Variably protease-sensitive prionopathy: a new sporadic disease of the prion protein
Zou WQ , Puoti G , Xiao X , Yuan J , Qing L , Cali I , Shimoji M , Langeveld JP , Castellani R , Notari S , Crain B , Schmidt RE , Geschwind M , Dearmond SJ , Cairns NJ , Dickson D , Honig L , Torres JM , Mastrianni J , Capellari S , Giaccone G , Belay ED , Schonberger LB , Cohen M , Perry G , Kong Q , Parchi P , Tagliavini F , Gambetti P . Ann Neurol 2010 68 (2) 162-72 OBJECTIVE: The objective of the study is to report 2 new genotypic forms of protease-sensitive prionopathy (PSPr), a novel prion disease described in 2008, in 11 subjects all homozygous for valine at codon 129 of the prion protein (PrP) gene (129VV). The 2 new PSPr forms affect individuals who are either homozygous for methionine (129MM) or heterozygous for methionine/valine (129MV). METHODS: Fifteen affected subjects with 129MM, 129MV, and 129VV underwent comparative evaluation at the National Prion Disease Pathology Surveillance Center for clinical, histopathologic, immunohistochemical, genotypical, and PrP characteristics. RESULTS: Disease duration (between 22 and 45 months) was significantly different in the 129VV and 129MV subjects. Most other phenotypic features along with the PrP electrophoretic profile were similar but distinguishable in the 3,129 genotypes. A major difference laid in the sensitivity to protease digestion of the disease-associated PrP, which was high in 129VV but much lower, or altogether lacking, in 129MV and 129MM. This difference prompted the substitution of the original designation with "variably protease-sensitive prionopathy" (VPSPr). None of the subjects had mutations in the PrP gene coding region. INTERPRETATION: Because all 3,129 genotypes are involved, and are associated with distinguishable phenotypes, VPSPr becomes the second sporadic prion protein disease with this feature after Creutzfeldt-Jakob disease, originally reported in 1920. However, the characteristics of the abnormal prion protein suggest that VPSPr is different from typical prion diseases, and perhaps more akin to subtypes of Gerstmann-Straussler-Scheinker disease. |
Hepatitis B surface antigen (HBsAg): a 40-year-old hepatitis B virus seromarker gets new life
McMahon BJ . Gastroenterology 2010 139 (2) 380-2 There are an estimated 350 to 400 million persons in the world with chronic hepatitis B virus (HBV) infection. Approximately 15% to 25% may die prematurely of either hepatocellular carcinoma (HCC) or end-stage liver disease from cirrhosis.1 Hepatitis B surface antigen (HBsAg) was identified >40 years ago. Over the years, it has proven to be a steady, reliable but unspectacular marker of active HBV infection. Two papers in this month's edition of Gastroenterology will revive the interest in this HBV seromarker. | Most persons with chronic HBV are infected either at birth or in the first few years of life.1 Four phases of chronic HBV infection have been identified by the National Institutes of Health at Workshops of Hepatitis B Virus.2 Children infected at birth from mothers who are positive for HBsAg and hepatitis B e antigen (HBeAg) commonly develop what has been called the “immune tolerant phase” of chronic HBV. In this phase, HBV is not recognized by the immune system and liver disease is mild or not present. Later in life, when the immune system recognizes HBV as a foreign invader, most evolve into the immune active phase active and liver inflammation and fibrosis are present in various degrees. Eventually, most persons lose HBeAg and seroconvert to anti-HBe, at which time the majority go into an inactive phase of chronic HBV infection, in previous times called a healthy carrier state. However, some persons after HBeAg seroconversion develop HBeAg-negative immune active disease, whereas others who achieved the inactive phase of HBV may experience a reversion to HBeAg-positive immune active disease or develop HBeAg-negative immune active hepatitis.1 A minority, 0.5% to 1.0% of persons per year have a more favorable event occur, clearance of HBsAg, often accompanied by the emergence of antibody to HBsAg.3 |
The current availability of antiepileptic drugs in Zambia: implications for the ILAE/WHO "Out of the Shadows" campaign
Chomba EN , Haworth A , Mbewe E , Atadzhanov M , Ndubani P , Kansembe H , Birbeck GL . Am J Trop Med Hyg 2010 83 (3) 571-4 Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a study in the Lusaka and Southern Provinces to quantify the availability and cost of AEDs and assess determinants. Among 111 pharmacies, almost one-half did not carry AEDs (N = 54; 49.1%). Available AEDs were phenobarbitone (21; 18.9%), carbamazepine (27; 24.3%), valproic acid (4; 3.6%), and phenytoin (3; 2.7%). Adult out-of-pocket monthly costs ranged from US $7 to $30. Pediatric syrups were universally unavailable. Interviews revealed several barriers to AED provision, including that handling phenobarbitone (historically the most affordable AED) has become increasingly difficult because of newly enforced regulatory requirements. Personal communications with epilepsy-care providers in other low income countries suggest that this problem may be widespread. Improved enforcement of existing drug regulations may be contributing to the AED shortage. Social programs aimed at encouraging people with epilepsy to come "out of the shadows" must be preceded by improved AED access. |
HIV, transmitted drug resistance, and the paradox of preexposure prophylaxis
Supervie V , Garcia-Lerma JG , Heneine W , Blower S . Proc Natl Acad Sci U S A 2010 107 (27) 12381-6 The administration of antiretrovirals before HIV exposure to prevent infection (i.e., preexposure prophylaxis; PrEP) is under evaluation in clinical trials. Because PrEP is based on antiretrovirals, there is considerable concern that it could substantially increase transmitted resistance, particularly in resource-rich countries. Here we use a mathematical model to predict the effect of PrEP interventions on the HIV epidemic in the men-who-have-sex-with-men community in San Francisco. The model is calibrated using Monte Carlo filtering and analyzed by constructing nonlinear response hypersurfaces. We predict PrEP interventions could substantially reduce transmission but significantly increase the proportion of new infections caused by resistant strains. Two mechanisms can cause this increase. If risk compensation occurs, the proportion increases due to increasing transmission of resistant strains and decreasing transmission of wild-type strains. If risk behavior remains stable, the increase occurs because of reduced transmission of resistant strains coupled with an even greater reduction in transmission of wild-type strains. We define this as the paradox of PrEP (i.e., resistance appears to be increasing, but is actually decreasing). We determine this paradox is likely to occur if the efficacy of PrEP regimens against wild-type strains is greater than 30% and the relative efficacy against resistant strains is greater than 0.2 but less than the efficacy against wild-type. Our modeling shows, if risk behavior increases, that it is a valid concern that PrEP could significantly increase transmitted resistance. However, if risk behavior remains stable, we find the concern is unfounded and PrEP interventions are likely to decrease transmitted resistance. |
Rift Valley fever virus epidemic in Kenya, 2006/2007: the entomologic investigations
Sang R , Kioko E , Lutomiah J , Warigia M , Ochieng C , O'Guinn M , Lee JS , Koka H , Godsey M , Hoel D , Hanafi H , Miller B , Schnabel D , Breiman RF , Richardson J . Am J Trop Med Hyg 2010 83 28-37 In December 2006, Rift Valley fever (RVF) was diagnosed in humans in Garissa Hospital, Kenya and an outbreak reported affecting 11 districts. Entomologic surveillance was performed in four districts to determine the epidemic/epizootic vectors of RVF virus (RVFV). Approximately 297,000 mosquitoes were collected, 164,626 identified to species, 72,058 sorted into 3,003 pools and tested for RVFV by reverse transcription-polymerase chain reaction. Seventy-seven pools representing 10 species tested positive for RVFV, including Aedes mcintoshi/circumluteolus (26 pools), Aedes ochraceus (23 pools), Mansonia uniformis (15 pools); Culex poicilipes, Culex bitaeniorhynchus (3 pools each); Anopheles squamosus, Mansonia africana (2 pools each); Culex quinquefasciatus, Culex univittatus, Aedes pembaensis (1 pool each). Positive Ae. pembaensis, Cx. univittatus, and Cx. bitaeniorhynchus was a first time observation. Species composition, densities, and infection varied among districts supporting hypothesis that different mosquito species serve as epizootic/epidemic vectors of RVFV in diverse ecologies, creating a complex epidemiologic pattern in East Africa. |
Transmission dynamics of Francisella tularensis subspecies and clades by nymphal Dermacentor variabilis (Acari: Ixodidae)
Reese SM , Dietrich G , Dolan MC , Sheldon SW , Piesman J , Petersen JM , Eisen RJ . Am J Trop Med Hyg 2010 83 (3) 645-52 In the United States, the American dog tick, Dermacentor variabilis (Say) is considered an important biological vector of Francisella tularensis, the etiologic agent of tularemia. In this study, we evaluated the vector efficiency of nymphal D. variabilis infected as larvae with differing clades and subspecies (A1b, A2, and type B) of F. tularensis. In all cases, D. variabilis larvae were able to acquire, maintain, and transstadially transmit F. tularensis. Significant replication of the bacteria also occurred in infected nymphs. Transmission of F. tularensis to Swiss Webster mice was not observed with A1b, and low rates were observed with A2 (8.0%) and type B (13.5%). Negative effects on tick survivorship were also observed for A1b, A2, and type B infections. Our results provide evidence of a high fitness cost and low transmission rates during the immature stages, suggesting that D. variabilis may play a limited role in enzootic maintenance of F. tularensis. |
Prediction, assessment of the Rift Valley fever activity in East and Southern Africa 2006-2008 and possible vector control strategies
Anyamba A , Linthicum KJ , Small J , Britch SC , Pak E , de La Rocque S , Formenty P , Hightower AW , Breiman RF , Chretien JP , Tucker CJ , Schnabel D , Sang R , Haagsma K , Latham M , Lewandowski HB , Magdi SO , Mohamed MA , Nguku PM , Reynes JM , Swanepoel R . Am J Trop Med Hyg 2010 83 43-51 Historical outbreaks of Rift Valley fever (RVF) since the early 1950s have been associated with cyclical patterns of the El Nino/Southern Oscillation (ENSO) phenomenon, which results in elevated and widespread rainfall over the RVF endemic areas of Africa. Using satellite measurements of global and regional elevated sea surface temperatures, elevated rainfall, and satellite derived-normalized difference vegetation index data, we predicted with lead times of 2-4 months areas where outbreaks of RVF in humans and animals were expected and occurred in the Horn of Africa, Sudan, and Southern Africa at different time periods from September 2006 to March 2008. Predictions were confirmed by entomological field investigations of virus activity and by reported cases of RVF in human and livestock populations. This represents the first series of prospective predictions of RVF outbreaks and provides a baseline for improved early warning, control, response planning, and mitigation into the future. |
Genome sequences of the human body louse and its primary endosymbiont provide insights into the permanent parasitic lifestyle
Kirkness EF , Haas BJ , Sun W , Braig HR , Perotti MA , Clark JM , Lee SH , Robertson HM , Kennedy RC , Elhaik E , Gerlach D , Kriventseva EV , Elsik CG , Graur D , Hill CA , Veenstra JA , Walenz B , Tubio JM , Ribeiro JM , Rozas J , Johnston JS , Reese JT , Popadic A , Tojo M , Raoult D , Reed DL , Tomoyasu Y , Krause E , Mittapalli O , Margam VM , Li HM , Meyer JM , Johnson RM , Romero-Severson J , Vanzee JP , Alvarez-Ponce D , Vieira FG , Aguade M , Guirao-Rico S , Anzola JM , Yoon KS , Strycharz JP , Unger MF , Christley S , Lobo NF , Seufferheld MJ , Wang N , Dasch GA , Struchiner CJ , Madey G , Hannick LI , Bidwell S , Joardar V , Caler E , Shao R , Barker SC , Cameron S , Bruggner RV , Regier A , Johnson J , Viswanathan L , Utterback TR , Sutton GG , Lawson D , Waterhouse RM , Venter JC , Strausberg RL , Berenbaum MR , Collins FH , Zdobnov EM , Pittendrigh BR . Proc Natl Acad Sci U S A 2010 107 (27) 12168-73 As an obligatory parasite of humans, the body louse (Pediculus humanus humanus) is an important vector for human diseases, including epidemic typhus, relapsing fever, and trench fever. Here, we present genome sequences of the body louse and its primary bacterial endosymbiont Candidatus Riesia pediculicola. The body louse has the smallest known insect genome, spanning 108 Mb. Despite its status as an obligate parasite, it retains a remarkably complete basal insect repertoire of 10,773 protein-coding genes and 57 microRNAs. Representing hemimetabolous insects, the genome of the body louse thus provides a reference for studies of holometabolous insects. Compared with other insect genomes, the body louse genome contains significantly fewer genes associated with environmental sensing and response, including odorant and gustatory receptors and detoxifying enzymes. The unique architecture of the 18 minicircular mitochondrial chromosomes of the body louse may be linked to the loss of the gene encoding the mitochondrial single-stranded DNA binding protein. The genome of the obligatory louse endosymbiont Candidatus Riesia pediculicola encodes less than 600 genes on a short, linear chromosome and a circular plasmid. The plasmid harbors a unique arrangement of genes required for the synthesis of pantothenate, an essential vitamin deficient in the louse diet. The human body louse, its primary endosymbiont, and the bacterial pathogens that it vectors all possess genomes reduced in size compared with their free-living close relatives. Thus, the body louse genome project offers unique information and tools to use in advancing understanding of coevolution among vectors, symbionts, and pathogens. |
Interannual variability of human plague occurrence in the Western United States explained by tropical and north Pacific ocean climate variability
Ari TB , Gershunov A , Tristan R , Cazelles B , Gage K , Stenseth NC . Am J Trop Med Hyg 2010 83 (3) 624-32 Plague is a vector-borne, highly virulent zoonotic disease caused by the bacterium Yersinia pestis. It persists in nature through transmission between its hosts (wild rodents) and vectors (fleas). During epizootics, the disease expands and spills over to other host species such as humans living in or close to affected areas. Here, we investigate the effect of large-scale climate variability on the dynamics of human plague in the western United States using a 56-year time series of plague reports (1950-2005). We found that El Nino Southern Oscillation and Pacific Decadal Oscillation in combination affect the dynamics of human plague over the western United States. The underlying mechanism could involve changes in precipitation and temperatures that impact both hosts and vectors. It is suggested that snow also may play a key role, possibly through its effects on summer soil moisture, which is known to be instrumental for flea survival and development and sustained growth of vegetation for rodents. |
Effects of statins on serum inflammatory markers: the U.S. National Health and Nutrition Examination Survey 1999-2004
Yoon SS , Dillon CF , Carroll M , Illoh K , Ostchega Y . J Atheroscler Thromb 2010 17 (11) 1176-82 AIM: To evaluate the effects of HMG-CoA reductase inhibitor (statin) treatment on serum inflammatory markers using data from the National Health and Nutrition Examination Survey (NHANES 1999-2004). METHODS AND RESULTS: A total of 9,128 individuals aged 40 and older participated in the NHANES. The inflammatory markers studied were white blood cell counts (WBC), high sensitivity C-reactive protein (CRP) and ferritin. Other covariables were: age, gender, race/ethnicity, body mass index, prescription or nonprescription medication use within the previous 30 days (statins, anti-inflammatory drugs, antibiotics). Four analytic groups for drug use were defined: Statin users; AI/Antibiotic users (use of either anti-inflammatory or antibiotic drugs); Combination group (use of both Statins and anti-inflammatory or antibiotic drugs), and a Non-use group (taking none of the listed drugs). The mean CRP level was significantly lower in the Statin use group than the Non-use group (0.3 mg/dL, 95%CI: 0.3-0.3 and 0.4 mg/dL, 95%CI: 0.4-0.5). In multivariable regression modeling, the Statin use group had significantly lower predicted mean WBC (Beta Coeff: -0.2, p < 0.05) and CRP (Beta Coeff: -0.1, p < 0.01) values than the Non-use group. CONCLUSIONS: Treatment with statins was significantly associated with decreased WBC and CRP levels in this large population-based sample. |
Henoch-Scholein purpura and polysaccharide meningococcal vaccine
Goodman MJ , Nordin JD , Belongia EA , Mullooly JP , Baggs J . Pediatrics 2010 126 (2) e325-9 BACKGROUND: We describe here a case of Henoch-Schonlein purpura (HSP) that occurred 10 days after administration of the meningococcal polysaccharide vaccine and came to the attention of a Vaccine Safety Datalink (VSD) investigator (but did not occur in the VSD cohort). Periodic case reports have linked vaccines to HSP. OBJECTIVE: To better understand the potential risk for HSP after immunization with the meningococcal polysaccharide vaccine. PATIENTS AND METHODS: We studied the VSD cohort to estimate the 42-day postvaccination incidence rate of HSP in the VSD population 16 to 20 years of age. Electronic data from all 8 VSD sites were gathered. All subjects aged 16 to 20 years who received a meningococcal polysaccharide vaccine were followed for 42 days after that vaccination for evidence of HSP. Background rates were determined by examining all the nonexposed time of the same cohort. RESULTS: No cases of HSP were seen in the 42 days after 49,027 doses of meningococcal polysaccharide vaccine among the entire VSD adolescent and young adult population. The background incidence rate was 4.2 per 100,000 person-years. CONCLUSION: These data provide the strongest evidence so far that HSP is not associated with receipt of meningococcal polysaccharide vaccine in the 16- to 20-year age group. |
Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey
Stevenson DG , Decker SL , Dwyer LL , Huskamp HA , Grabowski DC , Metzger ED , Mitchell SL . Am J Geriatr Psychiatry 2010 18 (12) 1078-92 OBJECTIVES: To document the extent and appropriateness of use of antipsychotics and benzodiazepines among nursing home residents using a nationally representative survey. METHODS: Cross-sectional analysis of the 2004 National Nursing Home Survey. Bivariate and multivariate analyses examined relationships between resident and facility characteristics and antipsychotic and benzodiazepine use by appropriateness classification among residents aged 60 years and older (N = 12,090). Resident diagnoses and information about behavioral problems were used to categorize antipsychotic and benzodiazepine use as appropriate, potentially appropriate, or having no appropriate indication. RESULTS: More than one quarter (26%) of nursing home residents used an antipsychotic medication, 40% of whom had no appropriate indication for such use. Among the 13% of residents who took benzodiazepines, 42% had no appropriate indication. In adjusted analyses, the odds of residents taking an antipsychotic without an appropriate indication were highest for residents with diagnoses of depression (odds ratio [OR] = 1.31; 95% confidence interval [CI]: 1.12-1.53), dementia (OR = 1.82; 95% CI: 1.52-2.18), and with behavioral symptoms (OR = 1.97, 95% CI: 1.56-2.50). The odds of potentially inappropriate antipsychotic use increased as the percentage of Medicaid residents in a facility increased (OR = 1.08, 95% CI: 1.02-1.15) and decreased as the percentage of Medicare residents increased (OR = 0.46, 95% CI: 0.25-0.83). The odds of taking a benzodiazepine without an appropriate indication were highest among residents who were female (OR = 1.44; 95% CI: 1.18-1.75), white (OR = 1.95; 95% CI: 1.47-2.60), and had behavioral symptoms (OR = 1.69; 95% CI: 1.41-2.01). CONCLUSION: Antipsychotics and benzodiazepines seem to be commonly prescribed to residents lacking an appropriate indication for their use. |
Variability over one week in the urinary concentrations of metabolites of diethyl phthalate and di(2-Ethylhexyl) phthalate among 8 adults: an observational study
Preau Jr JL , Wong LY , Silva MJ , Needham LL , Calafat AM . Environ Health Perspect 2010 118 (12) 1748-54 BACKGROUND: Phthalates are metabolized and eliminated in urine within hours after exposure. Several reports suggest that concentrations of phthalate metabolites in a spot urine sample can provide a reliable estimation of exposure to phthalates for up to several months. OBJECTIVES: We examined inter- and intra-participant and inter- and intra-day variability in the concentrations of monoethyl phthalate (MEP), the major metabolite of diethyl phthalate, commonly used in personal care products, and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), a metabolite of di(2-ethylhexyl) phthalate (DEHP), a polyvinyl chloride plasticizer of which diet is the principal exposure source, among eight adults who collected all urine voids (average 7.6 samples/person/day) for 1 week. METHODS: We analyzed the urine samples using online solid-phase extraction coupled to isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. RESULTS: Regardless of the type of void (spot, first morning, 24-hour collections), for MEP, inter-participant variability in concentrations accounted for > 75% of the total variance. By contrast, for MEHHP, within-participant variability was the main contributor (69%-83 %) of the total variance. Furthermore, we observed considerable intra-day variability in the concentrations of spot samples for MEHHP (51%) and MEP (21%). CONCLUSIONS: MEP and MEHHP urinary concentrations varied considerably during 1 week, but the main contributors to the total variance differed (inter-day variability, MEHHP; inter-participant variability, MEP) regardless of the sampling strategy (spot, first morning, 24-hour collection). The nature of the exposure (diet vs. other lifestyle factors) and timing of urine sampling to evaluate exposure to phthalates should be considered. For DEHP and phthalates to which people are mostly exposed through diet, collecting 24-hour voids for only 1 day may not be advantageous compared with multiple spot collections. When collecting multiple spot urine samples, changing the time of collection may provide the most complete approach to assess exposure to diverse phthalates. |
Indoor moulds, Sick Building Syndrome and building related illness
Crook B , Burton NC . Fungal Biol Rev 2010 24 106-113 Humans are constantly exposed to fungi, or moulds, usually without suffering harm to health. However, in some instances inhalation of sufficient numbers of mould spores can trigger symptoms of asthma, rhinitis or bronchitis. Respiratory ill health associated with the built environment is often referred to either as Sick Building Syndrome [SBS] (i.e. building related symptoms) or building related illness. For many, the difference between SBS and building related illness is unclear and the two overlap. This review examines the differences between the two and describes in more detail the role of moulds in building related illness. Using as examples the after-effects of flooding in the UK in 2007, and Hurricane Katrina in USA in 2005, methods used to investigate exposure to indoor mould contamination are described, together with strategies for remediating mould contaminated buildings. |
Survey of knowledge, attitudes, and practice management patterns of Atlanta-area obstetricians regarding stillbirth
Duke W , Shin M , Correa A , Alverson CJ . Womens Health Issues 2010 20 (5) 366-70 OBJECTIVE: Existing surveillance data on fetal death certificates are suboptimal for conducting reliable epidemiologic studies on stillbirth. The objective of this survey was to better understand the factors potentially affecting the quality of data collected on stillbirths among a defined population. METHODS: A survey was mailed to all physicians (n = 661) listed in the July 2007 version of the American Medical Association master file with a primary specialty of obstetrics/gynecology and a mailing address within five counties in metropolitan Atlanta. RESULTS: A total of 487 physicians met eligibility criteria: 279 returned the survey, 179 did not return the survey, and 29 were returned as unable to locate. Two respondents returned incomplete surveys, leaving 277 participants for the final analysis. Respondents reported seeing an average of six stillbirths per year. A cause of death was not identified in two thirds of cases. Almost half (46.8%) of participants responded that 20 weeks was the minimum gestational age defining stillbirth, whereas 33.1% responded that it was 24 weeks. A majority (92.6%) responded that a standardized definition for stillbirth should be adopted. More than 80% agreed that a comprehensive evaluation was important to identify a cause of death, and 91.9% agreed that the use of a standardized protocol for post-mortem stillbirth evaluation would be helpful. A majority also agreed that ongoing surveillance of stillbirths and a national research agenda on causes of stillbirth are important. CONCLUSION: Comprehensive educational and awareness efforts for obstetricians and other related health care personnel are needed to further improve on the data collected for surveillance purposes on stillbirth. |
Pneumonia incidence and mortality in Mainland China: systematic review of Chinese and English literature, 1985-2008
Guan X , Silk BJ , Li W , Fleischauer AT , Xing X , Jiang X , Yu H , Olsen SJ , Cohen AL . PLoS One 2010 5 (7) e11721 BACKGROUND: Pneumonia is a leading infectious disease killer worldwide, yet the burden in China is not well understood as much of the data is published in the non-English literature. METHODOLOGY/PRINCIPAL FINDINGS: We systematically reviewed the Chinese- and English-language literature for studies with primary data on pneumonia incidence and mortality in mainland China. Between 1985 and 2008, 37 studies met the inclusion criteria. The quality of the studies was highly variable. For children <5 years, incidence ranged from 0.06-0.27 episodes per person-year and mortality ranged from 184-1,223 deaths per 100,000 population. Overall incidence and mortality were stable or decreased over the study period and were higher in rural compared to urban areas. CONCLUSIONS/SIGNIFICANCE: Pneumonia continues to be a major public health challenge in young children in China, and estimates of pneumonia incidence and mortality vary widely. Reliable surveillance data and new prevention efforts may be needed to achieve and document additional declines, especially in areas with higher incidence and mortality such as rural settings. |
An investigation of a major outbreak of Rift Valley fever in Kenya: 2006-2007
Nguku PM , Sharif SK , Mutonga D , Amwayi S , Omolo J , Mohammed O , Farnon EC , Gould LH , Lederman E , Rao C , Sang R , Schnabel D , Feikin DR , Hightower A , Njenga MK , Breiman RF . Am J Trop Med Hyg 2010 83 5-13 An outbreak of Rift Valley fever (RVF) occurred in Kenya during November 2006 through March 2007. We characterized the magnitude of the outbreak through disease surveillance and serosurveys, and investigated contributing factors to enhance strategies for forecasting to prevent or minimize the impact of future outbreaks. Of 700 suspected cases, 392 met probable or confirmed case definitions; demographic data were available for 340 (87%), including 90 (26.4%) deaths. Male cases were more likely to die than females, Case Fatality Rate Ratio 1.8 (95% Confidence Interval [CI] 1.3-3.8). Serosurveys suggested an attack rate up to 13% of residents in heavily affected areas. Genetic sequencing showed high homology among viruses from this and earlier RVF outbreaks. Case areas were more likely than non-case areas to have soil types that retain surface moisture. The outbreak had a devastatingly high case-fatality rate for hospitalized patients. However, there were up to 180,000 infected mildly ill or asymptomatic people within highly affected areas. Soil type data may add specificity to climate-based forecasting models for RVF. |
Racial/ethnic differences in association of fasting glucose-associated genomic loci with fasting glucose, HOMA-B, and impaired fasting glucose in the U.S. adult population.
Yang Q , Liu T , Shrader P , Yesupriya A , Chang MH , Dowling NF , Ned RM , Dupuis J , Florez JC , Khoury MJ , Meigs JB . Diabetes Care 2010 33 (11) 2370-7 OBJECTIVE: To estimate allele frequencies, marginal and combined effects of novel fasting glucose (FG)-associated SNPs on FG levels and on risk of impaired fasting glucose (IFG) among non-Hispanic white, non-Hispanic black and Mexican American. RESEARCH DESIGN AND METHODS: DNA samples from 3024 adult fasting participants in NHANES III (1991-1994) were genotyped for 16 novel FG-associated SNPs in multiple genes. We determined the allele frequencies and influence of these SNPs alone and in a weighted genetic risk score on FG, homeostasis model-assessed beta-cell function (HOMA-B), and IFG by race/ethnicity while adjusting for age and sex. RESULTS: All allele frequencies varied significantly by race/ethnicity. A weighted genetic risk score, based on the 16 SNPs, was associated with a 0.022 mmol/L (95% confidence interval [CI] 0.009, 0.035), 0.036 mmol/L (95% CI 0.019, 0.052), and 0.033 mmol/L (95% CI 0.020, 0.046) increase in FG levels per risk allele among non-Hispanic whites, non-Hispanic blacks, and Mexican Americans, respectively. Adjusted odds ratios for IFG were 1.78 for non-Hispanic whites (95% CI 1.00, 3.17), 2.40 for non-Hispanic blacks (CI 1.07, 5.37), and 2.39 for Mexican American (95% CI 1.37, 4.14) when we compared the highest to lowest quintiles of genetic risk score (p = 0.365 for testing heterogeneity of effect across race/ethnicity). CONCLUSIONS: We conclude that allele frequencies of 16 novel FG-associated SNPs vary significantly by race/ethnicity, but the influence of these SNPs on FG levels, HOMA-B, and IFG were generally consistent across all racial/ethnic groups. |
Sexual transmission risk behavior of adolescents with HIV acquired perinatally or through risky behaviors
Koenig LJ , Pals SL , Chandwani S , Hodge K , Abramowitz S , Barnes W , D'Angelo L . J Acquir Immune Defic Syndr 2010 55 (3) 380-90 OBJECTIVE: To describe the prevalence and predictors of the transmission-related behaviors of adolescents with HIV acquired perinatally (perinatal) or through risky behaviors (behavioral). METHODS: HIV-positive adolescents (n = 166) aged 13-21, receiving care in 3 US cities, reported sexual behaviors, drug use, and psychosocial and demographic characteristics. HIV-related data were abstracted from medical records. RESULTS: Of 105 sexually experienced adolescents reporting risk history (42 perinatal, 63 behavioral), 49 had engaged in unprotected sex since learning their diagnosis (12 perinatal, 37 behavioral). Of sexually experienced girls, 19 had been pregnant (5 of 24 perinatal, 14 of 31 behavioral). Risk information was provided for 115 of 132 recent sex partners, 61 of whom had unprotected sex with study participants (10 with 8 perinatal participants; 51 with 33 behavioral participants). Recent unprotected sex was associated with sexual abuse during adolescence (adjusted odds ratio = 9.61, 95% CI: 1.07 to 86.12) and greater HIV knowledge (adjusted odds ratio = 1.29, 95% CI: 1.00 to 1.66) when transmission category, age, and sexual orientation were controlled. CONCLUSIONS: To limit HIV transmission and prevent unplanned pregnancies, developmentally appropriate risk-reduction interventions, and screening and treatment referral for sexual abuse, must be integrated into the care of both perinatally and behaviorally HIV-infected adolescents. |
What does the public know about preventing cancer? Results from the Health Information National Trends Survey (HINTS)
Hawkins NA , Berkowitz Z , Peipins LA . Health Educ Behav 2010 37 (4) 490-503 This study provides information about the public's familiarity with cancer prevention strategies and examines the association between this familiarity and actual prevention behavior. Data from interviews with 5,589 adults included in the 2003 Health Information National Trends Survey (HINTS) were analyzed. Most respondents were able to cite one or two strategies for reducing the chances of cancer. On average, the fewest number of strategies were cited by Hispanics, respondents aged 65 years or older, and those with the lowest levels of education and income. Avoiding tobacco and eating a healthy diet were most commonly cited. People who cited the following strategies for preventing cancer were more likely to practice them: eating plenty of fruits and vegetables, exercising regularly, not smoking, and participating in cancer screening. Results indicate that efforts are needed to increase public familiarity with recommended strategies, especially among groups that are least familiar with recommendations for cancer prevention. |
Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates
Bigogo G , Audi A , Aura B , Aol G , Breiman RF , Feikin DR . Int J Infect Dis 2010 14 (11) e967-73 BACKGROUND: Calculation of disease rates in developing countries using facility-based surveillance is affected by patterns of health utilization. We describe temporal patterns in health care seeking by syndrome as part of population-based morbidity surveillance in rural western Kenya. METHODS: From July 2006 to June 2008, health utilization data were collected from 27,171 participants at biweekly home visits and at Lwak Hospital, the designated referral clinic where free care provided by dedicated study clinical staff was available. Ill persons were asked if and where they sought care. Proportions seeking care for children and adults with fever, acute respiratory infection (ARI), acute lower respiratory infection (ALRI), and diarrhea were compared by Chi-square test. Care-seeking by distance was evaluated by logistic regression. RESULTS: While care-seeking outside the home was common for all syndromes (>50%), only 18-38% of care-seeking was to health facilities. Children were more likely than adults to visit health facilities for all syndromes. Of ill persons visiting Lwak Hospital, 45-54% had previously sought care elsewhere, mostly from informal drug sellers, and 11-24% with fever, ARI, or ALRI had already taken an antimalarial or antibiotic. The distance from the participant's home to Lwak Hospital was the most common reason (71%) for ill participants not seeking care there. The likelihood of visiting Lwak decreased with increasing distance of residence (p<0.001) and fluctuated significantly over the study period. CONCLUSIONS: Even in a study setting where free and reliable care is offered, health utilization is affected by other factors, such as distance. Health utilization data in population-based surveillance are important in adjusting disease rates. |
An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group
Mansergh G , Koblin BA , McKirnan DJ , Hudson SM , Flores SA , Wiegand RE , Purcell DW , Colfax GN . PLoS Med 2010 7 (8) e1000329 BACKGROUND: Substance use during sex is associated with sexual risk behavior among men who have sex with men (MSM), and MSM continue to be the group at highest risk for incident HIV in the United States. The objective of this study is to test the efficacy of a group-based, cognitive-behavioral intervention to reduce risk behavior of substance-using MSM, compared to a randomized attention-control group and a nonrandomized standard HIV-testing group. METHODS AND FINDINGS: Participants (n = 1,686) were enrolled in Chicago, Los Angeles, New York City, and San Francisco and randomized to a cognitive-behavioral intervention or attention-control comparison. The nonrandomized group received standard HIV counseling and testing. Intervention group participants received six 2-h group sessions focused on reducing substance use and sexual risk behavior. Attention-control group participants received six 2-h group sessions of videos and discussion of MSM community issues unrelated to substance use, sexual risk, and HIV/AIDS. All three groups received HIV counseling and testing at baseline. The sample reported high-risk behavior during the past 3 mo prior to their baseline visit: 67% reported unprotected anal sex, and 77% reported substance use during their most recent anal sex encounter with a nonprimary partner. The three groups significantly (p<0.05) reduced risk behavior (e.g., unprotected anal sex reduced by 32% at 12-mo follow-up), but were not different (p>0.05) from each other at 3-, 6-, and 12-mo follow-up. Outcomes for the 2-arm comparisons were not significantly different at 12-mo follow-up (e.g., unprotected anal sex, odds ratio = 1.14, confidence interval = 0.86-1.51), nor at earlier time points. Similar results were found for each outcome variable in both 2- and 3-arm comparisons. CONCLUSIONS: These results for reducing sexual risk behavior of substance-using MSM are consistent with results of intervention trials for other populations, which collectively suggest critical challenges for the field of HIV behavioral interventions. Several mechanisms may contribute to statistically indistinguishable reductions in risk outcomes by trial group. More explicit debate is needed in the behavioral intervention field about appropriate scientific designs and methods. As HIV prevention increasingly competes for behavior-change attention alongside other "chronic" diseases and mental health issues, new approaches may better resonate with at-risk groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT00153361 Please see later in the article for the Editors' Summary. |
Reduction of seasonal influenza transmission among healthcare workers in an intensive care unit: a 4-year intervention study in Thailand
Apisarnthanarak A , Uyeki TM , Puthavathana P , Kitphati R , Mundy LM . Infect Control Hosp Epidemiol 2010 31 (10) 996-1003 OBJECTIVE: To evaluate the feasibility and effectiveness of an influenza control bundle to minimize healthcare-associated seasonal influenza transmission among healthcare workers (HCWs) in an intensive care unit (ICU) equipped with central air conditioning. METHODS: A quasi-experimental study was conducted in a 500-bed tertiary care center in Thailand from July 1, 2005, through June 30, 2009. The medical ICU (MICU) implemented an influenza control bundle including healthcare worker (HCW) education, influenza screening of adult community-acquired pneumonia patients, antiviral treatment of patients and ill HCWs who tested positive for influenza, promotion of influenza vaccination among HCWs, and reinforcement of standard infection control policies. The surgical ICU (SICU) and coronary care unit (CCU) received no intervention. RESULTS: The numbers of influenza infections among HCWs during the pre- and postintervention periods were 18 cases in 5,294 HCW-days and 0 cases in 5,336 HCW-days in the MICU (3.4 vs 0 cases per 1,000 HCW-days; [Formula: see text]), 19 cases in 4,318 HCW-days and 20 cases in 4,348 HCW-days in the SICU (4.4 vs 4.6 cases per 1,000 HCW-days; [Formula: see text]), and 18 cases in 5,000 HCW-days and 18 cases in 5,143 HCW-days in the CCU (3.6 vs 3.5 cases per 1,000 HCW-days; [Formula: see text]), respectively. Outbreak-related influenza occurred in 7 MICU HCWs, 6 SICU HCWs, and 4 CCU HCWs before intervention and 0 MICU HCWs, 9 SICU HCWs, and 8 CCU HCWs after intervention. Before and after intervention, 25 (71%) and 35 (100%) of 35 MICU HCWs were vaccinated, respectively ([Formula: see text]); HCW vaccination coverage did not change significantly in the SICU (21 [70%] of 30 vs 24 [80%] of 30; [Formula: see text]) and CCU (19 [68%] of 28 vs 21 [75%] of 28; [Formula: see text]). The estimated costs of US $6,471 per unit for postintervention outbreak investigations exceeded the intervention costs of US $4,969. CONCLUSION: A sustained influenza intervention bundle was associated with clinical and economic benefits to a Thai hospital. |
Nursing home-associated infections in Department of Veterans Affairs community living centers
Tsan L , Langberg R , Davis C , Phillips Y , Pierce J , Hojlo C , Gibert C , Gaynes R , Montgomery O , Bradley S , Danko L , Roselle G . Am J Infect Control 2010 38 (6) 461-6 BACKGROUND: Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs. METHODS: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007. RESULTS: Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs. CONCLUSION: Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs. |
A public health perspective on cochlear implants and meningitis in children
Reefhuis J , Whitney CG , Mann EA . Otol Neurotol 2010 31 (8) 1329-30 Following a cluster of case reports of meningitis among cochlear implant recipients to the U.S. Food and Drug Administration (FDA) by a cochlear implant manufacturer in 2002, an epidemiological investigation by the Centers for Disease Control and Prevention (CDC) in collaboration with the FDA showed an association between cochlear implants and meningitis in children (1). Identified risk factors included the use of the implant model that contained a positioner and the combined presence of both an inner ear malformation and an intraoperative cerebrospinal fluid leak. | Even before the epidemiological study was finished, the manufacturer voluntarily recalled the only marketed cochlear implant that included the positioner, based on the high prevalence of use of this model among recipients who had developed meningitis. A notice to readers in CDC's Morbidity and Mortality Weekly Report added cochlear implant recipients to the high-risk group for pneumococcal vaccinations (2,3). This designation ensured that cochlear implant recipients would be able to receive the vaccines even during vaccine shortages, such as during the fall of 2002. |
Risk of fatal adverse events after H1N1 influenza vaccine: limitations of passive surveillance data
McNeil MM , Broder KR , Vellozzi C , Destefano F . Clin Infect Dis 2010 51 (7) 871-2 We read with interest the report by Nakada et al [1] of 107 fatal outcomes after the administration of monovalent, inactivated H1N1 influenza vaccine in Japan during October-December 2009. An estimated 15 million doses of the vaccine were reported to have been distributed during this period. The majority of these reported deaths involved elderly patients (98 [91.6%] were aged >60 years); all deaths involved patients with underlying diseases, including respiratory disease (39 patients), cardiovascular disease (31 patients), and neurologic disorders (19 patients); and in 22 cases, exacerbation of underlying disease was identified as the major cause of death. An autopsy was performed in 2 cases. A causal relationship between receipt of monovalent, inactivated H1N1 influenza vaccine and death was not found in 34 cases and was unclear in the other 73 cases; however, methods for assessing causality were not described. Despite these unremarkable findings, the authors emphasize a temporal association (the highest death count occurred ⩽24 h and the majority of deaths occurred ⩽4 days after vaccination) [1, Figure 1] between vaccination and death. We maintain that data limitations that were omitted from the report by Nakada and colleagues have led to the erroneous conclusion that their “results suggest a strong association between H1N1 influenza vaccination and the patient deaths” [1, p 1549], which is contrary to the reported US experience for H1N1 influenza vaccines. |
Protective immunity against H5N1 influenza virus by a single dose vaccination with virus-like particles
Song JM , Hossain J , Yoo DG , Lipatov AS , Davis CT , Quan FS , Chen LM , Hogan RJ , Donis RO , Compans RW , Kang SM . Virology 2010 405 (1) 165-75 We generated influenza virus-like particles (VLPs) containing the wild type (WT) H5 hemagglutinin (HA) from A/Viet Nam/1203/04 virus or a mutant H5 HA with a deletion of the multibasic cleavage motif. VLPs containing mutant H5 HA were found to be as immunogenic as VLPs containing WT HA. A single intramuscular vaccination with either type of H5 VLPs provided complete protection against lethal challenge. In contrast, the recombinant H5 HA vaccine was less immunogenic and vaccination even with a 5 fold higher dose did not induce protective immunity. VLP vaccines were superior to the recombinant HA in inducing T helper type 1 immune responses, hemagglutination inhibition titers, and antibody secreting cells, which significantly contribute to inducing protective immunity after a single dose vaccination. This study provides insights into the potential mechanisms of improved immunogenicity by H5 VLP vaccines as an approach to improve the protective efficacy against potential pandemic viruses. |
Influenza vaccination of household contacts of newborns: a hospital-based strategy to increase vaccination rates
Walter EB , Allred NJ , Swamy GK , Hellkamp AS , Dolor RJ . Infect Control Hosp Epidemiol 2010 31 (10) 1070-3 We implemented a hospital-based influenza vaccination program for household contacts of newborns. Among mothers not vaccinated prenatally, 44.7% were vaccinated through the program, as were 25.7% of fathers. A hospital-based program provided opportunities for vaccination of household contacts of newborns, thereby facilitating better adherence to national vaccination guidelines. |
Accuracy of influenza vaccination status in a computer-based immunization tracking system of a managed care organization
Sy LS , Liu IL , Solano Z , Cheetham TC , Lugg MM , Greene SK , Weintraub ES , Jacobsen SJ . Vaccine 2010 28 (32) 5254-9 Influenza vaccine safety and effectiveness studies conducted using electronic medical records rely on accurate assessment of influenza vaccination status. However, influenza immunization in non-traditional settings (e.g., the workplace) may not be captured in patient immunization tracking systems. We compared influenza vaccination status from electronic records with self-reported vaccination status for five hundred and two 50-79 years olds enrolled in a large managed care organization. Influenza vaccination status in the medical record had a high positive predictive value and specificity (both >99%). The negative predictive value was 80% and sensitivity was 78%. These data suggest that an electronic record of influenza vaccination reliably indicates immunization, while the absence of such a record is only moderately accurate, partly due to vaccines received in non-traditional settings. |
Intimate partner aggression perpetrated and sustained by male Afghanistan, Iraq, and Vietnam veterans with and without posttraumatic stress disorder
Teten AL , Schumacher JA , Taft CT , Stanley MA , Kent TA , Bailey SD , Dunn NJ , White DL . J Interpers Violence 2010 25 (9) 1612-30 Veterans with posttraumatic stress disorder (PTSD) consistently evidence higher rates of intimate partner aggression perpetration than veterans without PTSD, but most studies have examined rates of aggression among Vietnam veterans several years after their deployment. The primary aim of this study was to examine partner aggression among male Afghanistan or Iraq veterans who served during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and compare this aggression to that reported by Vietnam veterans with PTSD. Three groups were recruited, OEF/OIF veterans with PTSD (n = 27), OEF/OIF veterans without PTSD (n = 31), and Vietnam veterans with PTSD (n = 28). Though only a few comparisons reached significance, odds ratios suggested that male OEF/OIF veterans with PTSD were approximately 1.9 to 3.1 times more likely to perpetrate aggression toward their female partners and 1.6 to 6 times more likely to report experiencing female perpetrated aggression than the other two groups. Significant correlations among reports of violence perpetrated and sustained suggested many men may have been in mutually violent relationships. Taken together, these results suggest that partner aggression among Iraq and Afghanistan veterans with PTSD may be an important treatment consideration and target for prevention. |
Automated monitoring of clusters of falls associated with severe winter weather using the BioSense system
Dey AN , Hicks P , Benoit S , Tokars JI . Inj Prev 2010 16 (6) 403-7 OBJECTIVES: To identify and characterise clusters of emergency department (ED) visits for fall injuries during the 2007-2008 winter season. METHODS: Hospital ED chief complaints and diagnoses from hospitals reporting to the Centers for Disease Control and Prevention BioSense system were analysed. The authors performed descriptive analyses, used time series charts on data aggregated by metropolitan statistical areas (MSAs), and used SaTScan to find spatial-temporal clusters of visits from falls. RESULTS: In 2007-2008, 17 clusters of falls in 13 MSAs were found; the median number of excess ED visits for falls was 71 per day. SaTScan identified 11 clusters of falls, of which seven corresponded to MSA clusters found by time series and five included more than one state/district. Most clusters coincided with known periods of snowfall or freezing rain. CONCLUSION: The results show the role that a national automated system can play in tracking widespread injuries. Such a system could be harnessed to assist with prevention strategies. |
Rapid detection of multidrug resistant tuberculosis using real-time PCR and high resolution melt analysis
Ramirez MV , Cowart KC , Campbell PJ , Morlock GP , Sikes D , Winchell JM , Posey JE . J Clin Microbiol 2010 48 (11) 4003-9 The current study describes the development of a unique real-time PCR assay for the detection of mutations conferring drug resistance in Mycobacterium tuberculosis (Mtb). The Rifampicin Resistance Determinant Region (RRDR) of rpoB and specific regions of katG and the inhA promoter were targeted for the detection of rifampicin (RIF) and isoniazid (INH) resistance, respectively. Additionally, this assay was multiplexed to discriminate Mycobacterium tuberculosis complex (MTBC) strains from Nontuberculous Mycobacteria (NTM) strains by targeting the IS6110 insertion element. High resolution melting (HRM) analysis following real-time PCR was used to identify Mtb strains containing mutations at the targeted loci, and locked nucleic acid (LNA) probes were used to enhance the detection of strains containing specific SNP transversion mutations. This method was used to screen 252 Mtb clinical isolates including 154 RIF resistant strains and 174 INH resistant strains based on the agar proportion method of drug susceptibility testing (DST). Of the 154 RIF resistant strains, 148 were also resistant to INH and therefore classified as multidrug resistant (MDR). The assay demonstrated a sensitivity and specificity of 91% and 98%, respectively, for the detection of RIF resistance, and 87% and 100% for the detection of INH resistance. Overall, this assay showed a sensitivity of 85% and a specificity of 98% for the detection of MDR strains. This method provides a rapid, robust, and inexpensive way to detect the dominant mutations known to confer MDR in Mtb strains and offers several advantages over current molecular and culture-based techniques. |
Robust hepatitis B virus genotyping by mass spectrometry
Ganova-Raeva L , Ramachandran S , Honisch C , Forbi JC , Zhai X , Khudyakov Y . J Clin Microbiol 2010 48 (11) 4161-8 Genotyping of hepatitis B virus (HBV) is important for tracking HBV infections, prognosticating the development of severe liver disease and predicting outcomes of therapy. Current genotyping methods can be laborious, costly and rely on subjective data interpretation. To identify less expensive but equally reliable alternatives, we compared gold standard sequencing to a novel mass spectrometry approach. Sera from individuals with acute or chronic HBV infection (n=756), representing all genotypes, were used to PCR-amplify the HBV S gene. All amplicons were subject to base-specific cleavage and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The resulting mass peak patterns were used to identify HBV genotype by automated comparison to peak patterns simulated from reference sets of HBV sequences of known genotypes. The MALDI-TOF MS data and phylogenetic analysis of HBV sequences produced completely concordant results. Several parameters such as genetic relatedness of tested HBV variants to the reference set, chronic infections, as well as the quality of PCR products, can lower the MS score but never affected the accuracy of the genotype call. This new streamlined MS-based method provides for rapid and accurate HBV genotyping, produces automated data reports and is therefore suitable for routine use in diagnostic settings. |
Variability of the polymerase gene (NS5B) in HCV-infected women
Blackard JT , Ma G , Limketkai BN , Welge JA , Dryer PD , Martin CM , Hiasa Y , Taylor LE , Mayer KH , Jamieson DJ , Sherman KE . J Clin Microbiol 2010 48 (11) 4256-9 There are limited data on diversity within the HCV polymerase (NS5B). In concordance with its key functional role during the life cycle, NS5B intrapatient variability was low. Moreover, NS5B dN-dS values were positively correlated with CD4 cell count, while non-synonymous mutations were strongly correlated with reduced replication in vivo. |
Emergence of resistance among USA300 methicillin-resistant Staphylococcus aureus isolates causing invasive disease in the United States
McDougal LK , Fosheim GE , Nicholson A , Bulens SN , Limbago BM , Shearer JE , Summers AO , Patel JB . Antimicrob Agents Chemother 2010 54 (9) 3804-11 USA300 methicillin-resistant Staphylococcus aureus (MRSA) isolates are usually resistant only to oxacillin, erythromycin, and, increasingly, levofloxacin. Of these, oxacillin and levofloxacin resistances are chromosomally encoded. Plasmid-mediated clindamycin, mupirocin, and/or tetracycline resistance has been observed among USA300 isolates, but these descriptions were limited to specific patient populations or isolated occurrences. We examined the antimicrobial susceptibilities of invasive MRSA isolates from a national surveillance population in order to identify USA300 isolates with unusual, possibly emerging, plasmid-mediated antimicrobial resistance. DNA from these isolates was assayed for the presence of resistance determinants and the presence of a pSK41-like conjugative plasmid. Of 823 USA300 isolates, 72 (9%) were tetracycline resistant; 69 of these were doxycycline susceptible and tetK positive, and 3 were doxycycline resistant and tetM positive. Fifty-one (6.2%) isolates were clindamycin resistant and ermC positive; 22 (2.7%) isolates were high-level mupirocin resistant (mupA positive); 5 (0.6%) isolates were trimethoprim-sulfamethoxazole (TMP-SMZ) resistant, of which 4 were dfrA positive; and 7 (0.9%) isolates were gentamicin resistant and aac6'-aph2'' positive. Isolates with pSK41-like plasmids (n = 24) were positive for mupA (n = 19), dfrA (n = 6), aac6'-aph2'' (n = 6), tetM (n = 2), and ermC (n = 8); 20 pSK41-positive isolates were positive for two or more resistance genes. Conjugative transfer of resistance was demonstrated between four gentamicin- and mupirocin-resistant and three gentamicin- and TMP-SMZ-resistant USA300 isolates; transconjugants harbored a single pSK41-like plasmid, which was PCR positive for aac6'-aph2'' and either mupA and/or dfrA. USA300 and USA100 isolates from the same state with identical resistance profiles contained pSK41-like plasmids with indistinguishable restriction and Southern blot profiles, suggesting horizontal plasmid transfer between USA100 and USA300 isolates. |
Enhanced determination of Streptococcus pneumoniae serotypes associated with invasive disease in Laos by using a real-time polymerase chain reaction serotyping assay with cerebrospinal fluid
Moore CE , Sengduangphachanh A , Thaojaikong T , Sirisouk J , Foster D , Phetsouvanh R , McGee L , Crook DW , Newton PN , Peacock SJ . Am J Trop Med Hyg 2010 83 (3) 451-457 A prospective hospital-based study was undertaken to define the incidence of invasive pneumococcal disease (IPD) and circulating serotypes in Laos. Of 10,799 patients with hemocultures and 353 patients with cerebrospinal fluid samples, 0.21% and 5.4%, respectively, were positive for Streptococcus pneumoniae, giving a total of 35 IPD patients. We developed a real-time polymerase chain reaction to detect serotypes represented in the 13-valent pneumococcal vaccine. A blinded evaluation comparing serotype as defined by the Quellung reaction versus the polymerase chain reaction demonstrated 100% concordance. The most frequent serotype (n = 33 patients) was 1 (n = 6), followed by serotypes 5, 6A/B/C, 14, and 23F. Serotypes represented in the 7-valent polysaccharide-protein conjugate vaccine (PCV-7) infected 39% of patients, with 73% coverage for the PCV-10 and PCV-13 vaccines. Although the sample size is small, these data suggest that the PCV-7 vaccine may have relatively low efficacy in Laos. Further studies are urgently needed to guide pneumococcal vaccine policy in Laos. |
Extraction of BoNT/A, /B, /E, and /F with a single, high affinity monoclonal antibody for detection of botulinum neurotoxin by Endopep-MS
Kalb SR , Garcia-Rodriguez C , Lou J , Baudys J , Smith TJ , Marks JD , Smith LA , Pirkle JL , Barr JR . PLoS One 2010 5 (8) e12237 Botulinum neurotoxins (BoNTs) are extremely potent toxins that are capable of causing respiratory failure leading to long-term intensive care or death. The best treatment for botulism includes serotype-specific antitoxins, which are most effective when administered early in the course of the intoxication. Early confirmation of human exposure to any serotype of BoNT is an important public health goal. In previous work, we focused on developing Endopep-MS, a mass spectrometry-based endopeptidase method for detecting and differentiating the seven serotypes (BoNT/A-G) in buffer and BoNT/A, /B, /E, and /F (the four serotypes that commonly affect humans) in clinical samples. We have previously reported the success of antibody-capture to purify and concentrate BoNTs from complex matrices, such as clinical samples. However, to check for any one of the four serotypes of BoNT/A, /B, /E, or /F, each sample is split into 4 aliquots, and tested for the specific serotypes separately. The discovery of a unique monoclonal antibody that recognizes all four serotypes of BoNT/A, /B, /E and /F allows us to perform simultaneous detection of all of them. When applied in conjunction with the Endopep-MS assay, the detection limit for each serotype of BoNT with this multi-specific monoclonal antibody is similar to that obtained when using other serotype-specific antibodies. |
Human isolates of Bartonella tamiae induce pathology in experimentally inoculated immunocompetent mice
Colton L , Zeidner N , Lynch T , Kosoy MY . BMC Infect Dis 2010 10 229 BACKGROUND: Bartonella tamiae, a newly described bacterial species, was isolated from the blood of three hospitalized patients in Thailand. These patients presented with headache, myalgia, anemia, and mild liver function abnormalities. Since B. tamiae was presumed to be the cause of their illness, these isolates were inoculated into immunocompetent mice to determine their relative pathogenicity in inducing manifestations of disease and pathology similar to that observed in humans. METHODS: Three groups of four Swiss Webster female mice aged 15-18 months were each inoculated with 10(6-7) colony forming units of one of three B. tamiae isolates [Th239, Th307, and Th339]. A mouse from each experimental group was sampled at 3, 4, 5 and 6 weeks post-inoculation. Two saline inoculated age-matched controls were included in the study. Samples collected at necropsy were evaluated for the presence of B. tamiae DNA, and tissues were formalin-fixed, stained with hematoxylin and eosin, and examined for histopathology. RESULTS: Following inoculation with B. tamiae, mice developed ulcerative skin lesions and subcutaneous masses on the lateral thorax, as well as axillary and inguinal lymphadenopathy. B. tamiae DNA was found in subcutaneous masses, lymph node, and liver of inoculated mice. Histopathological changes were observed in tissues of inoculated mice, and severity of lesions correlated with the isolate inoculated, with the most severe pathology induced by B. tamiae Th239. Mice inoculated with Th239 and Th339 demonstrated myocarditis, lymphadenitis with associated vascular necrosis, and granulomatous hepatitis and nephritis with associated hepatocellular and renal necrosis. Mice inoculated with Th307 developed a deep dermatitis and granulomas within the kidneys. CONCLUSIONS: The three isolates of B. tamiae evaluated in this study induce disease in immunocompetent Swiss Webster mice up to 6 weeks after inoculation. The human patients from whom these isolates were obtained had clinical presentations consistent with the multi-organ pathology observed in mice in this study. This mouse model for B. tamiae induced disease not only strengthens the causal link between this pathogen and clinical illness in humans, but provides a model to further study the pathological processes induced by these bacteria. |
Andes virus disrupts the endothelial cell barrier by induction of VEGF and down-regulation of VE-cadherin
Shrivastava-Ranjan P , Rollin PE , Spiropoulou CF . J Virol 2010 84 (21) 11227-34 Hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS) are severe diseases associated with hantavirus infections. High levels of virus replication occur in microvascular endothelial cells but without virus induced cytopathic effect. However, virus infection results in microvascular leakage, which is the hallmark of these diseases. VE-cadherin is a major component of adherens junctions, and its interaction with the VEGF receptor, VEGF-R2, is important for maintaining the integrity of the endothelial barrier. Here we report that increased secreted VEGF and concomitant decreased VE-cadherin is seen at early times post-infection of human primary lung endothelial cells with an HPS associated hantavirus, Andes virus. Furthermore, active virus replication results in increased permeability and loss of the integrity of the endothelial cell barrier. VEGF binding to VEGF-R2 is known to result in dissociation of VEGF-R2 from VE-cadherin and VE-cadherin activation, internalization and degradation. Consistent with this, we showed that an antibody which blocks VEGF-R2 activation resulted in inhibition of the Andes virus induced VE-cadherin reduction. These data implicate virus induction of VEGF and reduction in VE-cadherin in the endothelial cell permeability seen in HPS, and suggest potential immunotherapeutic targets for the treatment of the disease. |
Bartonella genotypes in fleas (Insecta: Siphonaptera) collected from rodents in the Negev Desert, Israel
Morick D , Krasnov BR , Khokhlova IS , Shenbrot GI , Kosoy MY , Harrus S . Appl Environ Microbiol 2010 76 (20) 6864-9 Fleas collected from rodents in the Negev Desert in southern Israel were molecularly screened for Bartonella species. A total of 1,148 fleas, collected from 122 rodents belonging to six species, were pooled in 245 pools based on flea species, sex, and rodent host species. Two Bartonella gene fragments, corresponding to RNA polymerase B (rpoB) and citrate synthase (gltA) were targeted, and 94 and 74 flea pools were found PCR positive, respectively. The Bartonella 16S-23S internal transcribed spacer (ITS) region was also targeted and 66 flea pools were found PCR-positive. Sixteen different Bartonella gltA-genotypes were detected in 94 positive flea pools collected from 5 different rodent species, indicating that fleas collected from each rodent species can harbor several Bartonella genotypes. Based on the gltA analysis, identified Bartonella genotypes were highly similar or identical to strains previously detected in rodent species from different parts of the world. A gltA fragment, 100% similar to Bartonella henselae was detected in one flea pool. Another 2 flea pools contained gltA fragments that were closely related to B. henselae (98% similarity). The high sequence similarities to the zoonotic pathogen, B. henselae warrant further investigation. |
Characterization of 2 human genotype G10 rotavirus strains, 3008CM and 1784/CI/1999, isolated in Cameroon and Cote d'Ivoire during the 1999-2000 rotavirus season
Esona MD , Page NA , Akran VA , Armah GE , Steele AD . J Infect Dis 2010 202 Suppl S212-9 During routine rotavirus surveillance projects in Cameroon and Cote d'Ivoire, 2 fecal samples collected from 2 children <5 years of age who presented with symptoms of gastroenteritis were found to give anomalous G typing results. These specimens were strongly rotavirus positive by enzyme immunoassay, displayed VP6 subgroup II specificity and long RNA electropherotypes, and were typed as rotavirus serotype G2 with monoclonal antibodies. In addition, the strains were typed as rotavirus VP7 genotype G3 and VP4 genotype P[8] by reverse-transcription polymerase chain reaction. Further investigation of the polymerase chain reaction G-typing results with a second set of primers revealed that the specimens were not genotype G3, and both samples were sequenced to elucidate the problem. Both strains were found to be genotype G10 by nucleotide sequence. Comparison of nucleotide and amino acid sequences and phylogenetic analysis of the African G10 strains revealed that these strains are closely related to the human G10 strains that were detected during the 2001-2003 rotavirus season in Ghana. The detection of G10 rotavirus in Africa adds to the global distribution of this strain and strengthens the need to continue strain surveillance in developing countries to understand the extent of strain distribution and diversity. |
Cholesterol and phytosterols differentially regulate the expression of caveolin 1 and a downstream prostate cell growth-suppressor gene
Ifere GO , Equan A , Gordon K , Nagappan P , Igietseme JU , Ananaba GA . Cancer Epidemiol 2010 34 (4) 461-71 BACKGROUND: The purpose of our study was to show the distinction between the apoptotic and anti-proliferative signaling of phytosterols and cholesterol-enrichment in prostate cancer cell lines, mediated by the differential transcription of caveolin-1, and N-myc downstream-regulated gene 1 (NDRG1), a pro-apoptotic androgen-regulated tumor suppressor. METHODS: PC-3 and DU145 cells were treated with sterols (cholesterol and phytosterols) for 72h, followed by trypan blue dye-exclusion measurement of necrosis and cell growth measured with a Coulter counter. Sterol induction of cell growth-suppressor gene expression was evaluated by mRNA transcription using RT-PCR, while cell cycle analysis was performed by FACS analysis. Altered expression of Ndrg1 protein was confirmed by Western blot analysis. Apoptosis was evaluated by real time RT-PCR amplification of P53, Bcl-2 gene and its related pro- and anti-apoptotic family members. RESULTS: Physiological doses (16microM) of cholesterol and phytosterols were not cytotoxic in these cells. Cholesterol-enrichment promoted cell growth (P<0.05), while phytosterols significantly induced growth-suppression (P<0.05) and apoptosis. Cell cycle analysis showed that contrary to cholesterol, phytosterols decreased mitotic subpopulations. We demonstrated for the first time that cholesterols concertedly attenuated the expression of caveolin-1 (cav-1) and NDRG1 genes in both prostate cancer cell lines. Phytosterols had the opposite effect by inducing overexpression of cav-1, a known mediator of androgen-dependent signals that presumably control cell growth or apoptosis. CONCLUSIONS: Cholesterol and phytosterol treatment differentially regulated the growth of prostate cancer cells and the expression of p53 and cav-1, a gene that regulates androgen-regulated signals. These sterols also differentially regulated cell cycle arrest, downstream pro-apoptotic androgen-regulated tumor suppressor, NDRG1 suggesting that cav-1 may mediate pro-apoptotic NDRG1 signals. Elucidation of the mechanism for sterol modulation of growth and apoptosis signaling may reveal potential targets for cancer prevention and/or chemotherapeutic intervention. Sterol regulation of NDRG1 transcription suggests its potential as biomarker for prediction of neoplasms that would be responsive to chemoprevention by phytosterols. |
Determination of the G and P types of previously nontypeable rotavirus strains from the African rotavirus network, 1996-2004: identification of unusual G types
Esona MD , Steele D , Kerin T , Armah G , Peenze I , Geyer A , Page N , Nyangao J , Agbaya VA , Trabelsi A , Tsion B , Aminu M , Sebunya T , Dewar J , Glass R , Gentsch J . J Infect Dis 2010 202 Suppl S49-54 A total of 215 nontypeable rotavirus samples collected from children <5 years of age by members of the African Rotavirus Network were characterized using reverse-transcription polymerase chain reaction analysis and sequencing. The most predominant strain identified was P[8]G1 (46.9%). Genotypes P[8]G10, P[8]G8, P[6]G8, and P[7]G5 were also detected at frequencies varying from 0.5% to 2.3%. This study suggests that reassortment of unusual G types into a background of globally common genotype P[8] strains may be a major mechanism of generating rotavirus diversity. Nucleotide substitutions at the P[8], P[6], and G1 primer binding sites accounted for the failure to type these strains initially. Hence, these findings highlight the need for regular evaluation of rotavirus genotyping methods. |
Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis
Lasswell SM , Barfield WD , Rochat RW , Blackmon L . JAMA 2010 304 (9) 992-1000 CONTEXT: For more than 30 years, guidelines for perinatal regionalization have recommended that very low-birth-weight (VLBW) infants be born at highly specialized hospitals, most commonly designated as level III hospitals. Despite these recommendations, some regions continue to have large percentages of VLBW infants born in lower-level hospitals. OBJECTIVE: To evaluate published data on associations between hospital level at birth and neonatal or predischarge mortality for VLBW and very preterm (VPT) infants. DATA SOURCES: Systematic search of published literature (1976-May 2010) in MEDLINE, CINAHL, EMBASE, and PubMed databases and manual searches of reference lists. STUDY SELECTION AND DATA EXTRACTION: Forty-one publications met a priori inclusion criteria (randomized controlled trial, cohort, and case-control studies measuring neonatal or predischarge mortality among live-born infants < or = 1500 g or < or = 32 weeks' gestation delivered at a level III vs lower-level facility). Paired reviewers independently assessed publications for inclusion and extracted data using standardized forms. Discrepancies were decided by a third reviewer. Publications were reviewed for quality by 3 authors based on 2 content areas: adjustment for confounding and description of hospital levels. We calculated weighted, combined odds ratios (ORs) using a random-effects model and comparative unadjusted pooled mortality rates. DATA SYNTHESIS: We observed increased odds of death for VLBW infants (38% vs 23%; adjusted OR, 1.62; 95% confidence interval [CI], 1.44-1.83) and VPT infants (15% vs 17%; adjusted OR, 1.55; 95% CI, 1.21-1.98) born outside of level III hospitals. Consistent results were obtained when restricted to higher-quality evidence (mortality in VLBW infants, 36% vs 21%; adjusted OR, 1.60; 95% CI, 1.33-1.92 and in VPT infants, 7% vs 12%; adjusted OR, 1.42; 95% CI, 1.06-1.88) and infants weighing less than 1000 g (59% vs 32%; adjusted OR, 1.80; 95% CI, 1.31-2.46). No significant differences were found through subgroup analysis of study characteristics. Meta-regression by year of publication did not reveal a change over time (slope, 0.00; P = .87). CONCLUSION: For VLBW and VPT infants, birth outside of a level III hospital is significantly associated with increased likelihood of neonatal or predischarge death. |
Mitochondrial dysfunction and loss of Parkinson's disease-linked proteins contribute to neurotoxicity of manganese-containing welding fumes
Sriram K , Lin GX , Jefferson AM , Roberts JR , Wirth O , Hayashi Y , Krajnak KM , Soukup JM , Ghio AJ , Reynolds SH , Castranova V , Munson AE , Antonini JM . FASEB J 2010 24 (12) 4989-5002 Welding generates complex metal aerosols, inhalation of which is linked to adverse health effects among welders. An important health concern of welding fume (WF) exposure is neurological dysfunction akin to Parkinson's disease (PD), thought to be mediated by manganese (Mn) in the fumes. Also, there is a proposition that welding might accelerate the onset of PD. Our recent findings link the presence of Mn in the WF with dopaminergic neurotoxicity seen in rats exposed to manual metal arc-hard surfacing (MMA-HS) or gas metal arc-mild steel (GMA-MS) fumes. To elucidate the molecular mechanisms further, we investigated the association of PD-linked (Park) genes and mitochondrial function in causing dopaminergic abnormality. Repeated instillations of the two fumes at doses that mimic approximately 1 to 5 yr of worker exposure resulted in selective brain accumulation of Mn. This accumulation caused impairment of mitochondrial function and loss of tyrosine hydroxylase (TH) protein, indicative of dopaminergic injury. A fascinating finding was the altered expression of Parkin (Park2), Uchl1 (Park5), and Dj1 (Park7) proteins in dopaminergic brain areas. A similar regimen of manganese chloride (MnCl2) also caused extensive loss of striatal TH, mitochondrial electron transport components, and Park proteins. As mutations in PARK genes have been linked to early-onset PD in humans, and because welding is implicated as a risk factor for parkinsonism, PARK genes might play a critical role in WF-mediated dopaminergic dysfunction. Whether these molecular alterations culminate in neurobehavioral and neuropathological deficits reminiscent of PD remains to be ascertained. |
Investigating reduced bag weight as an effective risk mediator for mason tenders
Davis KG , Kotowski SE , Albers J , Marras WS . Appl Ergon 2010 41 (6) 822-31 Masonry workers face some of the highest physical demands in the construction industry where large bags of masonry material weighing 42.7 kg are commonly handled by mason tenders who mix the mortar, distribute mortar and bricks/blocks, and erect/dismantle scaffolding throughout the day. The objective of this study was to determine the effectiveness of using half-weight bags (21.4 kg) on reducing the biomechanical loading, physiological response, and perceived exertions. Ten male subjects performed asymmetric lifting tasks simulating unloading bags from a pallet. Muscle activity, trunk kinematics, heart rate, blood pressure and subjective rating data were collected. Spine loads were predicted from a well-validated EMG-assisted model. Bag weight, lift type, bag height at origin, and asymmetry at destination significantly impacted the spine loads. While there was a 50% reduction in bag weight, the peak loads for the half-weight bags were only 25% less than the more available full-weight bags (a reduction of about 320 N of shear and 1000 N of compression). Lifts allowing movement of the feet reduced the loads by about 22% in shear and 27% in compression compared to constrained postures. Interestingly, cumulative spine loads were greater for the lighter bags than the heavy bags ( approximately 40%). The subjective ratings of exertion and risk were significantly lower for the lighter bags. RELEVANCE TO INDUSTRY: The reduction in peak spine loading for the half-weight bags, particularly at the higher heights and when the feet were allowed to move could significantly reduce the injuries of masonry workers. However, there were trade-offs with cumulative loads that may minimize the reduced risk. Overall, given the limited amount of time lifting bags, the reduction of peak loads. |
Challenges in assessing nanomaterial toxicology: a personal perspective
Geraci CL , Castranova V . Wiley Interdiscip Rev Nanomed Nanobiotechnol 2010 2 (6) 569-77 Nanotechnology exploits the fact that nanoparticles exhibit unique physicochemical properties, which are distinct from fine-sized particles of the same composition. It follows that nanoparticles may also express distinct bioactivity and unique interactions with biological systems. Therefore, it is essential to assess the potential health risks of exposure to nanoparticles to allow development and implementation of prevention measures. Risk assessment requires data concerning hazard and exposure. Several challenges face the field of nanotoxicology in obtaining the necessary data for assessment of the bioactivity of nanoparticles. They include: (1) the vast number of nanoparticle types to be evaluated, (2) the need to use nanoparticle doses and structure sizes in cellular and animal test systems which are relevant to anticipated workplace exposures, and (3) artifactual in vitro results due to absorption of nutrients or assay indicator compounds from the culture media. This 'opinion' reviews the progress made in the field of nanotoxicology in recent years to overcome these challenges. Copyright (c) 2010 John Wiley & Sons, Inc. For further resources related to this article, please visit the WIREs website The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. |
Characteristics of beryllium exposure to small particles at a beryllium production facility
Virji MA , Stefaniak AB , Day GA , Stanton ML , Kent MS , Kreiss K , Schuler CR . Ann Occup Hyg 2010 55 (1) 70-85 Epidemiological studies have reported process-specific elevated prevalence of beryllium sensitization (BeS) and chronic beryllium disease (CBD) among workers. However, exposure-response relationships have been inconsistent, possibly due to incomplete characterization of many biologically relevant aspects of exposure, including particle size. In 1999, two surveys were conducted 3-5 months apart at a beryllium metal, oxide, and alloy production facility during which personal impactor samples (n = 198) and personal 37-mm closed-face cassette (CFC) 'total' samples (n = 4026) were collected. Among process areas, median particle mass median aerodynamic diameter ranged from 5 to 14 mum. A large fraction of the beryllium aerosol was in the nonrespirable size range. Respirable beryllium concentrations were among the highest for oxide production [geometric mean (GM) = 2.02 mug m(-3), geometric standard deviation (GSD) = 1.3] and pebbles plant (GM = 1.05 mug m(-3), GSD = 2.9), areas historically associated with high risk of BeS and CBD. The relationship between GM 'CFC total' and GM respirable beryllium for jobs varied by process areas; the rank order of the jobs showed high overall consistency (Spearman r = 0.84), but the overall correlation was moderate (Pearson r = 0.43). Total beryllium concentrations varied greatly within and between workers among process areas; within-worker variance was larger than between-worker variance for most processes. A review of exposure characteristics among process areas revealed variation in chemical forms and solubility. Process areas with high risk of BeS and CBD had exposure to both soluble and insoluble forms of beryllium. Consideration of biologically relevant aspects of exposure such as beryllium particle size distribution, chemical form, and solubility will likely improve exposure assessment. |
Factors affecting the willingness of counselors to integrate preconception care into sexually transmitted disease clinics
Parker CS , Ghaddar S , Zhang Q , Cooke B . Womens Health Issues 2010 20 (5) 329-34 BACKGROUND: The high rate of unintended pregnancy is an immediate barrier to providing preconception care (PCC). Failure to deliver additional PCC messages at sexually transmitted disease (STD) clinics might represent a major missed opportunity to target women at increased risk for unintended pregnancy for behaviors that also put them at risk for adverse pregnancy outcomes. METHODS: Using a survey questionnaire, we assessed perceptions of PCC and factors influencing the willingness of STD counselors to integrate PCC as an intervention service provided by the STD clinics of 140 STD counselors. We used a cross-sectional design and selected survey participants with a minimum of 2 years' experience in providing HIV pretest and posttest counseling and syphilis interviewing using a nonprobability, purposive sample. RESULTS: The level of occupational responsibility and the amount of time available seemed to affect counselor perceptions of the importance of PCC and whether it should be integrated as an intervention service provided by STD clinics. Findings suggested that, although most STD counselors reported that PCC was an important issue, there was significant variation in the perception of whether PCC should be delivered at STD clinics. CONCLUSION: STD counselors perceived PCC to be an important intervention service that can be delivered at STD clinics. Additional study is needed to identify factors that might affect full integration into the STD clinic setting. |
Understanding attitudes toward people with Down syndrome
Pace JE , Shin M , Rasmussen SA . Am J Med Genet A 2010 152A (9) 2185-92 Understanding attitudes of the public toward people with Down syndrome is important because negative attitudes might create barriers to social integration, which can affect their success and quality of life. We used data from two 2008 U.S. surveys (HealthStyles(c) survey of adults 18 years or older and YouthStyles(c) survey of youth ages 9-18) that asked about attitudes toward people with Down syndrome, including attitudes toward educational and occupational inclusion and toward willingness to interact with people with Down syndrome. Results showed that many adults continue to hold negative attitudes toward people with Down syndrome: A quarter of respondents agreed that students with Down syndrome should go to special schools, nearly 30% agreed that including students with Down syndrome in typical educational settings is distracting, and 18% agreed that persons with Down syndrome in the workplace increase the chance for accidents. Negative attitudes were also held by many youth: 30% agreed that students with Down syndrome should go to separate schools, 27% were not willing to work with a student with Down syndrome on a class project, and nearly 40% indicated they would not be willing to spend time with a student with Down syndrome outside of school. Among both adult and youth, female sex and respondents with previous relationships with people with Down syndrome were consistently associated with more positive attitudes. These results may be helpful in the development of educational materials about Down syndrome and in guiding policies on educational and occupational inclusion. Published 2010 Wiley-Liss, Inc. |
Association of childhood trauma with cognitive function in healthy adults: a pilot study
Majer M , Nater UM , Lin JM , Capuron L , Reeves WC . BMC Neurol 2010 10 61 BACKGROUND: Animal and human studies suggest that stress experienced early in life has detrimental consequences on brain development, including brain regions involved in cognitive function. Cognitive changes are cardinal features of depression and posttraumatic stress disorder. Early-life trauma is a major risk factor for these disorders. Only few studies have measured the long-term consequences of childhood trauma on cognitive function in healthy adults. METHODS: In this pilot study, we investigated the relationship between childhood trauma exposure and cognitive function in 47 healthy adults, who were identified as part of a larger study from the general population in Wichita, KS. We used the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wide-Range-Achievement-Test (WRAT-3) to examine cognitive function and individual achievement. Type and severity of childhood trauma was assessed by the Childhood Trauma Questionnaire (CTQ). Data were analyzed using multiple linear regression on CANTAB measures with primary predictors (CTQ scales) and potential confounders (age, sex, education, income). RESULTS: Specific CTQ scales were significantly associated with measures of cognitive function. Emotional abuse was associated with impaired spatial working memory performance. Physical neglect correlated with impaired spatial working memory and pattern recognition memory. Sexual abuse and physical neglect were negatively associated with WRAT-3 scores. However, the association did not reach the significance level of p < 0.01. CONCLUSIONS: Our results suggest that physical neglect and emotional abuse might be associated with memory deficits in adulthood, which in turn might pose a risk factor for the development of psychopathology. |
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