Racial and ethnic differences in mortality among individuals with chronic kidney disease: results from the Kidney Early Evaluation Program (KEEP)
Jolly SE , Burrows NR , Chen SC , Li S , Jurkovitz CT , Norris KC , Shlipak MG . Clin J Am Soc Nephrol 2011 6 (8) 1858-65 BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is prevalent in minority populations and racial/ethnic differences in survival are incompletely understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Secondary analysis of Kidney Early Evaluation Program participants from 2000 through 2008 with CKD, not on dialysis, and without previous kidney transplant was performed. Self-reported race/ethnicity was categorized into five groups: non-Hispanic white, African American, Asian, American Indian/Alaska Native, and Hispanic. CKD was defined as a urinary albumin to creatinine ratio of ≥30 mg/g among participants with an estimated GFR (eGFR) ≥60 ml/min per 1.73 m(2) or an eGFR of <60 ml/min per 1.73 m(2). The outcome was all-cause mortality. Covariates used were age, sex, obesity, diabetes, hypertension, albuminuria, baseline eGFR, heart attack, stroke, smoking, family history, education, health insurance, geographic region, and year screened. RESULTS: 19,205 participants had prevalent CKD; 55% (n = 10,560) were White, 27% (n = 5237) were African American, 9% (n = 1638) were Hispanic, 5% (n = 951) were Asian, and 4% (n = 813) were American Indian/Alaska Native. There were 1043 deaths (5.4%). African Americans had a similar risk of death compared with Whites (adjusted Hazard Ratio (AHR) 1.07, 95% CI 0.90 to 1.27). Hispanics (AHR 0.66, 95% CI 0.50 to 0.94) and Asians (AHR 0.63, 95% CI 0.41 to 0.97) had a lower mortality risk compared with Whites. In contrast, American Indians/Alaska Natives had a higher risk of death compared with Whites (AHR 1.41, 95% CI 1.08 to 1.84). CONCLUSIONS: Significant differences in mortality among some minority groups were found among persons with CKD detected by community-based screening. |
Reversing the tide of obesity
Dietz WH . Lancet 2011 378 (9793) 744-6 The accompanying four papers in The Lancet1, 2, 3, 4 address several crucial areas relevant to the impact and future course of the obesity epidemic. In the past 30 years, obesity has increased in most countries and regions of the world.5 Boyd Swinburn and colleagues1 emphasise that obesity control will require policy interventions to improve the environments that promote poor dietary intake and physical inactivity rather than individually focused interventions, and that the necessary policy changes are fraught with political challenges not associated with clinical interventions that focus on individuals. | Claire Wang and colleagues2 model the effect of increasing rates of obesity on the incidence and costs of type 2 diabetes, cardiovascular disease and stroke, arthritis, and several types of cancer in the USA and UK. If US trends based on historical data for 1988–2008 continue, the prevalence of obesity in US adults will increase from its present level of about 32% to about 50% by 2030, with increased costs of up to US$66 billion per year for treatment of obesity-associated diseases. If the UK trends for 1993–2008 continue, the prevalence of obesity will rise from 26% to 35–48% by 2030, depending on the sex considered, and the costs will increase by £2 billion per year. In both countries, the rate of increase in the prevalence of obesity has slowed in the past decade. Nonetheless, even when the more recent trends are taken into account, annual US and UK costs are still projected to increase by $48 billion and £1·9 billion, respectively, by 2030. As the authors show, even a modest 1% reduction in body-mass index (BMI) would substantially reduce the number of obesity-related diseases and their costs. |
Trends in colorectal cancer test use among vulnerable populations in the United States
Klabunde CN , Cronin KA , Breen N , Waldron WR , Ambs AH , Nadel MR . Cancer Epidemiol Biomarkers Prev 2011 20 (8) 1611-21 BACKGROUND: Evaluating trends in colorectal cancer (CRC) screening use is critical for understanding screening implementation, and whether population groups targeted for screening are receiving it, consistent with guidelines. This study examines recent national trends in CRC test use, including among vulnerable populations. METHODS: We used the 2000, 2003, 2005, and 2008 National Health Interview Survey to examine national trends in CRC screening use overall and for fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy. We also assessed trends by race/ethnicity, educational attainment, income, time in the United States, and access to health care. RESULTS: During 2000 to 2008, significant declines in FOBT and sigmoidoscopy use and significant increases in colonoscopy use and in the percentages of adults up-to-date with CRC screening occurred overall and for most population subgroups. Subgroups with consistently lower rates of colonoscopy use and being up-to-date included Hispanics; people with minimal education, low income, or no health insurance; recent immigrants; and those with no usual source of care or physician visits in the past year. Among up-to-date adults, there were few subgroup differences in the type of test by which they were up-to-date (i.e., FOBT, sigmoidoscopy, or colonoscopy). CONCLUSIONS: Although use of CRC screening and colonoscopy increased among U.S. adults, including those from vulnerable populations, 45% of adults aged 50 to 75-or nearly 35 million people-were not up-to-date with screening in 2008. IMPACT: Continued monitoring of CRC screening rates among population subgroups with consistently low utilization is imperative. Improvement in CRC screening rates among all population groups in the United States is still needed. Cancer Epidemiol Biomarkers Prev; 20(8); 1611-21. (c)2011 AACR. |
Incident cognitive impairment is elevated in the Stroke Belt: The REGARDS Study
Wadley VG , Unverzagt FW , McGuire LC , Moy CS , Go R , Kissela B , McClure LA , Crowe M , Howard VJ , Howard G . Ann Neurol 2011 70 (2) 229-36 OBJECTIVE: To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. METHODS: A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments. RESULTS: A total of 1,937 participants (8.1%) declined to an SIS score ≤4 at their most recent assessment, over a mean of 4.1 (+/-1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment. INTERPRETATION: Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt. ANN NEUROL 2011. |
Factors associated with social contacts in four communities during the 2007-2008 influenza season
DeStefano F , Haber M , Currivan D , Farris T , Burrus B , Stone-Wiggins B , McCalla A , Guled H , Shih H , Edelson P , Wetterhall S . Epidemiol Infect 2011 139 (8) 1181-90 Mathematical models of influenza pandemics are sensitive to changes in contact rates between individuals. We conducted population-based telephone surveys in four North Carolina counties to determine the number of social interactions between individuals during the 2007-2008 influenza season. Influenza activity was monitored through sentinel medical practices. Among 3845 adults, the number of social contacts varied with age, was lower on weekends than on weekdays, and further decreased during school holiday periods. Adults with influenza-like illnesses had fewer social contacts. Adults' contacts in the community setting increased during periods of peak influenza activity. Among 290 children, potential contacts (i.e. other people in the same location) were lowest among preschool-age children and decreased on weekends and during school holidays. In adjusted analyses, children's potential social contacts did not change during periods of peak influenza activity. These results should be useful for modelling influenza epidemics and pandemics and in planning mitigation and response strategies. |
HIV seroprevalence among orphaned and homeless youth: no place like home
Hillis SD , Zapata L , Robbins CL , Kissin DM , Skipalska H , Yorick R , Finnerty E , Marchbanks PA , Jamieson DJ . AIDS 2011 26 (1) 105-10 OBJECTIVES: We evaluated the combined influences of orphaned status and homelessness on HIV seroprevalence and risk among street-involved Ukrainian youth in 2008. DESIGN: Systematic, multi-city, community-based, cross-sectional assessment. METHODS: Time-location sampling was used to identify eligible youth ages 15-24 after city-wide mapping of 91 sites where street-involved youth gathered in Odessa, Kiev, and Donetsk. Universal sampling identified 961 youth in 74 randomly selected sites; 97% consented. Youth reporting 1 or both parents dead were classified as orphaned; those without a stable residence or sleeping outside their residence ≥2 nights/wk were classified as homeless. Trained staff provided HIV counseling and rapid testing via mobile vans. Adjusted odds ratios (AORs) were calculated using logistic regression, accounting for intra-cluster homogeneity. RESULTS: We found 32%(300/929) were both orphaned and homeless; 48% either homeless/not orphaned(37%[343/929]) or orphaned/not homeless(11%[104/929]); and 20%(182/929) neither orphaned nor homeless. HIV seroprevalences were 7% for neither orphaned/homeless; 16% and 17%, respectively, for either orphaned/homeless; 28% for both orphaned/homeless (p for trend<.0001). Adjusted odds ratios for HIV infection were 1.0 for neither; 2.3 and 2.4 for either homeless(95% confidence interval (CI) 1.7-2.9) or orphaned(CI 1.8-3.3); 3.3 for both orphaned/homeless(CI 2.3-4.4). Ever-use of injection drugs increased from 15% to 32% to 48% for those who neither, either, or both orphaned and homeless, respectively (p for trend <.0001). CONCLUSIONS: One of four youth who were both homeless and orphaned was HIV-infected; these youth were significantly more likely to be HIV-infected and to report injection drug use than those with adequate housing and living parents. |
Commerson's leaf-nosed bat (Hipposideros commersoni) is the likely reservoir of Shimoni bat virus
Kuzmin IV , Turmelle AS , Agwanda B , Markotter W , Niezgoda M , Breiman RF , Rupprecht CE . Vector Borne Zoonotic Dis 2011 11 (11) 1465-70 In this study we attempted to identify whether Commerson's leaf-nosed bat (Hipposideros commersoni) is the reservoir of Shimoni bat virus (SHIBV), which was isolated from a bat of this species in 2009. An alternative explanation is that the isolation of SHIBV from H. commersoni was a result of spill-over infection from other species, particularly from the Egyptian fruit bats (Rousettus aegyptiacus), which frequently sympatrically roost with H. commersoni and are known as the reservoir of the phylogenetically related Lagos bat virus (LBV). To evaluate these hypotheses, 769 bats of at least 17 species were sampled from 18 locations across Kenya during 2009-2010. Serum samples were subjected to virus neutralization tests against SHIBV and LBV. A limited amount of cross-neutralization between LBV and SHIBV was detected. However, H. commersoni bats demonstrated greater seroprevalence to SHIBV than to LBV, and greater virus-neutralizing titers to SHIBV than to LBV, with a mean difference of 1.16 log(10) (95% confidence intervals [CI]: 0.94-1.40; p<0.001). The opposite pattern was observed for sera of R. aegyptiacus bats, with a mean titer difference of 1.06 log(10) (95% CI: 0.83-1.30; p<0.001). Moreover, the seroprevalence in H. commersoni to SHIBV in the cave where these bats sympatrically roosted with R. aegyptiacus (and where SHIBV was isolated in 2009) was similar to their seroprevalence to SHIBV in a distant cave where no R. aegyptiacus were present (18.9% and 25.0%, respectively). These findings suggest that H. commersoni is the host species of SHIBV. Additional surveillance is needed to better understand the ecology of this virus and the potential risks of infection to humans and other mammalian species. |
Risk of brain tumours in relation to estimated RF dose from mobile phones: results from five Interphone countries
Cardis E , Armstrong BK , Bowman JD , Giles GG , Hours M , Krewski D , McBride M , Parent ME , Sadetzki S , Woodward A , Brown J , Chetrit A , Figuerola J , Hoffmann C , Jarus-Hakak A , Montestruq L , Nadon L , Richardson L , Villegas R , Vrijheid M . Occup Environ Med 2011 68 (9) 631-40 OBJECTIVES: The objective of this study was to examine the associations of brain tumours with radio frequency (RF) fields from mobile phones. METHODS: Patients with brain tumour from the Australian, Canadian, French, Israeli and New Zealand components of the Interphone Study, whose tumours were localised by neuroradiologists, were analysed. Controls were matched on age, sex and region and allocated the 'tumour location' of their matched case. Analyses included 553 glioma and 676 meningioma cases and 1762 and 1911 controls, respectively. RF dose was estimated as total cumulative specific energy (TCSE; J/kg) absorbed at the tumour's estimated centre taking into account multiple RF exposure determinants. RESULTS: ORs with ever having been a regular mobile phone user were 0.93 (95% CI 0.73 to 1.18) for glioma and 0.80 (95% CI 0.66 to 0.96) for meningioma. ORs for glioma were below 1 in the first four quintiles of TCSE but above 1 in the highest quintile, 1.35 (95% CI 0.96 to 1.90). The OR increased with increasing TCSE 7+ years before diagnosis (p-trend 0.01; OR 1.91, 95% CI 1.05 to 3.47 in the highest quintile). A complementary analysis in which 44 glioma and 135 meningioma cases in the most exposed area of the brain were compared with gliomas and meningiomas located elsewhere in the brain showed increased ORs for tumours in the most exposed part of the brain in those with 10+ years of mobile phone use (OR 2.80, 95% CI 1.13 to 6.94 for glioma). Patterns for meningioma were similar, but ORs were lower, many below 1.0. CONCLUSIONS: There were suggestions of an increased risk of glioma in long-term mobile phone users with high RF exposure and of similar, but apparently much smaller, increases in meningioma risk. The uncertainty of these results requires that they be replicated before a causal interpretation can be made. |
Estimation of RF energy absorbed in the brain from mobile phones in the Interphone Study
Cardis E , Varsier N , Bowman JD , Deltour I , Figuerola J , Mann S , Moissonnier M , Taki M , Vecchia P , Villegas R , Vrijheid M , Wake K , Wiart J . Occup Environ Med 2011 68 (9) 686-93 OBJECTIVES: The objective of this study was to develop an estimate of a radio frequency (RF) dose as the amount of mobile phone RF energy absorbed at the location of a brain tumour, for use in the Interphone Epidemiological Study. METHODS: We systematically evaluated and quantified all the main parameters thought to influence the amount of specific RF energy absorbed in the brain from mobile telephone use. For this, we identified the likely important determinants of RF specific energy absorption rate during protocol and questionnaire design, we collected information from study subjects, network operators and laboratories involved in specific energy absorption rate measurements and we studied potential modifiers of phone output through the use of software-modified phones. Data collected were analysed to assess the relative importance of the different factors, leading to the development of an algorithm to evaluate the total cumulative specific RF energy (in joules per kilogram), or dose, absorbed at a particular location in the brain. This algorithm was applied to Interphone Study subjects in five countries. RESULTS: The main determinants of total cumulative specific RF energy from mobile phones were communication system and frequency band, location in the brain and amount and duration of mobile phone use. Though there was substantial agreement between categorisation of subjects by cumulative specific RF energy and cumulative call time, misclassification was non-negligible, particularly at higher frequency bands. Factors such as adaptive power control (except in Code Division Multiple Access networks), discontinuous transmission and conditions of phone use were found to have a relatively minor influence on total cumulative specific RF energy. CONCLUSIONS: While amount and duration of use are important determinants of RF dose in the brain, their impact can be substantially modified by communication system, frequency band and location in the brain. It is important to take these into account in analyses of risk of brain tumours from RF exposure from mobile phones. |
Preliminary results of 2009 pandemic influenza surveillance in the United States using the Aggregate Hospitalization and Death Reporting Activity
Jhung MA , Davidson H , McIntyre A , Gregg WJ , Dasgupta S , D'Mello T , White V , Fowlkes A , Brammer L , Finelli L . Influenza Other Respir Viruses 2011 5 (5) 321-7 BACKGROUND: To augment established influenza surveillance systems in the United States, the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists implemented the Aggregate Hospitalization and Death Reporting Activity (AHDRA) in August 2009. The AHDRA was designed to meet increased demands for timely and detailed information describing illness severity during the 2009 H1N1 influenza A (pH1N1) pandemic response. OBJECTIVES: We describe the implementation of AHDRA and provide preliminary results from this new surveillance activity. METHODS: All 50 US states were asked to report influenza-associated hospitalizations and deaths to AHDRA each week using either a laboratory-confirmed or syndromic surveillance definition. Aggregate counts were used to calculate age-specific weekly and cumulative rates per 100,000, and laboratory-confirmed reports were used to estimate the age distribution of pH1N1 influenza-associated hospitalizations and deaths. RESULTS: From August 30, 2009, through April 6, 2010, AHDRA identified 41 689 laboratory-confirmed influenza-associated hospitalizations and 2096 laboratory-confirmed influenza-associated deaths. Aggregate Hospitalization and Death Reporting Activity rates peaked earlier than hospitalization and death rates seen in previous influenza seasons with other surveillance systems, and the age distribution of cases revealed a tendency for hospitalizations and deaths to occur in persons <65 years for age. CONCLUSIONS: Aggregate Hospitalization and Death Reporting Activity laboratory-confirmed reports provided important information during the 2009 pandemic response. Aggregate Hospitalization and Death Reporting Activity syndromic reports were marked by low representativeness and specificity and were therefore less useful. The AHDRA was implemented quickly and may be a useful surveillance system to monitor severe illness during future influenza pandemics. |
'Less education' is associated with use and sharing of antiretroviral medications for prophylaxis of HIV infection by US men who have sex with men
Mansergh G , Koblin B , Colfax GN , Flores SA , Hudson SM . Sex Transm Infect 2011 87 (6) 510 Pre-exposure prophylaxis (PrEP) of HIV infection with antiretroviral therapy (ART) was recently found to reduce HIV infection through sexual contact in men who have sex with men (MSM).1 Non-prescribed use and sharing of ART to prevent HIV infection were reported by MSM in the USA before efficacy was determined.2 We report on demographic factors associated with ART use for prophylaxis purposes prior to known efficacy. | A convenience sample of MSM was enrolled in Chicago, Los Angeles, New York City and San Francisco.2 3 We assessed pre-efficacy use of ART medications by HIV-negative MSM (n=454) and sharing of ART medications by HIV-positive MSM (n=557) with their sex partners for use ‘before sex’ (PrEP) and ‘after sex’ (post-exposure prophylaxis, PEP) to prevent HIV infection. Demographic characteristics included: 22% 18–29 years, 35% 30–39 years and 43% 40+ years old; 33% black, 18% Hispanic, 38% white and 11% other race/ethnicity; and 31% high school equivalency or less, 34% some post-high school education and 35% college degree or more education. | HIV-negative men with a high school diploma/equivalency or less (‘less education’) were more likely than others to report using PrEP (5% vs 1%, p<0.05) and PEP (8% vs 3%, p<0.05) in the prior 6 months. In multivariate analysis adjusting for age, race/ethnicity and city, ‘less education’ was associated with recent use of PEP (OR=3.5, 95% CI=1.1 to 11.8) but not PrEP (p>0.05) compared with those with at least a college degree; none of the other demographic variables was associated with PrEP or PEP use (p>0.05) by HIV-negative men. |
Knowing a sexual partner is HIV-1-uninfected is associated with higher condom use among HIV-1-infected adults in Kenya
Benki-Nugent S , Chung MH , Ackers M , Richardson BA , McGrath CJ , Kohler P , Thiga J , Attwa M , John-Stewart GC . Sex Transm Dis 2011 38 (9) 808-10 The relation between awareness of sexual partner's HIV serostatus and unprotected sex was examined in HIV clinic enrollees. Increased condom use was associated with knowing that a partner was HIV-negative (adjusted odds ratio = 5.99; P < 0.001) versus not knowing partner's status. Partner testing may increase condom use in discordant couples. |
Risk of rheumatoid arthritis following vaccination with tetanus, influenza and hepatitis B vaccines among persons 15-59 years of age
Ray P , Black S , Shinefield H , Dillon A , Carpenter D , Lewis E , Ross P , Chen RT , Klein NP , Baxter R . Vaccine 2011 29 (38) 6592-6597 BACKGROUND: Associations between vaccinations, particularly hepatitis B, and onset of rheumatoid arthritis (RA) have been reported, but examined in few large-scale studies. METHOD: Onset of RA cases and dates of vaccination against hepatitis B, tetanus, and influenza were identified in a retrospective chart review of approximately 1 million Kaiser Permanente Northern California members ages 15-59 years from 1997 through 1999. In a cohort analysis, rates of new-onset RA were compared between vaccinated and unvaccinated within 90, 180, and 365 days. In a case-control analysis, rates of vaccination during exposure intervals (90, 180, 365, and 730 days) were compared between cases and controls using conditional logistic regression. RESULTS: 378 RA cases were included in the cohort analysis; 37 additional cases were included in the case-control analysis. In the cohort analysis the relative risks of RA onset within 90, 180, or 365 days of hepatitis B vaccination were not significant (R.R.=1.44, p=0.53; R.R.=1.67, p=0.22; R.R.=1.23, p=0.59 respectively). We found a possible association between RA and influenza vaccine in the previous 180 and 365 days in the cohort analysis (R.R=1.36, p=0.03; R.R.=1.34, p=0.01 respectively), but in the case-control analysis, cases were no more likely than controls to have received any of the three vaccines. CONCLUSIONS: In this large retrospective study we found no statistically significant association between exposure to hepatitis B vaccine and onset of RA. A possible association between RA and influenza vaccination in the cohort study was not borne out in the larger case-control analysis. |
Effectiveness of non-adjuvanted pandemic influenza A vaccines for preventing pandemic influenza acute respiratory illness visits in 4 U.S. communities
Griffin MR , Monto AS , Belongia EA , Treanor JJ , Chen Q , Chen J , Talbot HK , Ohmit SE , Coleman LA , Lofthus G , Petrie JG , Meece JK , Hall CB , Williams JV , Gargiullo P , Berman L , Shay DK . PLoS One 2011 6 (8) e23085 We estimated the effectiveness of four monovalent pandemic influenza A (H1N1) vaccines (three unadjuvanted inactivated, one live attenuated) available in the U.S. during the pandemic. Patients with acute respiratory illness presenting to inpatient and outpatient facilities affiliated with four collaborating institutions were prospectively recruited, consented, and tested for influenza. Analyses were restricted to October 2009 through April 2010, when pandemic vaccine was available. Patients testing positive for pandemic influenza by real-time RT-PCR were cases; those testing negative were controls. Vaccine effectiveness was estimated in logistic regression models adjusted for study community, patient age, timing of illness, insurance status, enrollment site, and presence of high-risk medical conditions. Pandemic virus was detected in 1,011 (15%) of 6,757 enrolled patients. Fifteen (1%) of 1,011 influenza positive cases and 1,042 (18%) of 5,746 test-negative controls had record-verified pandemic vaccination >14 days prior to illness onset. Adjusted effectiveness (95% confidence interval) for pandemic vaccines combined was 56% (23%, 75%). Adjusted effectiveness for inactivated vaccines alone (79% of total) was 62% (25%, 81%) overall and 32% (-92%, 76%), 89% (15%, 99%), and -6% (-231%, 66%) in those aged 0.5 to 9, 10 to 49, and 50+ years, respectively. Effectiveness for the live attenuated vaccine in those aged 2 to 49 years was only demonstrated if vaccination >7 rather than >14 days prior to illness onset was considered (61%: 12%, 82%). Inactivated non-adjuvanted pandemic vaccines offered significant protection against confirmed pandemic influenza-associated medical care visits in young adults. |
Effectiveness of pentavalent rotavirus vaccine against severe disease
Staat MA , Payne DC , Donauer S , Weinberg GA , Edwards KM , Szilagyi PG , Griffin MR , Hall CB , Curns AT , Gentsch JR , Salisbury S , Fairbrother G , Parashar UD . Pediatrics 2011 128 (2) e267-e275 OBJECTIVE: To determine the vaccine effectiveness (VE) of complete and partial vaccination with the pentavalent rotavirus vaccine (RV5) in the prevention of rotavirus acute gastroenteritis (AGE) hospitalizations and emergency department visits during the first 3 rotavirus seasons after vaccine introduction. METHODS: Active, prospective population-based surveillance for AGE and acute respiratory infection (ARIs) in inpatient and emergency department settings provided subjects for a case-control evaluation of VE in 3 US counties from January 2006 through June 2009. Children with laboratory-confirmed rotavirus AGE (cases) were matched according to date of birth and onset of illness to 2 sets of controls: children with rotavirus-negative AGE and children with ARI. The main outcome measure was VE with complete (3 doses) or partial (1 or 2 doses) RV5 vaccination. RESULTS: Of age-eligible children enrolled, 18% of cases, 54% of AGE controls, and 54% of ARI controls received ≥1 dose of RV5. The VE of RV5 for 1, 2, and 3 doses against all rotavirus genotypes with the use of rotavirus-negative AGE controls was 74% (95% confidence interval [CI]: 37%-90%), 88% (95% CI: 66%-96%), and 87% (95% CI: 71%-94%), respectively, and with the use of ARI controls was 73% (95% CI: 43%-88%), 88% (95% CI: 68%-95%), and 85% (95% CI: 72%-91%), respectively. The overall VE estimates were comparable during the first and second years of life and against AGE caused by different rotavirus strains. CONCLUSION: RV5 was highly effective in preventing severe rotavirus disease, even after a partial series, with protection persisting throughout the second year of life. |
Infant rotavirus vaccination may provide indirect protection to older children and adults in the United States
Lopman BA , Curns AT , Yen C , Parashar UD . J Infect Dis 2011 204 (7) 980-6 Following the introduction of rotavirus vaccination in the United States, rotavirus and cause-unspecified gastroenteritis discharges significantly decreased in 2008 in the 0-4, 5-14, and 15-24-year age groups, with significant reductions observed in March, the historic peak rotavirus month, in all age groups. We estimate that 15% of the total 66,000 averted hospitalizations and 20% of the $204 million in averted direct medical costs attributable to the vaccination program were among unvaccinated 5-24 year-olds. This study demonstrates a previously unrecognized burden of severe rotavirus in the population >5 years and the primacy of very young children in the transmission of rotavirus. (See the editorial commentary by Glass, on pages 975-7.) |
Influenza vaccine effectiveness in Wisconsin during the 2007-08 season: comparison of interim and final results
Belongia EA , Kieke BA , Donahue JG , Coleman LA , Irving SA , Meece JK , Vandermause M , Lindstrom S , Gargiullo P , Shay DK . Vaccine 2011 29 (38) 6558-63 BACKGROUND: During the 2007-08 influenza season, we reported an interim vaccine effectiveness (VE) estimate of 44% for preventing medically attended influenza. In this analysis we report results for the entire season and compare them with the interim estimate. METHODS: Patients with feverishness, chills, or cough <8 days duration were prospectively recruited over 10 weeks and tested for influenza by real-time reverse transcriptase PCR (rRT-PCR). Case-control analyses were performed using data from patients with rRT-PCR confirmed influenza (cases) and ill patients without influenza (test-negative controls). VE was estimated as 100x(1-adjusted odds ratio) in a logistic regression model adjusting for age, week, and high risk medical condition. A sample of influenza isolates was antigenically characterized. RESULTS: Influenza was detected by rRT-PCR in 865 (44%) of 1972 patients; 73% were type A and 27% were type B. VE was 37% (95% CI, 22-49%) overall and 44% (95% CI, 27-58%) among participants tested 0-3 days after illness onset. VE was 39% (95% CI, 2-62%) in children 6-59 months old and 37% (95% CI, -2% to 61%) in adults ≥50 years old. VE was 41% (95% CI, 24-53%) for influenza A and 31% (95% CI, 3-51%) for influenza B. All 24 characterized influenza A viruses were antigenically matched to the H3N2 vaccine strain, although 14 viruses exhibited mild antigenic drift. There was a lineage mismatch with the vaccine strain for all 39 characterized influenza B viruses. CONCLUSIONS: The 2007-08 influenza vaccine provided modest protection against medically attended influenza in this population. The interim estimate of VE after 17 days closely approximated the final season VE, supporting the potential use of interim VE estimates while influenza seasons are still in progress. |
Design of future rabies biologics and antiviral drugs
Smith TG , Wu X , Franka R , Rupprecht CE . Adv Virus Res 2011 79 345-63 In recent years, no major paradigm shifts have occurred in the utilization of new products for the prevention and control of rabies. Development of new cost-effective rabies biologics and antiviral drugs is critical in continuing to prevent and reduce disease. Current rabies vaccines are highly effective but have developed largely based on technical improvements in the vaccine industry. In the future, alternative approaches for improved vaccines, including novel avirulent rabies virus (RABV) vectors, should be pursued. Any rabies vaccine that is effective without the need for rabies immune globulin (RIG) will contribute fundamentally to disease prevention by reducing the cost and complexity of postexposure prophylaxis (PEP). The lack of high quality, affordable RIG is a continuing problem. Virus-specific monoclonal antibodies (mAbs) will soon fulfill the PEP requirement for passive immunity, currently met with RIG. Several relevant strategies for mAb production, including use of transgenic mice, humanization of mouse mAbs, and generation of human immune libraries, are underway. As a result of successful PEP and pre-exposure prophylaxis in developed countries, until recently, no significant focused efforts have been devoted to RABV-specific antiviral agents. To date, combination therapy including broad spectrum antiviral agents has been successful in only one case, and reports of antiviral activity are often conflicting. Current antiviral strategies target either the nucleoprotein or phosphoprotein, but drugs targeting the viral polymerase should be considered. Considering the lag from creation of new concepts to experimental development and clinical trials, many years will likely elapse between today's ideas and tomorrow's practices. |
Parents' retrospective reports of youth psychological responses to the sniper attacks in the Washington, DC, area
Self-Brown SR , Massetti GM , Chen J , Schulden J . Violence Vict 2011 26 (1) 116-29 A random-digit-dial telephone survey was conducted in May 2003, with 355 parents of children ages 2-17 years old, living in Washington, DC, or in the two surrounding counties during the October 2002 sniper shootings, to examine parent retrospective reports of child event-related psychological distress. An estimated 32% of parents reported that children experienced at least one psychological distress symptom related to sniper shootings. Older children, females, children with a history of trauma exposure prior to sniper attacks, children whose parents reported routine disruption as the result of attacks, children whose parents perceived them as at great risk for harm from sniper attacks, and those children whose parents reported more traumatic stress symptoms in response to attacks were at greatest risk for reported psychological distress. |
Preventing youth violence perpetration among girls
Massetti GM , Vivolo AM , Brookmeyer K , Degue S , Holland KM , Holt MK , Matjasko JL . J Womens Health (Larchmt) 2011 20 (10) 1415-28 In the last 10 years, several reviews of research on violence among girls have been conducted. This research helps to determine the extent of girls' use of violence however, it has not been translated into effective prevention programs for girls. This article reviews the research on risk and protective factors associated with violence, with particular attention on factors unique to girls or shared between boys and girls. Individual risk factors for youth violence include hyperactivity/inattention/impulsivity, risk taking/sensation seeking, low academic achievement, exposure to stress and victimization, and early puberty. Parent-child relationships/parental monitoring and supervision, parent criminal and antisocial behavior, and family conflicts and instability have been found to be relationship-level risk factors. Peer risk factors include deviant peer affiliation and gang membership. Risk factors at the community level include economic deprivation; community disorganization; the availability of drugs, alcohol, and firearms; and neighborhood crime. This review also includes a description of program effects for girls within the Model and Promising Blueprints for Violence Prevention Initiative programs. Very few evaluations have examined program effectiveness in preventing violence among girls. More evaluation research is needed to determine if evidence-based programs have positive impact on reducing violence and related risk factors among girls. |
Injury research: a perspective from the National Center for Injury Prevention and Control
Degutis LC , Sattin RW . Inj Prev 2011 17 (5) 357 In 1985 the Institute of Medicine report Injury in America recommended that a centre for injury control be established at the Centers for Disease Control and that funding for research on injury should be commensurate with its public health burden.1 In 1992 the National Center for Injury Prevention and Control (NCIPC) was created at the Centers for Disease Control and Prevention (CDC), setting up a federal organisation whose sole focus is on injury—preventing injury and mitigating the consequences of injuries, using a public health approach to research and practice. Since then the USA has made significant progress in decreasing injury-related death and disability while continuing to develop a national infrastructure to support these efforts. Much of this progress has been done with little fanfare, working with our partners to translate evidence-based strategies to help communities and change environments, practice and policy. The nature of these efforts is exemplified in David Hemenway's recent book While We Were Sleeping which documents successful initiatives in injury prevention, such as the change in temperature controls on water heaters so that far fewer children are burned in bathtubs by water that is too hot.2 | Despite this progress, we still face many challenges in injury prevention, including identifying successful strategies that are scalable. In the USA we still see over 180 000 deaths from injury each year, and millions of hospitalisations and emergency department visits for the treatment of injury.3 There are untold numbers of both short-term and long-term injury-related disability, all of which result in increasing healthcare costs, lost productivity, family changes and community impacts. The network of CDC-funded Injury Control Research Centers, located in academic centres, together with non-CDC-funded Injury Centers and other injury researchers, continue to grow the evidence base and educate students and practitioners in the science of injury prevention and control. NCIPC has provided research grants that have advanced the science and seeded the careers of many scientists in the field of injury and violence prevention. Translation of research into practice has occurred at the national, state and local levels through practice change, policy initiatives and environmental interventions. Injury prevention programmes located in state health departments funded through the CDC continue to be leaders in translating effective interventions into practice. Many local health departments are also using the evidence to decrease injury in the communities that they serve. |
Roles of the ERK, JNK/AP-1/cyclin D1-CDK4 pathway in silica-induced cell cycle changes in human embryo lung fibroblast cells
Jia X , Liu B , Shi X , Ye M , Zhang F , Liu H . Cell Biol Int 2011 35 (7) 697-704 Silica is a potent occupational fibrogenic agent capable of inducing lung fibrosis and many other lung diseases. Our current study focused on the signalling pathways regulating cell cycle changes in HELF (human embryo lung fibroblast) after silica (alpha-quartz) exposure. Our results showed silica exposure could lead to cell cycle changes. The cell cycle alternations were accompanied with overexpression of cyclin D1 and CDK4 (cyclin-dependent kinase 4) in a time-dependent manner. Silica exposure also decreased E2F-4 expression in HELF. These changes were blocked by overexpression of dominant-negative mutants of ERK (extracellular signal-regulated protein kinase) or the JNK (stress-activated c-Jun NH2-terminal kinase), respectively. Moreover, pretreatment of cells with curcumin, an activation of AP-1 (activator protein-1) inhibitor, inhibited silica-induced cell cycle alteration, the decreased expression of E2F-4 and overexpression of cyclin D1 and CDK4. Furthermore, both antisense cyclin D1 and antisense CDK4 can block silica-induced cell cycle changes. These results suggest that silica exposure can induce cell cycle changes, which may be mediated through ERK, JNK/AP-1/cyclin D1-CDK4-dependent pathway. |
Utility of Botulinum Toxin ELISA A, B, E, F kits for clinical laboratory investigations of human botulism
Maslanka SE , Luquez C , Raphael BH , Dykes JK , Joseph LA . Botulinum J 2011 2 (1) 72-92 The Botulinum Toxin ELISA effectively provided presumptive identification of toxin in 1381 investigation samples including clinical specimens, suspect foods, and cultures. Additionally, the ELISA detected all toxins produced by a panel of stock strains representing known subtypes and was negative for non-botulinum toxin producing Clostridium and enteric pathogens. ELISA results were reproducible both within the same kit (CV < 9%) and among different production lots (CV < 23%). Fifty-five of 57 laboratories correctly identified unknown samples in a multi-laboratory study. The ELISA provides a rapid, robust in vitro screening method which will reduce animal dependence during laboratory investigations of botulism. Copyright 2011 Inderscience Enterprises Ltd. |
Virulence of pathogenic Coxiella burnetii strains after growth in the absence of host cells
Kersh GJ , Oliver LD , Self JS , Fitzpatrick KA , Massung RF . Vector Borne Zoonotic Dis 2011 11 (11) 1433-8 Coxiella burnetii is a gram-negative bacterium that causes the zoonotic disease Q fever. Traditionally considered an obligate intracellular agent, the requirement to be grown in tissue culture cells, embryonated eggs, or animal hosts has made it difficult to isolate strains and perform genetic studies on C. burnetii. However, it was recently demonstrated that the attenuated Nine Mile Phase 2 (NM2) C. burnetii strain will grow axenically in acidified citrate cysteine medium (ACCM) in a 2.5% oxygen environment. The current study was undertaken to determine whether more virulent C. burnetii strains could be grown in ACCM, and whether virulence would be maintained after passage. The ACCM medium supported an approximately 1000-fold expansion of Nine Mile Phase 1 (NM1), NM2, M44, and Henzerling strains of C. burnetii, whereas the Priscilla (Q177) strain expanded only 100-fold, and the K strain (Q154) grew poorly in ACCM. To determine if passage in ACCM would maintain the virulence of C. burnetii, the NM1 strain was grown for up to 26 weekly passages in ACCM. C. burnetii maintained in ACCM for 5 or 8 passages maintained full virulence in a mouse model, but NM1 passaged for 23 or 26 times was somewhat attenuated. These data demonstrate that virulent strains of C. burnetii can be successfully passaged in ACCM; however, some strains can lose virulence after extended passage, and other strains grow poorly in this medium. The loss of virulence in axenic culture was associated with some truncation of lipopolysaccharide chains, suggesting a possible mechanism for attenuation. |
Natural substrate concentrations can modulate the prophylactic efficacy of nucleotide HIV reverse transcriptase inhibitors
Garcia-Lerma JG , Aung W , Cong ME , Zheng Q , Youngpairoj AS , Mitchell J , Holder A , Martin A , Kuklenyik S , Luo W , Lin CY , Hanson DL , Kersh E , Pau CP , Ray AS , Rooney JF , Lee WA , Heneine W . J Virol 2011 85 (13) 6610-7 Preexposure prophylaxis (PrEP) with antiretroviral drugs is a novel human immunodeficiency virus (HIV) prevention strategy. It is generally thought that high systemic and mucosal drug levels are sufficient for protection. We investigated whether GS7340, a next-generation tenofovir (TFV) prodrug that effectively delivers tenofovir diphosphate (TFV-DP) to lymphoid cells and tissues, could protect macaques against repeated weekly rectal simian-human immunodeficiency virus (SHIV) exposures. Macaques received prophylactic GS7340 treatment 3 days prior to each virus exposure. At 3 days postdosing, TFV-DP concentrations in peripheral blood mononuclear cells (PBMCs) were about 50-fold higher than those seen with TFV disoproxil fumarate (TDF), and they remained above 1,000 fmol/10(6) cells for as long as 7 days. TFV-DP accumulated in lymphoid and rectal tissues, with concentrations at 3 days exceeding 500 fmol/10(6) mononuclear cells. Despite high mucosal and systemic TFV levels, GS7340 was not protective. Since TFV-DP blocks reverse transcription by competing with the natural dATP substrate, we measured dATP contents in peripheral lymphocytes, lymphoid tissue, and rectal mononuclear cells. Compared to those in circulating lymphocytes and lymphoid tissue, rectal lymphocytes had 100-fold higher dATP concentrations and dATP/TFV-DP ratios, likely reflecting the activated status of the cells and suggesting that TFV-DP may be less active at the rectal mucosa. Our results identify dATP/TFV-DP ratios as a possible correlate of protection by TFV and suggest that natural substrate concentrations at the mucosa will likely modulate the prophylactic efficacy of nucleotide reverse transcriptase inhibitors. |
Production, characterization and utility of a panel of monoclonal antibodies for the detection of toluene diisocyanate haptenated proteins
Ruwona TB , Johnson VJ , Hettick JM , Schmechel D , Beezhold D , Wang W , Simoyi RH , Siegel PD . J Immunol Methods 2011 373 127-35 Diisocyanates (dNCOs) are highly reactive low molecular weight chemicals used in the manufacture of polyurethane products and are the most commonly reported cause of occupational asthma. Mechanistic disease studies and development of biomonitoring and research tools, such as monoclonal antibodies (mAbs) have been hampered by dNCOs' ability to self-polymerize and to cross-link biomolecules. Toluene diisocyanate (TDI)-specific monoclonal antibodies (mAbs), with potential use in immunoassays for exposure and biomarker assessments, were produced and reactivities characterized against mono- and diisocyanate and dithioisocyanate protein conjugates. In general, TDI reactive mAbs displayed stronger recognition of isocyanate haptenated proteins when the NCO was in the ortho position relative to the tolyl group, and were capable of discriminating between isocyanate and isothiocyanate conjugates and between aromatic and aliphatic dNCOs. Preliminary studies using TDI vapor exposed cells suggest potential utility of these mAbs for both research and biomonitoring. |
Pulmonary exposure of rats to ultrafine titanium dioxide enhances cardiac protein phosphorylation and substance P synthesis in nodose ganglia
Kan H , Wu Z , Young SH , Chen TH , Cumpston JL , Chen F , Kashon ML , Castranova V . Nanotoxicology 2011 6 (7) 736-45 The inhalation of engineered nanoparticles stimulates the development of atherosclerosis and impairs vascular function. However, the cardiac effects of inhaled engineered nanoparticles are unknown. Here, we investigate the effects of ultrafine titanium dioxide (UFTiO(2)) on the heart, and we define the possible mechanisms underlying the measured effects. Pulmonary exposure of rats to UFTiO(2) increased the phosphorylation levels of p38 mitogen-activated protein kinase and cardiac troponin I, but not Akt, in the heart and substance P synthesis in nodose ganglia. Circulatory levels of pro-inflammatory cytokines, and blood cell counts and differentials were not significantly changed after pulmonary exposure. Separately, the incubation of cardiac myocytes isolated from naive adult rat hearts in vitro with UFTiO(2) did not alter the phosphorylation status of the same cardiac proteins. In conclusion, the inhalation of UFTiO(2) enhanced the phosphorylation levels of cardiac proteins. Such responses are likely independent of systemic inflammation, but may involve a lung-neuron-regulated pathway. |
Hydroxyl radical mediates cisplatin-induced apoptosis in human hair follicle dermal papilla cells and keratinocytes through Bcl-2-dependent mechanism
Luanpitpong S , Nimmannit U , Chanvorachote P , Leonard SS , Pongrakhananon V , Wang L , Rojanasakul Y . Apoptosis 2011 16 (8) 769-82 Induction of massive apoptosis of hair follicle cells by chemotherapy has been implicated in the pathogenesis of chemotherapy-induced alopecia (CIA), but the underlying mechanisms of regulation are not well understood. The present study investigated the apoptotic effect of cisplatin in human hair follicle dermal papilla cells and HaCaT keratinocytes, and determined the identity and role of specific reactive oxygen species (ROS) involved in the process. Treatment of the cells with cisplatin induced ROS generation and a parallel increase in caspase activation and apoptotic cell death. Inhibition of ROS generation by antioxidants inhibited the apoptotic effect of cisplatin, indicating the role of ROS in the process. Studies using specific ROS scavengers further showed that hydroxyl radical, but not hydrogen peroxide or superoxide anion, is the primary oxidative species responsible for the apoptotic effect of cisplatin. Electron spin resonance studies confirmed the formation of hydroxyl radicals induced by cisplatin. The mechanism by which hydroxyl radical mediates the apoptotic effect of cisplatin was shown to involve down-regulation of the anti-apoptotic protein Bcl-2 through ubiquitin-proteasomal degradation. Bcl-2 was also shown to have a negative regulatory role on hydroxyl radical. Together, our results indicate an essential role of hydroxyl radical in cisplatin-induced cell death of hair follicle cells through Bcl-2 regulation. Since CIA is a major side effect of cisplatin and many other chemotherapeutic agents with no known effective treatments, the knowledge gained from this study could be useful in the design of preventive treatment strategies for CIA through localized therapy without compromising the chemotherapy efficacy. |
Analysis of multilocus sequence typing for identification of Leptospira spp. isolates in Brazil
Romero EC , Blanco RM , Galloway RL . J Clin Microbiol 2011 49 (11) 3940-2 A collection of 101 Leptospira isolates was tested by MLST and by traditional serotyping. MLST divided the isolates into 4 sequence types while serotyping classified in 6 serogroups. Two isolates failed to generate products for some genes by MLST. MLST was less discriminatory than serotyping for uncommonly-occurring isolates from humans in Brazil. |
Nelfinavir and its active metabolite, hydroxyl-t-butylamidenelfinavir (M8), are transferred in low quantities to breast milk and do not result in biologically significant concentrations in breast-feeding infants whose mothers are taking nelfinavir
Weidle PJ , Zeh C , Martin A , Lando R , Angira F , Osoga J , Ogindo P , Girde S , Minniear TD , Thomas TK . Antimicrob Agents Chemother 2011 55 (11) 5168-71 Antiretroviral drugs cross from maternal plasma to breast milk and from breast milk to the infant in different concentrations. We measured concentrations of nelfinavir and its active metabolite (M8) in maternal plasma and breast milk from women and in dried blood spots collected from their infants at delivery and postnatal weeks 2, 6, 14, and 24 in the Kisumu Breastfeeding Study, Kisumu, Kenya. Nelfinavir-based antiretroviral regimens given to mothers as PMTCT do not expose the breastfeeding infant to biologically significant concentrations of nelfinavir or M8. |
Factors associated with low drinking water intake among adolescents: the Florida Youth Physical Activity and Nutrition Survey, 2007
Park S , Sherry B , O'Toole T , Huang Y . J Am Diet Assoc 2011 111 (8) 1211-7 There is limited information on which characteristics are associated with water intake among adolescents. This cross-sectional study examined the association between demographic, dietary, and behavioral factors and low water intake as the outcome measure. Analyses were based on the 2007 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,292 students in grades six through eight in 86 Florida public middle schools. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for factors associated with low water intake (<3 glasses water per day). About 64% of students had low water intake. Factors significantly associated with low water intake were Hispanic ethnicity and non-Hispanic other (vs non-Hispanic white; ORs 0.79 and 0.76, respectively), drinking no 100% juice, drinking it <1 time/day, and drinking it 1 to 2 times/day (vs drinking it ≥3 times/day; ORs 1.83, 1.91, and 1.32, respectively), drinking no milk and drinking <2 glasses of milk/day (vs drinking ≥2 glasses/day; ORs 1.42 and 1.41, respectively), drinking <1 soda/day (vs drinking none; OR 1.40), drinking fruit-flavored drinks/sports drinks <1 time/day and drinking it ≥1 time/day (vs drinking none; ORs 1.49 and 1.41, respectively), eating at a fast-food restaurant ≥3 days/week (vs none; OR 1.38, respectively), not participating on team sports or participating on 1 to 2 team sports in previous 12 months (vs participating on ≥3 teams; ORs 1.77 and 1.24, respectively), and consuming snack/soda while watching television/movies "sometimes" and "most/every time" (vs never; ORs 1.65 and 2.20, respectively). The strongest factor associated with low water intake was frequent consumption of snacks/sodas while watching television/movies. Although study findings should be corroborated in other states and in a nationally representative sample, they may be useful in targeting adolescents for increased water consumption. |
Sensitization and chronic beryllium disease at a primary manufacturing facility, part 3: exposure-response among short-term workers
Schuler CR , Virji MA , Deubner DC , Stanton ML , Stefaniak AB , Day GA , Park JY , Kent MS , Sparks R , Kreiss K . Scand J Work Environ Health 2011 38 (3) 270-81 OBJECTIVES: Exposure-response relations for beryllium sensitization (BeS) and chronic beryllium disease (CBD) using aerosol mass concentration have been inconsistent, although process-related risks found in most studies suggest that exposure-dependent risks exist. We examined exposure-response relations using personal exposure estimates in a beryllium worker cohort with limited work tenure to minimize exposure misclassification. METHODS: The population comprised workers employed in 1999 with six years or less tenure. Each completed a work history questionnaire and was evaluated for immunological sensitization and CBD. A job-exposure matrix was combined with work histories to create individual estimates of average, cumulative, and highest-job-worked exposure for total, respirable, and submicron beryllium mass concentrations. We obtained odds ratios from logistic regression models for exposure-response relations, and evaluated process-related risks. RESULTS: Participation was 90.7% (264/291 eligible). Sensitization prevalence was 9.8% (26/264), with 6 sensitized also diagnosed with CBD (2.3%, 6/264). A general pattern of increasing sensitization prevalence was observed as exposure quartile increased. Both total and respirable beryllium mass concentration estimates were positively associated with sensitization (average and highest job), and CBD (cumulative). Increased sensitization prevalence was identified in metal/oxide production, alloy melting and casting, and maintenance, and for CBD in melting and casting. Lower sensitization prevalence was observed in plant-area administrative work. CONCLUSIONS: Sensitization was associated with average and highest job exposures, and CBD was associated with cumulative exposure. Both total and respirable mass concentrations were relevant predictors of risk. New process-related risks were identified in melting and casting and maintenance. |
Ear and fingertip oxygen saturation measurements of healthcare workers wearing protective masks
Roberge RJ , Coca A , Williams WJ , Powell JB , Palmiero AJ . Respir Ther 2011 6 (4) 26-29 Minor, but statistically significant, differences in oxygen saturation measured by pulse oximetry were noted between N95 filtering facepiece respirators with and without an exhalation valve and one model of an elastomeric air-purifying respirator worn by healthcare workers over one hour at two low work rates. Pulse oximetry determinations at the earlobe were significantly greater than concurrently obtained fingertip oximetry values, but the absolute differences were small and would presumably not be of practical significance. The use of respiratory protective equipment by healthy healthcare workers over a one hour period is not likely to result in any clinically significant oxygen desaturations. |
Modified tail section reduces noise on a continuous mining machine
Zimmerman JJ , Smith AK , Michael R , Kovalchik PG . Min Eng 2011 63 (7) 83-85 Overexposure to noise remains a widespread, serious health hazard in the U.S. mining industries. Most other categories of illnesses and injuries associated with mining have improved, with the exception of hearing loss. Mine Safety and Health Administration (MSHA) coal noise data from 2000-2004 show that the continuous mining machine is first among all equipment with 35 percent of the noise overexposures. Joy Mining Machinery, in collaboration with the National Institute for Occupational Safety and Health (NIOSH), is conducting research to reduce noise generated by continuous mining machines. This paper describes a "JOY-Designed for Noise Reduction" (JOY-DNR; Patent Pending) tail section as a noise control for reducing the noise overexposures of continuous mining machine operators. Underground results show a 45 percent and 65 percent noise exposure reduction for the operator when compared to a standard machine. Utilizing this newly developed noise control, along with previously proven controls, will provide continuous mining machine operators an opportunity to be within the MSHA-Permissible Exposure Limit (MSHA-PEL). |
Physician practices related to use of BMI-for-age and counseling for childhood obesity prevention: a cross-sectional study
Wethington HR , Sherry B , Polhamus B . BMC Fam Pract 2011 12 80 BACKGROUND: Screening for obesity and providing appropriate obesity-related counseling in the clinical setting are important strategies to prevent and control childhood obesity. The purpose of this study is to document pediatricians (PEDs) and general practitioners (GPs) with pediatric patients use of BMI-for-age to screen for obesity, confidence in explaining BMI, access to referral clinics, and characteristics associated with screening and counseling to children and their caregivers. METHODS: The authors used 2008 DocStyles survey data to examine these practices at every well child visit for children aged two years and older. Counseling topics included: physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages. Chi-square tests were used to examine differences in proportions and logistic regression to identify characteristics associated with screening and counseling. RESULTS: The final analytic sample included 250 PEDs and 621 GPs. Prevalence of using BMI-for-age to screen for obesity at every well child visit was higher for PEDs than GPs (50% vs. 22%, chi(2) = 67.0, p ≤ 0.01); more PEDs reported being very/somewhat confident in explaining BMI (94% vs. GPs, 87%, p < 0.01); more PEDs reported access to a pediatric obesity specialty clinic for referral (PEDs = 65% vs. GPs = 42%, chi(2) = 37.5, p ≤ 0.0001).In general, PEDs reported higher counseling prevalence than GPs. There were significant differences in the following topics: TV viewing (PEDs, 79% vs. GPs, 61%, chi(2) = 19.1, p ≤ 0.0001); fruit and vegetable consumption (PEDs, 87% vs. GPs, 78%, chi(2) = 6.4, p ≤ 0.01). The only characteristics associated with use of BMI for GPs were being female (OR = 2.3, 95% CI = 1.5-3.5) and serving mostly non-white patients (OR = 1.8, 95% CI = 1.1-2.9); there were no significant associations for PEDs. CONCLUSIONS: The findings for use of BMI-for-age, counseling habits, and access to a pediatric obesity specialty clinic leave room for improvement. More research is needed to better understand why BMI-for-age is not being used to screen at every well child visit, which may increase the likelihood overweight and obese patients receive counseling and referrals for additional services. The authors also suggest more communication between PEDs and GPs through professional organizations to increase awareness of existing resources, and to enhance access and referral to pediatric obesity specialty clinics. |
'Pregnancy comes accidentally - like it did with me': reproductive decisions among women on ART and their partners in rural Uganda
King R , Khana K , Nakayiwa S , Katuntu D , Homsy J , Lindkvist P , Johansson E , Bunnell R . BMC Public Health 2011 11 530 BACKGROUND: As highly active antiretroviral therapy (ART) restores health, fertility and sexual activity among HIV-infected adults, understanding how ART influences reproductive desires and decisions could inform interventions to reduce sexual and vertical HIV transmission risk. METHODS: We performed a qualitative sub-study among a Ugandan cohort of 1,000 adults on ART with four purposively selected categories of participants: pregnant, not pregnant, delivered, and aborted. In-depth interviews examined relationships between HIV, ART and pregnancy, desire for children, perceived risks and benefits of pregnancy, decision-making regarding reproduction and family planning (FP) among 29 women and 16 male partners. Analysis focused on dominant explanations for emerging themes across and within participant groups. RESULTS: Among those who had conceived, most couples stated that their pregnancy was unintentional, and often occurred because they believed that they were infertile due to HIV. Perceived reasons for women not getting pregnant included: ill health (included HIV infection and ART), having enough children, financial constraints, fear of mother-to-child HIV transmission or transmission to partner, death of a child, and health education. Most women reported FP experiences with condoms and hormonal injections only. Men had limited FP information apart from condoms. CONCLUSIONS: Counselling at ART initiation may not be sufficient to enable women who do not desire children to adopt relevant family planning practices. On-going reproductive health education and FP services, with emphasis on the restoration of fertility after ART initiation, should be integrated into ART programs for men and women. |
Gynecologic clostridial toxic shock in women of reproductive age
Zane S , Guarner J . Curr Infect Dis Rep 2011 13 (6) 561-70 Clostridial toxic shock, caused by Clostridium sordellii or Clostridium perfringens, is a rare and largely fatal syndrome among reproductive-aged women with genital tract infection, and may occur following various pregnancy outcomes or without pregnancy. Clinicians should be aware of common clinical features of this very rapidly-progressing syndrome including abdominal pain, tachycardia, hypotension, third-space fluid accumulations, hemoconcentration, and marked leukemoid response, often with lack of fever. In this review, we summarize known cases through mid-2011 and information on clinical presentation, diagnosis, treatment, and results of recent investigations regarding pathogenesis, including germination, toxins, and host response that may have important implications for development of preventive or therapeutic interventions. |
Bacterial vaginosis and the natural history of human papillomavirus
King CC , Jamieson DJ , Wiener J , Cu-Uvin S , Klein RS , Rompalo AM , Shah KV , Sobel JD . Infect Dis Obstet Gynecol 2011 2011 319460 OBJECTIVE: To evaluate associations between common vaginal infections and human papillomavirus (HPV). STUDY DESIGN: Data from up to 15 visits on 756 HIV-infected women and 380 high-risk HIV-uninfected women enrolled in the HIV Epidemiology Research Study (HERS) were evaluated for associations of bacterial vaginosis, trichomoniasis, and vaginal Candida colonization with prevalent HPV, incident HPV, and clearance of HPV in multivariate analysis. RESULTS: Bacterial vaginosis (BV) was associated with increased odds for prevalent (aOR = 1.14, 95% CI: 1.04, 1.26) and incident (aOR = 1.24, 95% CI: 1.04, 1.47) HPV and with delayed clearance of infection (aHR = 0.84, 95% CI: 0.72, 0.97). Whereas BV at the preceding or current visit was associated with incident HPV, in an alternate model for the outcome of incident BV, HPV at the current, but not preceding, visit was associated with incident BV. CONCLUSION: These findings underscore the importance of prevention and successful treatment of bacterial vaginosis. |
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