions where resources are limited. However, this strategy requires validation in larger populations over a greater period of time. |
Impact of a community-based lymphedema management program on episodes of adenolymphangitis (ADLA) and lymphedema progression - Odisha State, India
Mues KE , Deming M , Kleinbaum DG , Budge PJ , Klein M , Leon JS , Prakash A , Rout J , Fox LM . PLoS Negl Trop Dis 2014 8 (9) e3140 BACKGROUND: Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. METHODOLOGY/PRINCIPAL FINDINGS: A lymphedema management program was implemented in Odisha State, India from 2007-2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. CONCLUSIONS/SIGNIFICANCE: These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes. |
The challenge of artemisinin resistance can only be met by eliminating Plasmodium falciparum malaria across the Greater Mekong subregion
Smith Gueye C , Newby G , Hwang J , Phillips AA , Whittaker M , MacArthur JR , Gosling RD , Feachem RG . Malar J 2014 13 286 Artemisinin-based combinations are currently the most effective anti-malarials and, in addition to vector control, have led to significant declines in malaria morbidity and mortality. However, foci of artemisinin drug resistance have been identified in the Greater Mekong subregion (GMS) of the Asia Pacific, threatening the major gains made in malaria control and potentially creating a parasite pool that is more difficult to treat and eliminate. Efforts are underway to halt the spread of artemisinin resistance, including coordination of activities and funding, and identification of areas of suspected artemisinin resistance, now using a newly identified molecular marker. However, targeting resources to the containment of resistant parasites is likely inefficient and monitoring impact is challenging. A more sustainable solution is the rapid elimination of all Plasmodium falciparum parasites from the GMS. This strategy is more efficient for several reasons. First, a subregional strategy is in line with current commitment to elimination and will build upon the existing national political support for elimination as well as enhancing collaboration among countries. Second, the challenge of human mobility in the GMS is subregional in scope and requires a harmonized elimination strategy. Third, countries will need to improve and intensify malaria operations to reach elimination, and this will be a singular goal across the subregion. Rallying around the goal of P. falciparum elimination will not only utilize existing regional bodies to catalyze political and funding support, but will also leverage the funding already in place to achieve this subregional goal. |
Sexual health interventions: a meta-analysis
Becasen JS , Ford J , Hogben M . J Sex Res 2014 52 (4) 1-11 In the second of two companion papers, we conducted a meta-analysis of sexual health interventions in three domains. The interventions chosen for the meta-analysis were a subset of studies presented in a narrative review (the first of the two companion papers); these in turn were selected on the basis of fit to principles derived from the World Health Organization (WHO) and other definitions of sexual health. Studies (n = 20) were drawn from Medline and PsycINFO databases (English language, adult populations, 1996-2011) and fell into three domains: knowledge, attitudes, and sexual behaviors. We estimated intervention effects via Hedges' g, using the random-effects approach. Initial estimates revealed a large effect for knowledge, g = 1.32 (95% CI = 0.51-2.14), and smaller effects for attitude change, g = 0.17 (0.11-0.24) and behavior, g = 0.21 (0.13-0.29). After removing outliers to produce more precise estimates, the final effect sizes for knowledge, attitudes, and sexual behavior were, respectively, 0.25 (0.03-0.48), 0.18 (0.12-0.24), and 0.18 (0.11-0.24). Interventions yielded positive effects across populations and in all the domains studied. |
Legal mechanisms supporting accountable care principles
Ramanathan T . Am J Public Health 2014 104 (11) e1-e4 Public health and private providers and facilities may shape the future of the US health system by engaging in new ways to deliver care to patients. "Accountable care" contracts allow private health care and public health providers and facilities to collaboratively serve defined populations. Accountable care frameworks emphasize health care quality and cost savings, among other goals. In this article, I explore the legal context for accountable care, including the mechanisms by which providers, facilities, and public health coordinate activities, avoid inefficiencies, and improve health outcomes. I highlight ongoing evaluations of the impact of accountable care on public health outcomes. |
A ride in the time machine: information management capabilities health departments will need
Foldy S , Grannis S , Ross D , Smith T . Am J Public Health 2014 104 (9) 1592-600 We have proposed needed information management capabilities for future US health departments predicated on trends in health care reform and health information technology. Regardless of whether health departments provide direct clinical services (and many will), they will manage unprecedented quantities of sensitive information for the public health core functions of assurance and assessment, including population-level health surveillance and metrics. Absent improved capabilities, health departments risk vestigial status, with consequences for vulnerable populations. Developments in electronic health records, interoperability and information exchange, public information sharing, decision support, and cloud technologies can support information management if health departments have appropriate capabilities. The need for national engagement in and consensus on these capabilities and their importance to health department sustainability make them appropriate for consideration in the context of accreditation. |
Receipt of reproductive health services among sexually experienced persons aged 15-19 years - National Survey of Family Growth, United States, 2006-2010
Tyler CP , Warner L , Gavin L , Barfield W . MMWR Suppl 2014 63 (2) 89-98 The prevention of pregnancy, childbirth, and sexually transmitted diseases (STDs) among teenagers has garnered recent attention both from public health and clinical organizations. In 2011, the U.S. birth rate among teenagers reached a historic low of 31.3 births per 1,000 females aged 15-19 years and has decreased 49% percent from 1991 to 2011. Despite recent decreases, U.S. birth rates among teenagers remain higher than those in other industrialized countries. For example, in 2009, the U.S. teenage birth rate was approximately 1.5 times the birth rate in the United Kingdom, nearly 3 times the birth rate in Canada, and nearly 8 times the birth rate of Denmark. Approximately 20% of births to teenagers aged 15-19 years are repeat births, and significant disparities by race and ethnicity persist. |
Tobacco use screening and cessation assistance during physician office visits among persons aged 11-21 years - National Ambulatory Medical Care Survey, United States, 2004-2010
Jamal A , Dube SR , Babb SD , Malarcher AM . MMWR Suppl 2014 63 (2) 71-9 Tobacco use continues to be the leading cause of preventable disease and death in the United States. Cigarette smoking accounts for approximately 480,000 premature deaths annually and approximately $130 billion in direct medical expenses and $150 billion in lost productivity in the United States each year. Approximately 88% of adults who smoke daily began smoking by the age of 18 years. Although tobacco cessation is beneficial at any age, intervening as early as possible is important to maximize potential health benefits. After years of steady progress in decreasing smoking prevalence, decreases in smoking among youths and young adults have slowed in recent years. In 2011, a total of 18.1% of U.S. high school students in the United States were current cigarette smokers, and 49.9% of these smokers had tried to quit in the past 12 months. The proportion of youth cigarette smokers who tried to quit smoking in the past year decreased from 57.4% in 2001 to 49.9% in 2011. |
Associations of self-reported cigarette smoking with chronic obstructive pulmonary disease and co-morbid chronic conditions in the United States
Cunningham TJ , Ford ES , Rolle IV , Wheaton AG , Croft JB . COPD 2014 12 (3) 276-86 BACKGROUND: The question of how smoking, COPD, and other chronic diseases are related remains unresolved. Therefore, we examined relationships between smoking, COPD, and 10 other chronic diseases and assessed the prevalence of co-morbid chronic conditions among people with COPD. METHODS: We analyzed cross-sectional data from 405,856 US adults aged 18 years or older in the 2011 Behavioral Risk Factor Surveillance System. We used log-linear regression to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals (CIs) for these relationships adjusting for age, gender, race/ethnicity, marital status, educational attainment, annual household income, and health insurance coverage. RESULTS: Overall, 17.5% reported being current cigarette smokers, 6.9% reported having COPD, and 71.2% reported another chronic condition. After age-adjustment, prevalence of COPD was 14.1% (adjusted PR = 3.9; 95% CI: 3.7, 4.1) among current smokers and 7.1% (adjusted PR = 2.5; 95% CI: 2.4, 2.7) among former smokers compared to 2.9% among never smokers. The most common chronic conditions among current smokers after age-adjustment were high cholesterol (36.7%), high blood pressure (34.6%), arthritis (29.4%), depression (27.4%), and asthma (16.9%). In separate multivariable models, smoking and COPD were associated with each of the 10 other chronic conditions (p < 0.05), which also included cancer, coronary heart disease, diabetes, kidney disease, and stroke; COPD modified associations between smoking and co-morbidities, while smoking did not modify associations between COPD and co-morbidities. CONCLUSIONS: Our findings confirm previous evidence and highlight the continuing importance of comprehensive care coordination for people with COPD and co-morbid chronic conditions and also tobacco prevention and control strategies. |
Bias in calculation of attributable fractions using relative risks from nonsmokers only
Flegal KM . Epidemiology 2014 25 (6) 913-6 Studies of weight and mortality sometimes state that the mortality relative risks for obesity from nonsmokers are valid estimates of the relative risks for obesity in both smokers and nonsmokers. Extending this idea, several influential articles have used relative risks for obesity from nonsmokers and attributable fraction methods for unadjusted risks to estimate attributable fractions of deaths in the entire population (smokers and nonsmokers combined). However, stratification by smoking is a form of adjustment for confounding. Simplified examples show that the use of relative risks from only 1 stratum to estimate attributable fractions, without incorporating data on the stratification variable, gives incorrect results for the entire population. Even if the mortality relative risks for obesity from nonsmokers are indeed valid in both smokers and nonsmokers, these relative risks nonetheless need to be treated as adjusted relative risks for the purpose of calculating attributable fractions for the whole sample. |
Ball python nidovirus: a candidate etiologic agent for severe respiratory disease in Python regius
Stenglein MD , Jacobson ER , Wozniak EJ , Wellehan JF , Kincaid A , Gordon M , Porter BF , Baumgartner W , Stahl S , Kelley K , Towner JS , DeRisi JL . mBio 2014 5 (5) e01484-14 A severe, sometimes fatal respiratory disease has been observed in captive ball pythons (Python regius) since the late 1990s. In order to better understand this disease and its etiology, we collected case and control samples and performed pathological and diagnostic analyses. Electron micrographs revealed filamentous virus-like particles in lung epithelial cells of sick animals. Diagnostic testing for known pathogens did not identify an etiologic agent, so unbiased metagenomic sequencing was performed. Abundant nidovirus-like sequences were identified in cases and were used to assemble the genome of a previously unknown virus in the order Nidovirales. The nidoviruses, which were not previously known to infect nonavian reptiles, are a diverse order that includes important human and veterinary pathogens. The presence of the viral RNA was confirmed in all diseased animals (n = 8) but was not detected in healthy pythons or other snakes (n = 57). Viral RNA levels were generally highest in the lung and other respiratory tract tissues. The 33.5-kb viral genome is the largest RNA genome yet described and shares canonical characteristics with other nidovirus genomes, although several features distinguish this from related viruses. This virus, which we named ball python nidovirus (BPNV), will likely establish a new genus in Torovirinae subfamily. The identification of a novel nidovirus in reptiles contributes to our understanding of the biology and evolution of related viruses, and its association with lung disease in pythons is a promising step toward elucidating an etiology for this long-standing veterinary disease. IMPORTANCE: Ball pythons are popular pets because of their diverse coloration, generally nonaggressive behavior, and relatively small size. Since the 1990s, veterinarians have been aware of an infectious respiratory disease of unknown cause in ball pythons that can be fatal. We used unbiased shotgun sequencing to discover a novel virus in the order Nidovirales that was present in cases but not controls. While nidoviruses are known to infect a variety of animals, this is the first report of a nidovirus recovered from any reptile. This report will enable diagnostics that will assist in determining the role of this virus in the causation of disease, which would allow control of the disease in zoos and private collections. Given its evolutionary divergence from known nidoviruses and its unique host, the study of reptile nidoviruses may further our understanding of related diseases and the viruses that cause them in humans and other animals. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Disease Reservoirs and Vectors
- Environmental Health
- Food Safety
- Genetics and Genomics
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Program Evaluation
- Public Health Law
- Public Health Leadership and Management
- Reproductive Health
- Substance Use and Abuse
- Veterinary Medicine
About
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.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure