Socioeconomic status and mortality: the contribution of health care access and psychological distress among United States adults with diagnosed diabetes
Saydah SH , Imperatore G , Beckles GL . Diabetes Care 2012 36 (1) 49-55 OBJECTIVE: Although several studies have examined the association between socioeconomic status (SES) and mortality in the general population, few have investigated this relationship among people with diabetes. This study sought to determine how risk of mortality associated with measures of SES among adults with diagnosed diabetes is mitigated by association with demographics, comorbidities, diabetes treatment, psychological distress, or health care access and utilization. RESEARCH DESIGN AND METHODS: The study included 6,177 adults aged 25 years or older with diagnosed diabetes, who participated in the National Health Interview Surveys (1997-2003) linked to mortality data (follow-up through 2006). SES was measured by education attained, financial wealth (either stocks/dividends or home ownership), and income-to-poverty ratio. RESULTS: In unadjusted analysis, risk of death was significantly greater for people with lower levels of education and income-to-poverty ratio than for those at the highest levels. After adjusting for demographics, comorbidities, diabetes treatment and duration, health care access, and psychological distress variables, the association with greater risk of death remained significant only for people with the lowest level of education (relative hazard 1.52 [95% CI 1.04-2.23]). After multivariate adjustment, the risk of death was significantly greater for people without certain measures of financial wealth (e.g., stocks, home ownership) (1.56 [1.07-2.27]) than for those with them. CONCLUSIONS: The findings suggest that after adjustments for demographics, health care access, and physiological distress, the level of education attained and financial wealth remain strong predictors of mortality risk among adults with diabetes. |
Prevalence of polycystic ovary syndrome among the privately insured, United States, 2003-2008
Okoroh EM , Hooper WC , Atrash HK , Yusuf HR , Boulet SL . Am J Obstet Gynecol 2012 207 (4) 299 e1-7 OBJECTIVE: The purpose of this study was to estimate the prevalence of polycystic ovary syndrome (PCOS) and its phenotypes as defined by the National Institutes of Health, Rotterdam criteria, and Androgen Society. STUDY DESIGN: Thomson Reuters MarketScan Commercial databases (Thomson Reuters Healthcare Inc, New York, NY) for 2003-2008 were used to calculate the prevalence of PCOS and to assess differences in demographic characteristics and comorbid conditions among women who were 18-45 years old with and without PCOS. RESULTS: The prevalence of PCOS was 1585.1 per 100,000; women with phenotype A or classic PCOS were most prevalent at 1031.5 per 100,000. Women with PCOS were more likely than those without PCOS to be 25-34 years old, be from the South, be infertile, have metabolic syndrome, have been seen by an endocrinologist, and have taken oral contraceptives. CONCLUSION: This is the first study to use all available criteria to estimate the prevalence of PCOS. Providers should evaluate women with menstrual dysfunction for the presence of PCOS. |
The effect of body mass index and weight change on epithelial ovarian cancer survival in younger women: a long-term follow-up study
Tyler CP , Whiteman MK , Zapata LB , Hillis SD , Curtis KM , McDonald J , Wingo PA , Kulkarni A , Marchbanks PA . J Womens Health (Larchmt) 2012 21 (8) 865-71 OBJECTIVE: The objective of this study was to assess the relationship between body mass index (BMI) and epithelial ovarian cancer survival among young women. METHODS: We conducted a cohort analysis of 425 women aged 20-54 years with incident epithelial ovarian cancer enrolled during 1980-1982 in Cancer and Steroid Hormone (CASH), a population-based, case-control study. Participants' vital status was ascertained though linkage with the Surveillance, Epidemiology and End Results (SEER) program. Using Cox proportional hazards models, we estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between survival and usual adult BMI, BMI at age 18, and weight change from age 18 to adult. RESULTS: During a follow-up of up to 17 years, 215 women died. Compared to women with an adult BMI in the lowest quartile (<20.7), women in the second (20.8-22.5), third (22.6-24.9), and fourth (≥25.0) quartiles were not at increased risk for death (HR 1.2, 95% CI 0.8-1.8; HR 1.1, 95% CI 0.7-1.6; and HR 0.9, 95% CI 0.6-1.4, respectively) (p trend=0.6). Similarly, neither age 18 BMI nor weight change were associated with ovarian cancer survival. CONCLUSIONS: Although elevated BMI is associated with increased ovarian cancer risk among young women, we found no evidence of its association with ovarian cancer survival in this population. |
Increased risk of acute hepatitis B among adults with diagnosed diabetes mellitus
Reilly ML , Schillie SF , Smith E , Poissant T , Vonderwahl CW , Gerard K , Baumgartner J , Mercedes L , Sweet K , Muleta D , Zaccaro DJ , Klevens RM , Murphy TV . J Diabetes Sci Technol 2012 6 (4) 858-66 INTRODUCTION: The risk of acute hepatitis B among adults with diabetes mellitus is unknown. We investigated the association between diagnosed diabetes and acute hepatitis B. METHODS: Confirmed acute hepatitis B cases were reported in 2009-2010 to eight Emerging Infections Program (EIP) sites; diagnosed diabetes status was determined. Behavioral Risk Factor Surveillance System respondents residing in EIP sites comprised the comparison group. Odds ratios (ORs) comparing acute hepatitis B among adults with diagnosed diabetes versus without diagnosed diabetes were determined by multivariate logistic regression, adjusting for age, sex, and race/ethnicity, and stratified by the presence or absence of risk behaviors for hepatitis B virus (HBV) infection. RESULTS: During 2009-2010, EIP sites reported 865 eligible acute hepatitis B cases among persons aged ≥23 years; 95 (11.0%) had diagnosed diabetes. Comparison group diabetes prevalence was 9.1%. Among adults without hepatitis B risk behaviors and with reported diabetes status, the OR for acute hepatitis B comparing adults with and without diabetes was 1.9 (95% confidence interval [CI] = 1.4, 2.6); ORs for adults ages 23-59 and ≥60 years were 2.1 (95% CI = 1.6, 2.8) and 1.5 (95% = CI 0.9, 2.5), respectively. CONCLUSIONS: Diabetes was independently associated with an increased risk for acute hepatitis B among adults without HBV risk behaviors. |
Bolivian health providers' attitudes toward alternative technologies for cervical cancer prevention: a focus on visual inspection with acetic acid and cryotherapy
Stormo AR , Altamirano VC , Perez-Castells M , Espey D , Padilla H , Panameno K , Soria M , Santos C , Saraiya M , Luciani S . J Womens Health (Larchmt) 2012 21 (8) 801-8 BACKGROUND: Little is known about health providers' attitudes toward visual inspection with acetic acid (VIA) and cryotherapy in the prevention of cervical cancer, as most research in Latin America and the Caribbean (LAC) has examined attitudes of the general population. This study describes attitudes of Bolivian health professionals toward new technologies for cervical cancer prevention, focusing on VIA and cryotherapy. METHODS: Between February 2011 and March 2012, we surveyed 7 nurses and 35 physicians who participated in 5-day workshops on VIA and cryotherapy conducted in Bolivia. Multiple choice and open-ended questions were used to assess participants' acceptability of these procedures and the feasibility of their implementation in the context of perceived barriers for the early detection of cervical cancer in this country. RESULTS: Most believed that cultural factors represent the main barrier for the early detection of cervical cancer (70%), although all stated that VIA and cryotherapy would be accepted by women, citing the advantages of VIA over cytology for this belief. Most also believed their colleagues would accept VIA and cryotherapy (71%) and that VIA should replace Pap testing (61%), reiterating the advantages of VIA for these beliefs. Those who believed the contrary expressed a general resistance to change associated with an already existing cytology program and national norms prioritizing Pap testing. CONCLUSIONS: Most participants had favorable attitudes toward VIA and cryotherapy; however, a sizable minority cited challenges to their adoption by colleagues and believed VIA should not replace cytology. This report can inform the development of strategies to expand the use of alternative cervical cancer screening methods in LAC and Bolivia. |
Seroprevalence of antibodies to avian influenza A (H5) and A (H9) viruses among market poultry workers, Hanoi, Vietnam, 2001
Uyeki TM , Nguyen DC , Rowe T , Lu X , Hu-Primmer J , Huynh LP , Hang NL , Katz JM . PLoS One 2012 7 (8) e43948 BACKGROUND: The frequency of avian influenza A virus infections among poultry workers is not well understood. METHODS: A seroprevalence study of market poultry workers and persons without occupational poultry exposure was conducted during 2001 in Hanoi, Vietnam. Sera were tested for avian influenza H5 and H9 antibodies by microneutralization and Western blot assays. RESULTS: Seroprevalence of H5 and H9 antibodies was 4% and 3% in poultry workers and 1% and 3.5% in non-poultry workers, respectively. CONCLUSIONS: Seroprevalence of H5 and H9 antibodies was low among Hanoi market poultry workers in 2001, but can serve as a baseline for additional studies. |
Practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic
Rasmussen SA , Power ML , Jamieson DJ , Williams J , Schulkin J , Kahn EB , Zhang Y , Macfarlane K , Kissin DM . Am J Obstet Gynecol 2012 207 (4) 294 e1-7 OBJECTIVE: We examined practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. STUDY DESIGN: From February-May 2010, a survey was sent to a random sample of members of the American College of Obstetricians and Gynecologists involved in obstetric care. RESULTS: Obstetrician-gynecologists varied in their adherence to 2009 H1N1 influenza public health recommendations. Nearly all reported prescribing antiviral medications to pregnant women with suspected influenza. Most obstetrician-gynecologists reported using preventive practices in the outpatient setting to reduce exposure of well patients to ill ones. A wide range of responses was provided regarding postpartum infection control practices, suggesting lack of awareness of, disagreement with, or difficulty adhering to these recommendations. CONCLUSION: Obstetrician-gynecologists reported that they adhered to some recommendations related to 2009 H1N1 influenza, but not to others. These data provide insight into strategies for development and dissemination of recommendations in a future pandemic. |
Prevalence of hepatitis B virus infection among persons with diagnosed diabetes mellitus in the United States, 1999-2010
Schillie SF , Xing J , Murphy TV , Hu DJ . J Viral Hepat 2012 19 (9) 674-6 SUMMARY: The prevalence of hepatitis B virus (HBV) infection among persons with diabetes has not been assessed among the US population, despite increasing reports of HBV transmission in institutional care settings. Using national survey data, we found a 60% higher prevalence of HBV infection among persons with (vs without) diagnosed diabetes. |
Effectiveness of gentamicin for gonorrhoea treatment: systematic review and meta-analysis
Dowell D , Kirkcaldy RD . Sex Transm Infect 2012 88 (8) 589-94 OBJECTIVES: The development of resistance to multiple antimicrobial agents has limited treatment options for gonorrhoea. The potential emergence of cephalosporin resistance in Neisseria gonorrhoeae and cephalosporin allergy in some patients make it necessary to evaluate the effectiveness of other available antimicrobial agents. Gentamicin is widely available in the USA and is used for gonorrhoea treatment in several countries. We conducted a systematic review of the medical literature to assess the effectiveness of gentamicin for treatment of uncomplicated urogenital gonococcal infections. METHODS: Two reviewers assessed relevant articles and independently selected studies that met prespecified selection criteria (including systematic enrolment and assignment to treatment and culture-confirmed diagnosis and outcome). Summary measures for selected studies were pooled using inverse variance-weighted averages with fixed effects. Heterogeneity was assessed using I(2), which estimates proportion (0-100%) of variability attributable to heterogeneity between studies. Pooled percentage with negative follow-up culture was compared with Centers for Disease Control and Prevention (CDC) criteria for selection of recommended therapy (lower 95% CI of efficacy ≥95%). RESULTS: Twenty-nine potentially relevant studies were identified; three met inclusion criteria. Two studies used 240 mg intramuscular gentamicin and one used 280 mg. Percentages with negative culture after single-dose treatment were 90.7% (n=86), 91.4% (n=220) and 95.0% (n=40). Pooled percentage with negative culture after single-dose treatment was 91.5% (95% CI 88.1% to 94.0%, I(2)=0%). CONCLUSIONS: Gentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted. |
HIV-1 and herpes simplex virus type-2 genital shedding among co-infected women using self-collected swabs in Chiang Rai, Thailand
Forhan SE , Dunne EF , Sternberg MR , Whitehead SJ , Leelawiwat W , Thepamnuay S , Chen C , Evans-Strickfaden T , McNicholl JM , Markowitz LE . Int J STD AIDS 2012 23 (8) 560-4 We analysed 528 genital self-collected swabs (SCS) from 67 HIV-1 and herpes simplex virus type-2 (HSV-2) co-infected women collected during the placebo month of a randomized crossover clinical trial of suppressive acyclovir in Chiang Rai, Thailand. In this first longitudinal study of HIV-1 and HSV-2 co-infected women using genital SCS specimens, we found frequent mucosal HIV-1 shedding. Overall, 372 (70%) swabs had detectable HIV-1 RNA with median HIV-1 viral load of 2.61 log(10) copies/swab. We found no statistically significant association between detectable HIV-1 RNA and HSV-2 DNA in the same SCS specimen (adjusted odds ratio [aOR] 1.40; 95% confidence intervals [CI], 0.78-2.60, P = 0.25). Only baseline HIV-1 plasma viral load was independently associated with genital HIV-1 RNA shedding (aOR, 7.6; 95% CI, 3.3-17.2, P < 0.0001). SCS may be useful for future HIV-1 and HSV-2 studies because this method allows for frequent genital sampling, and inclusion of genital sites other than the cervix. |
Challenges for HIV pre-exposure prophylaxis among men who have sex with men in the United States
Mansergh G , Koblin BA , Sullivan PS . PLoS Med 2012 9 (8) e1001286 In light of recent research, Gordon Mansergh and colleagues discuss barriers to effective implementation of HIV pre-exposure prophylaxis for men who have sex with men. |
Data to guide the "Test and Treat Era" of hepatitis C
Ward JW , Rein DB , Smith BD . Gastroenterology 2012 143 (4) 887-9 Health leaders around the world are facing critical questions regarding how to combat a rising tide of hepatitis C virus (HCV)-associated liver disease. Worldwide, an estimated 130–170 million persons are living with chronic HCV infection, and HCV causes 1 in 4 cases of cirrhosis and 170,000 deaths per year.1 Persons living with HCV are often unaware they are infected, reflecting the relatively asymptomatic nature of HCV infection until late in the course of disease and the often decades-long latency between acquisition of HCV and the development of end-stage liver disease and death. Many HCV-infected persons were infected decades ago, before the discovery of the virus in the late 1980s and the advent of blood bank screening and other prevention measures. As time passes and HCV has a longer opportunity to cause progressive liver damage, the number of HCV-infected persons developing end-stage liver disease (hepatocellular carcinoma and liver cirrhosis) is increasing at an accelerating rate.2 For example, in the United States, the number of persons dying from HCV-associated conditions recently surpassed the number of deaths from HIV/AIDS. The US Centers for Disease Control and Prevention (CDC) estimate that HCV-related cirrhosis and morbidity will continue to increase year over year into the next decade and beyond.3, 4 | Fortunately, health officials are not empty handed in facing this looming crisis. A growing arsenal of direct-acting antiviral agents can clear HCV from the body (ie, achieve virologic cure). The addition of 1 of 2 commercially available protease inhibitors to treatment regimens can increase rates of sustained virologic response (ie, viral eradication after completion of treatment) to 63%–75%.5, 6 Other compounds under study in clinical trials may increase rates of viral eradication even further.7 Achieving a sustained virologic response is important, because persons successfully clearing virus after HCV therapy have lower rates of hepatocellular carcinoma and all-cause mortality.8, 9 |
A new phlebovirus associated with severe febrile illness in Missouri.
McMullan LK , Folk SM , Kelly AJ , MacNeil A , Goldsmith CS , Metcalfe MG , Batten BC , Albarino CG , Zaki SR , Rollin PE , Nicholson WL , Nichol ST . N Engl J Med 2012 367 (9) 834-41 Two men from northwestern Missouri independently presented to a medical facility with fever, fatigue, diarrhea, thrombocytopenia, and leukopenia, and both had been bitten by ticks 5 to 7 days before the onset of illness. Ehrlichia chaffeensis was suspected as the causal agent but was not found on serologic analysis, polymerase-chain-reaction (PCR) assay, or cell culture. Electron microscopy revealed viruses consistent with members of the Bunyaviridae family. Next-generation sequencing and phylogenetic analysis identified the viruses as novel members of the phlebovirus genus. Although Koch's postulates have not been completely fulfilled, we believe that this phlebovirus, which is novel in the Americas, is the cause of this clinical syndrome. |
A regional climatography of West Nile, Uganda, to support human plague modeling
Monaghan AJ , MacMillan K , Moore SM , Mead PS , Hayden MH , Eisen RJ . J Appl Meteorol Climatol 2012 51 (7) 1201-1221 The West Nile region in northwestern Uganda is a focal point for human plague, which peaks in boreal autumn and is spread by fleas that travel on rodent hosts. The U.S. Centers for Disease Control and Prevention is collaborating with the National Center for Atmospheric Research to quantitatively address the linkages between climate and human plague in this region. The aim of this paper is to advance knowledge of the climatic conditions required to maintain enzootic cycles and to trigger epizootic cycles and ultimately to target limited surveillance, prevention, and control resources. A hybrid dynamical-statistical downscaling technique was applied to simulations from the Weather Research and Forecasting Model (WRF) to generate a multiyear 2-km climate dataset for modeling plague in the West Nile region. The resulting dataset resolves the spatial variability and annual cycle of temperature, humidity, and rainfall in West Nile relative to satellite-based and in situ records. Topography exerts a first-order influence on the climatic gradients in West Nile, which lies in a transition zone between the drier East African Plateau and the wetter Congo Basin, and between the unimodal rainfall regimes of the Sahel and the bimodal rainfall regimes characteristic of equatorial East Africa. The results of a companion paper in which the WRF-based climate fields were applied to develop an improved logistic regression model of human plague occurrence in West Nile are summarized, revealing robust positive associations with rainfall at the tails of the rainy season and negative associations with rainfall during a dry spell each summer. |
Mercury exposure among artisanal gold miners in Madre de Dios, Peru: a cross-sectional study
Yard EE , Horton J , Schier JG , Caldwell K , Sanchez C , Lewis L , Gastanaga C . J Med Toxicol 2012 8 (4) 441-8 INTRODUCTION: Exposure to mercury, a toxic metal, occurs primarily from inhaling mercury vapors or consuming methylmercury-contaminated fish. One third of all anthropogenic mercury emissions worldwide are from artisanal gold mining, which uses mercury to extract gold. Although recent reports suggest that the Madre de Dios region in Peru (with >30,000 artisanal miners) has extensive mercury contamination, residents had never been assessed for mercury exposure. Thus, our objective was to quantify mercury exposure among residents of an artisanal mining town in Madre de Dios and to assess risk factors for exposure. METHODS: We conducted a cross-sectional assessment of 103 residents of an artisanal gold mining town in July 2010. Each participant provided a urine and blood sample and completed a questionnaire assessing potential exposures and health outcomes. We calculated geometric mean (GM) urine total mercury and blood methylmercury concentrations and compared log-transformed concentrations between subgroups using linear regression. RESULTS: One third (34.0 %) of participants were gold miners. All participants had detectable urine total mercury (GM, 5.5 mug/g creatinine; range, 0.7-151 mug/g creatinine) and 91 % had detectable blood methylmercury (GM, 2.7 mug/L; range, 0.6-10 mug/L); 13 participants (13 %) reported having kidney dysfunction or a neurological disorder. Urine total mercury concentrations were higher among people who heated gold-mercury amalgams compared with people who never heated amalgams (p < 0.05); methylmercury concentrations were higher among fish consumers compared with nonfish consumers (p < 0.05). CONCLUSION: Our findings suggest that mercury exposure may be widespread in Huaypetue. |
Dominant microbial volatile organic compounds in 23 US homes
Ryan TJ , Beaucham C . Chemosphere 2012 90 (3) 977-85 Associating Microbial Volatile Organic Compounds (MVOCs) with the species producing them may open the path to more rapid and reliable chemical methods to detect mold problems, especially for mold hidden in wall cavities or small enclosed spaces. This study associated the dominant MVOCs in a convenience sample of 23 homes with the mold species present. Three semi-quantitative predictors of mold growth ("MOW scores") were assessed in the homes through a comparison of basement to main floor areas. MVOC samples were collected and analyzed by GC/MS. Aerotek N-6 samplers were co-located with the MVOC samplers to collect bioaerosols. Concentration and prevalence data for 19 definitive MVOCs were compared with the bioaerosol data. Mold predictor scores were elevated in basement locations as compared with main floor areas. Of the 23 mold genera identified, the predominant genera (ranked occurrences) were Cladosporium, Penicillium, Basidiomycetes, and Aspergilli. The MVOCs 2-octen-1-ol, 3-octenone, 2-heptanone, 1-octen-3-ol, and 1-butanol showed the highest average concentrations (11-37mugm(-3)), but no single MVOC was significantly elevated in basement locations as compared with main floor living areas in these non-problematic homes. Using a less conservative one-tail test of significance, average 2-octen-1-ol concentrations in basements were higher (p<0.040), and both 3-octenone and 1-octen-3-ol were elevated (p<0.095). Differences in MVOC occurrence were greatest between homes, with MVOCs found in basement locations typically detected in living areas at similar concentrations and frequencies. Based on these findings, the C(8) MVOCs show promise as gross indicators of fungal growth related to the most frequently found mold genera. |
Profile: The KEMRI/CDC Health and Demographic Surveillance System--Western Kenya
Odhiambo FO , Laserson KF , Sewe M , Hamel MJ , Feikin DR , Adazu K , Ogwang S , Obor D , Amek N , Bayoh N , Ombok M , Lindblade K , Desai M , Ter Kuile F , Phillips-Howard P , van Eijk AM , Rosen D , Hightower A , Ofware P , Muttai H , Nahlen B , Decock K , Slutsker L , Breiman RF , Vulule JM . Int J Epidemiol 2012 41 (4) 977-87 The KEMRI/Centers for Disease Control and Prevention (CDC) Health and Demographic Surveillance System (HDSS) is located in Rarieda, Siaya and Gem Districts (Siaya County), lying northeast of Lake Victoria in Nyanza Province, western Kenya. The KEMRI/CDC HDSS, with approximately 220 000 inhabitants, has been the foundation for a variety of studies, including evaluations of insecticide-treated bed nets, burden of diarrhoeal disease and tuberculosis, malaria parasitaemia and anaemia, treatment strategies and immunological correlates of malaria infection, and numerous HIV, tuberculosis, malaria and diarrhoeal disease treatment and vaccine efficacy and effectiveness trials for more than a decade. Current studies include operations research to measure the uptake and effectiveness of the programmatic implementation of integrated malaria control strategies, HIV services, newly introduced vaccines and clinical trials. The HDSS provides general demographic and health information (such as population age structure and density, fertility rates, birth and death rates, in- and out-migrations, patterns of health care access and utilization and the local economics of health care) as well as disease- or intervention-specific information. The HDSS also collects verbal autopsy information on all deaths. Studies take advantage of the sampling frame inherent in the HDSS, whether at individual, household/compound or neighbourhood level. |
Completeness of West Nile virus testing in patients with meningitis and encephalitis during an outbreak in Arizona, USA
Weber IB , Lindsey NP , Bunko-Patterson AM , Briggs G , Wadleigh TJ , Sylvester TL , Levy C , Komatsu KK , Lehman JA , Fischer M , Staples JE . Epidemiol Infect 2012 140 (9) 1632-6 SUMMARY: Accurate data on West Nile virus (WNV) cases help guide public health education and control activities, and impact regional WNV blood product screening procedures. During an outbreak of WNV disease in Arizona, records from patients with meningitis or encephalitis were reviewed to determine the proportion tested for WNV. Of 60 patients identified with meningitis or encephalitis, 24 (40%) were tested for WNV. Only 12 (28%) of 43 patients aged <50 years were tested for WNV compared to 12 (71%) of 17 patients aged 50 years (P<0.01). Patients with clinical signs of weakness or paralysis, elevated CSF protein, admitted to an inpatient facility, or discharged to a rehabilitation facility were also more likely to have WNV testing performed. The lack of testing in younger age groups and in those with less severe disease probably resulted in substantial underestimates of WNV neuroinvasive disease burden. |
Design, methodological issues and participation in a multiple sclerosis case-control study
Williamson DM , Marrie RA , Ashley-Koch A , Schiffer R , Trottier J , Wagner L . Acta Neurol Scand 2012 126 (3) 197-204 OBJECTIVES: This study was conducted to determine whether the risk of developing multiple sclerosis (MS) was associated with certain environmental exposures or genetic factors previously reported to influence MS risk. This paper describes the methodological issues, study design and characteristics of the study population. MATERIALS AND METHODS: Individuals with definite MS were identified from a prevalence study conducted in three geographic areas. The target number of cases was not reached, so an additional study area was added. Identifying clinic controls was inefficient, so controls were recruited using random digit dialing. All study participants completed a detailed questionnaire regarding environmental exposures using computer-assisted telephone interviewing, and blood was collected for genetic analysis. RESULTS: In total, 276 cases and 590 controls participated, but participation rates were low, ranging from 28.4% to 38.9%. Only one-third (33.6%) of individuals identified in the prevalence study agreed to participate in the case-control study. Cases were more likely to be non-Hispanic white and older than their source populations as identified in the preceding prevalence study (P < 0.05). Most participants provided a blood sample for genotyping (91%; n = 789). CONCLUSIONS: Epidemiological studies play a key role in identifying genetic and environmental factors that are associated with complex diseases like MS. Methodological issues arise in every study, and investigators need to be able to detect, respond to and correct problems in a timely and scientifically valid manner. |
A diagnostics platform for the integrated mapping, monitoring, and surveillance of neglected tropical diseases: rationale and target product profiles
Solomon AW , Engels D , Bailey RL , Blake IM , Brooker S , Chen JX , Chen JH , Churcher TS , Drakeley CJ , Edwards T , Fenwick A , French M , Gabrielli AF , Grassly NC , Harding-Esch EM , Holland MJ , Koukounari A , Lammie PJ , Leslie J , Mabey DC , Rhajaoui M , Secor WE , Stothard JR , Wei H , Willingham AL , Zhou XN , Peeling RW . PLoS Negl Trop Dis 2012 6 (7) e1746 Control and elimination strategies for trachoma, lymphatic filariasis, onchocerciasis, schistosomiasis, ascariasis, trichuriasis and hookworm infection have striking similarities, including the use of periodic mass drug administration (MDA). Because these diseases tend to be co-endemic in the poorest communities of the poorest countries, such that multiple NTDs are frequently found not just in the same populations but within the same individuals [1], it has been suggested that mapping, treatment, impact monitoring, and post-elimination surveillance could be coordinated to better utilise limited human and financial resources. Although many programmes now distribute multiple anthelmintics simultaneously, progress in integrating mapping [2], [3], [4], monitoring, and surveillance [5] activities has been slow [6]. Ideally, population sampling strategies, fieldwork protocols, and sample types (e.g., blood or urine) could all be harmonised between diseases to increase population compliance, simplify overall survey procedures, and decrease costs. | For each of these diseases, current diagnostic tools are imperfect (Table S1A), especially for areas with low prevalence. A cost-effective strategy for improved tool development would incorporate integration of diagnostic strategies from the outset [7], [8]. |
Epidemiology of a large restaurant-associated outbreak of Shiga toxin-producing Escherichia coli O111:NM
Bradley KK , Williams JM , Burnsed LJ , Lytle MB , McDermott MD , Mody RK , Bhattarai A , Mallonee S , Piercefield EW , McDonald-Hamm CK , Smithee LK . Epidemiol Infect 2012 140 (9) 1644-54 SUMMARY: In August 2008, a large outbreak of Shiga toxin-producing Escherichia coli (STEC) O111:NM infections associated with a buffet-style restaurant in rural Oklahoma was identified. A case-control study of restaurant patrons and a retrospective cohort study of catered event attendees were conducted coupled with an environmental investigation to determine the outbreak's source and mode of transmission. Of 1823 persons interviewed, 341 (18.7%) met the outbreak case definition; 70 (20.5%) were hospitalized, 25 (7.3%) developed haemolytic uraemic syndrome, and one died. Multiple food items were significantly associated with illness by both bivariate and multivariate analyses, but none stood out as a predominant transmission vehicle. All water, food, and restaurant surface swabs, and stool cultures from nine ill employees were negative for the presence of Shiga toxin and E. coli O111:NM although epidemiological evidence suggested the outbreak resulted from cross-contamination of restaurant food from food preparation equipment or surfaces, or from an unidentified infected food handler. |
Detecting and controlling foodborne infections in humans: lessons for China from the United States experience
Varma JK , Wu S , Feng Z . Glob Public Health 2012 7 (7) 766-78 In the past 50 years, the United States has made major advances in human health surveillance, research and outbreak investigation that have helped reduce microbial contamination of food. In China, food safety has emerged as one of the country's most prominent domestic concerns, but there has been limited investment in surveillance, inter-agency coordination, outbreak investigation and data synthesis. After large outbreaks of Salmonella in the 1960s and E. coli O157:H7 in the 1990s, the United States transformed its approach to detecting and investigating foodborne infections, including deployment of a national, laboratory-based surveillance system that uses molecular subtyping. In China, the absence of a national, laboratory-based surveillance system means that it is difficult to rapidly detect a widely dispersed foodborne infection outbreak or the emergence of new foodborne infections. Based on lessons learned in the United States, we propose policy and administrative changes that China can adopt to strengthen detection and control of foodborne infections. |
Simian genogroup I picobirnaviruses: prevalence, genetic diversity, and zoonotic potential.
Wang Y , Banyai K , Tu X , Jiang B . J Clin Microbiol 2012 50 (8) 2779-82 We previously reported the first detection of simian picobirnaviruses (PBVs) by polyacrylamide gel electrophoresis in fecal specimens of two monkeys with diarrhea in China. We now report the detection of genogroup I PBVs in 48% (44/92) of the fecal specimens by reverse transcriptase PCR (RT-PCR) and amplicon sequencing using primers specific for the RNA-dependent RNA polymerase (RDRP) gene. Molecular characterization of these 44 strains demonstrated both sequence conservation and diversity among simian PBVs and among simian, porcine, and human PBVs. We further determined full-length sequences of segment 2 of the two simian PBV strains, monkey/CHN-14/2002 and monkey/CHN-49/2002, and demonstrated 52.5% to 54.2% nucleotide sequence similarity to the corresponding gene of the bovine strain RUBV and the prototype human strain 1-CHN-97 of genogroup I PBVs and an even lower similarity (38.4%) to segment 2 of the prototype human genogroup II strain 4-GA-91. Further studies are needed to investigate the epidemiology and pathogenesis of PBVs in animals and humans. |
Phylogeny of shiga toxin-producing Escherichia coli O157 isolated from cattle and clinically ill humans
Bono JL , Smith TP , Keen JE , Harhay GP , McDaneld TG , Mandrell RE , Jung WK , Besser TE , Gerner-Smidt P , Bielaszewska M , Karch H , Clawson ML . Mol Biol Evol 2012 29 (8) 2047-62 Cattle are a major reservoir for Shiga toxin-producing Escherichia coli O157 (STEC O157) and harbor multiple genetic subtypes that do not all associate with human disease. STEC O157 evolved from an E. coli O55:H7 progenitor; however, a lack of genome sequence has hindered investigations on the divergence of human- and/or cattle-associated subtypes. Our goals were to 1) identify nucleotide polymorphisms for STEC O157 genetic subtype detection, 2) determine the phylogeny of STEC O157 genetic subtypes using polymorphism-derived genotypes and a phage insertion typing system, and 3) compare polymorphism-derived genotypes identified in this study with pulsed field gel electrophoresis (PFGE), the current gold standard for evaluating STEC O157 diversity. Using 762 nucleotide polymorphisms that were originally identified through whole-genome sequencing of 189 STEC O157 human- and cattle-isolated strains, we genotyped a collection of 426 STEC O157 strains. Concatenated polymorphism alleles defined 175 genotypes that were tagged by a minimal set of 138 polymorphisms. Eight major lineages of STEC O157 were identified, of which cattle are a reservoir for seven. Two lineages regularly harbored by cattle accounted for the majority of human disease in this study, whereas another was rarely represented in humans and may have evolved toward reduced human virulence. Notably, cattle are not a known reservoir for E. coli O55:H7 or STEC O157:H(-) (the first lineage to diverge within the STEC O157 serogroup), which both cause human disease. This result calls into question how cattle may have originally acquired STEC O157. The polymorphism-derived genotypes identified in this study did not surpass PFGE diversity assessed by BlnI and XbaI digestions in a subset of 93 strains. However, our results show that they are highly effective in assessing the evolutionary relatedness of epidemiologically unrelated STEC O157 genetic subtypes, including those associated with the cattle reservoir and human disease. |
Health care-associated infections studies project: an American Journal of Infection Control and National Healthcare Safety Network data quality collaboration case study 7
Wright MO , Hebden JN , Allen-Bridson K , Morrell GC , Horan T . Am J Infect Control 2012 40 (6) 554-5 Welcome to the seventh publication of a joint effort between the American Journal of Infection Control and the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). This collaboration is a series of case studies representing surveillance scenarios faced everyday by infection preventionists (IPs) using NHSN definitions. | With each case, a link to an online survey will be provided, where you may answer the questions posed and receive immediate feedback in the form of answers and explanations. All individual participant answers will remain confidential, although it is the authors' hope to share a summary of the findings at a later date. The content development was a partnership between the listed authors, and all cases, answers, and explanations have been reviewed and approved by NHSN. |
A three dose intramuscular schedule of anthrax vaccine adsorbed generates sustained humoral and cellular immune responses to protective antigen and provides long term protection against inhalation anthrax in rhesus macaques
Quinn CP , Sabourin CL , Niemuth NA , Li H , Semenova VA , Rudge TL , Mayfield HJ , Schiffer J , Mittler RS , Ibegbu CC , Wrammert J , Ahmed R , Brys AM , Hunt RE , Levesque D , Estep JE , Barnewall RE , Robinson DM , Plikaytis BD , Marano N . Clin Vaccine Immunol 2012 19 (11) 1730-45 A 3 dose (0, 1, 6 months) intramuscular (3-IM) priming series of a human dose (HuAVA) and dilutions up to 1:10 of anthrax vaccine adsorbed (AVA) provided statistically significant levels of protection (60-100%) against inhalation anthrax for up to 4 years in rhesus macaques.Serum anti-protective antigen (PA) IgG and lethal toxin neutralization activity (TNA) were detectable following a single injection of HuAVA or 1:5 AVA, or two injections of diluted vaccine (1:10, 1:20, 1:40 AVA). Anti-PA and TNA were highly correlated (overall r(2) = 0.89 for log(10) transformed data). Peak responses were at 6.5 months (mo). In general, with the exception of animals receiving 1:40 AVA, serum anti-PA and TNA responses remained significantly above control levels at 28.5mo (last time point measured for 1:20 AVA) and through 50.5mo in HuAVA, 1:5 and 1:10 AVA groups (p <0.05).PA-specific IFN-gamma and IL-4 CD4(+) cell frequencies and T cell stimulation indices were sustained to 50.5mo (last time point measured). PA-specific memory B cell frequencies were highly variable, but in general were detectable in PBMC by 2mo, significantly above controls by 7mo, and remained detectable in the HuAVA, 1:5 and 1:20 AVA groups to 42mo (last time point measured).HuAVA and diluted AVA elicited a combined Th1/Th2 response and robust immunological priming with sustained production of high avidity PA-specific functional antibody, long term immune cell competence and immunological memory (30mo for 1:20 AVA; 52mo for 1:10 AVA). Vaccinated animals surviving inhalation anthrax developed high magnitude anamnestic anti-PA IgG and TNA responses. |
Potential intussusception risk versus benefits of rotavirus vaccination in the United States
Desai R , Cortese MM , Meltzer MI , Shankar M , Tate JE , Yen C , Patel MM , Parashar UD . Pediatr Infect Dis J 2012 32 (1) 1-7 BACKGROUND: International data show a low-level increased risk of intussusception associated with rotavirus vaccination. While US data have not documented a risk, we assumed a risk similar to international settings and compared potential vaccine-associated intussusception cases with benefits of prevention of rotavirus gastroenteritis by a fully implemented US rotavirus vaccine program. METHODS: To calculate excess intussusception cases, we used national data on vaccine coverage and baseline intussusception rates, and assumed a vaccine-associated intussusception relative risk of 5.3 (95% CI: 3.0 - 9.3) in the first week after the first vaccine dose, the risk seen in international settings. We used post-licensure vaccine effectiveness data to calculate rotavirus disease burden averted. RESULTS: For a US birth cohort of 4.3 million infants, vaccine-associated intussusception could cause an excess 0.2 (range: 0.1 - 0.3) deaths, 45 (range: 21 - 86) hospitalizations, and 13 (range: 6 - 25) cases managed in short-stay or emergency department settings. Vaccination would avert 14 (95% CI: 10 - 19) rotavirus-associated deaths, 53,444 (95% CI: 37,622 - 72,882) hospitalizations, and 169,949 (95% CI: 118,161-238,630) emergency department visits. Summary benefit-risk ratios for death and hospitalization are 71:1 and 1,093:1, respectively. CONCLUSIONS: The burden of severe rotavirus disease averted due to vaccination compared with the vaccine-associated intussusception events offers a side-by-side analysis of the benefits and potential risks. If an intussusception risk similar to that seen internationally exists in the US, it is substantially exceeded by the benefits of rotavirus disease burden averted by vaccination. |
The effect of electronic medical record-based clinical decision support on HIV care in resource-constrained settings: A systematic review
Oluoch T , Santas X , Kwaro D , Were M , Biondich P , Bailey C , Abu-Hanna A , de Keizer N . Int J Med Inform 2012 81 (10) e83-92 BACKGROUND: It is estimated that one million people infected with HIV initiate anti-retroviral therapy (ART) in resource-constrained countries annually. This occurs against a background of overburdened health workers with limited skills to handle rapidly changing treatment standards and guidelines hence compromising quality of care. Electronic medical record (EMR)-based clinical decision support systems (CDSS) are considered a solution to improve quality of care. Little evidence, however, exists on the effectiveness of EMR-based CDSS on quality of HIV care and treatment in resource-constrained settings. OBJECTIVE: The aim of this systematic review was to identify original studies on EMR-based CDSS describing process and outcome measures as well as reported barriers to their implementation in resource-constrained settings. We characterized the studies by guideline adherence, data and process, and barriers to CDSS implementation. METHODS: Two reviewers independently assessed original articles from a search of the MEDLINE, EMBASE, CINAHL and Global Health Library databases until January 2012. The included articles were those that evaluated or described the implementation of EMR-based CDSS that were used in HIV care in low-income countries. RESULTS: A total of 12 studies met the inclusion criteria, 10 of which were conducted in sub-Saharan Africa and 2 in the Caribbean. None of the papers described a strong (randomized controlled) evaluation design. Guideline adherence: One study showed that ordering rates for CD4 tests were significantly higher when reminders were used. Data and process: Studies reported reduction in data errors, reduction in missed appointments, reduction in missed CD4 results and reduction in patient waiting time. Two studies showed a significant increase in time spent by clinicians on direct patient care. Barriers to CDSS implementation: Technical infrastructure problems such as unreliable electric power and erratic Internet connectivity, clinicians' limited computer skills and failure by providers to comply with the reminders are key impediments to the implementation and effective use of CDSS. CONCLUSION: The limited number of evaluation studies, the basic and heterogeneous study designs, and varied outcome measures make it difficult to meaningfully conclude on the effectiveness of CDSS on quality of HIV care and treatment in resource-limited settings. High quality evaluation studies are needed. Factors specific to implementation of EMR-based CDSS in resource-limited setting should be addressed before such countries can demonstrate its full benefits. More work needs to be done to overcome the barriers to EMR and CDSS implementation in developing countries such as technical infrastructure and care providers' computer illiteracy. However, simultaneously evaluating and describing CDSS implementation strategies that work can further guide wise investments in their wider rollout. |
Effect of screening for partner violence on women's quality of life: a randomized controlled trial
Klevens J , Kee R , Trick W , Garcia D , Angulo FR , Jones R , Sadowski LS . JAMA 2012 308 (7) 681-9 CONTEXT: Although partner violence screening has been endorsed by many health organizations, there is insufficient evidence that it has beneficial health outcomes. OBJECTIVE: To determine the effect of computerized screening for partner violence plus provision of a partner violence resource list vs provision of a partner violence list only on women's health in primary care settings, compared with a control group. DESIGN, SETTING, AND PARTICIPANTS: A 3-group blinded randomized controlled trial at 10 primary health care centers in Cook County, Illinois. Participants were enrolled from May 2009-April 2010 and reinterviewed 1 year (range, 48-56 weeks) later. Participants were English- or Spanish-speaking women meeting specific inclusion criteria and seeking clinical services at study sites. Of 3537 women approached, 2727 were eligible, 2708 were randomized (99%), and 2364 (87%) were recontacted 1 year later. Mean age of participants was 39 years. Participants were predominantly non-Latina African American (55%) or Latina (37%), had a high school education or less (57%), and were uninsured (57%). INTERVENTION: Randomization into 3 intervention groups: (1) partner violence screen (using the Partner Violence Screen instrument) plus a list of local partner violence resources if screening was positive (n = 909); (2) partner violence resource list only without screen (n = 893); and (3) no-screen, no-partner violence list control group (n=898). MAIN OUTCOME MEASURES: Quality of life (QOL, physical and mental health components) was the primary outcome, measured on the 12-item Short Form (scale range 0-100, mean of 50 for US population). RESULTS: At 1-year follow-up, there were no significant differences in the QOL physical health component between the screen plus partner violence resource list group (n = 801; mean score, 46.8; 95% CI, 46.1-47.4), the partner violence resource list only group (n = 772; mean score, 46.4; 95% CI, 45.8-47.1), and the control group (n = 791; mean score, 47.2; 95% CI, 46.5-47.8), or in the mental health component (screen plus partner violence resource list group [mean score, 48.3; 95% CI, 47.5-49.1], the partner violence resource list only group [mean score, 48.0; 95% CI, 47.2-48.9], and the control group [mean score, 47.8; 95% CI, 47.0-48.6]). There were also no differences between groups in days unable to work or complete housework; number of hospitalizations, emergency department, or ambulatory care visits; proportion who contacted a partner violence agency; or recurrence of partner violence. CONCLUSIONS: Among women receiving care in primary care clinics, providing a partner violence resource list with or without screening did not result in improved health. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00526994. |
Emergency department visits for traumatic brain injury in older adults in the United States: 2006-08
Pearson WS , Sugerman DE , McGuire LC , Coronado VG . West J Emerg Med 2012 13 (3) 289-293 INTRODUCTION: Traumatic brain injury (TBI) can be complicated among older adults due to age-related frailty, a greater prevalence of chronic conditions and the use of anticoagulants. We conducted this study using the latest available, nationally-representative emergency department (ED) data to characterize visits for TBI among older adults. METHODS: We used the 2006-2008 National Hospital Ambulatory Medical Care - Emergency Department (NHAMCS-ED) data to examine ED visits for TBI among older adults. Population-level estimates of triage immediacy, receipt of a head computed tomography (CT) and/or head magnetic resonance imaging (MRI), and hospital admission by type were used to characterize 1,561 sample visits, stratified by age <65 and ≥65 years of age. RESULTS: Of ED visits made by persons ≥65 years of age, 29.1% required attention from a physician within 15 minutes of arrival; 82.1% required a head CT, and 20.9% required hospitalization. Persons ≥65 years of age were 3 times more likely to receive a head CT or MRI compared to younger patients presenting with TBI (adjusted odds ratio [aOR] 3.2; 95% confidence interval [CI], 1.8-5.8), and were 4 times more likely to be admitted to an intensive care unit, step-down unit, or surgery (aOR 4.1; 95% CI 2.1-8.0) compared to younger patients presenting with TBI, while controlling for sex and race. CONCLUSION: Results demonstrate increased emergent service delivery for older persons presenting with TBI. As the United States population ages and continues to grow, TBI will become an even more important public health issue that will place a greater demand on the healthcare system. |
Two linear regression models predicting cumulative dynamic L5/S1 joint moment during a range of lifting tasks based on static postures
Xu X , Chang CC , Lu ML . Ergonomics 2012 55 (9) 1093-103 Previous studies have indicated that cumulative L5/S1 joint load is a potential risk factor for low back pain. The assessment of cumulative L5/S1 joint load during a field study is challenging due to the difficulty of continuously monitoring the dynamic joint load. This study proposes two regression models predicting cumulative dynamic L5/S1 joint moment based on the static L5/S1 joint moment of a lifting task at lift-off and set-down and the lift duration. Twelve men performed lifting tasks at varying lifting ranges and asymmetric angles in a laboratory environment. The cumulative L5/S1 joint moment was calculated from continuous dynamic L5/S1 moments as the reference for comparison. The static L5/S1 joint moments at lift-off and set-down were measured for the two regression models. The prediction error of the cumulative L5/S1 joint moment was 21+/-14 Nm x s (12% of the measured cumulative L5/S1 joint moment) and 14+/-9 Nm x s (8%) for the first and the second models, respectively. Practitioner Summary: The proposed regression models may provide a practical approach for predicting the cumulative dynamic L5/S1 joint loading of a lifting task for field studies since it requires only the lifting duration and the static moments at the lift-off and/or set-down instants of the lift. |
Evaluation of methods for identification and determination of the taxonomic status of strains belonging to the Streptococcus porcinus-Streptococcus pseudoporcinus complex isolated from animal, human, and dairy sources
Shewmaker PL , Steigerwalt AG , Whitney AM , Morey RE , Graziano JC , Facklam RR , Musser KA , Merquior VL , Teixeira LM . J Clin Microbiol 2012 50 (11) 3591-7 Ninety-seven animal, human, and dairy Streptococcus porcinus or Streptococcus pseudoporcinus isolates in the CDC Streptococcus strain collection were evaluated based on DNA-DNA reassociation, 16S rRNA and rpoB gene sequencing, conventional biochemical and rapid ID 32 STREP identification methods, and antimicrobial susceptibility testing to determine their taxonomic status, characteristics for species differentiation, antimicrobial susceptibility and relevance of clinical source. Nineteen of the 97 isolates (1 human, 18 swine) were identified as S. porcinus. The remaining 72 human isolates and 6 dairy isolates were identified as S. pseudoporcinus. The use of 16S rRNA or rpoB gene sequencing was required to differentiate S. porcinus from S. pseudoporcinus. The human and dairy S. pseudoporcinus isolates were biochemically distinct from each other as well as distinct by 16S rRNA and rpoB gene sequencing. Therefore, we propose the subspecies denominations S. pseudoporcinus subsp. hominis subsp. nov. for the human isolates and S. pseudoporcinus subsp. lactis subsp. nov. for the dairy isolates. Most strains were susceptible to the antimicrobials tested, with the exception of tetracycline. Two strains of each species were also resistant to clindamycin and erythromycin and carried the erm(A) (S. pseudoporcinus) or the erm(B) (S. porcinus) genes. S. porcinus was identified from a single human isolate recovered from a wound in an abattoir worker. S. pseudoporcinus was primarily isolated from the genitourinary tract of women, but was also associated with blood, placental, and wound infections. Isolates reacting with group B antiserum and demonstrating wide beta hemolysis should be suspected of being S. pseudoporcinus and not S. agalactiae. |
Immune evasion and recognition of the syphilis spirochete in blood and skin of secondary syphilis patients: two immunologically distinct compartments
Cruz AR , Ramirez LG , Zuluaga AV , Pillay A , Abreu C , Valencia CA , La Vake C , Cervantes JL , Dunham-Ems S , Cartun R , Mavilio D , Radolf JD , Salazar JC . PLoS Negl Trop Dis 2012 6 (7) e1717 BACKGROUND: The clinical syndrome associated with secondary syphilis (SS) reflects the propensity of Treponema pallidum (Tp) to escape immune recognition while simultaneously inducing inflammation. METHODS: To better understand the duality of immune evasion and immune recognition in human syphilis, herein we used a combination of flow cytometry, immunohistochemistry (IHC), and transcriptional profiling to study the immune response in the blood and skin of 27 HIV(-) SS patients in relation to spirochetal burdens. Ex vivo opsonophagocytosis assays using human syphilitic sera (HSS) were performed to model spirochete-monocyte/macrophage interactions in vivo. RESULTS: Despite the presence of low-level spirochetemia, as well as immunophenotypic changes suggestive of monocyte activation, we did not detect systemic cytokine production. SS subjects had substantial decreases in circulating DCs and in IFNgamma-producing and cytotoxic NK-cells, along with an emergent CD56-/CD16+ NK-cell subset in blood. Skin lesions, which had visible Tp by IHC and substantial amounts of Tp-DNA, had large numbers of macrophages (CD68+), a relative increase in CD8+ T-cells over CD4+ T-cells and were enriched for CD56+ NK-cells. Skin lesions contained transcripts for cytokines (IFN-gamma, TNF-alpha), chemokines (CCL2, CXCL10), macrophage and DC activation markers (CD40, CD86), Fc-mediated phagocytosis receptors (FcgammaRI, FcgammaR3), IFN-beta and effector molecules associated with CD8 and NK-cell cytotoxic responses. While HSS promoted uptake of Tp in conjunction with monocyte activation, most spirochetes were not internalized. CONCLUSIONS: Our findings support the importance of macrophage driven opsonophagocytosis and cell mediated immunity in treponemal clearance, while suggesting that the balance between phagocytic uptake and evasion is influenced by the relative burdens of bacteria in blood and skin and the presence of Tp subpopulations with differential capacities for binding opsonic antibodies. They also bring to light the extent of the systemic innate and adaptive immunologic abnormalities that define the secondary stage of the disease, which in the skin of patients trends towards a T-cell cytolytic response. |
An outbreak of Klebsiella pneumoniae late-onset sepsis in a neonatal intensive care unit in Guatemala
Gray J , Arvelo W , McCracken J , Lopez B , Lessa FC , Kitchel B , Wong B , Reyes L , Lindblade K . Am J Infect Control 2012 40 (6) 516-20 BACKGROUND: Gram-negative bloodstream infections are an important cause of neonatal mortality. In October 2009, we investigated a Klebsiella spp outbreak in a neonatal intensive care unit in Guatemala. METHODS: Probable cases were defined as a Klebsiella spp isolated from blood in neonates aged <28 days in the neonatal intensive care unit between October 1 and November 10, 2009; confirmed cases were identified as Klebsiella pneumoniae. Clinical data were abstracted from medical charts. K pneumoniae isolates were genotyped by pulsed-field gel electrophoresis (PFGE) and tested for antimicrobial susceptibility. Infection control practices were inspected. RESULTS: There were 14 confirmed cases. The median age at onset of infection was 3 days (range, 2-8 days). Nine patients died (64%). K pneumoniae isolates were resistant to multiple antimicrobials. PFGE revealed 2 distinct clusters. Breaches in infection control procedures included inappropriate intravenous solution use and inadequate hand hygiene and contact precautions. CONCLUSIONS: We report a K pneumoniae outbreak with high neonatal mortality in Guatemala. PFGE clustering suggested a common source possibly related to reuse of a single-use intravenous medication or solution. The risk for K pneumoniae bloodstream infections in neonates in low-resource settings where sharing of solutions is common needs to be emphasized. |
Exploring the choice to refuse or delay vaccines: a national survey of parents of 6- through 23-month-olds
McCauley MM , Kennedy A , Basket M , Sheedy K . Acad Pediatr 2012 12 (5) 375-83 OBJECTIVE: The purpose of this study was to assess respondents' self-reported choices for vaccinating their young children; knowledge, attitudes, and beliefs (KABs) about vaccination; and communication with their child's vaccination provider. METHODS: A national telephone survey of 1500 parents of children aged 6 to 23 months was conducted in 2010. We calculated proportions of parents who had chosen-or planned-to refuse or delay 1 or more recommended vaccines, and proportions for responses to KABs and communication questions, stratified by vaccination choice (ie, refuse or delay). RESULTS: The response rate was 46%. Among the 96.6% of respondents (95% confidence interval [CI], 95.5%-97.4%; weighted n = 1453) who had chosen for their child to receive at least 1 vaccine, 80.6% (95% CI, 78.8%-83.0%) reported that their child had received all vaccines when recommended and 86.5% (95% CI, 84.7%-88.2%) reported that their child would receive remaining vaccines when recommended. Respondents who considered not following recommendations, but ultimately did, cited the physician's recommendation as the reason for vaccinating. Most vaccinators who reported past or planned deviations from recommendations cited only 1 vaccine that they would refuse and/or delay; all vaccines were mentioned. These parents reported approaching vaccination with serious concerns, while believing other parents did not. All parents cited "vaccine side effects" as their top question or concern. Almost all parents talked to a doctor or nurse about vaccines and, overall, satisfaction with communication was high. CONCLUSIONS: Communication about vaccines is important to most parents, but may be challenging for providers, because parental choices vary; thus, efforts to improve and support vaccine communication by providers should continue. |
Breastfeeding practices: does method of delivery matter?
Ahluwalia IB , Li R , Morrow B . Matern Child Health J 2012 16 Suppl 2 231-7 Objective of this study was to assess the relationship between method of delivery and breastfeeding. Using data (2005-2006) from the longitudinal Infant Feeding Practices Study II (n = 3,026) we assessed the relationship between delivery method (spontaneous vaginal, induced vaginal, emergency cesarean, and planned cesarean) and breastfeeding: initiation, any breastfeeding at 4 weeks, any breastfeeding at 6 months, and overall duration. We used SAS software to analyze data using multivariable analyses adjusting for several confounders, including selected demographic characteristics, participants' pre-delivery breastfeeding intentions and attitude, and used event-history analysis to estimate breastfeeding duration by delivery method. We found no significant association between delivery method and breastfeeding initiation. In the fully adjusted models examining breastfeeding duration to 4 weeks with spontaneous vaginal delivery group as the reference, those with induced vaginal deliveries were significantly less likely to breastfeed [adjusted odds ratio (AOR) = 0.53; 95 % CI = 0.38-0.71]; and no significant relationship was observed for those who had planned or emergency cesarean deliveries. Again, compared with spontaneous vaginal delivery group, those with induced vaginal [AOR = 0.60; 96 % CI = 0.47-0.78] and emergency cesarean [AOR = 0.68; 96 % CI = 0.48-0.95] deliveries were significantly less likely to breastfeed at 6 months. Median breastfeeding duration was 45.2 weeks among women with spontaneous vaginal, 38.7 weeks among planned cesarean, 25.8 weeks among induced vaginal and 21.5 weeks among emergency cesarean deliveries. While no significant association was observed between delivery method and breastfeeding initiation; breastfeeding duration varied substantially with method of delivery, perhaps indicating a need for additional support for women with assisted deliveries. |
Support among U.S. adults for local and state policies to increase fruit and vegetable access
Foltz JL , Harris DM , Blanck HM . Am J Prev Med 2012 43 S102-8 BACKGROUND: Few American children or adults meet national objectives for consumption of both fruits and vegetables (FV). State and local policies that support community access to FV can help support individuals and families in having easier access to FV for purchase and ultimately consumption. PURPOSE: To assess U.S. adult support for state and local policies designed to increase community-level access to FV. METHODS: Data were analyzed from the 2008 HealthStyles survey of U.S. adults (N=5181), in which participants were asked how likely they would be to support four types of changes to local or state policies: those that would create farmers' markets and community gardens, or increase FV offerings in small stores and public sector venues. Respondents' answers were collapsed into three categories ("supportive," "neutral," and "unsupportive"); the prevalence of support for each type of policy was determined, and logistic regression was used to calculate ORs for support of each by selected demographic variables. RESULTS: Overall, 62.1% supported farmers' markets, 57.7% supported the public sector, 54.3% supported small stores, and 47.2% supported community garden policies. Support for policy changes was relatively high among women, Hispanics, and non-Hispanic blacks. CONCLUSIONS: Although some variation in support exists, the majority of Americans support state or local policy changes designed to increase community access to FV. Future research should augment this work by including questions on willingness to pay, trade-off methods, or referendum-style questions to inform priorities among FV policy initiatives. |
Creating supportive nutrition environments for population health impact and health equity: an overview of the Nutrition and Obesity Policy Research and Evaluation Network's efforts
Blanck HM , Kim SA . Am J Prev Med 2012 43 S85-90 Childhood obesity is a major threat to individual health and society overall. Policies that support healthier food and beverage choices have been endorsed by many decision makers. These policies may reach a large proportion of the population or in some circumstances aim to reduce nutrition disparities to ensure health equity. The Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) evaluates policy as a tool to improve food and beverage environments where Americans live, work, play, and learn. The network aspires to address research and evaluation gaps related to relevant policies, create standardized research tools, and help build the evidence base of effective policy solutions for childhood obesity prevention with a focus on reach, equity, cost effectiveness, and sustainability. |
Psychosocial job stress and immunity: a systematic review
Nakata A . Methods Mol Biol 2012 934 39-75 The purpose of this review was to provide current knowledge about the possible association between psychosocial job stress and immune parameters in blood, saliva, and urine. Using bibliographic databases (PubMed, PsychINFO, Web of Science, Medline) and the snowball method, 56 studies were found. In general, exposure to psychosocial job stress (high job demands, low job control, high job strain, job dissatisfaction, high effort-reward imbalance, overcommitment, burnout, unemployment, organizational downsizing, economic recession) had a measurable impact on immune parameters (reduced NK cell activity, NK and T cell subsets, CD4+/CD8+ ratio, and increased inflammatory markers). The evidence supports that psychosocial job stresses are related to disrupted immune responses but further research is needed to demonstrate cause-effect relationships. |
Incidence and cost of depression after occupational injury
Asfaw A , Souza K . J Occup Environ Med 2012 54 (9) 1086-91 OBJECTIVES: We examined if injured workers were more likely than noninjured workers to be treated for depression after an occupational injury and estimated the cost paid by group medical insurance. METHOD: Nearly 367,900 injured and noninjured workers were drawn from the 2005 Thomson Reuters MarketScan data. Descriptive, logistic, and two-part model regression analyses were used. RESULTS: The odds of injured workers being treated for depression within the study period were 45% higher than those of noninjured workers (95% confidence interval, 1.17-1.78). The unconditional average cost of outpatient depression treatment was 63% higher for injured workers than for noninjured workers. CONCLUSIONS: Injured workers were more likely than noninjured workers to suffer from depression during the study period. Consequently, additional costs are incurred for treating injured workers' depression; these costs were not covered by the workers' compensation system. |
Assessment of lifetime occupational exposure in an epidemiologic study of COPD
Graziani M , Doney B , Hnizdo E , Villnave J , Breen V , Weinmann S , Vollmer WM , McBurnie MA , Buist AS , Heumann M . Open Epidemiol J 2012 5 (1) 27-35 Ascertainment of lifetime occupational exposures in an epidemiological study of chronic obstructive pulmonary disease (COPD) is important in order to investigate its effect on the disease and develop prevention strategies. The aim of our paper is to describe and evaluate a methodology used to assign lifetime occupational exposure to participants in a case-control study of COPD where lifetime occupational history was ascertained through telephone questionnaire interviews. The methodology involved assigning to each individual a qualitative index of potential exposure to eight occupational hazards, summarized individually overall the job categories reported by the individual, and an overall qualitative index of lifetime exposure to all eight hazards. The eight occupational hazards scored were mineral dusts, metal dusts/fumes, organic dusts, irritant gases/vapors, sensitizers, organic solvents, diesel exhaust, and environmental tobacco smoke (ETS). Two industrial hygienists independently assigned the above indices based on: their expert opinion, a priori knowledge based on literature review, and study participants’ responses to interviewer questions regarding types and duration of exposure. To evaluate agreement of the assigned scores, we used the Kappa statistic to test the agreement between the two scorers on each of the indices. The Kappa statistic generally indicated good agreement between the industrial hygienists’ scores but varied by exposure from 0.42 to 0.86. Although the exposure scoring is somewhat subjective, it is based on experience of experts and review of the literature. This method, with subject interviews providing qualitative lifetime exposure data when air monitoring has not been conducted, is useful for reconstructing lifetime exposures. |
The CUPID (Cultural and Psychosocial Influences on Disability) study: methods of data collection and characteristics of study sample
Coggon D , Ntani G , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Serra C , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir M , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Sarquis LM , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Salazar Vega EJ , Harris EC , Vargas-Prada S , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Sirk T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kielkowski D , Kelsall HL , Hoe VC , Urquhart DM , Derett S , McBride D , Gray A . PLoS One 2012 7 (7) e39820 BACKGROUND: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. METHODS/PRINCIPAL FINDINGS: A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI). CONCLUSIONS/SIGNIFICANCE: The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively. |
New global estimates of malaria deaths
Lynch M , Korenromp E , Eisele T , Newby H , Steketee R , Kachur SP , Nahlen B , Yoon S , MacArthur J , Newman R , Cibulskis R . Lancet 2012 380 (9841) 559 Christopher Murray and colleagues' paper (Feb 4, p 413)1 estimating the number of malaria deaths worldwide, 1980–2010, invites caution in its interpretation. Murray and colleagues estimate that there were 1 238 000 malaria deaths worldwide in 2010, compared with WHO's estimate of 655 000.2 However, wide uncertainty ranges accompany both the Murray and colleagues and WHO estimates, and with one exception—for deaths in people older than 5 years in Africa—these ranges overlap, so the estimates cannot be regarded as significantly different (figure). |
Obstetric providers' knowledge, awareness, and use of CDC'S HIV testing recommendations and One Test. Two Lives.
Green DR , Anderson BL , Burke MF , Griffith J , Schulkin J . Matern Child Health J 2012 16 (5) 1113-9 This study examined the impact of the Centers for Disease Control and Prevention's (CDC's) One Test. Two Lives. (OTTL) campaign on key outcomes related to CDC's revised HIV testing recommendations and the use of the campaign materials. Data from three cross-sectional surveys were used to assess the effect of OTTL on Obstetricians/Gynecologists' (OB/GYN) HIV knowledge and practice. A 2-year combined sample of 500 OB/GYNs completed DocStyles, a Web-based survey for physicians, and 575 American College of Obstetricians and Gynecologists (ACOG) Fellows completed an ACOG survey. The surveys were similar in focus but did not contain the same items. Data were analyzed using cross-tabulations, chi(2) analyses, and logistic regression. There was a 20% recall of exposure to OTTL with DocStyles and 25% with ACOG. DocStyles respondents reporting having seen OTTL materials were significantly more likely to report awareness of CDC's recommendations [chi(2)(1) = 25.43, P < .001] and include HIV testing as a regular screening test for all patients [chi(2)(1) = 4.98, P < .05]. ACOG respondents not using the materials indicated high levels of willingness to use the materials-63.0 to 71.5%, depending on the material. Of the ACOG sample, 68.1% correctly answered the knowledge items regarding the recommendations. However, a significant relationship between correct knowledge and campaign exposure was not found. Overall, results suggest that OTTL is instrumental in raising awareness and implementation of the testing recommendations and plays an important role in facilitating HIV testing practices with obstetric providers and their patients. |
Building leadership skills and promoting workforce development: evaluation data collected from public health professionals in the field of maternal and child health
Kroelinger CD , Kasehagen L , Barradas DT , Ali Z . Matern Child Health J 2012 16 Suppl 2 370-5 Professional development, including training and leadership skill building, is important for maternal and child health (MCH) epidemiologists. Current workforce development and training opportunities vary, but lack an emphasis on linking leadership competencies with MCH epidemiology. This paper describes efforts at the annual MCH Epidemiology Conference (the "Conference") to promote leadership activities and workforce development, and recommendations to enhance professional development. An evaluation of attendee opinions on Conference workforce development activities was conducted during the 2009 and 2010 Conferences (70 and 66 % response rates, respectively). Frequencies and percentages were calculated overall and by attendee profession. Qualitative responses to questions regarding workforce and professional development were classified by theme in 2009, and a categorical question was developed for the 2010 evaluation. A combined 38 % of Conference attendees in 2009 and 2010 were MCH epidemiologists and 62 % were other MCH professionals. Attendees recommended more support and access to training, mentoring, and resources including job opportunities. Continuing education (41 %), special knowledge and skills-building training (51 %), and development of online resources for training (57 %) were highly recommended by attendees. Career (47 %) and leadership (49 %) mentoring by senior-level professionals in the field were also highly recommended. Promotion of leadership can be achieved by integrating the concept of leadership into the Conference itself; by publishing and disseminating MCH epidemiologic research in scientific, program, and policy settings; and by communicating the importance of epidemiologic findings to stakeholders and other non-scientific audiences. |
The Prevention Research Centers program: translating research into public health practice and impact
Greenlund KJ , Giles WH . Am J Prev Med 2012 43 S91-2 Chronic diseases such as heart disease, cancer, stroke, and diabetes account for 7 of the 10 leading causes of death in the United States each year, and they are leading causes of disability and impaired health related quality of life.1 Yet, these conditions and the risk factors and behaviors related to them—e.g., tobacco use, high blood pressure and cholesterol, obesity, physical inactivity, unhealthy diets—are largely preventable. We know much about the development of chronic diseases and what must be done to prevent them or at the very least greatly lower risk. To achieve greater health impact, more effective translation of prevention science into action and practice is urgently needed. | The Prevention Research Centers (PRC) program (www.cdc.gov/prc/index.htm) of the Centers for Disease Control and Prevention (CDC) provides an important role in the application, evaluation, and translation of public health research into practice.2 The thirty-seven PRCs, which are community-based academic research centers, conduct both formal and applied prevention research that assess interventions (individual based as well as broader policy or environmental level) for application to communities and scalability for public health impact. The PRCs assess and disseminate effective approaches, translate research into public health practice, evaluate the impact of interventions, and develop and deliver training programs. |
We will be known forever by the tracks we leave: rising up to meet the reproductive health needs of American Indian and Alaska Native youth
de Ravello L , Tulloch S , Taylor M . Am Indian Alsk Native Ment Health Res 2012 19 (1) i-x Many U.S. adolescents of all races/ethnicities engage in multiple behaviors that increase their risk for poor reproductive health outcomes (Eaton, 20101; Everett Jones, Anderson, Lowry, & Conner, 2011; Ramisetty-Mikler & Ebama, 2011; Rutman, Park, Castor, Taualii, & Forquera, 2008). American Indian and Alaska Native (AI/AN) youth are disproportionately affected by poor reproductive health outcomes, including high rates of sexually transmitted diseases (STDs) and teen pregnancy. Peer-reviewed literature on AI/AN reproductive health issues is sparse and often not generalizable to all AI/AN because of small and geographically specific study populations. In the limited studies that have been conducted, some have shown high rates of STDs and teen pregnancy among AI/AN adolescents may result from a lack of familial support, a history of sexual and physical abuse, and early sexual debut (Palacios & Kennedy, 2010); alcohol and substance use and low and inconsistent condom use (Kaufman, 2006); and multiple sex partners (Marsiglia, Nieri, & Stiffman, 2006). | The Journal of American Indian and Alaska Native Mental Health Research disseminated the call for submissions for this special issue through its extensive formal and informal networks. The journal received 11 submissions; 9 of those are included in this special issue of the journal and 2 will appear in a later issue. No submission was rejected. Authors were instructed to attain necessary approvals prior to submission. Every author was assigned a mentor to help polish and finalize the manuscripts; the articles were reviewed by two external reviewers with expertise in the manuscripts’ subject areas. |
Mass screening for severe problem behavior among infants and toddlers in Peru
Mayo-Ortega L , Oyama-Ganiko R , Leblanc J , Schroeder SR , Brady N , Butler MG , Reese RM , Richman DM , Peacock G , Foster J , Marquis J . J Ment Health Res Intellect Disabil 2012 5 246-259 Severe behavior problems among people with intellectual and developmental disabilities (IDD) are a major barrier to integration in the community. Recent research suggests that these behaviors often begin very early in life and might be prevented by early identification and intervention (Rojahn, Schroeder, & Hoch, 2008). The current article presents a method of mass screening for early signs of severe behavior problems among infants and toddlers in Peru. A Parental Concerns Questionnaire (PCQ), which asks 15 questions, each related to a risk factor for severe behavior problems, based on past research on IDD, was used by veteran parents to interview 341 new parents who had been solicited by TV, radio, and public service announcements across the country. Of these, 262 were recruited and enrolled in a longitudinal study in which they will be followed for 12 months to see if at-risk children actually will develop severe behavior problems. An extensive initial interdisciplinary evaluation was given to each child. Consumer satisfaction questionnaires were given to the parents as to their attitude toward the screening method. Data from the Interdisciplinary Evaluations of the sample suggest a very high hit rate (96%) by the screening instrument (PCQ). Consumer satisfaction was 98%, suggesting that the method was tolerated well by parents. The PCQ is a brief and efficient method to screen infants and toddlers at risk for severe behavior problems. The data also suggest that parents suspect these problems at a very early age. Early intervention thus seems a feasible strategy to intervene before these problems become deeply ingrained as children develop. |
Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009
Ko JY , Farr SL , Dietz PM , Robbins CL . J Womens Health (Larchmt) 2012 21 (8) 830-6 BACKGROUND: Depression is often undiagnosed and untreated. It is not clear if differences exist in the diagnosis and treatment of depression among pregnant and nonpregnant women. We sought to estimate the prevalence of undiagnosed depression, treatment by modality, and treatment barriers by pregnancy status among U.S. reproductive-aged women. METHODS: We identified 375 pregnant and 8,657 nonpregnant women 18-44 years of age who met criteria for past-year major depressive episode (MDE) from 2005-2009 nationally representative data. Chi-square statistics and adjusted prevalence ratios (aPR) were calculated. RESULTS: MDE in pregnant women (65.9%) went undiagnosed more often than in nonpregnant women (58.6%) (aPR 1.1, 95% confidence interval [CI] 1.0-1.3). Half of depressed pregnant (49.6%) and nonpregnant (53.7%) women received treatment (aPR 1.0, 95% CI 0.90-1.1), with prescription medication the most common form for both pregnant (39.6%) and nonpregnant (47.4%) women. Treatment barriers did not differ by pregnancy status and were cost (54.8%), opposition to treatment (41.7%), and stigma (26.3%). CONCLUSIONS: Pregnant women with MDE were no more likely than nonpregnant women to be diagnosed with or treated for their depression. |
Varenicline for smoking cessation: nausea severity and variation in nicotinic receptor genes.
Swan GE , Javitz HS , Jack LM , Wessel J , Michel M , Hinds DA , Stokowksi RP , McClure JB , Catz SL , Richards J , Zbikowski SM , Deprey M , McAfee T , Conti DV , Bergen AW . Pharmacogenomics J 2012 12 (4) 349-58 This study evaluated association between common and rare sequence variants in 10 nicotinic acetylcholine receptor subunit genes and the severity of nausea 21 days after initiating the standard, Food and Drug Administration-approved varenicline regimen for smoking cessation. A total of 397 participants from a randomized clinical effectiveness trial with complete clinical and DNA resequencing data were included in the analysis (mean age=49.2 years; 68.0% female). Evidence for significant association between common sequence variants in CHRNB2 and nausea severity was obtained after adjusting for age, gender and correlated tests (all P(ACT)<0.05). Individuals with the minor allele of CHRNB2 variants experienced less nausea than did those without the minor allele, consistent with previously reported findings for CHRNB2 and the occurrence of nausea and dizziness as a consequence of first smoking attempt in adolescents, and with the known neurophysiology of nausea. As nausea is the most common reason for discontinuance of varenicline, further pharmacogenetic investigations are warranted. |
A cross-country study of cigarette prices and affordability: evidence from the Global Adult Tobacco Survey
Kostova D , Chaloupka FJ , Yurekli A , Ross H , Cherukupalli R , Andes L , Asma S . Tob Control 2012 23 (1) e3 OBJECTIVE: To describe the characteristics of two primary determinants of cigarette consumption: cigarette affordability and the range of prices paid for cigarettes (and bidis, where applicable) in a set of 15 countries. From this cross-country comparison, identify places where opportunities may exist for reducing consumption through tax adjustments. DATA: Self-response data from 45,838 smokers from 15 countries, obtained from the Global Adult Tobacco Survey (GATS) 2008-2011. DESIGN: Using self-response data on individual cigarette expenditure and consumption, we construct a measure of the average cigarette price smokers pay for manufactured cigarettes (and bidis, where applicable) in 15 countries. We use these prices to evaluate cigarette affordability and the range of prices available in each country. These survey-derived measures of cigarette price and affordability are uniquely suited for cross-country comparison because they represent each country's distinctive mix of individual consumption characteristics such as brand choice, intensity of consumption, and purchasing behavior. RESULTS: In this sample of countries, cigarettes are most affordable in Russia, which has the most room for tobacco tax increase. Affordability is also relatively high in Brazil and China for cigarettes, and in India and Bangladesh for bidis. Although the affordability of cigarettes in India is relatively low, the range of cigarette prices paid is relatively high, providing additional evidence to support the call for simplifying the existing tax structure and reducing the width of price options. China has both high affordability and wide price ranges, suggesting multiple opportunities for reducing consumption through tax adjustments. |
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