Classification of body fatness by body mass index-for-age categories among children
Freedman DS , Wang J , Thornton JC , Mei Z , Sopher AB , Pierson RN Jr , Dietz WH , Horlick M . Arch Pediatr Adolesc Med 2009 163 (9) 805-11 OBJECTIVE: To examine the ability of various body mass index (BMI)-for-age categories, including the Centers for Disease Control and Prevention's 85th to 94th percentiles, to correctly classify the body fatness of children and adolescents. DESIGN: Cross-sectional. SETTING: The New York Obesity Research Center at St Luke's-Roosevelt Hospital from 1995 to 2000. PARTICIPANTS: Healthy 5- to 18-year-old children and adolescents (N = 1196) were recruited in the New York City area through newspaper notices, announcements at schools and activity centers, and word of mouth. MAIN OUTCOME MEASURES: Percent body fat as determined by dual-energy x-ray absorptiometry. Body fatness cutoffs were chosen so that the number of children in each category (normal, moderate, and elevated fatness) would equal the number of children in the corresponding BMI-for-age category (<85th percentile, 85th-94th percentile, and > or =95th percentile, respectively). RESULTS: About 77% of the children who had a BMI for age at or above the 95th percentile had an elevated body fatness, but levels of body fatness among children who had a BMI for age between the 85th and 94th percentiles (n = 200) were more variable; about one-half of these children had a moderate level of body fatness, but 30% had a normal body fatness and 20% had an elevated body fatness. The prevalence of normal levels of body fatness among these 200 children was highest among black children (50%) and among those within the 85th to 89th percentiles of BMI for age (40%). CONCLUSION: Body mass index is an appropriate screening test to identify children who should have further evaluation and follow-up, but it is not diagnostic of level of adiposity. |
Lack of evidence for human herpesvirus-8 transmission via blood transfusion in a historical US cohort
Cannon MJ , Operskalski EA , Mosley JW , Radford K , Dollard SC . J Infect Dis 2009 199 (11) 1592-8 BACKGROUND: Recent studies have found evidence of occasional human herpesvirus (HHV)-8 transmission via blood transfusion. However, because these studies were conducted outside the United States or did not have linked donor-recipient pairs, they have a limited ability to inform US blood-banking policy. METHODS: We investigated HHV-8 transmission via blood transfusion in the United States by conducting HHV-8 serologic testing among participants of the Transfusion-Transmitted Viruses Study (TTVS), who enrolled during the 1970s. RESULTS: HHV-8 seroprevalence was 2.8% (29/1023) among blood donors, 7.1% (96/1350) among transfusion recipients, 7.7% (46/599) among surgical control patients who did not receive transfusions, and 96.3% (77/80) among control patients with Kaposi sarcoma. One transfusion recipient seroconverted (0.08% [1/1259]), but this patient did not receive any HHV-8-seropositive blood units, suggesting that the infection was not related to blood transfusion. One of the surgical control patients who did not receive transfusions also seroconverted (0.18% [1/556]). Rates of seroconversion were 1.6 per 1000 person-years (95% confidence interval [CI], 0.04-8.9 per 1000 person-years) for the transfusion recipients and 3.6 per 1000 person-years (95% CI, 0.09-20.1 per 1000 person-years) for the surgical control patients who did not receive transfusions (P = .61). CONCLUSIONS: Rates of HHV-8 seroconversion in the transfusion and nontransfusion groups were not statistically different, and the historical nature of the cohort (e.g., before leukoreduction) suggests that any current transmission via blood transfusion is rare. |
Missed and delayed syphilis treatment and partner elicitation: a comparison between STD clinic and non-STD clinic patients
Chen SY , Johnson M , Sunenshine R , England B , Komatsu K , Taylor M . Sex Transm Dis 2009 36 (7) 445-51 BACKGROUND: Because of increases in reported syphilis, we sought to identify factors associated with missed and delayed syphilis treatment and partner elicitation interview. METHODS: We reviewed syphilis cases reported during June 1, 2006 to May 31, 2007 and conducted multivariate logistic regression analyses to determine demographic and clinical predictors of missed and delayed syphilis treatment and partner elicitation interview. RESULTS: Of 638 syphilis cases, 38 (6%) were identified as untreated cases. Median time-to-treatment was 7 days (range: 0-380) and median time-to-partner elicitation interview was 14 days (range: 0-380 days) for all case-patients. Both intervals were shorter for patients among whom syphilis was diagnosed at the STD clinic versus non-STD facilities. In multivariate analysis, diagnosis at a non-STD clinic (AOR: 2.6; 95% CI, 1.0-6.9) and having a late infection of unknown duration (AOR: 2.1; 95% CI, 1.0-4.6) were significantly associated with untreated syphilis. CONCLUSION: Time-to-treatment and time-to-partner elicitation interview were shorter for patients among whom syphilis was diagnosed at the STD clinic. For non-STD settings in Maricopa County, improvements in quality of care (i.e., timely treatment) and expeditious public health interventions (i.e., partner elicitation interview) are needed. |
A public health approach to rapid scale-up of free antiretroviral treatment in China: an ounce of prevention is worth a pound of cure
Bulterys M , Vermund SH , Chen RY , Ou CY . Chin Med J (Engl) 2009 122 (11) 1352-5 China's rapidly evolving HIV/AIDS epidemic calls for a dramatic expansion of both prevention and treatment services.1,2 Official state media recently reported that for the first time, in 2008, HIV/AIDS became China's leading cause of death among infectious diseases.3 Estimates from the Ministry of Health indicate that around 700 000 people were living with HIV and 85 000 people had AIDS in 2007.4 Initially, HIV-1 infection was confined primarily to certain high-risk populations such as injection drug users (IDU) along drug-trafficking routes, and former plasma donors (FPD) in rural communities in east-central China.1,5–7 Now, however, HIV prevalence is increasing among female sex workers (FSW) and men who have sex with men (MSM).4,8 It is estimated that in 2008, approximately 45% of new HIV cases in China were attributed to heterosexual transmission and 12% to MSM; the proportion of women infected has also doubled in the past decade. | To respond effectively to the urgent need of patients with advanced HIV disease, the Chinese government in 2003 started the National Free Antiretroviral Treatment Program (NFATP). Initially focused on FPD in rural communities,6 this program has since expanded to all 31 provinces. In 2009, the government announced that second-line antiretroviral treatment (ART) — at a cost of approximately $1760 per patient per year — will be provided free to AIDS patients who have become resistant to first-line ART.9 In this issue of the Chinese Medical Journal, investigators and leaders from the National Center for AIDS/STD Control and Prevention (NCAIDS) at the Chinese Center for Disease Control and Prevention describe the formidable challenges in rolling out ART to all those who need it.10 They highlight ethical considerations in distributing the benefits of ART equitably in the context of seeking to minimize development of multi-drug resistant HIV strains. The authors conclude that the aim of universal access to ART is achievable in China with additional and innovative strategies. |
Relapse associated with active disease caused by Beijing strain of Mycobacterium tuberculosis
Burman WJ , Bliven EE , Cowan L , Bozeman L , Nahid P , Diem L , Vernon A , Tuberculosis Trials Consortium . Emerg Infect Dis 2009 15 (7) 1061-7 The role of microbial factors in outcomes of tuberculosis treatment has not been well studied. We performed a case-control study to evaluate the association between a Beijing strain and tuberculosis treatment outcomes. Isolates from patients with culture-positive treatment failure (n = 8) or relapse (n = 54) were compared with isolates from randomly selected controls (n = 296) by using spoligotyping. Patients with Beijing strains had a higher risk for relapse (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0-4.0, p = 0.04) but not for treatment failure. Adjustment for factors previously associated with relapse had little effect on the association between Beijing strains and relapse. Beijing strains were strongly associated with relapse among Asian-Pacific Islanders (OR 11, 95% CI 1.1-108, p = 0.04). Active disease caused by a Beijing strain was associated with increased risk for relapse, particularly among Asian-Pacific Islanders. |
Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant shigella sonnei: Implications for the management of shigellosis outbreaks among children
Arvelo W , Hinkle CJ , Nguyen TA , Weiser T , Steinmuller N , Khan F , Gladbach S , Parsons M , Jennings D , Zhu BP , Mintz E , Bowen A . Pediatr Infect Dis J 2009 28 (11) 976-80 BACKGROUND: Shigellosis outbreaks in daycare centers result in substantial disease and economic burdens in the United States. The emergence of multidrug resistant Shigella strains raises questions regarding control of transmission within daycare centers and treatment for children. From May to October 2005, 639 Shigella sonnei cases were reported in northwest Missouri, mostly among persons exposed to daycare centers. METHODS: We conducted a case-control investigation among licensed daycare centers (LDCs) in northwest Missouri to determine transmission risk factors, tested isolates for antimicrobial resistance, and described treatment practices. Case LDCs had secondary attack rates of shigellosis ≥2% (range, 2%-25%) and control LDCs ≤2% (range, 0%-1.3%). We interviewed LDC staff and performed on-site inspections. Thirty-one outbreak isolates were tested for antimicrobial resistance. We interviewed physicians and reviewed health department outbreak-related treatment data. RESULTS: We enrolled 18 case and 21 control LDCs. LDCs with ≥1 sink in every room (odds ratio [OR]: 0.1; 95% confidence interval [CI]: 0.02-0.5) or a diapering station in every room (OR: 0.1; 95% CI: 0.01-0.6) were less likely to be case-LDCs. Resistance to ampicillin and trimethoprim-sulfamethoxazole was found in 90% of the outbreak strains. Among 210 children treated with antimicrobial agents, azithromycin was used in 92 (44%) while a fluoroquinolone was used in 11 (5%) children. CONCLUSIONS: During a large daycare center-associated shigellosis outbreak, strains were highly resistant to ampicillin and trimethoprim-sulfamethoxazole. Children were frequently treated with azithromycin and occasionally fluoroquinolones. Appropriate handwashing and diapering infrastructure are necessary to minimize spread of shigellosis within daycare centers, and could reduce use of antimicrobial agents. |
Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans
Garten RJ , Davis CT , Russell CA , Shu B , Lindstrom S , Balish A , Sessions WM , Xu X , Skepner E , Deyde V , Okomo-Adhiambo M , Gubareva L , Barnes J , Smith CB , Emery SL , Hillman MJ , Rivailler P , Smagala J , de Graaf M , Burke DF , Fouchier RA , Pappas C , Alpuche-Aranda CM , Lopez-Gatell H , Olivera H , Lopez I , Myers CA , Faix D , Blair PJ , Yu C , Keene KM , Dotson PD Jr , Boxrud D , Sambol AR , Abid SH , St George K , Bannerman T , Moore AL , Stringer DJ , Blevins P , Demmler-Harrison GJ , Ginsberg M , Kriner P , Waterman S , Smole S , Guevara HF , Belongia EA , Clark PA , Beatrice ST , Donis R , Katz J , Finelli L , Bridges CB , Shaw M , Jernigan DB , Uyeki TM , Smith DJ , Klimov AI , Cox NJ . Science 2009 325 (5937) 197-201 Since its identification in April 2009, an A(H1N1) virus containing a unique combination of gene segments from both North American and Eurasian swine lineages has continued to circulate in humans. The lack of similarity between the 2009 A(H1N1) virus and its nearest relatives indicates that its gene segments have been circulating undetected for an extended period. Its low genetic diversity suggests that the introduction into humans was a single event or multiple events of similar viruses. Molecular markers predictive of adaptation to humans are not currently present in 2009 A(H1N1) viruses, suggesting that previously unrecognized molecular determinants could be responsible for the transmission among humans. Antigenically the viruses are homogeneous and similar to North American swine A(H1N1) viruses but distinct from seasonal human A(H1N1). |
Etiology of a suspected measles outbreak: preceding measles reduction activities in Pakistan
Cohen AL , Salam A , Bosan A , Perry R , Iqbal S , Qureshi SN , Cairns L , Mach O , Mahoney F , Hafiz R . J Coll Physicians Surg Pak 2009 19 (9) 591-4 OBJECTIVE: To characterize patients with suspected measles, determine the magnitude of the outbreak in selected areas, and perform laboratory testing on patients with suspected measles to confirm the etiology of the outbreak. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Islamabad and Rawalpindi in June 2006. METHODOLOGY: Survey and specimen collection from households was carried out in areas affected by rash and fever during the outbreak. Teams asked if household members had rash and fever and administered a detailed questionnaire of clinical signs and symptoms for measles for each person who reported a rash and fever episode. A sample of cases with fever, rash, and either cough, conjunctivitis, or coryza was laboratory tested for measles and rubella. RESULTS: Of 2,225 households visited, 284 individuals met the rash and fever case definition. Laboratory testing of eleven blood specimens revealed that the rash and fever outbreak was caused by rubella in 6 and measles in 2 with three equivocal results. CONCLUSION: Laboratory confirmation of suspected measles cases is essential during measles elimination activities in Pakistan and other countries with endemic rubella. |
Factors affecting QuickVue Influenza A + B rapid test performance in the community setting
Cheng CK , Cowling BJ , Chan KH , Fang VJ , Seto WH , Yung R , Uyeki TM , Houck PM , Peiris JS , Leung GM . Diagn Microbiol Infect Dis 2009 65 (1) 35-41 Rapid diagnosis of influenza can facilitate timely clinical management. We evaluated the performance of the QuickVue Influenza A + B test (Quidel, San Diego, CA) in a community setting and investigated the factors affecting test sensitivity. We recruited 1008 subjects from 30 outpatient clinics in Hong Kong between February and September 2007. Each subject provided 2 pooled pairs of nose and throat swabs; 1 pair was tested by the QuickVue rapid test on site, and the other pair was sent to a laboratory for reference tests. Among 998 enrolled subjects with valid results, the rapid test had overall sensitivity of 0.68 and specificity of 0.96 compared with viral culture. Sensitivity for both influenza A and B was significantly higher for specimens with viral loads greater than 5 log(10) copies/mL. The QuickVue Influenza A + B test has similar sensitivity in point-of-care community settings to more controlled conditions. |
Human infection with highly pathogenic avian influenza A (H5N1) virus: review of clinical issues
Uyeki TM . Clin Infect Dis 2009 49 (2) 279-90 This article provides an updated review of the clinical issues related to human infection with highly pathogenic avian influenza A (H5N1) virus. The clinical data available to date are presented, as well as recent findings on the pathogenesis of and antiviral treatment and immunotherapy for H5N1 virus infection in humans and animal models. |
Screening male prisoners for Chlamydia trachomatis: impact on test positivity among women from their neighborhoods who were tested in family planning clinics
Peterman TA , Newman DR , Goldberg M , Anschuetz GL , Salmon M , Satterwhite CL , Berman SM . Sex Transm Dis 2009 36 (7) 425-9 BACKGROUND: Chlamydia trachomatis screening test positivity among women in the United States has remained high, leading researchers to suggest that programs should also screen men. Men have been screened in Philadelphia prisons since 2002. Philadelphia prisons are similar to jails in other jurisdictions; in 2003 the median duration of incarceration was 17 days. We studied whether screening and treating men in prison influenced C. trachomatis infection among women living in their communities. METHODS: We divided the city into 2 areas: "high-treatment" (high percentage of men were treated for C. trachomatis detected in prison) and "low-treatment" (low percentage of men were treated for C. trachomatis detected in prison). We compared changes in test positivity among women from those areas, who were tested in family planning clinics during the 2 years before versus the 3 years after the male prison screening program began. RESULTS: In 2002 to 2004, prison screening led to treatment of 1054 infections among 23,203 men aged 20 to 24 years living in high-treatment areas and 98 infections among 21,057 men aged 20 to 24 years in low-treatment areas. Test positivity declined among 20- to 24-year-old women in both areas. In high-treatment areas, positivity decreased 9.1% per year from 1999 to 2001 and 4.9% per year from 2001 to 2004. In low-treatment areas, positivity decreased 13.2% per year from 1999 to 2001 and 7.5% per year from 2001 to 2004. CONCLUSION: C. trachomatis test positivity among 20- to 24-year-old women tested in family planning clinics continued to decrease after men were treated for C. trachomatis; however, we found no evidence that the continued decrease was due to the new prison screening program. |
Surface chemistry of dihydromyrcenol (2,6-dimethyl-7-octen-2-ol) with ozone on silanized glass, glass, and vinyl flooring tiles
Ham JE , Wells JR . Atmos Environ (1994) 2009 43 (26) 4023-32 The surface-phase reaction products of dihydromyrcenol (2,6-dimethyl-7-octen-2-ol) with ozone (O-3), air, or nitrogen (N-2) on silanized glass, glass and vinyl flooring tile were investigated using the recently published FACS (FLEC (Field and Laboratory Emission Cell) Automation and Control System). The FACS was used to deliver ozone (100 ppb), air, or N-2 to the surface at a specified flow rate (300 mL min(-1)) and relative humidity (50%) after application of a 2.0% dihydromyrcenol solution in methanol. Oxidation products were detected using the derivatization agents: O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine hydrochloride (PFBHA) and N,O-bis(trimethysilyl)trifluoroacetamide (BSTFA). The positively identified reaction products were glycolaldehyde, 2,6-dimethyl-5-heptenal, and glyoxal. The proposed oxidation products based on previously published VOC/O-3 reaction mechanisms were: 2,6-dimethyl-4-heptenal, 6-methyl-7-octen-2-one and the surface-specific reaction products: 6-methyl-6-hepten-2-one, 6-methyl-5-hepten-2-one, and 6-hydroxy-6-methylheptan-2-one. Though similar products were observed in gasphase dihydromyrcenol/O-3 reactions, the ratio, based on peak area, of the reaction products was different suggesting stabilization of larger molecular weight species by the surface. Emission profiles of these oxidation products over 72 h are also reported. Published by Elsevier Ltd. |
Tobacco smoke exposure and levels of urinary metals in the U.S. youth and adult population: the National Health and Nutrition Examination Survey (NHANES) 1999-2004
Richter PA , Bishop EE , Wang J , Swahn MH . Int J Environ Res Public Health 2009 6 (7) 1930-46 We assessed 12 urine metals in tobacco smoke-exposed and not exposed National Health and Nutrition Examination Survey participants. Our analysis included age, race/ethnicity, and poverty status. Gender and racial/ethnic differences in cadmium and lead and creatinine-adjusted and unadjusted data for group comparisons are presented. Smokers' had higher cadmium, lead, antimony, and barium levels than nonsmokers. Highest lead levels were in the youngest subjects. Lead levels among adults with high second-hand smoke exposure equaled smokers. Older smokers had cadmium levels signaling the potential for cadmium-related toxicity. Given the potential toxicity of metals, our findings complement existing research on exposure to chemicals in tobacco smoke. |
Characterization of PM2.5-bound polycyclic aromatic hydrocarbons in Atlanta - Seasonal variations at urban, suburban, and rural ambient air monitoring sites
Li Z , Porter EN , Sjodin A , Needham LL , Lee S , Russell AG , Mulholland JA . Atmos Environ (1994) 2009 43 (27) 4187-93 Twenty-eight polycyclic aromatic hydrocarbons (PAH) and methylated PAHs (Me-PAH) were measured in daily PM2.5 samples collected at an urban site, a suburban site, and a rural site in and near Atlanta during 2004 (5 samples/month/site). The suburban site, located near a major highway, had higher PM2.5-bound PAH concentrations than did the urban site, and the rural site had the lowest PAH levels. Monthly variations are described for concentrations of total PAHs ([summation sign]PAHs) and individual PAHs. PAH concentrations were much higher in cold months than in warm months, with average monthly [summation sign]PAH concentrations at the urban and suburban-highway monitoring sites ranging from 2.12 to 6.85 ng m-3 during January-February and November-December 2004, compared to 0.38-0.98 ng m-3 during May-September 2004. [summation sign]PAH concentrations were found to be well correlated with PM2.5 and organic carbon (OC) within seasons, and the fractions of PAHs in PM2.5 and OC were higher in winter than in summer. Methyl phenanthrenes were present at higher levels than their un-substituted homologue (phenanthrene), suggesting a petrogenic (unburned petroleum products) input. Retene, a proposed tracer for biomass burning, peaked in March, the month with the highest acreage and frequency of prescribed burning and unplanned fires, and in December, during the high residential wood-burning season, indicating that retene might be a good marker for burning of all biomass materials. In contrast, potassium peaked only in December, indicating that it might be a more specific tracer for wood-burning. |
Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States
Harrison KM , Song R , Zhang X . J Acquir Immune Defic Syndr 2009 53 (1) 124-30 INTRODUCTION: We estimate life expectancy and average years of life lost (AYLL) after an HIV diagnosis using population-based surveillance data from 25 states that have had name-based HIV surveillance since 1996. METHODS: We used US national HIV surveillance data (cases ≥13 years old) to model life expectancy after an HIV diagnosis using the life table approach. We then compared life expectancy at HIV diagnosis with that in the general population of the same age, sex, and race/ethnicity in the same calendar year using vital statistics data to estimate the AYLL due to an HIV diagnosis. RESULTS: Average life expectancy after HIV diagnosis increased from 10.5 to 22.5 years from 1996 to 2005. Life expectancy (years) was better for females than for males but improved less for females (females: 12.6-23.6 and males: 9.9-22.0). In 2005, life expectancy for black males was shortest, followed by Hispanic males and then white males. AYLL for cases diagnosed in 2005 was 21.1 years (males: 19.1 and females: 22.7) compared with 32.9 years in 1996. CONCLUSIONS: Disparity in life expectancy for females and both black and Hispanic males, compared with males and white males, respectively, persists and should be addressed. |
Patterns of change in cardiometabolic risk factors associated with the metabolic syndrome among children and adolescents: the Fels Longitudinal Study
Li C , Ford ES , Huang TT , Sun SS , Goodman E . J Pediatr 2009 155 (3) S5 e9-16 OBJECTIVES: To examine the patterns of change in cardiometabolic risk factors associated with the metabolic syndrome in children and adolescents between the ages of 8 to 19 years. STUDY DESIGN: Data of children and adolescents who participated in the Fels Longitudinal Study were analyzed. Body mass index, waist circumference, fasting insulin, fasting glucose, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure were assessed annually with a standardized protocol. RESULTS: The proportion of participants having at least 1 change between states of high and normal risk ranged from of 11.0% for body mass index to 30.4% for triglycerides. Youth in the high-risk category at baseline had a higher proportion having changed their status for all risk factors (all P < .05) except waist circumference compared with those in the normal-risk category. There were significant time effects for all risk factors (all P < .01) except fasting glucose and triglyceride levels in metric scores, but insignificant time effects for all risk factors in Z-scores in growth curve analyses. CONCLUSIONS: The cardiometabolic risk factors associated with the MetS were relatively stable among white children and adolescents in the normal risk category. Changes in status were common if the risk factor was elevated. |
State-specific prevalence and trends in adult cigarette smoking, United States
Davis S , Malarcher A , Thorne S , Maurice E , Trosclair A , Mowery P . Oncol Times 2009 31 (13) 36-8 Cigarette smoking in the United States results in an estimated 443,000 premature deaths and $193 billion in direct health care expenditures and productivity losses each year.1 During 2007, an estimated 19.8% of adults in the United States were current smokers.2 To update 2006 state-specific estimates of cigarette smoking, CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey and examined trends in cigarette smoking from 1998 to 2007. | The results of these analyses indicated substantial variation in current cigarette smoking during 2007 (range of 8.7% to 31.1%) among the 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands. | Trend analyses of 1998–2007 data indicated that smoking prevalence decreased in 44 states, the District of Columbia, and Puerto Rico, and six states had no substantial changes in prevalence after controlling for age, sex, and race/ethnicity. | However, only Utah and the US Virgin Islands met the Healthy People 2010 target for reducing adult smoking prevalence to 12% (Objective 27-1a).3 The Institute of Medicine (IOM) calls for full implementation of comprehensive, evidence-based tobacco control programs at CDC-recommended funding levels to achieve substantial reductions in tobacco use in all states and areas.4 |
A systematic review of epidemiologic studies assessing condom use and risk of syphilis
Koss CA , Dunne EF , Warner L . Sex Transm Dis 2009 36 (7) 401-5 BACKGROUND: Although systematic reviews of epidemiologic studies have been conducted for condom use and the risk of several sexually transmitted diseases, there have been no such reviews for condom use and syphilis. METHODS: A systematic literature review of epidemiologic studies published from 1972 to 2008 was conducted to evaluate study methods and measures of association reported for condom use and risk of syphilis. RESULTS: All 12 included studies had significant methodologic limitations. Nine (75%) studies were cross-sectional. Although 11 (92%) studies assessed consistent condom use, no studies assessed correct use or condom use problems, nor did any document exposure to a partner infected with syphilis. Ten studies had insufficient information to distinguish prevalent from incident infections. Two studies that assessed both incident infection and consistent condom use suggested a reduced risk of syphilis with consistent condom use; 1 study was statistically significant. CONCLUSIONS: Significant methodologic limitations exist for all reviewed studies of syphilis and condom use. Among the 2 most rigorously designed studies, both suggested a reduced risk of syphilis with consistent condom use. Additional studies incorporating rigorous methods are needed to further assess the effect of condom use on risk of syphilis. |
Trends in hepatitis C virus infection among patients in the HIV Outpatient Study, 1996-2007
Spradling PR , Richardson JT , Buchacz K , Moorman AC , Finelli L , Bell BP , Brooks JT , HIVOutpatient Study Investigators . J Acquir Immune Defic Syndr 2009 53 (3) 388-96 BACKGROUND: Coinfection with hepatitis C virus (HCV) contributes increasingly to the morbidity and mortality of persons infected with HIV. We assessed HCV infection screening practices and determined trends in the prevalence of HCV infection in the HIV Outpatient Study (HOPS) from 1996 to 2007. METHODS: We calculated the proportion of patients eligible to be tested for HCV infection (i.e., never tested or previously tested negative) and the prevalence of HCV infection annually from 1996 to 2007 by sociodemographic, clinical, and HIV risk category characteristics. We used multiple logistic regression analyses to evaluate factors independently associated with HCV testing. RESULTS: A total of 7618 patients were active in the HOPS from 1996 through 2007. The proportion of eligible patients tested for HCV infection increased from 10.7% in 1996 to 76.6% in 2007 and increased among all demographic and risk groups. Overall HCV prevalence decreased from 36.7% in 1996 to 19.7% in 2007; decreases in prevalence occurred among all groups except for injection drug users (IDUs). In multivariate analysis, age older than 35 years, nonwhite race, Hispanic ethnicity, high-risk heterosexual and IDU risk categories, and at least 3 years of enrollment in the HOPS were associated with increased odds of having been tested for HCV infection. CONCLUSIONS: Screening for HCV infection in the HOPS has improved, although a sizable fraction of patients remain unscreened. The decline in overall HCV infection prevalence from 1996 to 2007 resulted primarily from a decline in the fraction of all prevalent infections in the cohort attributable to IDU patients. |
Using spatial regression methods to examine the association between county-level racial/ethnic composition and reported cases of chlamydia and gonorrhea: An illustration with data from the state of Texas
Owusu-Edusei K Jr , Chesson HW . Sex Transm Dis 2009 36 (10) 657-64 BACKGROUND: Several studies have reported racial/ethnic disparities in the incidence of sexually transmitted diseases. However, very few studies have accounted for potential spatial dependence. Additionally, little is known about the relative magnitudes of the associations between county-level racial/ethnic composition and the 2 most commonly reported sexually transmitted diseases. METHODS: We used county-level data from the National Electronic Telecommunications System for Surveillance and the 2000 Census data to investigate the association between county-level racial/ethnic composition and reported cases of the 2 most commonly reported sexually transmitted diseases (chlamydia and gonorrhea) in Texas. We also estimated ordinary least square (OLS) models for comparison. RESULTS: Preliminary results from the spatial regression models indicated that the choice of spatial relationships criteria was important for model specification. The spatial error model (SEM) was superior to the spatial autoregressive model, spatial Durbin model, and OLS. The SEM for the 2 disease equations were further analyzed using a seemingly unrelated regression estimation (SURE) procedure. Although the SEM was superior to all models (using standard criteria), the coefficients were fairly stable across models. Our results showed that a unit change in percent black was associated with 1.6 (1.1 for Hispanic) and 3.3 (0.5 for Hispanic) percent change in chlamydia and gonorrhea rates (on average), respectively, compared with percent white. CONCLUSION: Although there were no substantial differences in the magnitude of the estimated parameters, spatial regression models are potentially superior to OLS models and should be explored in future sexually transmitted disease studies. |
Alcohol assessment among college students using wireless mobile technology
Bernhardt JM , Usdan S , Mays D , Martin R , Cremeens J , Arriola KJ . J Stud Alcohol Drugs 2009 70 (5) 771-5 OBJECTIVE: This study used a two-group randomized design to assess the validity of measuring self-reported alcohol consumption among college students using the Handheld Assisted Network Diary (HAND), a daily diary assessment administered using wireless mobile devices. METHOD: A convenience sample of college students was recruited at a large, public university in the southeastern United States and randomized into two groups. A randomly assigned group of 86 students completed the daily HAND assessment during the 30-day study and a Timeline Followback (TLFB) at 30-day follow-up. A randomly assigned group of 82 students completed the paper-and-pencil Daily Social Diary (DSD) over the same study period. Data from the daily HAND assessment were compared with the TLFB completed at follow-up by participants who completed the HAND using 95% limits of agreement analysis. Furthermore, individual growth models were used to examine differences between the HAND and DSD by comparing the total drinks, drinking days, and drinks per drinking day captured by the two assessments over the study period. RESULTS: Results suggest that the HAND captured similar levels of alcohol use compared with the TLFB completed at follow-up by the same participants. In addition, comparisons of the two study groups suggest that, controlling for baseline alcohol use and demographics, the HAND assessment captured similar levels of total drinks, drinking days, and drinks per drinking day as the paper-and-pencil DSD. CONCLUSIONS: The study findings support the validity of wireless mobile devices as a daily assessment of alcohol use among college students. |
Cerebral palsy: classification and epidemiology
Pakula AT , Van Naarden Braun K , Yeargin-Allsopp M . Phys Med Rehabil Clin N Am 2009 20 (3) 425-52 This article reviews the historical background, classification, and etiology of cerebral palsy (CP), the most common motor disability of childhood. The various methods employed to measure the prevalence of CP in the population are examined. Causes of CP are numerous, and the etiology multi-factorial. Risk factors are categorized by the timing of their proposed occurrence: prenatal, perinatal, and postnatal. The leading prenatal and perinatal risk factors for CP are birth weight and gestational age. Other risk factors include neonatal encephalopathy, multiple pregnancy, infection and inflammation, and a variety of genetic factors. |
Convergence and divergence: differences in disability prevalence estimates in the United States and Canada based on four health survey instruments
Altman BM , Gulley SP . Soc Sci Med 2009 69 (4) 543-52 An analysis of data from the Joint Canada/United States Survey of Health (JCUSH), allows us to compare prevalence estimates that result from four different question sets designed to assess disability from a group of respondents residing in either Canada or the United States. Depending upon the question set used and the coding applied to the responses, age-standardized prevalence estimates varied widely in both countries. In the U.S. noninstitutionalized adult population, disability prevalence estimates ranged from as low as 15.3% to as high as 36.4%, while in Canada the estimates ranged from 13.4% to 37.3%. Concordance and discordance in identification as disabled among these question sets were also examined. In both countries, less than 20% of those identified as disabled by any question set were identified as disabled on all four question sets when using conservative response coding to define disability. Concordance in answers to these questions was also found to be associated with older age, single marital status, low education and low income in both countries. Discordance between question set pairs was similar across both countries whether among measures based on the same domains of disability or different domains of disability. The theory, methods and future of disability measurement in health surveys are discussed in light of these findings. We conclude that understanding and interpreting national prevalence estimates requires more thoughtful attention to the purposes for which data are being collected, the specific definition and operationalizations of disability for those purposes, the methodology used in the data collection and analysis process and the areas of both commonality and difference in the populations identified by each question set. In terms of cross-cultural comparisons, the use of a common set of questions and answer categories and similar survey methodologies provides much more robust results. |
Diagnostic methodologies for chlamydia screening in females aged 15 to 25 years from private insurance claims data in the United States, 2001 to 2005
Owusu-Edusei K , Bohm MK , Kent CK . Sex Transm Dis 2009 36 (7) 419-21 Untreated Chlamydial Infection Can Progress into serious sequelae including pelvic inflammatory disease, ectopic pregnancy, and tubal infertility.1–4 In view of the potential sequelae, routine screening for chlamydia is recommended.5–10 Identifying chlamydia is essential for effective control and prevention programs. However, the majority of chlamydial infections are asymptomatic requiring specific and periodic diagnostic tests for detection.11,12 In the United States, an estimated 2.8 million cases occur each year among youth,13 for whom reported incidence rates are highest.14,15 Diagnostic tests for detecting chlamydia have evolved over the last 2 decades with substantial technological improvements in sensitivity. The corollary to the improvement in sensitivity is the increased potential to detect low-organism loads associated with asymptomatic infections.16,17 The increased use of more sensitive tests and expanded screening resulted in increased number of reports of chlamydia and has consequently been used to explain, in part, recent national and local increases in the incidence of chlamydia.18 Previous studies on the trends and volume of diagnostic tests used survey data largely from public laboratories.16–21 However, very little is known about the trends and volume of chlamydia diagnostic tests using claims data. Results from analyzing medical claims data can complement existing knowledge by providing additional information on the use of diagnostic tests from the private sector’s perspective, including some insights into their respective billing patterns. Closer examination of claims data may also provide insight into trends in the chlamydia Health Plan Employer Data and Information Set (HEDIS) measure. |
Epidemiologic investigation of a 2007 outbreak of Serratia marcescens bloodstream infection in Texas caused by contamination of syringes prefilled with heparin and saline
Su JR , Blossom DB , Chung W , Gullion JS , Pascoe N , Heseltine G , Srinivasan A . Infect Control Hosp Epidemiol 2009 30 (6) 593-5 This retrospective cohort study found that syringes prefilled with heparin flush solution caused an outbreak of Serratia marcescens bloodstream infection at an outpatient treatment center in Texas in 2007. The epidemiologic study supported this conclusion, despite the lack of microbiologic evidence of contamination from environmental and product testing. This report underscores the crucial contributions that epidemiologic studies can make to investigations of outbreaks that are possibly product related. |
An evaluation of the reliability of HIV partner notification disposition coding by disease intervention specialists in the United States
Katz DA , Hogben M , Dooley SW Jr , Golden MR . Sex Transm Dis 2009 36 (7) 459-62 BACKGROUND: The reliability of CDC HIV partner notification (PN) disposition codes has not been evaluated. METHODS: Disease Intervention Specialists (DIS) working for health departments in high HIV/STD-morbidity metropolitan areas completed a questionnaire that presented vignettes describing PN interviews. Questionnaires asked DIS to indicate whether they would record a disposition and what codes they would assign to each partner. RESULTS: A total of 136 DIS from 28 of 29 eligible states participated. Partner 1: The index case says he will inform his partner of his HIV diagnosis and, at follow-up, reports that the partner has tested negative. Seventeen percent of DIS indicated they would record a partner disposition. DIS used 7 different codes to define the PN outcomes. Partner 2: The index case says she will inform her partner, who attends the clinic, indicates no history of testing, and tests HIV-negative. 93% of DIS reported they would record a disposition, 90% of whom used code 6, "Not Previously Tested, New Negative." Partner 3: The index case with partner 2 (above) agrees to have DIS notify her second partner. When contacted, the partner tells DIS that he had previously tested negative and will arrange to be tested himself. He subsequently reports testing HIV-negative, but DIS do not confirm this. Seventy-three percent of DIS recorded a disposition for the partner, of whom 84% used code J, "Located, Refused Counseling and Testing." CONCLUSIONS: CDC HIV PN disposition codes are reliable for simple scenarios with verified outcomes, but less reliable when DIS elicit partner-reported outcomes. |
From biological anthropology to applied public health: epidemiological approaches to the study of infectious disease
Albalak R . Am J Hum Biol 2009 21 (5) 687-93 This article describes two large, multisite infectious disease programs: the Tuberculosis Epidemiologic Studies Consortium (TBESC) and the Emerging Infections Programs (EIPs). The links between biological anthropology and applied public health are highlighted using these programs as examples. Funded by the Centers for Disease Control and Prevention (CDC), the TBESC and EIPs conduct applied public health research to strengthen infectious disease prevention and control efforts in the United States. They involve collaborations among CDC, public health departments, and academic and clinical institutions. Their unique role in national infectious disease work, including their links to anthropology, shared elements, key differences, strengths and challenges, is discussed. |
Sources of outbreaks of foodborne infections in different regions of the world
Gerner-Smidt P , Whichard JM . Foodborne Pathog Dis 2009 6 (5) 523-4 Food attribution analysisis the estimation of the pro-portion of human disease that can be attributed to specificfood commodities. Attribution analysis may be performed indifferent ways and is usually done at the national level. One ofthe ways to determine the relative importance of different foodcommodities as source of human infections is to analyze datafrom outbreaks. However, only outbreak reports that containinformation about both the infecting microorganism and thevehicle are useful for attribution analysis. Recently, Greig andRavel (2009) ascertained the vehicles of foodborne infectionsassociated with outbreaks in the United States, Canada, theEuropean Union (EU), Australia and New Zealand, and othercountries. They used publicly available outbreak reports iden-tified between 1988 and 2007 from governmental sources, peer-reviewed and non-peer-reviewed journals, and list-servs. Atotal of 4093 outbreak reports were ascertained, with the ma-jority originating from the United States (2168) and EU (1287);there were 246 reports from Australia and New Zealand, 208from Canada, and 184 from other countries. A table containingdata in the three dimensions (microorganism, region, and foodvehicle) was constructed and analyzed by multiple corre-spondence analysis |
Young adult injection drug users in the United States continue to practice HIV risk behaviors
Rondinelli AJ , Ouellet LJ , Strathdee SA , Latka MH , Hudson SM , Hagan H , Garfein RS . Drug Alcohol Depend 2009 104 167-74 BACKGROUND: Injection drug users (IDUs) are at risk of acquiring HIV through injection and sexual practices. METHODS: We analyzed data collected in five U.S. cities between 2002 and 2004 to identify correlates of HIV infection among 3285 IDUs ages 15-30 years. RESULTS: Overall, HIV prevalence was 2.8% (95% CI 2.3-3.4), ranging from 0.8% in Chicago to 6.3% in Los Angeles. Mean age was 24 years, 70% were male, 64% non-Hispanic (NH) white, 7% NH black, 17% Hispanic, and 12% were other/mixed race. HIV infection was independently associated with: race/ethnicity (NH black [AOR 4.1, 95% CI 1.9-9.1], Hispanic [AOR 3.6, 95% CI 1.5-8.4], or other/mixed [AOR 2.3, 95% CI 1.1-5.2] vs. NH white); males who only had sex with males compared to males who only had sex with females (AOR 15.3, 95% CI 6.8-34.5); injecting methamphetamine alone or with heroin compared to heroin only (AOR 4.0, 95% CI 1.7-9.7); reporting inconsistent means of obtaining income compared to regular jobs (AOR 2.3, 95% CI 1.1-4.8); and having a history of exchanging sex for money/drugs (AOR 2.8, 95% CI 1.5-5.2). CONCLUSIONS: More than two decades after injection and sexual practices were identified as risk factors for HIV infection, these behaviors remain common among young IDUs. While racial/ethnic disparities persist, methamphetamine may be replacing cocaine as the drug most associated with HIV seropositivity. HIV prevention interventions targeting young IDUs and address both sexual and injection practices are needed. |
Delivery of an HIV prevention counseling program in an infectious diseases clinic: implementation process and lessons learned
Patel SN , Golin CE , Marks G , Grodensky CA , Earp JA , Zeveloff A , O'Daniels C , Gardner L , Boland MS , Davis R , Quinlivan EB . AIDS Patient Care STDS 2009 23 (6) 433-41 Current national guidelines recommend that all HIV care providers routinely counsel their HIV-infected patients about reducing HIV transmission behaviors. In this article we identify the challenges and lessons learned from implementing a provider-delivered HIV transmission risk-reduction intervention for HIV-infected patients (Positive Steps). Based on a multi-site Centers for Disease Control and Prevention (CDC) initiative, we integrated the Positive Steps program into an infectious diseases clinic in North Carolina. Of the nearly 1200 HIV-infected patients, 59% were African American, 44% were white, 33% were women, and over 50% were between 25 and 44 years of age. We obtained feedback from a community advisory board, input from clinic staff, and conducted formative interviews with clinic patients and providers to achieve overall acceptance of the program within the clinic. Clinic providers underwent training to deliver standardized prevention counseling. During program implementation we conducted a quality assessment of program components, including reviewing whether patients were screened for HIV transmission risk behaviors and whether providers counseled their patients. Once Positive Steps was implemented, on average, 69% of patients were screened and 77% of screened patients were counseled during the first 12 months. In analyses of quarterly exit surveys of patients after their medical exams, on average, 73% of respondents reported being asked about safer sex and 51% reported having safer-sex discussions with their providers across six quarterly periods. Of those who had discussions, 91% reported that those discussions were "very" or "moderately helpful." Providers reported time and competing medical priorities as barriers for discussing prevention with patients, however, provider-delivered counseling was routinely performed for 12 months. Overall, the findings indicate that the Positive Steps program was successfully integrated in an infectious diseases clinic and received well by patients. |
Multicenter study of the impact of community-onset Clostridium difficile infection on surveillance for C. difficile infection
Dubberke ER , Butler AM , Hota B , Khan YM , Mangino JE , Mayer J , Popovich KJ , Stevenson KB , Yokoe DS , McDonald LC , Jernigan J , Fraser VJ , Prevention Epicenters Program from the Centers for Disease Control and Prevention . Infect Control Hosp Epidemiol 2009 30 (6) 518-25 OBJECTIVE: To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI. DESIGN: A retrospective multicenter cohort study. SETTING: Five university-affiliated, acute care HCFs in the United States. METHODS: We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July 1, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks. RESULTS: The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P < .01). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (rho range, 0.94-0.99; P < .001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points ((kappa = 0.794; P < .001). CONCLUSIONS: Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak. |
Clostridium difficile infection in Ohio hospitals and nursing homes during 2006
Campbell RJ , Giljahn L , Machesky K , Cibulskas-White K , Lane LM , Porter K , Paulson JO , Smith FW , McDonald LC . Infect Control Hosp Epidemiol 2009 30 (6) 526-33 CONTEXT: Healthcare data suggest that the incidence and severity of Clostridium difficile infection (CDI) in hospitals are increasing. However, the overall burden of disease and the mortality rate associated with CDI, including the contribution from cases of infection that occur in nursing homes, are poorly understood. OBJECTIVE: To describe the epidemiology, disease burden, and mortality rate of healthcare-onset CDI. METHODS: In 2006, active public reporting of healthcare-onset CDI, using standardized case definitions, was mandated for all Ohio hospitals and nursing homes. Incidence rates were determined and stratified according to healthcare facility characteristics. Death certificates that listed CDI were analyzed for trends. RESULTS: There were 14,329 CDI cases reported, including 6,376 cases at 210 hospitals (5,217 initial cases [ie, cases identified more than 48 hours after admission to a healthcare facility in patients who had not had CDI during the previous 6 months] and 1,159 recurrent cases [ie, cases involving patients who had had CDI during the previous 6 months]) and 7,953 cases at 955 nursing homes (4,880 initial and 3,073 recurrent cases) . After adjusting for missing data, the estimated total was 18,200 cases of CDI, which included 7,000 hospital cases (5,700 initial and 1,300 recurrent cases) and 11,200 nursing homes cases (6,900 initial and 4,300 recurrent cases). The rate for initial cases was 6.4-7.9 cases/10,000 patient-days for hospitals and 1.7-2.9 cases/10,000 patient-days for nursing homes. The rate for initial cases in nursing homes decreased during the study (P < .001). Nonpediatric hospital status (P = .011), a smaller number of beds (P = .003), and location in the eastern or northeastern region of the state (P = .011) were each independently associated with a higher rate of initial cases in hospitals. Death certificates for 2006 listed CDI among the causes of death for 893 Ohio residents; between 2000 and 2006, this number increased more than 4-fold. CONCLUSION: Healthcare-onset CDI represents a major public health threat that, when considered in the context of an increasing mortality rate, should justify a major focus on prevention efforts. |
Evaluating the potential public health impact of a Staphylococcus aureus vaccine through use of population-based surveillance for invasive methicillin-resistant S. aureus disease in the United States
Lucero CA , Hageman J , Zell ER , Bulens S , Nadle J , Petit S , Gershman K , Ray S , Harrison LH , Lynfield R , Dumyati G , Townes JM , Schaffner W , Fridkin SK , Active Bacterial Core Surveillance MRSA Investigators . Vaccine 2009 27 (37) 5061-8 We evaluated the potential effects of a hypothetical vaccine in preventing invasive methicillin-resistant Staphylococcus aureus (MRSA) disease in the United States. Using an active, population-based surveillance program, we estimated baseline disease rates in the United States and compared three distinct vaccination strategies which targeted adults > or =65 years of age, persons at risk for recurrent invasive infection, and patients at hospital discharge. The strategies were projected to reduce the burden of invasive MRSA disease by 12.1%, 13.9% and 17.6%, respectively; with the strategy of vaccinating both adults > or =65 years of age and all adults at hospital discharge having the greatest impact per dose. Our data suggest that availability of an effective S. aureus vaccine could result in substantial reductions in invasive MRSA disease incidence. As candidate vaccines are evaluated, these data will be important in determining the optimal vaccination strategy. |
Evaluation of smallpox vaccines using variola neutralization
Damon IK , Davidson WB , Hughes CM , Olson VA , Smith SK , Holman RC , Frey SE , Newman F , Belshe RB , Yan L , Karem K . J Gen Virol 2009 90 1962-6 The search for a 'third'-generation smallpox vaccine has resulted in the development and characterization of several vaccine candidates. A significant barrier to acceptance is the absence of challenge models showing induction of correlates of protective immunity against variola virus. In this light, virus neutralization provides one of few experimental methods to show specific 'in vitro' activity of vaccines against variola virus. Here, we provide characterization of the ability of a modified vaccinia virus Ankara vaccine to induce variola virus-neutralizing antibodies, and we provide comparison with the neutralization elicited by standard Dryvax vaccination. |
Factorial design for improving influenza vaccination among employees of a large health system
Zimmerman RK , Nowalk MP , Lin CJ , Raymund M , Fox DE , Harper JD , Tanis MD , Willis BC . Infect Control Hosp Epidemiol 2009 30 (7) 691-7 OBJECTIVE: As healthcare personnel (HCP) influenza vaccination becomes a quality indicator for healthcare facilities, effective interventions are needed. This study was designed to test a factorial design to improve HCP vaccination rates. DESIGN: A before-after trial with education, publicity, and free and easily accessible influenza vaccines used a factorial design to determine the effect of mobile vaccination carts and incentives on vaccination rates of HCP, who were divided into groups on the basis of their level of patient contact (ie, business and/or administrative role, indirect patient contact, and direct patient contact). SETTING: Eleven acute care facilities in a large health system. PARTICIPANTS: More than 26,000 nonphysician employees. RESULTS: Influenza vaccination rates increased significantly in most facilities and increased system-wide from 32.4% to 39.6% (P<.001). In the baseline year, business unit employee vaccination rates were significantly higher than among HCP with patient contact; rates did not differ significantly across groups in the intervention year. In logistic regression that accounted for demographic characteristics, intervention year, and other factors, the use of incentives and/or mobile carts that provided access to vaccine at the work unit significantly increased the likelihood of vaccination among HCP with direct and indirect patient contact, compared with control sites. CONCLUSIONS: Interventions to improve vaccination rates are differentially effective among HCP with varying levels of patient contact. Mobile carts appear to remove access barriers, whereas incentives may motivate HCP to be vaccinated. Education and publicity may be sufficient for workers in business or administrative positions. Interventions tailored by worker type are likely to be most successful for improving HCP vaccination rates. |
Immunogenicity and reactogenicity of pneumococcal polysaccharide and conjugate vaccines in Alaska native adults 55-70 years of age
Miernyk KM , Butler JC , Bulkow LR , Singleton RJ , Hennessy TW , Dentinger CM , Peters HV , Knutsen B , Hickel J , Parkinson AJ . Clin Infect Dis 2009 49 (2) 241-8 BACKGROUND: Vaccination with conjugate vaccines stimulates T cell-dependent immunity, whereas vaccination with polysaccharide vaccines does not. Thus, vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7) followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) may offer better protection against invasive pneumococcal disease for older adults than does vaccination with PPV23 alone, which is what is currently recommended. METHODS: Alaska Native adults 55-70 years of age with no previous pneumococcal vaccination were randomized to receive (1) PPV23, (2) PCV7 followed 2 months later by PPV23, or (3) PCV7 followed 6 months later by PPV23. Participants recorded reactions after each vaccination. Serum samples collected during the period from May 2002 through February 2003 were tested for serotype-specific immunoglobulin G (IgG) and for opsonophagocytic activity (OPA) against serotypes 1, 4, 6B, 14, and 19F. RESULTS: Vaccination with PCV7 was well tolerated, but persons receiving PCV7 followed by PPV23 reported more local reactions than those receiving only PPV23. All reactions resolved spontaneously within 72 h of receiving vaccine. The geometric mean IgG concentrations of and the median OPA titers to serotypes 4, 6B, 14, and 19F increased in all groups after 1 dose of either PCV7 or PPV23. Serotype-specific geometric mean IgG concentrations and median OPA titers did not differ between any of the groups after vaccination with PPV23, regardless of whether they had previously received PCV7. CONCLUSIONS: In this study, PCV7 given 2 or 6 months before PPV23 was well tolerated but did not improve immune response to PPV23 in older Alaska Native adults. |
Meningococcus genome informatics platform: a system for analyzing multilocus sequence typing data
Katz LS , Bolen CR , Harcourt BH , Schmink S , Wang X , Kislyuk A , Taylor RT , Mayer LW , Jordan IK . Nucleic Acids Res 2009 37 W606-11 The Meningococcus Genome Informatics Platform (MGIP) is a suite of computational tools for the analysis of multilocus sequence typing (MLST) data, at http://mgip.biology.gatech.edu. MLST is used to generate allelic profiles to characterize strains of Neisseria meningitidis, a major cause of bacterial meningitis worldwide. Neisseria meningitidis strains are characterized with MLST as specific sequence types (ST) and clonal complexes (CC) based on the DNA sequences at defined loci. These data are vital to molecular epidemiology studies of N. meningitidis, including outbreak investigations and population biology. MGIP analyzes DNA sequence trace files, returns individual allele calls and characterizes the STs and CCs. MGIP represents a substantial advance over existing software in several respects: (i) ease of use-MGIP is user friendly, intuitive and thoroughly documented; (ii) flexibility--because MGIP is a website, it is compatible with any computer with an internet connection, can be used from any geographic location, and there is no installation; (iii) speed--MGIP takes just over one minute to process a set of 96 trace files; and (iv) expandability--MGIP has the potential to expand to more loci than those used in MLST and even to other bacterial species. |
Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258
Kitchel B , Rasheed JK , Patel JB , Srinivasan A , Navon-Venezia S , Carmeli Y , Brolund A , Giske CG . Antimicrob Agents Chemother 2009 53 (8) 3365-70 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have become more common in the United States and throughout the world. We used pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) to examine the molecular epidemiology of KPC-producing K. pneumoniae isolates sent to the Centers for Disease Control and Prevention (CDC) for reference testing from 1996 to 2008. A dominant strain, sequence type 258 (ST 258), was found and likely accounts for 70% of the CDC's K. pneumoniae PFGE database. Isolates with PFGE patterns related to ST 258 were identified in 10 of the 19 U.S. states currently reporting KPC-producing K. pneumoniae, in addition to one isolate from Israel. KPC subtyping and analysis of the surrounding genetic environment were subsequently performed on 23 representative isolates. Thirteen isolates identified as ST 258 possessed either bla(KPC-2) or bla(KPC-3) and some variability in the Tn4401 element upstream of the bla(KPC) gene. Escherichia coli DH10B was successfully transformed by electroporation with KPC-encoding plasmid DNA from 20 of the 23 isolates. Restriction analysis of plasmid DNA prepared from transformants revealed a diversity of band patterns, suggesting the presence of different plasmids harboring the bla(KPC) gene, even among isolates of the same ST. |
Potential impact of a 2-person security rule on BioSafety Level 4 laboratory workers
LeDuc JW , Anderson K , Bloom ME , Carrion R Jr , Feldmann H , Fitch JP , Geisbert JB , Geisbert TW , Holbrook MR , Jahrling PB , Ksiazek TG , Patterson J , Rollin PE . Emerg Infect Dis 2009 15 (7) e1 Directors of all major BioSafety Level 4 (BSL-4) laboratories in the United States met in 2008 to review the current status of biocontainment laboratory operations and to discuss the potential impact of a proposed 2-person security rule on maximum-containment laboratory operations. Special attention was paid to the value and risks that would result from a requirement that 2 persons be physically present in the laboratory at all times. A consensus emerged indicating that a video monitoring system represents a more efficient, economical standard; provides greater assurance that pathogens are properly manipulated; and offers an increased margin of employee safety and institutional security. The 2-person security rule (1 to work and 1 to observe) may decrease compliance with dual responsibilities of safety and security by placing undue pressure on the person being observed to quickly finish the work, and by placing the observer in the containment environment unnecessarily. |
Reassortment between avian H5N1 and human H3N2 influenza viruses in ferrets: a public health risk assessment
Jackson S , Van Hoeven N , Chen LM , Maines TR , Cox NJ , Katz JM , Donis RO . J Virol 2009 83 (16) 8131-40 This study investigated whether transmissible H5 subtype human-avian reassortant viruses could be generated in vivo. To this end, ferrets were coinfected with recent avian H5N1 (A/Thailand/16/04) and human H3N2 (A/Wyoming/3/03) viruses. Genotype analyses of plaque-purified viruses from nasal secretions of coinfected ferrets revealed that approximately 9% of recovered viruses contained genes from both progenitor viruses. H5 and H3 subtype viruses, including reassortants, were found in airways extending toward and in the upper respiratory tract of ferrets. However, only parental H5N1 genotype viruses were found in lung tissue. Approximately 34% of the recovered reassortant viruses possessed the H5 hemagglutinin (HA) gene, with five unique H5 subtypes recovered. These H5 reassortants were selected for further studies to examine their growth and transmissibility characteristics. Five H5 viruses with representative reassortant genotypes showed reduced titers in nasal secretions of infected ferrets compared to the parental H5N1 virus. No transmission by direct contact between infected and naive ferrets was observed. These studies indicate that reassortment between H5N1 avian influenza and H3N2 human viruses occurred readily in vivo and furthermore that reassortment between these two viral subtypes is likely to occur in ferret upper airways. Given the relatively high incidence of reassortant viruses from tissues of the ferret upper airway, it is reasonable to conclude that continued exposure of humans and animals to H5N1 alongside seasonal influenza viruses increases the risk of generating H5 subtype reassortant viruses that may be shed from upper airway secretions. |
Virulence variation among isolates of western equine encephalitis virus in an outbred mouse model
Logue CH , Bosio CF , Welte T , Keene KM , Ledermann JP , Phillips A , Sheahan BJ , Pierro DJ , Marlenee N , Brault AC , Bosio CM , Singh AJ , Powers AM , Olson KE . J Gen Virol 2009 90 1848-58 Little is known about viral determinants of virulence associated with western equine encephalitis virus (WEEV). Here, we have analysed six North American WEEV isolates in an outbred CD1 mouse model. Full genome sequence analyses showed < or =2.7 % divergence among the six WEEV isolates. However, the percentage mortality and mean time to death (MTD) varied significantly when mice received subcutaneous injections of 10(3) p.f.u. of each virus. Two WEEV strains, McMillan (McM) and Imperial 181 (IMP), were the most divergent of the six in genome sequence; McM caused 100 % mortality by 5 days post-infection, whereas IMP caused no mortality. McM had significantly higher titres in the brain than IMP. Similar differences in virulence were observed when McM and IMP were administered by aerosol, intranasal or intravenous routes. McM was 100 % lethal with an MTD of 1.9 days when 10(3) p.f.u. of each virus was administered by intracerebral inoculation; in contrast, IMP caused no mortality. The presence of IMP in the brains after infection by different routes and the lack of observed mortality confirmed that IMP is neuroinvasive but not neurovirulent. Based on morbidity, mortality, MTD, severity of brain lesions, virus distribution patterns, routes of infection and differences in infection of cultured cells, McM and IMP were identified as high- and low-virulence isolates, respectively. |
Improved MS/MS analysis of succinylacetone extracted from dried blood spots when combined with amino acids and acylcarnitine butyl esters
Chace DH , Lim T , Hansen CR , De Jesus VR , Hannon WH . Clin Chim Acta 2009 407 6-9 BACKGROUND: The utilization of succinylacetone (SUAC) as the primary metabolic marker for tyrosinemia Type I is now well known, thus new methods have been developed to analyze SUAC as a first tier test in newborn screening. One approach is to prepare a SUAC hydrazine derivative from the dried blood spots (DBS) previously utilized in the extraction of acylcarnitine (AC) and amino acids (AA). The final derivatized products of SUAC, AA and AC are combined in a single tandem mass spectrometric (MS/MS) analysis. However, butyl esterification techniques may result in contamination of underivatized acylcarnitines by as much as 20%. We have developed a simple wash step to improve the combined analysis of SUAC, AA and AC in DBS by MS/MS. METHODS: AA and AC were extracted with methanol containing labeled internal standard from 3.2mm punches taken from the DBS specimen. The previously extracted blood spot that remains after removal of the methanol extraction solvent was used in the preparation of SUAC with and without additional washing of the blood spot. The butyl ester eluates of AA and AC, and SUAC hydrazine derivatives were recombined and measured by MS/MS. RESULTS: Three additional methanol wash steps of the remaining DBS punches prior to SUAC derivatization reduced the presence of underivatized acylcarnitines, resulting in a 4-fold reduction of underivatized palmitoylcarnitine. Palmitoylcarnitine butyl ester is detected at m/z 456 while the underivatized species is detected at m/z 400, which is also the mass of dodecanoylcarnitine butyl ester. The linearity of the SUAC assay was unchanged by the additional wash steps. For butyl esterification methods, the preferred analytic procedure, the presence of AC can compromise the results of a newborn screen for the actual concentrations of acylcarnitines. It is essential to remove any underivatized acylcarnitines prior to SUAC analysis. CONCLUSION: The additional methanol wash steps did not alter SUAC assay results but did remove underivatized acylcarnitines which could result in the incorrect quantification of acylcarnitines. |
Mother-to-child transmission of GB virus C in a cohort of women coinfected with GB virus C and HIV in Bangkok, Thailand
Bhanich Supapol W , Remis RS , Raboud J , Millson M , Tappero J , Kaul R , Kulkarni P , McConnell MS , Mock PA , McNicholl JM , Vanprapar N , Asavapiriyanont S , Shaffer N , Butera S . J Infect Dis 2009 200 (2) 227-35 BACKGROUND: GB virus C (GBV-C) is an apathogenic virus that inhibits human immunodeficiency virus (HIV) replication in vitro. Mother-to-child transmission (MTCT) of GBV-C has been observed in multiple small studies. Our study examined the rate and correlates of MTCT of GBV-C in a large cohort of GBV-C-HIV-coinfected pregnant women in Thailand. METHODS: Maternal delivery plasma specimens from 245 GBV-C-HIV-infected women and specimens from their infants at 4 or 6 months of age were tested for GBV-C RNA. Associations with MTCT of GBV-C were examined using logistic regression. RESULTS: One hundred one (41%) of 245 infants acquired GBV-C infection. MTCT of GBV-C was independently associated with maternal antiretroviral therapy (adjusted odds ratio [AOR], 5.21 [95% confidence interval {CI}, 2.12-12.81]), infant HIV infection (AOR, 0.05 [95% CI, 0.01-0.26]), maternal GBV-C load (8.0 log(10) copies/mL: AOR, 86.77 [95% CI, 15.27-481.70]; 7.0-7.9 log(10) copies/mL: AOR, 45.62 [95% CI, 8.41-247.51]; 5.0-6.9 log(10) copies/mL: AOR, 9.07 [95% CI, 1.85-44.33]: reference, <5 log(10) viral copies/mL), and caesarean delivery (AOR, 0.26 [95% CI, 0.12-0.59]). CONCLUSIONS: Associations with maternal GBV-C load and mode of delivery suggest transmission during pregnancy and delivery. Despite mode of delivery being a common risk factor for virus transmission, GBV-C and HIV were rarely cotransmitted. The mechanisms by which maternal receipt of antiretroviral therapy might increase MTCT of GBV-C are unknown. |
Prevention of fetal alcohol spectrum disorders
Floyd RL , Weber MK , Denny C , O'Connor MJ . Dev Disabil Res Rev 2009 15 (3) 193-9 Alcohol use among women of childbearing age is a leading, preventable cause of birth defects and developmental disabilities in the United States. Although most women reduce their alcohol use upon pregnancy recognition, some women report drinking during pregnancy and others may continue to drink prior to realizing they are pregnant. These findings emphasize the need for effective prevention strategies for both pregnant and nonpregnant women who might be at risk for an alcohol-exposed pregnancy (AEP). This report reviews evidence supporting alcohol screening and brief intervention as an effective approach to reducing problem drinking and AEPs that can lead to fetal alcohol spectrum disorders. In addition, this article highlights a recent report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect that describes effective interventions to reduce alcohol use and AEPs, and outlines recommendations on promoting and improving these strategies. Utilizing evidence-based alcohol screening tools and brief counseling for women at risk for an AEP and other effective population-based strategies can help achieve future alcohol-free pregnancies. |
US obstetrician-gynaecologist's prevention and management of obesity in pregnancy
Power ML , Cogswell ME , Schulkin J . J Obstet Gynaecol 2009 29 (5) 373-7 A survey regarding management of obesity in pregnancy was mailed to 787 practising members of the American College of Obstetricians and Gynecologists (ACOG); 433 responded of whom 353 practised obstetrics. Most (79.2%) had read ACOG Committee Opinion, 'Obesity in Pregnancy,' and rated it helpful (68.6%) or very helpful (17.2%). Most responding physicians (91.2%) use BMI to assess their patients weight status; fewer (63.4%) use pre-pregnancy BMI to modify their pregnancy weight gain recommendation. Having read the Committee Opinion and being a woman were independent factors associated with using pre-pregnancy BMI. Responding physicians that had read the Committee Opinion were more knowledgeable about obesity-related pregnancy complications; but even among those physicians, only 32.2% were aware that maternal obesity is a risk factor for fetal neural tube defects. The responding physicians appeared well-versed on appropriate practice for caesarean delivery for obese patients whether they had read the Committee Opinion or not. |
Attitudes and practices regarding use of progesterone to prevent preterm births
Henderson ZT , Power ML , Berghella V , Lackritz EM , Schulkin J . Am J Perinatol 2009 26 (7) 529-36 We sought to describe current attitudes and practices of obstetrician-gynecologists regarding use of progesterone and prevention of preterm birth. A self-administered survey was mailed to American College of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in March to May 2007. The survey consisted of 36 questions, including respondents' demographic characteristics, preterm birth risk factor knowledge and screening practices, and use of progesterone for the prevention of preterm birth. The response rate was 52% ( N = 345); most respondents were general obstetrician-gynecologists (89%). Many (74%) reported recommending or offering progesterone for prevention of preterm birth. Almost all (93%) reported use for the indication of previous spontaneous preterm birth. However, many also reported use for other indications such as dilated/effaced cervix (37%), short cervix on ultrasound (34%), and cerclage (26%). These results suggest that most obstetricians recommend or offer progesterone to prevent preterm birth for women with a previous spontaneous preterm birth and many also offer it for women with other high-risk obstetric conditions. |
Efficacy of protocols for cleaning and disinfecting infant feeding bottles in less developed communities
Ma L , Zhang G , Swaminathan B , Doyle M , Bowen A . Am J Trop Med Hyg 2009 81 (1) 132-9 Although breastfeeding is the best choice for most infants, infant formula is used widely, commonly introduced during the neonatal period, and usually given to infants in bottles that can be difficult to clean. We artificially contaminated infant feeding bottles with low and high inocula of bacterial enteric pathogens and evaluated the efficacy of several cleaning and chlorine disinfection protocols. Rinsing with soapy water followed by tap water was the most effective cleaning method and reduced pathogen load by 3.7 and 3.1 log(10)s at the low and high inoculum levels, respectively. Submersion in 50 ppm hypochlorite solution for 30 minutes produced a 3.7-log(10) reduction in pathogens, resulting in no identifiable pathogens among bottles. This result was comparable to boiling. When combined with handwashing, use of safe water, and appropriate storage of prepared infant formula, these simple, inexpensive practices could improve the microbiological safety of infant formula feeding in less developed settings. |
An 84-year-old woman with fever and dark urine
Gallagher LG , Chau S , Owaisi AS , Konczyk M , Bishop HS , Arguin PM , Trenholme GM . Clin Infect Dis 2009 49 (2) 278, 310-1 In September 2007, an 84-year-old woman from Illinois was admitted to the intensive care unit with a fever of 102.6°F and complaints of chills, nausea, abdominal pain, and dark urine. She had been experiencing chills for 48 h and onset of fever occurred on the day of presentation to the hospital. She had a past medical history of chronic obstructive pulmonary disease, coronary artery disease, and upper gastrointestinal bleeding. In January 2007, the patient traveled by cruise ship to Key West; a private island in Florida; the Cayman Islands; and Co-zu-mel, Mexico. She stayed in a cabin in the Chippewa National Forest in northern Minnesota during July 2007. The patient had received multiple blood transfusions over the past year in Illinois and Minnesota for upper gastrointestinal bleeding. Two sets of blood cultures obtained on the date of hospital admission were negative. During the patient's hospitalization in the intensive care unit, the laboratory technician noted abnormalities while examining the blood smear (figure 1) because of the patient's anemia. Blood samples were then sent to the state laboratory and the US Centers for Disease Control and Prevention for additional evaluation. |
Hydraulic conductivity changes and influencing factors in longwall overburden determined by slug tests in gob gas ventholes
Karacan CO , Goodman G . Int J Rock Mech Min Sci 2009 46 (7) 1162-74 This study presents the results of core-log analyses from the exploration boreholes, the analyses of face advance rates, and the results of downhole monitoring studies performed in gob gas ventholes for calculation of changes in hydraulic properties in the longwall overburden at a mine site in southwestern (SW) Pennsylvania section of Northern Appalachian Basin. In the first part of the study, coal measure rocks in overburden strata were analyzed and the locations where possible fractures and bedding plane separations would occur were evaluated. In the second part, the hydraulic conductivities were computed by two different slug test analyses methods using the water level changes measured in gob gas ventholes as longwall face approached. Hydraulic conductivities were analyzed with respect to the changes in overburden depth, the locations of the borehole, and mine face advance rates. These data were used to interpret the potential productivities of the gob gas ventholes as a result of fracturing and changes in hydraulic conductivities. The general results showed that the probability of fracturing and bedding plane separations in the overburden increase between strong and weak rock interfaces. Also, the probability of bedding plane separations increases as the interface is close to the extracted coal seam. Evaluation of slug tests showed that the hydraulic conductivity developments in the boreholes and their potential production performances are affected by the underground strata and the roof materials. In situations where the roof material is stiff and thick, the development of high permeability fractures around the borehole will be less. Results also indicated that borehole location with respect to face position affects the fracturing time and permeability evolution as well. Greater overburden depths generally cause earlier fracturing as longwall face approaches, but eventually result in lower hydraulic conductivities and potentially less effective boreholes. Increasing mining rates also resulted in generally lower hydraulic conductivities in the overburden. The results of this study were intended to improve the interpretation of gob gas venthole performance and to provide better siting of these boreholes. |
Nonfatal work-related motor vehicle injuries treated in emergency departments in the United States, 1998-2002
Chen GX . Am J Ind Med 2009 52 (9) 698-706 BACKGROUND: Current data on nonfatal work-related motor vehicle injuries are limited and fragmented, often excluding government workers, self-employed workers, and workers on small farms. This study seeks to bridge the present data gap by providing a national profile of nonfatal work-related motor vehicle injuries across all industries and occupations. METHODS: Study subjects were people who suffered nonfatal work-related motor vehicle injuries and were treated in a hospital emergency department in the United States. Subjects were identified from a stratified probability sample of emergency departments. National estimates and rates were computed. RESULTS: From 1998 to 2002, the average annual rate of nonfatal work-related motor vehicle injuries was 7 injuries per 10,000 full-time equivalents. The rate was three times higher in men than in women. The rates were higher in workers 15-19 years of age and in workers 70 years or older. Justice, public order, and safety workers had the largest number of injuries, and taxicab service employees had the highest injury rate of all industries. Truck drivers had the largest number of injuries, and police and detectives, public service employees had the highest injury rate of all occupations. CONCLUSION: Future efforts need to develop and enhance the use of surveillance information at the federal and state level for work-related nonfatal motor vehicle injuries. Prevention efforts need to address occupational motor vehicle safety for both commercial truck/bus drivers and workers who are not commercial drivers but who drive light motor vehicles on the job. |
Police work and subclinical atherosclerosis
Joseph PN , Violanti JM , Donahue R , Andrew ME , Trevisan M , Burchfiel CM , Dorn J . J Occup Environ Med 2009 51 (6) 700-7 OBJECTIVE: Employment as an urban police officer was hypothesized to be associated with increased structural subclinical cardiovascular disease (CVD), measured by carotid artery intima-media thickness (IMT). METHODS: The sample of men and women consisted of police officers (n = 312) and the general population (n = 318), free of clinical CVD. RESULTS: Officers had elevated levels of age-adjusted CVD risk factors (blood pressure, total cholesterol, smoking prevalence) compared with the population sample. In age-, gender-, and traditional risk factor-adjusted models, police officers exhibited increased mean common carotid IMT (police = 0.67 mm, population = 0.64 mm; P = 0.03) and mean maximum carotid IMT (police = 0.99 mm, population = 0.95 mm; P = 0.13). CONCLUSIONS: Police officers have increased levels of atherosclerosis compared with a general population sample, which was not fully explained by elevated CVD risk factors; thereby potentially implicating other mechanisms whereby law enforcement work may increase CVD risk. |
Prevalence of lifetime asthma and current asthma attacks in U.S. working adults: an analysis of the 1997-2004 National Health Interview Survey data
Syamlal G , Mazurek JM , Bang KM . J Occup Environ Med 2009 51 (9) 1066-74 OBJECTIVE: To estimate national prevalences of lifetime asthma and asthma attacks among workers by age, sex, race, occupation and industry, and estimate population attributable fraction to employment for asthma attacks in the United States. METHODS: The 1997-2004 National Health Interview Survey data for currently working adults aged > or = 18 years were analyzed. RESULTS: Lifetime asthma prevalence was 9.2%; the social services religious and membership organizations industry and the health service occupation had the highest asthma prevalence. Asthma attack prevalence among workers with asthma was 35.4%; the primary metal industry and the health assessment and treating occupation had the highest attack prevalence. Approximately, 5.9% of cases reporting an asthma attack were attributed to employment when considering industries and 3.8% when considering occupations. CONCLUSIONS: Future studies and intervention strategies should address the higher prevalence of asthma in certain industries and occupations. |
Characterization of exposures among cemented tungsten carbide workers. Part I: Size-fractionated exposures to airborne cobalt and tungsten particles
Stefaniak AB , Virji MA , Day GA . J Expo Sci Environ Epidemiol 2009 19 (5) 475-91 As many as 30,000 workers in the United States of America are exposed to cemented tungsten carbides (CTC), alloys composed primarily of tungsten carbide and cobalt, which are used in cutting tools. Inhalation of cobalt-containing particles may be sufficient for the development of occupational asthma, whereas tungsten carbide particles in association with cobalt particles are associated with the development of hard metal disease (HMD) and lung cancer. Historical epidemiology and exposure studies of CTC workers often rely only on measures of total airborne cobalt mass concentration. In this study, we characterized cobalt- and tungsten-containing aerosols generated during the production of CTC with emphasis on (1) aerosol "total" mass (n=252 closed-face 37 mm cassette samples) and particle size-selective mass concentrations (n=108 eight-stage cascade impactor samples); (2) particle size distributions; and (3) comparison of exposures obtained using personal cassette and impactor samplers. Total cobalt and tungsten exposures were highest in work areas that handled powders (e.g., powder mixing) and lowest in areas that handled finished product (e.g., grinding). Inhalable, thoracic, and respirable cobalt and tungsten exposures were observed in all work areas, indicating potential for co-exposures to particles capable of getting deposited in the upper airways and alveolar region of the lung. Understanding the risk of CTC-induced adverse health effects may require two exposure regimes: one for asthma and the other for HMD and lung cancer. All sizes of cobalt-containing particles that deposit in the lung and airways have potential to cause asthma, thus a thoracic exposure metric is likely biologically appropriate. Cobalt-tungsten mixtures that deposit in the alveolar region of the lung may potentially cause HMD and lung cancer, thus a respirable exposure metric for both metals is likely biologically appropriate. By characterizing size-selective and co-exposures as well as multiple exposure pathways, this series of papers offer an approach for developing biologically meaningful exposure metrics for use in epidemiology. |
Cortisol patterns and brachial artery reactivity in a high stress environment
Violanti JM , Burchfiel CM , Fekedulegn D , Andrew ME , Dorn J , Hartley TA , Charles LE , Miller DB . Psychiatry Res 2009 169 (1) 75-81 Chronic stress can result in frequent or persistent challenges of the hypothalamic-pituitary-adrenal (HPA) axis resulting in abnormal cortisol patterns and increased risk for cardiovascular disease (CVD). Police work is an environment replete with stress. The present article describes associations between cortisol, a biomarker of stress, and brachial artery flow mediated dilation (FMD) in police officers. A random sample stratified on gender (n=100, 33% women) was generated from officers in a mid-sized urban department. Four salivary cortisol parameters were derived: after awakening, following a standardized high protein meal challenge, during the entire day, and after a dexamethasone suppression test. Continuous scan B-Mode ultrasound was used to measure percent change in brachial artery FMD following occlusion and release. Elevated cortisol secretion after awakening was significantly associated with impaired FMD in women, reflected by an inverse trend. Adjustment for age, smoking, and alcohol consumption did not appreciably alter this trend. A similar result was not evident among male officers. Responses of other cortisol challenges to the HPA axis were not associated with FMD. In conclusion, increased cortisol secretion after awakening was independently associated with impaired FMD in female police officers only, indicating a possible link between HPA axis stress response and subclinical CVD. However, because associations were not found with other cortisol parameters and were not evident in male officers, replication of these findings with a prospective study design may be warranted. |
Ionic determinants of exhaled breath condensate pH before and after exercise in adolescent athletes
Greenwald R , Ferdinands JM , Teague WG . Pediatr Pulmonol 2009 44 (8) 768-77 BACKGROUND: The pH of exhaled breath condensate (EBC) of adolescent athletes engaged in vigorous physical activity is low compared to healthy controls; however, the ionic determinants of EBC pH and the acute effects of exercise on those determinants have not been definitively established. OBJECTIVES: This study had two purposes: (1) to identify the ionic composition of EBC before and after exercise, and (2) to examine the effects of sample deaeration on EBC pH and composition. METHODS: EBC ionic composition was determined by ion chromatography and correlated with pH measured before and after deaeration. Bicarbonate concentration was calculated from the ion balance of other measured species and pH. RESULTS: EBC pH displayed a bimodal distribution, included values lower than expected for healthy individuals, and was correlated exclusively with volatile species, namely ammonia (mean concentration = 215 microM) and acetic (31.7 microM) and propionic acids (10.0 microM). Following exercise, raw EBC pH and ammonia concentration increased while propionic acid concentration fell. Following deaeration, EBC pH increased by one unit on average; however, the pH of samples with unusually low pH did not change significantly, and the concentrations of several ionic species were altered in a manner that cannot be explained in terms of volatility. CONCLUSIONS: We conclude that in healthy adolescents, exercise results in an acute increase in raw EBC pH in association with an increase in ammonium and a decrease in propionate concentration. Since exercise increases systemic ammonia and urea (which is hydrolyzed by oral bacteria to form ammonia), we propose that the likely source of these changes is gas-phase diffusion from epithelial and oral surface liquids and to a lesser extent, from pulmonary circulation. |
Ethical collection, storage, and use of public health data: a proposal for a national privacy protection
Lee LM , Gostin LO . JAMA 2009 302 (1) 82-4 Public health agencies at all levels—local, state, and federal—collect, store, and use personal health and behavior data to meet their legal obligation to identify and control health threats or evaluate and improve public health programs or services. The foundation for this collection of health data is public trust, which requires maintaining the privacy and security of sensitive information. Despite its critical importance, there is no national standard for safeguarding data held by public health agencies. Instead, privacy safeguards are fragmented across 50 states, creating uncertain and inconsistent privacy protection.1 During the 1990s, model laws were created to ensure uniform and strong privacy safeguards,2 but countrywide adoption has proved difficult. The US Congress is currently debating privacy standards for electronic medical records,3 but these reforms do not include public health records because they are effectively exempt from the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.4 It is now time to consider a national strategy for protecting public health data. |
Effect of the viral protein N(pro) on virulence of bovine viral diarrhea virus and induction of interferon type I in calves
Henningson JN , Topliff CL , Gil LH , Donis RO , Steffen DJ , Charleston B , Eskridge KM , Kelling CL . Am J Vet Res 2009 70 (9) 1117-23 OBJECTIVE: To characterize the influence of the viral protein N(pro) on virulence of bovine viral diarrhea virus (BVDV) and on type I interferon responses in calves. Animals-10 calves, 4 to 6 months of age. PROCEDURES: BVDV virulence and type I interferon responses of calves (n = 5) infected with a noncytopathic BVDV with a deleted N(pro) were compared with those of calves (5) infected with a noncytopathic BVDV with a functional N(pro). Rectal temperatures, clinical signs, platelet counts, and total and differential WBC counts were evaluted daily. Histologic examinations and immunohistochemical analyses of tissues were conducted to assess lesions and distribution of viral antigens, respectively. Serum type I interferon concentrations were determined. RESULTS: Calves infected with N(pro)-deleted BVDV developed leukopenia and lymphopenia, without developing increased rectal temperatures or lymphoid depletion of target lymphoid organs. There was minimal antigen deposition in lymphoid organs. Calves infected with N(pro) BVDV developed increased rectal temperatures, leukopenia, lymphopenia, and lymphoid depletion with marked BVDV antigen deposition in lymphatic tissues. Interferon type I responses were detected in both groups of calves. CONCLUSIONS AND CLINICAL RELEVANCE: Deletion of N(pro) resulted in attenuation of BVDV as evidenced by reduced virulence in calves, compared with BVDV with a functional N(pro). Deletion of N(pro) did not affect induction of type I interferon. The N(pro)-deleted BVDV mutant may represent a safe noncytopathic virus candidate for vaccine development. |
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