Trends in mean waist circumference and abdominal obesity among US adults, 1999-2012
Ford ES , Maynard LM , Li C . JAMA 2014 312 (11) 1151-3 Waist circumference is a simple and valuable anthropometric measure of total and intra-abdominal body fat.1 The clinical guidelines from the National Heart, Lung, and Blood Institute on the identification, evaluation, and treatment of overweight and obesity in adults recommend that clinicians assess waist circumference of their patients.2 Although the prevalence of abdominal obesity has increased in the United States through 2008,3 its trend in recent years is unknown. Therefore, our objective was to provide recent information about the trends in mean waist circumference and prevalence of abdominal obesity among adults in the United States from 1999 to 2012. |
Multimorbidity at the local level: implications and research directions
Posner SF , Goodman RA . Mayo Clin Proc 2014 89 (10) 1321-3 In this issue of Mayo Clinic Proceedings, Rocca et al1 report the results of a study of multimorbidity in a patient sample that represents nearly the total population of Olmsted County, Minnesota. (In this context, multimorbidity refers to the situation in which a patient receiving medical care for a sentinel condition has at least one additional chronic condition.) To our knowledge, this is the first report that uses the list of chronic conditions developed by the US Department of Health and Human Services (DHHS) to assist in systematically documenting the epidemiology and burden of chronic multimorbidity at this jurisdictional level.2 Other investigators have reported their use of the DHHS set of conditions to examine the burden of multimorbidity among nationally representative samples of persons in communities and in health care settings.3, 4, 5, 6 In addition, the Centers for Medicare and Medicaid Services has provided statistics on the prevalence of multiple chronic conditions for Medicare beneficiaries at the state, county, and hospital referral region level.7 However, the report by Rocca et al expands this understanding substantially by taking this work directly to the local level through their examination of multimorbidity in the setting of nearly all persons in a single, highly documented county who have had encounters with the health care system. |
Oral health conditions and dental visits among pregnant and nonpregnant women of childbearing age in the United States, National Health and Nutrition Examination Survey, 1999-2004
Azofeifa A , Yeung LF , Alverson CJ , Beltran-Aguilar E . Prev Chronic Dis 2014 11 E163 INTRODUCTION: Oral diseases can be prevented or improved with regular dental visits. Our objective was to assess and compare national estimates on self-reported oral health conditions and dental visits among pregnant women and nonpregnant women of childbearing age by using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: We analyzed self-reported oral health information on 897 pregnant women and 3,971 nonpregnant women of childbearing age (15-44 years) from NHANES 1999-2004. We used chi2 and 2-sample t tests to assess statistical differences between groups stratified by age, race/ethnicity, poverty, and education. We applied the Bonferroni adjustment for multiple comparisons. RESULTS: Our data show significant differences in self-reported oral health conditions and dental visits among women, regardless of pregnancy status, when stratified by selected sociodemographic characteristics. Significant differences were also found in self-reported oral health conditions and dental visits between pregnant and nonpregnant women, especially among young women, women from minority race/ethnicity groups, and women with less than high school education. CONCLUSION: We found disparities in self-reported oral health conditions and use of dental services among women regardless of pregnancy status. Results highlight the need to improve dental service use among US women of childbearing age, especially young pregnant women, those who are non-Hispanic black or Mexican American, and those with low family income or low education level. Prenatal visits could be used as an opportunity to encourage pregnant women to seek preventive dental care during pregnancy. |
Food insecurity and self-reported hypertension among Hispanic, black, and white adults in 12 states, Behavioral Risk Factor Surveillance System, 2009
Irving SM , Njai RS , Siegel PZ . Prev Chronic Dis 2014 11 E161 Food insecurity is positively linked to risk of hypertension; however, it is not known whether this relationship persists after adjustment for socioeconomic position (SEP). We examined the association between food insecurity and self-reported hypertension among adults aged 35 or older (N = 58,677) in 12 states that asked the food insecurity question in their 2009 Behavioral Risk Factor Surveillance System questionnaire. After adjusting for SEP, hypertension was more common among adults reporting food insecurity (adjusted prevalence ratio, 1.27; 95% confidence interval, 1.19-1.36). Our study found a positive relationship between food insecurity and hypertension after adjusting for SEP and other characteristics. |
Molecular surveillance of rotavirus strains circulating in Yaoundé, Cameroon, September 2007-December 2012.
Boula A , Waku-Kouomou D , Kinkela MN , Esona MD , Kemajou G , Mekontso D , Seheri M , Ndze VN , Emah I , Ela S , Dahl BA , Kobela M , Cavallaro KF , Mballa GA , Genstch JR , Bowen MD , Ndombo PK . Infect Genet Evol 2014 28 470-5 Rotavirus is the most common cause of severe diarrheal disease in children under 5 years of age worldwide. The World Health Organization (WHO) estimated that 453,000 rotavirus-attributable deaths occur annually. Through the WHO, the Rotavirus Sentinel Surveillance Program was established in Cameroon in September 2007 with the Mother and Child Center (MCC) in Yaounde playing the role of sentinel site and national laboratory for this program. The objectives of this surveillance were to assess the rotavirus disease burden and collect baseline information on rotavirus strains circulating in Cameroon. Diarrheal stool samples were collected in a pediatric hospital from children under 5, using the WHO case definition for rotavirus diarrhea. Antigen detection of rotavirus was performed by using an enzyme immunoassay (EIA). The genotypic characterization was performed using multiplexed semi-nested reverse transcription-polymerase chain reaction (RT-PCR) assays. Between September 2007 and December 2012, 2444 stool samples were received at the MCC laboratory for rotavirus antigen detection, of which 999 (41%) were EIA positive. Among EIA positive samples 898 were genotyped. Genotype prevalence varied each year. Genotype G9P[8] was the dominant type during 2007 (32%) and 2008 (24%), genotype G3P[6] predominated in 2010 (36%) and 2011 (25%), and G1P[8] was predominant in 2012 (44%). The findings showed that the rotavirus disease burden is high and there is a broad range of rotavirus strains circulating in Yaounde. These data will help measure the impact of vaccination in the future. |
Review of policy and status of implementation of collaborative HIV-TB activities in 23 high-burden countries
Gupta S , Granich R , Date A , Lepere P , Hersh B , Gouws E , Samb B . Int J Tuberc Lung Dis 2014 18 (10) 1149-58 Issuance of national policy guidance is a critical step to ensure quality HIV-TB (human immunodeficiency virus-tuberculosis) coordination and programme implementation. From the database of the Joint United Nations Programme on HIV/AIDS (UNAIDS), we reviewed 62 national HIV and TB guidelines from 23 high-burden countries for recommendations on HIV testing for TB patients, criteria for initiating antiretroviral therapy (ART) and the Three I's for HIV/TB (isoniazid preventive treatment [IPT], intensified TB case finding and TB infection control). We used UNAIDS country-level programme data to determine the status of implementation of existing guidance. Of the 23 countries representing 89% of the global HIV-TB burden, Brazil recommends ART irrespective of CD4 count for all people living with HIV, and four (17%) countries recommend ART at the World Health Organization (WHO) 2013 guidelines level of CD4 count 500 cells/mm(3) for asymptomatic persons. Nineteen (83%) countries are consistent with WHO 2013 guidelines and recommend ART for HIV-positive TB patients irrespective of CD4 count. IPT is recommended by 16 (70%) countries, representing 67% of the HIV-TB burden; 12 recommend symptom-based screening alone for IPT initiation. Guidelines from 15 (65%) countries with 79% of the world's HIV-TB burden include recommendations on HIV testing and counselling for TB patients. Although uptake of ART, HIV testing for TB patients, TB screening for people living with HIV and IPT have increased significantly, progress is still limited in many countries. There is considerable variance in the timing and content of national policies compared with WHO guidelines. Missed opportunities to implement new scientific evidence and delayed adaptation of existing WHO guidance remains a key challenge for many countries. |
Summary of notifiable diseases - United States, 2012
Adams DA , Jajosky RA , Ajani U , Kriseman J , Sharp P , Onwen DH , Schley AW , Anderson WJ , Grigoryan A , Aranas AE , Wodajo MS , Abellera JP . MMWR Morb Mortal Wkly Rep 2014 61 (53) 1-121 The Summary of Notifiable Diseases - United States, 2012 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2012. Unless otherwise noted, the data are final totals for 2012 reported as of June 30, 2013. These statistics are collected and compiled from reports sent by state health departments and territories to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). |
Evaluation of dried blood spots with a multiplex assay for measuring recent HIV-1 infection
Curtis KA , Ambrose KM , Kennedy MS , Owen SM . PLoS One 2014 9 (9) e107153 Laboratory-based HIV tests for recent infection (TRIs), which primarily measure a specific serological biomarker(s) that distinguishes recent from long-term HIV infection, have facilitated the estimation of population-based incidence. Dried blood spots (DBS) on filter paper are an attractive sample source for HIV surveillance, given the simplified and cost-effective methods of specimen collection, storage, and shipment. Here, we evaluated the use of DBS in conjunction with an in-house multiplex TRI, the HIV-1-specific Bio-Plex assay, which measures direct antibody binding and avidity to multiple HIV-1 analytes. The assay performance was comparable between matched plasma and DBS samples from HIV-1 infected individuals obtained from diverse sources. The coefficients of variation, comparing the median antibody reactivity for each analyte between plasma and DBS, ranged from 2.78% to 9.40% and the correlation coefficients between the two sample types ranged from 0.89 to 0.97, depending on the analyte. The correlation in antibody reactivity between laboratory and site-prepared DBS for each analyte ranged from 0.87 to 0.98 and from 0.90 to 0.97 between site-prepared DBS and plasma. The correlation in assay measures between plasma and DBS indicate that the sample types can be used interchangeably with the Bio-Plex format, without negatively impacting the misclassification rate of the assay. |
HIV status and viral loads among men testing positive for rectal gonorrhoea and chlamydia, Maricopa County, Arizona, USA, 2011-2013
Taylor M , Newman D , Gonzalez J , Skinner J , Khurana R , Mickey T . HIV Med 2014 16 (4) 249-54 OBJECTIVES: Men diagnosed with rectal gonorrhoea (GC) and chlamydia (CT) have engaged in unprotected receptive anal intercourse. We reviewed the HIV positivity and HIV viral loads (VLs) of men who had rectal GC and CT testing to evaluate potential HIV acquisition and transmission risk. METHODS: Rectal GC and CT testing data for men attending the Maricopa County STD clinic during the period from 1 October 2011 to 30 September 2013 were cross-matched with HIV surveillance data to identify men with HIV coinfection. We examined HIV status, HIV diagnosis date, and the values of VL collected nearest to the date of reported rectal infection. RESULTS: During the 2-year time period, 1591 men were tested for rectal GC and CT. Of the men tested, 506 (31.8%) were positive for GC (13.2%), CT (12.2%) or both (6.4%); 119 (23.5%) of those with rectal GC or CT were coinfected with HIV. Among the 275 men with HIV at the time of rectal testing, 54 (19.6%) had no reported VL; 63 (22.9%) had an undetectable VL (< 20 HIV-1 RNA copies/mL) and 158 (57.4%) had a detectable VL collected within 1 year of rectal diagnosis. Mean VL was higher among HIV and rectal GC/CT coinfected cases compared with men with HIV alone (174 316 vs. 57 717 copies/mL, respectively; P = 0.04). CONCLUSIONS: Approximately one-third of men undergoing rectal testing were positive for GC or CT and one-quarter of men with rectal GC or CT also had HIV infection. Of the HIV-infected men tested for rectal GC or CT, more than half had a detectable VL collected near the time of rectal testing, demonstrating a risk for transmitting HIV. |
HIV viral suppression among persons with varying levels of engagement in HIV medical care, 19 U.S. jurisdictions
Cohen SM , Hu X , Sweeney P , Johnson AS , Irene Hall H . J Acquir Immune Defic Syndr 2014 67 (5) 519-27 BACKGROUND: Ongoing HIV medical care is vital to achieving and maintaining viral suppression. We examined viral suppression applying retention in care definitions used by various federal agencies. METHODS: Using National HIV Surveillance System data from 19 U.S. jurisdictions with complete CD4 and viral load reporting, we determined viral suppression among persons who met the National HIV/AIDS Strategy retention in care definition (≥2 visits ≥3 months apart; "retained in continuous care") and among those who had evidence of care but did not meet the definition ("engaged in care"). We also examined viral suppression among persons who met the Health and Human Services Core Indicator definition for retention. RESULTS: Of 338,959 persons living with diagnosed HIV infection in 19 areas in 2010, 63.7% received any care; of these, 19.7% were "engaged in care" and 80.3% were "retained in continuous care". Of those "engaged in care," 47.7% achieved viral suppression, compared to 73.6% of persons "retained in continuous care." Significant differences were evident for all subpopulations within each care category; younger persons and blacks/African Americans had lower levels of viral suppression than their counterparts. Persons "engaged in care", regardless of sex, age, race/ethnicity, and transmission category, had significantly lower percentages of viral suppression than persons "retained in continuous care." Similar patterns of viral suppression were found for persons meeting the Health and Human Services definition compared to persons "retained in continuous care." CONCLUSION: Higher levels of engagement in care, including more frequent monitoring of CD4 and viral load, were associated with viral suppression. |
Improved health among people living with HIV/AIDS who received packages of proven preventive health interventions, Amhara, Ethiopia
O'Reilly CE , Taylor EV , Ayers T , Fantu R , Abayneh SA , Marston B , Molla YB , Sewnet T , Abebe F , Hoekstra RM , Quick R . PLoS One 2014 9 (9) e107662 In 2009, basic care packages (BCP) containing health products were distributed to HIV-infected persons in Ethiopia who were clients of antiretroviral therapy clinics. To measure health impact, we enrolled clients from an intervention hospital and comparison hospital, and then conducted a baseline survey, and 7 bi-weekly home visits. We enrolled 405 intervention group clients and 344 comparison clients. Intervention clients were more likely than comparison clients to have detectable chlorine in stored water (40% vs. 1%, p<0.001), soap (51% vs. 36%, p<0.001), and a BCP water container (65% vs. 0%, p<0.001) at every home visit. Intervention clients were less likely than comparison clients to report illness (44% vs. 67%, p<0.001) or health facility visits for illness (74% vs. 95%, p<0.001), and had lower median illness scores (1.0 vs. 3.0, p<0.05). Participation in the BCP program appeared to improve reported health outcomes. |
Incidence of influenza-associated hospitalization in rural communities in western and northern India, 2010-2012: a multi-site population-based study
Hirve S , Krishnan A , Dawood FS , Lele P , Saha S , Rai S , Gupta V , Lafond KE , Juvekar S , Potdar V , Broor S , Lal RB , Chadha M . J Infect 2014 70 (2) 160-70 BACKGROUND: The global burden of influenza is increasingly recognized, but data from India remain sparse. We conducted a multi-site population-based surveillance study to estimate and compare rates of influenza-associated hospitalization at two rural Indian health and demographic surveillance system (HDSS) sites at Ballabgarh and Vadu during 2010-2012. METHODS: Prospective facility-based surveillance for all hospitalizations (excluding those for trauma, elective surgery and obstetric, ophthalmic or psychiatric reasons) was conducted at 72 health facilities. After collection of clinical details, patients had nasopharyngeal swabs taken and tested by reverse transcription polymerase chain reaction for influenza viruses. Annual healthcare utilization surveys (HUS) were conducted in HDSS households to identify proportion of hospitalizations occurring at non-study facilities to adjust for hospitalizations missed through facility-based surveillance. RESULTS: HUS showed that 69% and 67% of hospitalizations occurred at study facilities at Ballabgarh and Vadu respectively. Overall, 6,004 patients hospitalized with acute medical illness at participating facilities were enrolled (1,717 from Ballabgarh; 4,287 from Vadu). The proportion of patients with influenza was higher at Vadu than Ballabgarh annually (2010: 21% vs. 5%, p<0.05; 2011: 18% vs. 5%, p<0.05; 2012: 23% vs. 5%, p<0.05). Annual adjusted influenza-associated hospitalization rates were 5-11 fold higher in Vadu (20.3-51.6 per 10,000) versus Ballabgarh (4.4-6.3 per 10,000). At both sites, influenza A/H1N1pdm09 and B predominated during 2010, A/H3N2 and B during 2011, and A/H1N1pdm09 and B during 2012. CONCLUSION: The markedly different influenza hospitalization rates by season and across communities in India highlight the need for sustained multi-site surveillance system for estimating national influenza disease burden. That would be the first step for initiating discussions around Influenza prevention and control strategies in the country. |
Age-specific influenza-related emergency department visits and hospitalizations in 2010-2011 compared with the pandemic year 2009-2010
Jules A , Grijalva CG , Zhu Y , Talbot HK , Williams JV , Edwards KM , Shay DK , Schaffner W , Griffin MR . Infect Dis Clin Pract (Baltim Md) 2014 22 (5) 271-278 BACKGROUND: During the 2009-2010 influenza A(H1N1)pdm09 pandemic, influenza-associated encounters had an unusual age distribution, with relative sparing of older adults. In postpandemic 2010-2011, influenza A(H3N2), A(H1N1)pdm09, and B cocirculated. PURPOSE: To compare influenza-associated encounter rates in pandemic and postpandemic years. METHODS: We enrolled and tested patients with acute respiratory illness (ARI) at selected Middle Tennessee hospitals. Age-specific proportions of influenza-positive patients were multiplied by the number of ARI encounters during influenza season to estimate the numbers of influenza encounters. These were divided by the respective populations to estimate rates. RESULTS: In pandemic and postpandemic years, overall influenza-associated emergency department (ED) visits, 10.2 (95% confidence interval [CI], 7.6-14.0) and 10.3 (CI, 8.0-13.4) per 1000 residents, were similar. Overall hospitalizations increased from 0.9 (CI, 0.6-1.4) to 1.2 (CI, 0.8-1.6) per 1000 residents. For residents 0.5 to 17 years, influenza encounter rates declined, 13.2 (CI, 9.0-19.1) versus 11.9 (CI, 9.6-14.5) ED visits and 0.3 (CI, 0.2-0.5) versus 0.2 (CI, 0.1-0.3) hospitalizations. For residents 65 years or older influenza encounter rates increased, 1.6 (CI, 0.3-8.7) versus 6.7 (CI, 2.4-16.5) ED visits and 1.0 (CI, 0.3-2.7) versus 4.5 (CI, 3.1-6.5) hospitalizations. During 2010-2011, influenza A(H1N1)pdm09 accounted for 26%, 55%, and 13% of influenza-associated ARI in those aged 0.5 to 17, 18 to 64, and 65 years or older, respectively; influenza B accounted for 62%, 33%, and 54% and influenza A(H3N2) accounted for 12%, 12%, and 33%, respectively. CONCLUSIONS: Overall influenza-associated ED rates were similar in both years, but hospitalizations increased modestly in the postpandemic year. Higher encounter rates in older adults in the postpandemic year were associated with the circulation of 2 nonpandemic influenza viruses. |
Awareness of HIV status, prevention knowledge and condom use among people living with HIV in Mozambique
Dokubo EK , Shiraishi RW , Young PW , Neal JJ , Aberle-Grasse J , Honwana N , Mbofana F . PLoS One 2014 9 (9) e106760 OBJECTIVE: To determine factors associated with HIV status unawareness and assess HIV prevention knowledge and condom use among people living with HIV/AIDS (PLHIV) in Mozambique. DESIGN: Cross-sectional household-based nationally representative AIDS Indicator Survey. METHODS: Analyses focused on HIV-infected adults and were weighted for the complex sampling design. We identified PLHIV who had never been tested for HIV or received their test results prior to this survey. Logistic regression was used to assess factors associated with HIV status unawareness. RESULTS: Of persons with positive HIV test results (N = 1182), 61% (95% confidence interval [CI] 57-65%) were unaware of their serostatus. Men had twice the odds of being unaware of their serostatus compared with women [adjusted odds ratio (aOR) 2.05, CI 1.40-2.98]. PLHIV in the poorest wealth quintile were most likely to be unaware of their serostatus (aOR 3.15, CI 1.09-9.12) compared to those in the middle wealth quintile. Most PLHIV (83%, CI 79-87%) reported not using a condom during their last sexual intercourse, and PLHIV who reported not using a condom during their last sexual intercourse were more likely to be unaware of their serostatus (aOR 2.32, CI 1.57-3.43) than those who used a condom. CONCLUSIONS: Knowledge of HIV-positive status is associated with more frequent condom use in Mozambique. However, most HIV-infected persons are unaware of their serostatus, with men and persons in the poorest wealth quintile being more likely to be unaware. These findings support calls for expanded HIV testing, especially among groups less likely to be aware of their HIV status and key populations at higher risk for infection. |
Cost-effectiveness of the Three I's for HIV/TB and ART to prevent TB among people living with HIV
Gupta S , Abimbola T , Date A , Suthar AB , Bennett R , Sangrujee N , Granich R . Int J Tuberc Lung Dis 2014 18 (10) 1159-65 OBJECTIVE: To evaluate the cost-effectiveness of the Three I's for HIV/TB (human immunodeficiency virus/tuberculosis): antiretroviral therapy (ART), intensified TB case finding (ICF), isoniazid preventive treatment (IPT), and TB infection control (IC). METHODS: Using a 3-year decision-analytic model, we estimated the cost-effectiveness of a base scenario (55% ART coverage at CD4 count 350 cells/mm(3)) and 19 strategies that included one or more of the following: 1) 90% ART coverage, 2) IC and 3) ICF using four-symptom screening and 6- or 36-month IPT. The TB diagnostic algorithm included 1) sputum smear microscopy with chest X-ray, and 2) Xpert((R)) MTB/RIF. RESULTS: In resource-constrained settings with a high burden of HIV and TB, the most cost-effective strategies under both diagnostic algorithms included 1) 55% ART coverage and IC, 2) 55% ART coverage, IC and 36-month IPT, and 3) expanded ART at 90% coverage with IC and 36-month IPT. The latter averted more TB cases than other scenarios with increased ART coverage, IC, 6-month IPT and/or IPT for tuberculin skin test positive individuals. The cost-effectiveness results did not change significantly under the sensitivity analyses. CONCLUSION: Expanded ART to 90% coverage, IC and a 36-month IPT strategy averted most TB cases and is among the cost-effective strategies. |
Does the length of specimen storage affect influenza testing results by real-time reverse transcription-polymerase chain reaction? An analysis of influenza surveillance specimens, 2008 to 2010
Caselton D , Arunga G , Emukule G , Muthoka P , Mayieka L , Kosgey A , Ochola R , Waiboci L , Feikin D , Mott J , Breiman R , Katz M . Euro Surveill 2014 19 (36) In some influenza surveillance systems, timely transport to laboratories for reverse transcription-polymerase chain reaction (RT-PCR) testing is challenging. Guidelines suggest that samples can be stored at 4°C for up to 96 hours but the effect of longer storage times has not been systematically evaluated. We collected nasopharyngeal and oropharyngeal specimens from patients in Kenya and stored them in viral transport medium at 2 to 8°C before testing for influenza A and B using real-time RT-PCR. From April 2008 to November 2010, we collected 7,833 samples; 940 (12%) were positive for influenza. In multivariable analysis, specimens stored for six days were less likely to be influenza-positive compared to specimens stored between zero and one day (adjusted odds ratio (aOR): 0.49, 95% confidence interval (CI): 0.27–0.93). There was no statistically significant difference in influenza positivity of specimens stored for five days compared to zero to one day. There was no statistically significant relationship between days in refrigeration and cycle threshold (Ct) values for positive samples (p=0.31). We found that samples could remain in storage for at least five days without affecting the proportion-positive of samples, potentially increasing the feasibility of including influenza surveillance sites in remote areas. |
The prevalence of ADHD: its diagnosis and treatment in four school districts across two states
Wolraich ML , McKeown RE , Visser SN , Bard D , Cuffe S , Neas B , Geryk LL , Doffing M , Bottai M , Abramowitz AJ , Beck L , Holbrook JR , Danielson M . J Atten Disord 2014 18 (7) 563-75 OBJECTIVE: To describe the epidemiology of ADHD in communities using a DSM-IVTR case definition. METHOD: This community-based study used multiple informants to develop and apply a DSM -IVTR-based case definition of ADHD to screening and diagnostic interview data collected for children 5-13 years of age. Teachers screened 10,427 children (66.4%) in four school districts across two states (SC and OK). ADHD ratings by teachers and parent reports of diagnosis and medication treatment were used to stratify children into high and low risk for ADHD. Parents (n = 855) of high risk and gender frequency-matched low risk children completed structured diagnostic interviews. The case definition was applied to generate community prevalence estimates, weighted to reflect the complex sampling design. RESULTS: ADHD prevalence was 8.7% in SC and 10.6% in OK. The prevalence of ADHD medication use was 10.1% (SC) and 7.4% (OK). Of those medicated, 39.5% (SC) and 28.3% (OK) met the case definition. Comparison children taking medication had higher mean symptom counts than other comparison children. CONCLUSIONS: Our ADHD estimates are at the upper end of those from previous studies. The identification of a large proportion of comparison children taking ADHD medication suggests that our estimates may be conservative; these children were not included as cases in the case definition, although some might be effectively treated. |
Association between school district policies that address chronic health conditions of students and professional development for school nurses on such policies
Jones SE , Brener ND , Bergren MD . J Sch Nurs 2014 31 (3) 163-6 Supportive school policies and well-prepared school nurses can best address the needs of students with chronic health conditions. We analyzed nationally representative data from the 2012 School Health Policies and Practices Study to examine whether districts with policies requiring that schools provide health services to students with chronic health conditions were more likely to provide funding for professional development (PD) or offer PD to school nurses on those health services than districts without such policies. Compared to districts without certain requirements for health services related to chronic health conditions, districts with those requirements were more likely to provide PD on related topics (for all comparisons, p ≤ .001). For some topics, however, regardless of district requirements, PD was fairly low and suggests the need for increases in the rates at which districts provide PD to support school nurses who deliver services to students with chronic health conditions. |
Sustained, area-wide control of Aedes aegypti using CDC autocidal gravid ovitraps
Barrera R , Amador M , Acevedo V , Hemme RR , Felix G . Am J Trop Med Hyg 2014 91 (6) 1269-1276 We have shown that the Centers for Disease Control and Prevention (CDC) autocidal gravid ovitraps (AGO trap) reduced the Aedes aegypti population and prevented mosquito outbreaks in southern Puerto Rico. After showing treatment efficacy for 1 year, we deployed three traps per home in an area that formerly did not have traps and in a site that served as the intervention area. Two new areas were selected as reference sites to compare the density of Ae. aegypti without traps. We monitored mosquitoes and weather every week in all four sites. The hypotheses were the density of Ae. aegypti in the former reference area converges to the low levels observed in the intervention area, and mosquito density in both areas having control traps is lower than in the new reference areas. Mosquito density in the former reference area was reduced to 79% and mosquito density in the new reference areas was 88% greater than in the intervention areas. |
Persistent organic pollutants (POPs) and metals in primiparous women: a comparison from Canada and Mexico
Adlard B , Davis K , Liang CL , SCurren M , Rodriguez-Dozal S , Riojas-Rodriguez H , Hernandez-Avila M , Foster W , Needham L , Wong LY , Weber JP , Marro L , Leech T , Van Oostdam J . Sci Total Environ 2014 500-501c 302-313 Under the North American Commission for Environmental Cooperation (CEC) and its Sound Management of Chemicals (SMOC) program, a tri-national human contaminant monitoring initiative was completed to provide baseline exposure information for several environmental contaminants in Canada, Mexico and the United States (U.S). Blood samples were collected from primiparous women in Canada and Mexico, and were analysed for a suite of environmental contaminants including polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene(p,p'-DDE),beta-hexachlorocyclohexane (beta-HCH), mercury and lead. A multiple stepwise linear regression analysis was conducted using data from Canadian and Mexican primiparous mothers, adjusting for ethnicity group, age, pre-pregnancy BMI, years at current city and ever-smoking status. Concentrations of p,p'-DDE, beta-HCH, and lead were found to be higher among Mexican participants; however, concentrations of most PCBs among Mexican participants were similar to Canadian primiparous women after adjusting for covariates. Concentrations of total mercury were generally higher among Mexican primiparous women although this difference was smaller as age increased. This initial dataset can be used to determine priorities for future activities and to track progress in the management of the selected chemicals, both domestically and on a broader cooperative basis within North America. |
Outbreak of Trichinella spiralis infections associated with a wild boar hunted at a game farm in Iowa
Holzbauer SM , Agger WA , Hall RL , Johnson GM , Schmitt D , Garvey A , Bishop HS , Rivera H , de Almeida ME , Hill D , Stromberg BE , Lynfield R , Smith KE . Clin Infect Dis 2014 59 (12) 1750-6 BACKGROUND: Rates of trichinellosis have declined significantly in the United States due to improved pork production practices and public awareness of the danger of eating raw or undercooked pork. In April 2011, the Minnesota Department of Health received a report of presumptive trichinellosis in a 50 year-old male with a history of wild boar consumption. A public health investigation was initiated. METHODS: Medical records reviews and patient and family interviews were conducted. Trichinella sp. serology was performed on patient and family serum samples, and larval identification was attempted on clinical specimens and meat samples. RESULTS: The index patient harvested a wild boar from an Iowa game farm; he processed the meat after returning home and developed gastrointestinal symptoms 2 days later. Four days after his illness onset, all five family members consumed a roast from the boar. The index-patient sought healthcare four times after illness onset before being definitively diagnosed with trichinellosis. Following initiation of albendazole therapy, the index-patient developed atrial fibrillation. One additional family member who processed the raw meat was diagnosed with trichinellosis. Trichinella spiralis larvae were identified in wild boar meat samples. CONCLUSIONS: Trichinellosis has long been recognized as a potential hazard of consuming undercooked wild carnivore meat and historically in pork from domestic swine but may be unfamiliar to practicing clinicians in the US. Education of hunters and the broader population on the potential for trichinellosis and the importance of proper handling and cooking meat from wild or free-range animals needs to be reinforced. |
Thymidylate synthase genotype-directed chemotherapy for patients with gastric and gastroesophageal junction cancers.
Goff LW , Thakkar N , Du L , Chan E , Tan BR , Cardin DB , McLeod HL , Berlin JD , Zehnbauer B , Fournier C , Picus J , Wang-Gillam A , Lee W , Lockhart AC . PLoS One 2014 9 (9) e107424 BACKGROUND: Retrospective studies indicate associations between TSER (thymidylate synthase enhancer region) genotypes and clinical outcomes in patients receiving 5-FU based chemotherapy, but well-controlled prospective validation has been lacking. METHODS: In this phase II study (NCT00515216 registered through ClinicalTrials.gov, http://clinicaltrials.gov/show/NCT00515216), patients with "good risk" TSER genotypes (at least one TSER*2 allele) were treated with FOLFOX chemotherapy to determine whether prospective patient selection can improve overall response rates (ORR) in patients with gastric and gastroesophageal junction (GEJ) cancers, compared with historical outcomes in unselected patients (estimated 43%). RESULTS: The ORR in genotype-selected patients was 39.1% (9 partial responses out of 23 evaluable patients, 95% CI, 22.2 to 59.2), not achieving the primary objective of improving ORR. An encouraging disease control rate (DCR, consisting of partial responses and stable diseases) of 95.7% was noted and patients with homozygous TSER*2 genotype showed better tumor response. CONCLUSIONS: In this first prospective, multi-institutional study in patients with gastric or GEJ cancers, selecting patients with at least one TSER*2 allele did not improve the ORR but led to an encouraging DCR. Further studies are needed to investigate the utility of selecting patients homozygous for the TSER*2 allele and additional genomic markers in improving clinical outcomes for patients with gastric and GEJ cancers. |
Rotavirus genotypes in Belarus, 2008-2012.
Semeiko G , Yermalovich M , Poliakova N , Mijatovic-Rustempasic S , Kerin T , Wasley A , Videbaek D , Gentsch JR , Bowen MD , Samoilovich E . Infect Genet Evol 2014 28 480-5 This study describes group A rotavirus (RVA) genotype prevalence in Belarus from 2008 to 2012. In 2008, data from 3 sites in Belarus (Brest, Mogilev, Minsk) indicated that G4P[8] was the predominant genotype. Data from Minsk (2008-2012) showed that G4P[8] was the predominant RVA genotype in all years except in 2011 when G3P[8] was most frequently detected. Other RVA genotypes common in Europe (G1P[8], G2P[4]) were detected each year of the study. This study reveals the dominance of genotype G4P[8] in Belarus and helps to establish the baseline genotype prevalence prior to RVA vaccine introduction in the country. |
Genome sequence analysis of in vitro and in vivo phenotypes of Bunyamwera and Ngari virus isolates from northern Kenya
Odhiambo C , Venter M , Limbaso K , Swanepoel R , Sang R . PLoS One 2014 9 (8) e105446 Biological phenotypes of tri-segmented arboviruses display characteristics that map to mutation/s in the S, M or L segments of the genome. Plaque variants have been characterized for other viruses displaying varied phenotypes including attenuation in growth and/or pathogenesis. In order to characterize variants of Bunyamwera and Ngari viruses, we isolated individual plaque size variants; small plaque (SP) and large plaque (LP) and determined in vitro growth properties and in vivo pathogenesis in suckling mice. We performed gene sequencing to identify mutations that may be responsible for the observed phenotype. The LP generally replicated faster than the SP and the difference in growth rate was more pronounced in Bunyamwera virus isolates. Ngari virus isolates were more conserved with few point mutations compared to Bunyamwera virus isolates which displayed mutations in all three genome segments but majority were silent mutations. Contrary to expectation, the SP of Bunyamwera virus killed suckling mice significantly earlier than the LP. The LP attenuation may probably be due to a non-synonymous substitution (T858I) that mapped within the active site of the L protein. In this study, we identify natural mutations whose exact role in growth and pathogenesis need to be determined through site directed mutagenesis studies. |
Cluster and sporadic cases of Herbaspirillum spp. infections in patients with cancer
Chemaly RF , Dantes R , Shah DP , Shah PK , Pascoe N , Ariza-Heredia E , Perego C , Nguyen DB , Nguyen K , Modarai F , Moulton-Meissner H , Noble-Wang J , Tarrand JJ , LiPuma JJ , Guh AY , MacCannell T , Raad I , Mulanovich V . Clin Infect Dis 2014 60 (1) 48-54 OBJECTIVE: Herbaspirillum spp. are gram-negative Betaproteobacteria that inhabit the rhizosphere. We investigated a potential cluster of hospital-based Herbaspirillum spp. Infections. METHODS: Cases were defined as Herbaspirillum spp. isolated from a patient in our comprehensive cancer center between January 1st, 2006 and October 15th, 2013. Case finding was performed by reviewing isolates initially identified as Burkholderia cepacia susceptible to all antibiotics tested, and 16S rDNA sequencing of available isolates to confirm their identity. Pulsed-field gel electrophoresis (PFGE) was performed to test genetic relatedness. Facility observations, infection prevention assessments, and environmental sampling were performed to investigate potential sources of Herbaspirillum spp. RESULTS: Eight cases of Herbaspirillum spp. were identified. Isolates from the first five clustered cases were initially misidentified as B. cepacia, and available isolates from 4 of these cases were indistinguishable. The 3 subsequent cases were identified by prospective surveillance and had different PFGE patterns. All but 1 case-patient had bloodstream infections, and 6 presented with sepsis. Underlying diagnoses included solid tumors (3), leukemia (3), lymphoma (1), and aplastic anemia (1). Herbaspirillum spp. infections were hospital-onset in five and community-onset in three patients. All symptomatic patients were treated with intravenous antibiotics and their infections resolved. No environmental source or common mechanism of acquisition was identified. CONCLUSIONS: This is the first report of hospital-based cluster of Herbaspirillum spp. infections. Herbaspirillum spp. are capable of causing bacteremia and sepsis in immunocompromised patients. Herbaspirillum spp. can be misidentified as Burkholderia cepacia by commercially available microbial identification systems. |
Review of global rotavirus strain prevalence data from six years post vaccine licensure surveillance: is there evidence of strain selection from vaccine pressure?
Doro R , Laszlo B , Martella V , Leshem E , Gentsch J , Parashar U , Banyai K . Infect Genet Evol 2014 28 446-61 Comprehensive reviews of pre licensure rotavirus strain prevalence data indicated the global importance of six rotavirus genotypes, G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]. Since 2006, two vaccines, the monovalent Rotarix (RV1) and the pentavalent RotaTeq (RV5) have been available in over 100 countries worldwide. Of these, 60 countries have already introduced either RV1 or RV5 in their national immunization programs. Post licensure vaccine effectiveness is closely monitored worldwide. This review aimed at describing the global changes in rotavirus strain prevalence over time. The genotype distribution of the nearly 47,000 strains that were characterized during 2007-2012 showed similar picture to that seen in the preceding period. An intriguing finding was the transient predominance of heterotypic strains, mainly in countries using RV1. Unusual and novel antigen combinations continue to emerge, including some causing local outbreaks, even in vaccinated populations. In addition, vaccine strains have been found in both vaccinated infants and their contacts and there is evidence for genetic interaction between vaccine and wild-type strains. In conclusion, the post-vaccine introduction strain prevalence data do not show any consistent pattern indicative of selection pressure resulting from vaccine use, although the increased detection rate of heterotypic G2P[4] strains in some countries following RV1 vaccination is unusual and this issue requires further monitoring. |
Recombinant influenza H7 hemagglutinins induce lower neutralizing antibody titers in mice than do seasonal hemagglutinins
Blanchfield K , Kamal RP , Tzeng WP , Music N , Wilson JR , Stevens J , Lipatov AS , Katz JM , York IA . Influenza Other Respir Viruses 2014 8 (6) 628-35 BACKGROUND: Vaccines against avian influenza viruses often require high hemagglutinin (HA) doses or adjuvants to achieve serological titers associated with protection against disease. In particular, viruses of the H7 subtype frequently do not induce strong antibody responses following immunization. OBJECTIVES: To evaluate whether poor immunogenicity of H7 viruses is an intrinsic property of the H7 hemagglutinin. METHODS: We compared the immunogenicity, in naive mice, of purified recombinant HA from two H7 viruses [A/Netherlands/219/2003(H7N7) and A/New York/107/2003(H7N2)] to that of HA from human pandemic [A/California/07/2009(H1N1pdm09)] and seasonal [A/Perth16/2009(H3N2)] viruses. RESULTS: After two intramuscular injections with purified hemagglutinin, mice produced antibodies to all HAs, but the response to the human virus HAs was greater than to H7 HAs. The difference was relatively minor when measured by ELISA, greater when measured by hemagglutination inhibition assays, and more marked still by microneutralization assays. H7 HAs induced little or no neutralizing antibody response in mice at either dose tested. Antibodies induced by H7 were of significantly lower avidity than for H3 or H1N1pdm09. CONCLUSIONS: We conclude that H7 HAs may be intrinsically less immunogenic than HA from seasonal human influenza viruses. |
Seasonal patterns in human A (H5N1) virus infection: analysis of global cases
Mathur MB , Patel RB , Gould M , Uyeki TM , Bhattacharya J , Xiao Y , Gillaspie Y , Chae C , Khazeni N . PLoS One 2014 9 (9) e106171 BACKGROUND: Human cases of highly pathogenic avian influenza (HPAI) A (H5N1) have high mortality. Despite abundant data on seasonal patterns in influenza epidemics, it is unknown whether similar patterns exist for human HPAI H5N1 cases worldwide. Such knowledge could help decrease avian-to-human transmission through increased prevention and control activities during peak periods. METHODS: We performed a systematic search of published human HPAI H5N1 cases to date, collecting month, year, country, season, hemisphere, and climate data. We used negative binomial regression to predict changes in case incidence as a function of season. To investigate hemisphere as a potential moderator, we used AIC and the likelihood-ratio test to compare the season-only model to nested models including a main effect or interaction with hemisphere. Finally, we visually assessed replication of seasonal patterns across climate groups based on the Koppen-Geiger climate classification. FINDINGS: We identified 617 human cases (611 with complete seasonal data) occurring in 15 countries in Southeast Asia, Africa, and the Middle East. Case occurrence was much higher in winter (n = 285, p = 0.03) than summer (n = 64), and the winter peak occurred across diverse climate groups. There was no significant interaction between hemisphere and season. INTERPRETATION: Across diverse climates, HPAI H5N1 virus infection in humans increases significantly in winter. This is consistent with increased poultry outbreaks and HPAI H5N1 virus transmission during cold and dry conditions. Prioritizing prevention and control activities among poultry and focusing public health messaging to reduce poultry exposures during winter months may help to reduce zoonotic transmission of HPAI H5N1 virus in resource-limited settings. |
Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP)
Tomczyk S , Bennett NM , Stoecker C , Gierke R , Moore MR , Whitney CG , Hadler S , Pilishvili T . MMWR Morb Mortal Wkly Rep 2014 63 (37) 822-5 On August 13, 2014, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Wyeth Pharmaceuticals, Inc., a subsidiary of Pfizer Inc.]) among adults aged ≥65 years. PCV13 should be administered in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Pneumovax23, Merck & Co., Inc.]), the vaccine currently recommended for adults aged ≥65 years. PCV13 was approved by the Food and Drug Administration (FDA) in late 2011 for use among adults aged ≥50 years. In June 2014, the results of a randomized placebo-controlled trial evaluating efficacy of PCV13 for preventing community-acquired pneumonia among approximately 85,000 adults aged ≥65 years with no prior pneumococcal vaccination history (CAPiTA trial) became available and were presented to ACIP. The evidence supporting PCV13 vaccination of adults was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and determined to be type 2 (moderate level of evidence); the recommendation was categorized as a Category A recommendation. This report outlines the new recommendations for PCV13 use, provides guidance for use of PCV13 and PPSV23 among adults aged ≥65 years, and summarizes the evidence considered by ACIP to make this recommendation. |
Influenza vaccination coverage among health care personnel - United States, 2013-14 influenza season
Black CL , Yue X , Ball SW , Donahue SM , Izrael D , de Perio MA , Laney AS , Lindley MC , Graitcer SB , Lu PJ , Williams WW , Bridges CB , DiSogra C , Sokolowski J , Walker DK , Greby SM . MMWR Morb Mortal Wkly Rep 2014 63 (37) 805-11 The Advisory Committee on Immunization Practices recommends that all health care personnel (HCP) be vaccinated annually against influenza. Vaccination of HCP can reduce influenza-related morbidity and mortality among both HCP and their patients. To estimate influenza vaccination coverage among HCP during the 2013-14 season, CDC analyzed results of an opt-in Internet panel survey of 1,882 HCP conducted during April 1-16, 2014. Overall, 75.2% of participating HCP reported receiving an influenza vaccination during the 2013-14 season, similar to the 72.0% coverage among participating HCP reported in the 2012-13 season. Coverage was highest among HCP working in hospitals (89.6%) and lowest among HCP working in long-term care (LTC) settings (63.0%). By occupation, coverage was highest among physicians (92.2%), nurses (90.5%), nurse practitioners and physician assistants (89.6%), pharmacists (85.7%), and "other clinical personnel" (87.4%) compared with assistants and aides (57.7%) and nonclinical personnel (e.g., administrators, clerical support workers, janitors, and food service workers) (68.6%). HCP working in settings where vaccination was required had higher coverage (97.8%) compared with HCP working in settings where influenza vaccination was not required but promoted (72.4%) or settings where there was no requirement or promotion of vaccination (47.9%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (61.6%) or multiple days (80.4%) compared with HCP working in settings not offering free on-site vaccination (49.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might be needed to increase vaccination coverage among HCP and minimize the risk for influenza to HCP and their patients. |
Influenza vaccination coverage among pregnant women - United States, 2013-14 influenza season
Ding H , Black CL , Ball S , Donahue S , Izrael D , Williams WW , Kennedy ED , Bridges CB , Lu PJ , Kahn KE , Grohskopf LA , Ahluwalia IB , Sokolowski J , DiSogra C , Walker DK , Greby SM . MMWR Morb Mortal Wkly Rep 2014 63 (37) 816-21 Pregnant women and infants are at increased risk for influenza-related complications and hospitalization. Influenza vaccination among pregnant women can reduce their risk for respiratory illness and reduce the risk for influenza in their infants aged <6 months. Since 2004, the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester. To assess influenza vaccination coverage among pregnant women during the 2013-14 influenza season, CDC analyzed data from an Internet panel survey conducted March 31-April 11, 2014. Among 1,619 survey respondents pregnant at any time during October 2013-January 2014, 52.2% reported vaccination before or during pregnancy (17.6% before and 34.6% during pregnancy), similar to the coverage in the preceding season. Overall, 65.1% of women reported receiving a clinician recommendation and offer of influenza vaccination, 15.1% received a clinician recommendation but no offer of vaccination, and 19.8% received no clinician recommendation or offer. Vaccination coverage among these women was 70.5%, 32.0%, and 9.7%, respectively. Continued efforts are needed to encourage clinicians to strongly recommend and offer influenza vaccination to their pregnant patients. |
Influenza vaccination performance measurement among acute care hospital-based health care personnel - United States, 2013-14 influenza season
Lindley MC , Bridges CB , Strikas RA , Kalayil EJ , Woods LO , Pollock D , Sievert D . MMWR Morb Mortal Wkly Rep 2014 63 (37) 812-5 Annual influenza vaccination is recommended for all health care personnel (HCP). In August 2011, the Centers for Medicare and Medicaid Services (CMS) published a final rule requiring acute care hospitals that participate in its Hospital Inpatient Quality Reporting Program to report HCP influenza vaccination data through the National Healthcare Safety Network (NHSN) beginning January 1, 2013. Data reported by 4,254 acute care hospitals, covering the period October 1, 2013, through March 31, 2014, were analyzed to collect estimates of the proportion of HCP vaccinated nationally and by state for three groups: 1) employees, 2) licensed independent practitioners (LIPs), and 3) adult students/trainees and volunteers. Overall in the United States, 81.8% of hospital-based HCP were reported vaccinated, with the highest proportion (86.1%) among employees and the lowest (61.9%) among LIPs. The proportion reported vaccinated varied widely by state, with ranges of 69.0%-97.6% for employees, 33.8%-93.6% for LIPs, and 50.3%-96.3% for adult students/trainees and volunteers. Public reporting of vaccination data has been shown to increase HCP influenza vaccination coverage. These new NHSN data provide a baseline for measuring changes in future hospital-based reporting of HCP influenza vaccination. |
A systematic review and content analysis of bullying and cyber-bullying measurement strategies
Vivolo-Kantor Alana M , Martell Brandi N , Holland Kristin M , Westby Ruth . Aggress Violent Behav 2014 19 (4) 423-434 Bullying has emerged as a behavior with deleterious effects on youth; however, prevalence estimates vary based on measurement strategies employed. We conducted a systematic review and content analysis of bullying measurement strategies to gain a better understanding of each strategy including behavioral content. Multiple online databases (i.e., PsychInfo, MedLine, ERIC) were searched to identify measurement strategies published between 1985 and 2012. Included measurement strategies assessed bullying behaviors, were administered to respondents with ages of 12 to 20, were administered in English, and included psychometric data. Each publication was coded independently by two study team members with a pre-set data extraction form, who subsequently met to discuss discrepancies. Forty-one measures were included in the review. A majority used differing terminology; student self-report as primary reporting method; and included verbal forms of bullying in item content. Eleven measures included a definition of bullying, and 13 used the term "bullying" in the measure. Very few definitions or measures captured components of bullying such as repetition, power imbalance, aggression, and intent to harm. Findings demonstrate general inconsistency in measurement strategies on a range of issues, thus, making comparing prevalence rates between measures difficult. |
A systematic review of primary prevention strategies for sexual violence perpetration
DeGue S , Valle LA , Holt MK , Massetti GM , Matjasko JL , Tharp AT . Aggress Violent Behav 2014 19 (4) 346-362 This systematic review examined 140 outcome evaluations of primary prevention strategies for sexual violence perpetration. The review had two goals: 1) to describe and assess the breadth, quality, and evolution of evaluation research in this area; and 2) to summarize the best available research evidence for sexual violence prevention practitioners by categorizing programs with regard to their evidence of effectiveness on sexual violence behavioral outcomes in a rigorous evaluation. The majority of sexual violence prevention strategies in the evaluation literature are brief, psycho-educational programs focused on increasing knowledge or changing attitudes, none of which have shown evidence of effectiveness on sexually violent behavior using a rigorous evaluation design. Based on evaluation studies included in the current review, only three primary prevention strategies have demonstrated significant effects on sexually violent behavior in a rigorous outcome evaluation: Safe Dates (Foshee et al., 2004); Shifting Boundaries (building-level intervention only, Taylor, Stein, Woods, Mumford, & Forum, 2011); and funding associated with the 1994 U.S. Violence Against Women Act (VAWA; Boba & Lilley, 2009). The dearth of effective prevention strategies available to date may reflect a lack of fit between the design of many of the existing programs and the principles of effective prevention identified by Nation et al. (2003). |
Modular laboratories--cost-effective and sustainable infrastructure for resource-limited settings.
Bridges DJ , Colborn J , Chan AS , Winters AM , Dengala D , Fornadel CM , Kosloff B . Am J Trop Med Hyg 2014 91 (6) 1074-8 High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. |
Detection of biomarkers of pathogenic Naegleria fowleri through mass spectrometry and proteomics.
Moura H , Izquierdo F , Woolfitt AR , Wagner G , Pinto T , delAguila C , Barr JR . J Eukaryot Microbiol 2014 62 (1) 12-20 Emerging methods based on mass spectrometry (MS) can be used in the rapid identification of microorganisms. Thus far, these practical and rapidly evolving methods have mainly been applied to characterize prokaryotes. We applied MALDI-TOF MS in the analysis of whole cells of 18 N. fowleri isolates belonging to three genotypes. Fourteen originated from the cerebrospinal fluid or brain tissue of primary amoebic meningoencephalitis patients and four originated from water samples of hot springs, rivers, lakes or municipal water supplies. Whole Naegleria trophozoites grown in axenic cultures were washed and mixed with MALDI matrix. Mass spectra were acquired with a 4700 TOF-TOF instrument. MALDI-TOF MS yielded consistent patterns for all isolates examined. Using a combination of novel data processing methods for visual peak comparison, statistical analysis and proteomics database searching we were able to detect several biomarkers that can differentiate all species and isolates studied, along with common biomarkers for all N. fowleri isolates. N. fowleri could be easily separated from other species within the genus Naegleria. A number of peaks detected were tentatively identified. MALDI-TOF MS fingerprinting is a rapid, reproducible, high-throughput alternative method for identifying Naegleria isolates. This method has potential for studying eukaryotic agents. |
Optimization of peptide substrates for botulinum neurotoxin E improves detection sensitivity in the Endopep-MS assay
Wang D , Krilich J , Baudys J , Barr JR , Kalb SR . Anal Biochem 2014 468 15-21 Botulinum neurotoxins (BoNTs) produced by Clostridium botulinum are the most poisonous substances known to mankind. It is essential to have a simple, quick and sensitive method for the detection and quantification of botulinum toxin in various media, including complex biological matrices. Our laboratory has developed a mass spectrometry-based Endopep-MS assay that is able to rapidly detect and differentiate all types of BoNTs by extracting the toxin with specific antibodies and detecting the unique cleavage products of peptide substrates. Botulinum neurotoxin type E (BoNT/E) is a member of a family of seven distinctive BoNT serotypes (A to G) and is the causative agent of botulism in both humans and animals. To improve the sensitivity of the Endopep-MS assay, we report here the development of novel peptide substrates for the detection of BoNT/E activity through systematic and comprehensive approaches. Our data demonstrate that several optimal peptides could accomplish 500-fold improvement in sensitivity compared to the current substrate for the detection of both not trypsin-activated and trypsin-activated BoNT/E toxin complexes. A limit of detection of 0.1 mouseLD50/mL was achieved using the novel peptide substrate in the assay to detect not trypsin-activated BoNT/E complex spiked in serum, stool and food samples. |
Fluorinated TiO as an ambient light-activated virucidal surface coating material for the control of human norovirus
Park GW , Cho M , Cates EL , Lee D , Oh BT , Vinje J , Kim JH . J Photochem Photobiol B 2014 140c 315-320 We evaluated the virucidal efficacy of light-activated fluorinated TiO2 surface coatings on human norovirus and several surrogates (bacteriophage MS2, feline calcivirus (FCV), and murine norovirus (MNV)). Inactivation of viruses on surfaces exposed to a common fluorescent lamp was monitored and the effects of UVA intensity, temperature, and fluoride content were assessed. Destruction of RNA and capsid oxidation were evaluated for human norovirus inocula on the F-TiO2 surfaces, while contact with the F-TiO2 surface and exposure to residual UVA radiation of 10muWcm-2 for 60min resulted in infectivity reductions for the norovirus surrogates of 2-3 log10. Infectivity reductions on pristine TiO2 surfaces in identical conditions were over 2 orders of magnitude lower. Under realistic room lighting conditions, MS2 infectivity declined below the lower detection limit after 12h. Reductions in RNA were generally low, with the exception of GII.4, while capsid protein oxidation likely played a larger role in infectivity loss. Inactivation of norovirus surrogates occurred significantly faster on F-TiO2 compared to pristine TiO2 surfaces. The material demonstrated antiviral action against human norovirus surrogates and was shown to effectively inhibit MS2 when exposed to residual UVA present in fluorescent room lighting conditions in a laboratory setting. |
Cerium oxide nanoparticles attenuate monocrotaline induced right ventricular hypertrophy following pulmonary arterial hypertension
Kolli MB , Manne ND , Para R , Nalabotu SK , Nandyala G , Shokuhfar T , He K , Hamlekhan A , Ma JY , Wehner PS , Dornon L , Arvapalli R , Rice KM , Blough ER . Biomaterials 2014 35 (37) 9951-9962 Cerium oxide (CeO2) nanoparticles have been posited to exhibit potent anti-oxidant activity which may allow for the use of these materials in biomedical applications. Herein, we investigate whether CeO2 nanoparticle administration can diminish right ventricular (RV) hypertrophy following four weeks of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Male Sprague Dawley rats were randomly divided into three groups: control, MCT only (60 mg/kg), or MCT + CeO2 nanoparticle treatment (60 mg/kg; 0.1 mg/kg). Compared to the control group, the RV weight to body weight ratio was 45% and 22% higher in the MCT and MCT + CeO2 groups, respectively (p < 0.05). Doppler echocardiography demonstrated that CeO2 nanoparticle treatment attenuated monocrotaline-induced changes in pulmonary flow and RV wall thickness. Paralleling these changes in cardiac function, CeO2 nanoparticle treatment also diminished MCT-induced increases in right ventricular (RV) cardiomyocyte cross sectional area, beta-myosin heavy chain, fibronectin expression, protein nitrosylation, protein carbonylation and cardiac superoxide levels. These changes with treatment were accompanied by a decrease in the ratio of Bax/Bcl2, diminished caspase-3 activation and reduction in serum inflammatory markers. Taken together, these data suggest that CeO2 nanoparticle administration may attenuate the hypertrophic response of the heart following PAH. |
Prevention of perinatal hepatitis B virus transmission
Nelson NP , Jamieson DJ , Murphy TV . J Pediatric Infect Dis Soc 2014 3 S7-s12 Hepatitis B virus (HBV) infection, the most common form of chronic hepatitis worldwide, is a major public health problem affecting an estimated 360 million people globally. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. An estimated 15%-40% of persons chronically infected develop HBV-related complications, such as cirrhosis and hepatic carcinoma, and 25% die from these complications. MTCT can occur during pregnancy or during delivery. Screening pregnant women for HBV infection, providing infant postexposure prophylaxis, and maternal treatment with antiviral medications are strategies for reducing MTCT transmission rates and the global burden of new chronic HBV infections. Administration of hepatitis B immune globulin (HBIG) and hepatitis B (HepB) vaccine within 24 hours of birth, followed by completion of the vaccine series, is 85%-95% efficacious for prevention of MTCT. Despite timely post-exposure prophylaxis, MTCT occurs in 5%-15% of infants. Hepatitis B surface antigen (HBsAg) positive, hepatitis e antigen (HBeAg) positive mothers with HBV DNA level ≥106 copies/mL (>200 000 IU/mL) are at greatest risk of transmitting HBV to their infants. Consensus recommendations and evidence-based guidelines for management of chronic HBV infection and screening of pregnant women have been developed. The safety and efficacy of antiviral drug use during pregnancy are areas of ongoing research. Substantial advances have been achieved globally in reducing MTCT, but MTCT remains an ongoing health problem. Attaining a better understanding of the mechanisms of MTCT, implementing existing policies on maternal screening and infant follow-up, and addressing research gaps are critical for further reductions in MTCT transmission. |
Emergency hospitalizations for unsupervised prescription medication ingestions by young children
Lovegrove MC , Mathew J , Hampp C , Governale L , Wysowski DK , Budnitz DS . Pediatrics 2014 134 (4) e1009-16 BACKGROUND: Emergency department visits and subsequent hospitalizations of young children after unsupervised ingestions of prescription medications are increasing despite widespread use of child-resistant packaging and caregiver education efforts. Data on the medications implicated in ingestions are limited but could help identify prevention priorities and intervention strategies. METHODS: We used nationally representative adverse drug event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and national retail pharmacy prescription data from IMS Health to estimate the frequency and rates of emergency hospitalizations for unsupervised prescription medication ingestions by young children (2007-2011). RESULTS: On the basis of 1513 surveillance cases, 9490 estimated emergency hospitalizations (95% confidence interval: 6420-12 560) occurred annually in the United States for unsupervised prescription medication ingestions among children aged <6 years from 2007 through 2011; 75.4% involved 1- or 2-year old children. Opioids (17.6%) and benzodiazepines (10.1%) were the most commonly implicated medication classes. The most commonly implicated active ingredients were buprenorphine (7.7%) and clonidine (7.4%). The top 12 active ingredients, alone or in combination with others, were implicated in nearly half (45.0%) of hospitalizations. Accounting for the number of unique patients who received dispensed prescriptions, the hospitalization rate for unsupervised ingestion of buprenorphine products was significantly higher than rates for all other commonly implicated medications and 97-fold higher than the rate for oxycodone products (200.1 vs 2.1 hospitalizations per 100 000 unique patients). CONCLUSIONS: Focusing unsupervised ingestion prevention efforts on medications with the highest hospitalization rates may efficiently achieve large public health impact. |
Assessing immunization interventions in the Women, Infants, and Children (WIC) Program
Thomas TN , Kolasa MS , Zhang F , Shefer AM . Am J Prev Med 2014 47 (5) 624-8 BACKGROUND: Vaccination promotion strategies are recommended in Women, Infants, and Children (WIC) settings for eligible children at risk for under-immunization due to their low-income status. PURPOSE: To determine coverage levels of WIC and non-WIC participants and assess effectiveness of immunization intervention strategies. METHODS: The 2007-2011 National Immunization Surveys were used to analyze vaccination histories and WIC participation among children aged 24-35 months. Grantee data on immunization activities in WIC settings were collected from the 2010 WIC Linkage Annual Report Survey. Coverage by WIC eligibility and participation status and grantee-specific coverage by intervention strategy were determined at 24 months for select antigens. Data were collected 2007-2011 and analyzed in 2013. RESULTS: Of 13,183 age-eligible children, 5,699 (61%, weighted) had participated in WIC, of which 3,404 (62%, weighted) were current participants. In 2011, differences in four or more doses of the diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine by WIC participation status were observed: 86% (ineligible); 84% (current); 77% (previous); and 69% (never-eligible). Children in WIC exposed to an immunization intervention strategy had higher coverage levels than WIC-eligible children who never participated, with differences as great as 15% (DTaP). CONCLUSIONS: Children who never participated in WIC, but were eligible, had the lowest vaccination coverage. Current WIC participants had vaccination coverage comparable to more affluent children, and higher coverage than previous WIC participants. |
Non-fatal work-related traumatic brain injuries treated in US hospital emergency departments, 1998-2007
Konda S , Reichard A , Tiesman HM , Hendricks S . Inj Prev 2014 21 (2) 115-20 PURPOSE: Little is known about work-related traumatic brain injuries (WRTBI). This study describes non-fatal WRTBIs treated in US emergency departments (ED) from 1998 through 2007. METHODS: Non-fatal WRTBIs were identified from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work) using the diagnoses of concussion, internal organ injury to the head and skull fracture. WRTBI rates and rate ratios were calculated, and the trend in rates was assessed. RESULTS: An estimated 586 600 (95% CI=+/-150 000) WRTBIs were reported during the 10-year period at a rate of 4.3 (CI=+/-1.1) per 10 000 full-time equivalent (FTE) workers (1 FTE=2000 h per year). From 1998 through 2007, the rate of WRTBIs increased at an average of 0.21 per 10 000 FTE per year (p<0.0001) and the rate of fall-related WRTBIs increased at an average of 0.10 per 10 000 FTE (p<0.0001). During the same period, the annual rate of WRTBIs resulting in hospitalisation increased 0.04 per 10 000 FTE (p<0.0001). Ten percent of WRTBIs were hospitalised, compared with hospitalisation of 2% all NEISS-Work injuries. Also, workers with highest fall-related TBI rates per 10 000 FTE were the youngest (2.4; CI=+/-1.4) and oldest (55 and older) workers (1.9; CI=+/-0.8). CONCLUSIONS: Non-fatal WRTBIs are one of the most serious workplace injuries among ED-treated work-related injuries. Non-fatal WRTBIs are much more likely to result in hospitalisation compared with other types of injuries. The upward trend of WRTBI rates from 1998 through 2007 underscore the need for more directed effective prevention methods to reduce WRTBI injuries. |
The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs
Wurzelbacher SJ , Bertke SJ , Lampl MP , Bushnell PT , Meyers AR , Robins DC , Al-Tarawneh IS . Am J Ind Med 2014 57 (12) 1398-412 BACKGROUND: This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. METHODS: Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. RESULTS: For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. CONCLUSIONS: The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. |
Resurgence of a debilitating and entirely preventable respiratory disease among working coal miners
Blackley DJ , Halldin CN , Laney AS . Am J Respir Crit Care Med 2014 190 (6) 708-9 For more than 40 years, the National Institute for Occupational Safety and Health (NIOSH) has monitored trends in coal workers’ pneumoconiosis, including progressive massive fibrosis (PMF). PMF is an advanced, debilitating, and lethal form of coal workers’ pneumoconiosis with limited, primarily palliative treatment options and no cure. As part of ongoing surveillance efforts, NIOSH administers the Coal Workers’ Health Surveillance Program (CWHSP), which offers underground coal miners periodic chest radiographs and confidentially informs them of their pneumoconiosis status (1). Just 15 years ago, PMF was virtually eradicated, with a prevalence of 0.08% among all CWHSP participants and 0.33% among active underground miners with at least 25 years of mining tenure. Since that time, the national prevalence of PMF identified through the CWHSP has increased; the rate of increase in the central Appalachian states of Kentucky, Virginia, and West Virginia has been especially pronounced (Figure 1). Excessive inhalation of coal mine dust is the sole cause of PMF in working coal miners, so this increase can only be the result of overexposures and/or increased toxicity stemming from changes in dust composition (2). During 1998 to 2012, NIOSH identified 154 cases of PMF among CWHSP participants, 125 of whom were long-tenured underground coal miners in central Appalachia. In 2012, the prevalence of PMF in this group of working miners reached 3.23% (5-year moving average), the highest level since the early 1970s. At the same time, NIOSH documented cases of PMF among surface coal miners with little or no underground mining tenure (3). |
"You need to take care of it like you take care of your soul": perceptions and behaviours related to mosquito net damage, care, and repair in Senegal
Loll DK , Berthe S , Faye SL , Wone I , Arnold B , Koenker H , Schubert J , Lo Y , Thwing J , Faye O , Weber R . Malar J 2014 13 (1) 322 BACKGROUND: Net care and repair behaviours are essential for prolonging the durability of long-lasting insecticidal nets. Increased net durability has implications for protection against malaria as well as cost savings from less frequent net distributions. This study investigated behaviours and motivations for net care and repair behaviours in Senegal with the aim of informing social and behaviour change communication (SBCC) programmes, using the Health Belief Model as a framework. METHODS: Data were collected from 114 participants in eight regions of Senegal. Participants were eligible for the study if they were at least 18 years old and if their household owned at least one net. These respondents included 56 in-depth interview respondents and eight focus groups with 58 participants. In addition, the qualitative data were supplemented with observational questionnaire data from a total of 556 sleeping spaces. Of these spaces, 394 had an associated net. RESULTS: Reported net care and repair behaviours and motivations varied substantially within this sample. Children and improper handling were seen as major sources of net damage and respondents often tried to prevent damage by storing nets when not in use. Washing was seen as an additional method of care, but practices for washing varied and may have been damaging to nets in some cases. Participants mentioned a sense of pride of having a net in good condition and the uncertainty around when they could expect another net distribution as motivations for net care. Net repair appeared to be a less common behaviour and was limited by the perspective that net degradation was inevitable and that repairs themselves could weaken nets. CONCLUSION: These findings can be understood using the Health Belief Model framework of perceived severity, perceived susceptibility, perceived barriers, perceived benefits, self-efficacy, and cues to action. This model can guide SBCC messages surrounding net care and repair to promote practices associated with net longevity. Such messages should promote the benefits of intact nets and provide tools for overcoming barriers to care and repair. |
Challenges in accessing sexual and reproductive health services by people with physical disabilities in Kampala, Uganda
Ahumuza SE , Matovu JK , Ddamulira JB , Muhanguzi FK . Reprod Health 2014 11 59 INTRODUCTION: Despite the universal right to access the same range, quality and standard of free or affordable health care and programs as provided to other persons, people with physical disabilities (PWPDs) continue to experience challenges in accessing these services. This article presents the challenges faced by PWPDs in accessing sexual and reproductive health (SRH) services in Kampala, Uganda. METHODS: This was a qualitative study that was conducted with male and female PWPDs in Kampala in 2007. Data on the challenges experienced by PWPDs in accessing SRH services were collected using in-depth interviews with 40 PWPDs and key informant interviews with 10 PWPDs' representatives, staff of agencies supporting PWPDs and health workers. All data were captured verbatim using an audio-tape recorder, entered into a Microsoft Word computer program and analyzed manually following a content thematic approach. RESULTS: The study findings show that PWPDs face a multitude of challenges in accessing SRH services including negative attitudes of service providers, long queues at health facilities, distant health facilities, high costs of services involved, unfriendly physical structures and the perception from able-bodied people that PWPDs should be asexual. CONCLUSION: People with physical disabilities (PWPDs) face health facility-related (service provider and facility-related challenges), economic and societal challenges in accessing SRH services. These findings call for a need to sensitize service providers on SRH needs of PWPDs for better support and for the government to enforce the provision of PWPD-friendly services in all health facilities. |
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