Sex-specific predictors of hearing-aid use in older persons: The age, gene/environment susceptibility - Reykjavik study.
Fisher DE , Li CM , Hoffman HJ , Chiu MS , Themann CL , Petersen H , Jonsson PV , Jonsson H , Jonasson F , Sverrisdottir JE , Launer LJ , Eiriksdottir G , Gudnason V , Cotch MF . Int J Audiol 2015 54 (9) 634-41 OBJECTIVE: We estimate the prevalence of hearing-aid use in Iceland and identify sex-specific factors associated with use. DESIGN: Population-based cohort study. STUDY SAMPLE: A total of 5172 age, gene/environment susceptibility - Reykjavik study (AGES-RS) participants, aged 67 to 96 years (mean age 76.5 years), who completed air-conduction and pure-tone audiometry. RESULTS: Hearing-aid use was reported by 23.0% of men and 15.9% of women in the cohort, although among participants with at least moderate hearing loss in the better ear (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz ≥ 35 dB hearing level [HL]) it was 49.9% and did not differ by sex. Self-reported hearing loss was the strongest predictor of hearing-aid use in men [OR: 2.68 (95% CI: 1.77, 4.08)] and women [OR: 3.07 (95% CI: 1.94, 4.86)], followed by hearing loss severity based on audiometry. Having diabetes or osteoarthritis were significant positive predictors of use in men, whereas greater physical activity and unimpaired cognitive status were important in women. CONCLUSIONS: Hearing-aid use was comparable in Icelandic men and women with moderate or greater hearing loss. Self-recognition of hearing loss was the factor most predictive of hearing-aid use; other influential factors differed for men and women. |
Potential impact of prescribing metformin according to eGFR rather than serum creatinine
Tuot DS , Lin F , Shlipak MG , Grubbs V , Hsu CY , Yee J , Shahinian V , Saran R , Saydah S , Williams DE , Powe NR . Diabetes Care 2015 38 (11) 2059-67 OBJECTIVE: Many societies recommend using estimated glomerular filtration rate (eGFR) rather than serum creatinine (sCr) to determine metformin eligibility. We examined the potential impact of these recommendations on metformin eligibility among U.S. adults. RESEARCH DESIGN AND METHODS: Metformin eligibility was assessed among 3,902 adults with diabetes who participated in the 1999-2010 National Health and Nutrition Examination Surveys and reported routine access to health care, using conventional sCr thresholds (eligible if <1.4 mg/dL for women and <1.5 mg/dL for men) and eGFR categories: likely safe, ≥45 mL/min/1.73 m2; contraindicated, <30 mL/min/1.73 m2; and indeterminate, 30-44 mL/min/1.73 m2). Different eGFR equations were used: four-variable MDRD, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine (CKD-EPIcr), and CKD-EPI cystatin C, as well as Cockcroft-Gault (CG) to estimate creatinine clearance (CrCl). Diabetes was defined by self-report or A1C ≥6.5% (48 mmol/mol). We used logistic regression to identify populations for whom metformin was likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population. RESULTS: Among adults with sCr above conventional cutoffs, MDRD eGFR ≥45 mL/min/1.73 m2 was most common among men (adjusted odds ratio [aOR] 33.3 [95% CI 7.4-151.5] vs. women) and non-Hispanic Blacks (aOR vs. whites 14.8 [4.27-51.7]). No individuals with sCr below conventional cutoffs had an MDRD eGFR <30 mL/min/1.73 m2. All estimating equations expanded the population of individuals for whom metformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with eGFR 30-44 mL/min/1.73 m2, for whom metformin safety is indeterminate, ranging from 784,700 (CKD-EPIcr) to 1,636,000 (CG). CONCLUSIONS: The use of eGFR or CrCl to determine metformin eligibility instead of sCr can expand the adult population with diabetes for whom metformin is likely safe, particularly among non-Hispanic blacks and men. |
Effect of family income on the relationship between parental education and sealant prevalence, National Health and Nutrition Examination Survey, 2005-2010
Al Agili DE , Griffin SO . Prev Chronic Dis 2015 12 E138 INTRODUCTION: We examined the association between sealant prevalence and parental education for different levels of family income, controlling for other covariates. METHODS: We combined data from 2005-2006, 2007-2008, and 2009-2010 cycles of the National Health and Nutrition Examination Survey. The study sample was 7,090 participants aged 6 to 19 years. Explanatory variables, chosen on the basis of Andersen and Aday's framework of health care utilization, were predisposing variables - child's age, sex, race/ethnicity, and parental education (<high school diploma; high school diploma; >high school diploma); enabling variables - family income (<100% of the federal poverty level [FPL]; 100%-200% of the FPL; and >200% of the FPL), health insurance status, and regular source of medical care; and a need variable - future need for care (perceived child health status is excellent/very good, good, fair/poor). We conducted bivariate and multivariate analyses and included a term for interaction between education and income in the multivariate model. We report significant findings (P ≤ .05). RESULTS: Sealant prevalence was associated with all explanatory variables in bivariate and multivariate analyses. In bivariate analyses, higher parental education and family income were independently associated with higher sealant prevalence. In the multivariate analysis, higher parental education was associated with sealant prevalence among higher income children, but not among low-income children (<100% FPL). Sealant prevalence was higher among children with parental education greater than a high school diploma versus less than a high school diploma in families with income ≥100% FPL. CONCLUSION: Our findings suggest that income modifies the association of parental education on sealant prevalence. Recognition of this relationship may be important for health promotion efforts. |
Gender- and race-specific metabolic score and cardiovascular disease mortality in adults: a structural equation modeling approach - United States, 1988-2006
Mercado CI , Yang Q , Ford ES , Gregg E , Valderrama AL . Obesity (Silver Spring) 2015 23 (9) 1911-1919 OBJECTIVE: Consider all metabolic syndrome (MetS) components [systolic (SBP) and diastolic (DBP) blood pressures, waist circumference, HDL cholesterol, triglycerides (TG), and fasting glucose] and gender/race differential risk when assessing cardiovascular disease (CVD) risk. METHODS: We estimated a gender- and race-specific continuous MetS score using structural equation modeling and tested its association with CVD mortality using data from National Health and Nutrition Examination Survey III linked with the National Death Index. Cox proportional hazard regression tested the association adjusted for sociodemographic and behavior characteristics. RESULTS: For men, continuous MetS components associated with CVD mortality were SBP (hazard ratio = 1.50, 95% confidence interval = 1.14-1.96), DBP (1.48, 1.16-1.90), and TG (1.15, 1.12-1.16). In women, SBP (1.44, 1.27-1.63) and DBP (1.24, 1.02-1.51) were associated with CVD mortality. MetS score was not significantly associated with CVD mortality in men; but significant associations were found for all women (1.34, 1.06-1.68), non-Hispanic white women (1.29, 1.01-1.64), non-Hispanic black women (2.03, 1.12-3.69), and Mexican-American women (3.57, 2.21-5.76). Goodness-of-fit and concordance were overall better for models with the MetS score than MetS (yes/no). CONCLUSIONS: When assessing CVD mortality risk, MetS score provided additional information than MetS (yes/no). |
Beyond body mass index: advantages of abdominal measurements for recognizing cardiometabolic disorders
Kahn HS , Bullard KM . Am J Med 2015 129 (1) 74-81 e2 BACKGROUND: The clinical recognition of cardiometabolic disorders might be enhanced by anthropometry based on the sagittal abdominal diameter (SAD; also called "abdominal height") or waist circumference rather than on weight. Direct comparisons of body mass index (BMI, weight/height2) with SAD/height ratio (SADHtR) or waist circumference/height ratio (WHtR) have not previously been tested in nationally representative populations. METHODS: Non-pregnant adults without diagnosed diabetes (ages 20-64 years; n=3,071) provided conventional anthropometry and supine sagittal abdominal diameter (by sliding-beam caliper) in the 2011-2012 US National Health and Nutrition Examination Survey. Population-weighted, logistic models estimated how strongly each anthropometric indicator was associated with five cardiometabolic disorders: Dysglycemia (glycated hemoglobin ≥5.7%), HyperNonHDLc (non-HDL-cholesterol ≥4.14 mmol/L or taking anticholesteremic medications), Hypertension (SBP ≥140 or DBP ≥90 or taking antihypertensive medications), HyperALT (alanine transaminase ≥p75, [75th percentile, sex-specific]), and HyperGGT (gamma-glutamyltransferase ≥p75 [sex-specific]). RESULTS: After scaling each indicator, adjusted odds ratios (aORs) tended to be highest for SADHtR and lowest for BMI when identifying each disorder excepting Dysglycemia. When SADHtR entered models simultaneously with BMI, the aORs for BMI no longer directly identified any condition, whereas SADHtR identified persons with HyperNonHDLc by aOR 2.78 [1.71-4.51], Hypertension by aOR 2.51 [1.22-5.15], HyperALT by aOR 2.89 [1.56-5.37], and HyperGGT by aOR 5.43 [3.01-9.79]. WHtR competed successfully against BMI with regard to Dysglycemia, HyperNonHDLc, and HyperGGT. C-statistics of SADHtR and WHtR were higher than those of BMI (p<0.001) for identifying HyperNonHDLc and HyperGGT. CONCLUSIONS: Among nonelderly adults SADHtR or WHtR recognized cardiometabolic disorders better than did the BMI. |
Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women
Wilmot KA , O'Flaherty M , Capewell S , Ford ES , Vaccarino V . Circulation 2015 132 (11) 997-1002 BACKGROUND: Coronary heart disease (CHD) mortality rates have fallen dramatically over the past four decades in the Western world. However, recent data from the US and elsewhere suggest a plateauing of CHD incidence and mortality among young women. We therefore examined recent trends in CHD mortality rates in the US according to age and sex. METHODS AND RESULTS: We analyzed mortality data between 1979 and 2011 for US adults ≥25 years. We calculated age-specific CHD mortality rates and compared annual percentage changes (EAPC) during three approximate decades of data (1979-1989, 1990-1999, and 2000-2011). We then used Joinpoint regression modeling to assess changes in trends over time, based on inflection points of the mortality rates. Adults aged 65+ years showed consistent mortality declines, which became even steeper after 2000 (women, -5.0% and men, -4.4%). In contrast, young men and women (aged <55 years) initially showed a clear decline in CHD mortality from 1979 until 1989 (EAPC -5.5% in men and -4.6% in women). However, the two subsequent decades saw stagnation with minimal improvement. Notably, young women demonstrated no improvements between 1990 and 1999 (EAPC +0.1%), and only -1% EAPC since 2000. Joinpoint analyses provided consistent results. CONCLUSIONS: The dramatic decline in CHD mortality since 1979 conceals major heterogeneities. CHD death rates in older groups are now falling steeply. However, young adults have experienced frustratingly small decreases in CHD mortality rates since 1990. The drivers of these major differences in CHD mortality trends by age and sex merit urgent study. |
Fatal Accelerated Cirrhosis after Imported HEV Genotype 4 Infection.
Perumpail RB , Ahmed A , Higgins JP , So SK , Cochran JL , Drobeniuc J , Mixson-Hayden TR , Teo CG . Emerg Infect Dis 2015 21 (9) 1679-81 Hepatitis E is a viral hepatitide that is endemic in many developing countries. In its classic form, it results from ingesting fecally contaminated water that carries hepatitis E virus (HEV), and it frequently resolves without treatment. When hepatitis E is imported to the United States, it originates mainly from persons who have acquired HEV genotype 1 infection from South Asia (1). We report imported HEV genotype 4 infection (Technical Appendix Figure, panel A) in a patient during which cirrhosis and fatal hepatic decompensation ensued. | The patient was a 68-year-old man of Chinese ethnicity who had been a California resident since 1985. He sought treatment for mild jaundice in April 2013 in Hong Kong, where he had been staying for 7 weeks. Sixteen years before, he had undergone orthotopic liver transplantation at Stanford University Medical Center (Palo Alto, California, USA) for hepatitis B cirrhosis. Since then, he had received entecavir and tacrolimus for maintenance and had been vaccinated against hepatitis A virus. Until his current illness, routine liver function tests had not indicated hepatic dysfunction (values in November 2012: alanine aminotransferase 2 IU/L, aspartate aminotransferase 24 IU/L, alkaline phosphatase 67 IU/L, total bilirubin 0.5 mg/dL). |
Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States.
Oster AM , Wertheim JO , Hernandez AL , Banez Ocfemia MC , Saduvala N , Hall HI . J Acquir Immune Defic Syndr 2015 70 (4) 444-51 BACKGROUND: Studying HIV transmission networks provides insight into the spread of HIV and opportunities for intervention. We identified transmission dynamics among risk groups and racial/ethnic groups in the United States. METHODS: For HIV-1 pol sequences reported to the U.S. National HIV Surveillance System during 2001-2012, we calculated pairwise genetic distance, identified linked pairs of sequences (those with distance ≤1.5%), and examined transmission category and race/ethnicity of these potential transmission partners. RESULTS: Of 40,950 sequences, 12,910 (32%) linked to ≥1 other sequence. Of men who have sex with men (MSM) who linked to ≥1 sequence, 88% were linked to other MSM and only 4% were linked to heterosexual women. Of heterosexual women for whom we identified potential transmission partners, 29% linked to MSM, 21% to heterosexual men, and 12% to persons who inject drugs. Older and black MSM were more likely to be linked to heterosexual women. Assortative mixing was present for all racial/ethnic groups; 81% of blacks/African Americans linked to other blacks. CONCLUSIONS: This analysis is the first use of U.S. surveillance data to infer an HIV transmission network. Our data suggest that HIV infections among heterosexual women predominantly originate from MSM, followed by heterosexual men. Although few MSM were linked to women, suggesting that a minority of MSM are involved in transmission with heterosexual women, these transmissions represent a substantial proportion of HIV acquisitions by heterosexual women. Interventions that reduce transmissions involving MSM are likely to also reduce HIV acquisition among other risk groups. |
Enteropathogenic and enteroaggregative E. coli in stools of children with acute gastroenteritis in Davidson County, Tennessee.
Foster MA , Iqbal J , Zhang C , McHenry R , Cleveland BE , Romero-Herazo Y , Fonnesbeck C , Payne DC , Chappell JD , Halasa N , Gomez-Duarte OG . Diagn Microbiol Infect Dis 2015 83 (3) 319-24 This prospective acute gastroenteritis (AGE) surveillance was conducted in the inpatient and emergency room settings at a referral pediatric hospital to determine the prevalence of diarrheagenic Escherichia coli (DEC) in children <12 years of age with AGE in Davidson County, Tennessee. Subjects 15 days to 11 years of age, who presented with diarrhea and/or vomiting, were enrolled. Stool specimens were processed for detection of DEC using multiplex polymerase chain reaction. From December 1, 2011, to June 30, 2012, a total of 79 (38%) out of 206 stool specimens from children with AGE tested positive for E. coli. A total of 12 (5.8%) out of 206 stool specimens from children with AGE were positive for a DEC. Eight (67%) out of these 12 were positive for enteropathogenic E. coli, and the remaining 4 were positive for enteroaggregative E. coli. DEC clinical isolates clustered with known E. coli enteropathogens according to multilocus sequencing typing. |
Severe enterovirus 68 respiratory illness in children requiring intensive care management
Schuster JE , Miller JO , Selvarangan R , Weddle G , Thompson MT , Hassan F , Rogers SL , Oberste MS , Nix WA , Jackson MA . J Clin Virol 2015 70 77-82 BACKGROUND: Enterovirus 68 (EV-D68) causes acute respiratory tract illness in epidemic cycles, most recently in Fall 2014, but clinical characteristics of severe disease are not well reported. OBJECTIVES: Children with EV-D68 severe respiratory disease requiring pediatric intensive care unit (PICU) management were compared with children with severe respiratory disease from other enteroviruses/rhinoviruses. STUDY DESIGN: A retrospective review was performed of all children admitted to Children's Mercy Hospital PICU from August 1-September 15, 2014 with positive PCR testing for enterovirus/rhinovirus. Specimens were subsequently tested for the presence of EV-D68. We evaluated baseline characteristics, symptomatology, lab values, therapeutics, and outcomes of children with EV-D68 viral infection compared with enterovirus/rhinovirus-positive, EV-D68-negative children. RESULTS: A total of 86 children with positive enterovirus/rhinovirus testing associated with respiratory symptoms were admitted to the PICU. Children with EV-D68 were older than their EV-D68-negative counterparts (7.1 vs. 3.5 years, P=0.01). They were more likely to have a history of asthma or recurrent wheeze (68% vs. 42%, P=0.03) and to present with cough (90% vs. 63%, P=0.009). EV-D68 children were significantly more likely to receive albuterol (95% vs. 79%, P=0.04), magnesium (75% vs. 42%, P=0.004), and aminophylline (25% vs. 4%, P=0.03). Other adjunctive medications used in EV-D68 children included corticosteroids, epinephrine, and heliox; 44% of EV-D68-positive children required non-invasive ventilatory support. CONCLUSIONS: EV-D68 causes severe disease in the pediatric population, particularly in children with asthma and recurrent wheeze; children may require multiple adjunctive respiratory therapies. |
Tracking pertussis and evaluating control measures through enhanced pertussis surveillance, Emerging Infections Program, United States
Skoff TH , Baumbach J , Cieslak PR . Emerg Infect Dis 2015 21 (9) 1568-73 Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis. |
Twenty years of Active Bacterial Core Surveillance
Langley G , Schaffner W , Farley MM , Lynfield R , Bennett NM , Reingold A , Thomas A , Harrison LH , Nichols M , Petit S , Miller L , Moore MR , Schrag SJ , Lessa FC , Skoff TH , MacNeil JR , Briere EC , Weston EJ , Van Beneden C . Emerg Infect Dis 2015 21 (9) 1520-8 Active Bacterial Core surveillance (ABCs) was established in 1995 as part of the Centers for Disease Control and Prevention Emerging Infections Program (EIP) network to assess the extent of invasive bacterial infections of public health importance. ABCs is distinctive among surveillance systems because of its large, population-based, geographically diverse catchment area; active laboratory-based identification of cases to ensure complete case capture; detailed collection of epidemiologic information paired with laboratory isolates; infrastructure that allows for more in-depth investigations; and sustained commitment of public health, academic, and clinical partners to maintain the system. ABCs has directly affected public health policies and practices through the development and evaluation of vaccines and other prevention strategies, the monitoring of antimicrobial drug resistance, and the response to public health emergencies and other emerging infections. |
The US Influenza Hospitalization Surveillance Network
Chaves SS , Lynfield R , Lindegren ML , Bresee J , Finelli L . Emerg Infect Dis 2015 21 (9) 1543-50 In 2003, surveillance for influenza in hospitalized persons was added to the Centers for Disease Control and Prevention Emerging Infections Program network. This surveillance enabled monitoring of the severity of influenza seasons and provided a platform for addressing priority questions associated with influenza. For enhanced surveillance capacity during the 2009 influenza pandemic, new sites were added to this platform. The combined surveillance platform is called the Influenza Hospitalization Surveillance Network (FluSurv-NET). FluSurv-NET has helped to determine the risk for influenza-associated illness in various segments of the US population, define the severity of influenza seasons and the 2009 pandemic, and guide recommendations for treatment and vaccination programs. |
Use of pneumococcal disease epidemiology to set policy and prevent disease during 20 years of the Emerging Infections Program
Moore MR , Whitney CG . Emerg Infect Dis 2015 21 (9) 1551-6 Two decades ago, the Emerging Infections Program of the US Centers for Disease Control and Prevention implemented what seemed like a simple yet novel idea: a population- and laboratory-based surveillance system designed to identify and characterize invasive bacterial infections, including those caused by Streptococcus pneumoniae. This system, known as Active Bacterial Core surveillance, has since served as a flexible platform for following trends in invasive pneumococcal disease and studying vaccination as the most effective method for prevention. We report the contributions of Active Bacterial Core surveillance to every pneumococcal vaccine policy decision in the United States during the past 20 years. |
On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings
Rutstein SE , Golin CE , Wheeler SB , Kamwendo D , Hosseinipour MC , Weinberger M , Miller WC , Biddle AK , Soko A , Mkandawire M , Mwenda R , Sarr A , Gupta S , Mataya R . AIDS Care 2015 28 (1) 1-10 Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider perceptions of VL monitoring and indicate the importance of policies responsive to individual and environmental challenges of VL monitoring program implementation. Findings may inform scale-up by helping policy-makers identify strategies to improve feasibility and sustainability of VL monitoring. |
Patient and provider reported reasons for lost to follow up in MDRTB treatment: a qualitative study from a Drug Resistant TB Centre in India
Deshmukh RD , Dhande DJ , Sachdeva KS , Sreenivas A , Kumar AM , Satyanarayana S , Parmar M , Moonan PK , Lo TQ . PLoS One 2015 10 (8) e0135802 INTRODUCTION: Multidrug-resistant Tuberculosis (MDR TB) is emerging public health concern globally. Lost to follow-up (LTFU) is one of the key challenge in MDRTB treatment. In 2013, 18% of MDR TB patients were reported LTFU in India. A qualitative study was conducted to obtain better understanding of both patient and provider related factors for LTFU among MDR TB treatment. METHODS: Qualitative semi-structured personal interviews were conducted with 20 MDRTB patients reported as LTFU and 10 treatment providers in seven districts linked to Nagpur Drug resistant TB Centre (DRTBC) during August 2012-February 2013. Interviews were transcribed and inductive content analysis was performed to derive emergent themes. RESULTS: We found multiple factors influencing MDR TB treatment adherence. Barriers to treatment adherence included drug side effects, a perceived lack of provider support, patient financial constraints, conflicts with the timing of treatment services, alcoholism and social stigma. CONCLUSIONS: Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of LTFU during MDRTB treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, reducing pill burden, motivational counselling, flexible timings for DOT services, social, family support for patients & improving awareness about disease. |
A pilot study of a portable hand washing station for recently displaced refugees during an acute emergency in Benishangul-Gumuz Regional State, Ethiopia
Husain F , Hardy C , Zekele L , Clatworthy D , Blanton C , Handzel T . Confl Health 2015 9 26 BACKGROUND: Diarrheal disease is a common cause of morbidity and mortality. Displaced populations are especially vulnerable due to overcrowded camps and limited access to water and sanitation facilities, increasing the risk for outbreaks. Hand washing with soap is effective against disease transmission, and studies suggest access to a convenient hand washing station may be the key to increasing hand washing behavior. This pilot study evaluated the acceptability, durability and use of a novel hand washing bag (HWB) at the household level among Sudanese refugees immediately following an acute emergency. METHODS: We distributed one HWB to every household (n = 874) in Adamazin Transit Center in western Ethiopia. The evaluation consisted of baseline and endline surveys, three monthly monitoring visits and focus group discussions (FGDs) over a six month period. FGD data were analyzed using the Risk, Attitudes, Norms, Abilities, and Self-Regulatory model. Survey and monitoring data were analyzed using SPSS. Note: Residents were resettled to Bambasi Refugee Camp during the study period where the endline survey was conducted. RESULTS: Baseline data suggested water quantity and availability of soap were below SPHERE standards, however participants responded positively to the HWB. At the end of the monitoring period, 73.9 % of the same households retained their original HWBs and 66.7 % of bags had water at the time of the visit. The mean lifespan of the HWB during the monitoring period was 2.73 months. From a new sample of households selected for the endline evaluation, 93.0 % had an original HWB, but only 39.4 % had water in the bag. Endline FGD participants felt the HWB was useful, but reported insufficient soap and hygiene messaging. CONCLUSION: The HWB performed well during the early phases of the emergency, however longer term results in this setting are unclear. The low levels of reported use measured by proxy indicators at six months indicated decreasing acceptability over time or a reflection of potential differences between the two sites. It is also unknown whether the HWB influenced hand washing behavior. Study findings were shared with the manufacturer in an effort to improve the bag's acceptability, utility, and durability. |
Pneumonia among adults hospitalized with laboratory-confirmed seasonal influenza virus infection - United States, 2005-2008
Garg S , Jain S , Dawood FS , Jhung M , Perez A , D'Mello T , Reingold A , Gershman K , Meek J , Arnold KE , Farley MM , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett N , Thomas A , Schaffner W , Finelli L . BMC Infect Dis 2015 15 369 BACKGROUND: Influenza and pneumonia combined are the leading causes of death due to infectious diseases in the United States. We describe factors associated with pneumonia among adults hospitalized with influenza. METHODS: Through the Emerging Infections Program, we identified adults ≥ 18 years, who were hospitalized with laboratory-confirmed influenza during October 2005 through April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of a CXR infiltrate and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. RESULTS: Among 4,765 adults hospitalized with influenza, 1392 (29 %) had pneumonia. In multivariable analysis, factors associated with pneumonia included: age ≥ 75 years, adjusted odds ratio (AOR) 1.27 (95 % confidence interval 1.10-1.46), white race AOR 1.24 (1.03-1.49), nursing home residence AOR 1.37 (1.14-1.66), chronic lung disease AOR 1.37 (1.18-1.59), immunosuppression AOR 1.45 (1.19-1.78), and asthma AOR 0.76 (0.62-0.92). Patients with pneumonia were significantly more likely to require intensive care unit (ICU) admission (27 % vs. 10 %), mechanical ventilation (18 % vs. 5 %), and to die (9 % vs. 2 %). CONCLUSIONS: Pneumonia was present in nearly one-third of adults hospitalized with influenza and was associated with ICU admission and death. Among patients hospitalized with influenza, older patients and those with certain underlying conditions are more likely to have pneumonia. Pneumonia is common among adults hospitalized with influenza and should be evaluated and treated promptly. |
Preference for condoms, antiretroviral preexposure prophylaxis or both methods to reduce risk for HIV acquisition among uninfected U.S. black and Latino MSM
Mansergh G , Herbst JH , Mimiaga MJ , Holman J . J Acquir Immune Defic Syndr 2015 70 (4) e153-5 Men who have sex with men (MSM) in the United States continue to be disproportionately affected by HIV, particularly those who are younger and African American/black and Latino MSM.1 Antiretroviral preexposure prophylaxis (PrEP) is an efficacious biomedical intervention for reducing HIV acquisition. An international study of MSM found PrEP efficacy levels to be 44% for the sample overall, 73% among men with good self-reported adherence, and 95% among men in which PrEP medication was detected in their blood.2 Although awareness of and access to PrEP is a concern,3 it is an additional option for reducing risk of HIV infection. This is particularly helpful since a recent study found only 70% effectiveness for condom use during anal sex among MSM.4 However, there are concerns about potential “risk compensation,” wherein a large shift occurs from condom use to PrEP use, potentially resulting in little practical net benefit (or even net loss) in protection from HIV infection with less than good adherence to PrEP.5 As information about PrEP continues to reach populations that could benefit from its use, prevention practitioners must understand the potential for PrEP uptake and risk compensation. | We analyzed data on behavioral intentions to use condoms, PrEP, or both methods among HIV-uninfected black and Latino MSM in the United States. Data are from Messages4Men, a 2014 cross-sectional study conducted to better understand preferences for new HIV prevention information and methods among black and Latino MSM in Chicago, Fort Lauderdale, and Kansas City. This analysis included HIV-uninfected (self-reported) black (n = 296) and Latino (n = 309) men who reported having sex with a man in the past year, recruited through online, agency, and street/venue outreach efforts. Demographic variables and anal sex without a condom in the previous 3 months were reported through computer assessment. After informing participants that a daily pill exists to prevent HIV infection (ie, PrEP) that was found to be 73% efficacious with good adherence2 and that condoms have been found to be 70% effective for anal use among MSM,4 participants were asked: If you had a choice of using condoms during anal sex or taking a pill every day to prevent HIV infection at no cost to you, which would you pick? Response options included condoms, PrEP, or both methods. |
Emerging Infections Program as surveillance for antimicrobial drug resistance
Fridkin SK , Cleveland AA , See I , Lynfield R . Emerg Infect Dis 2015 21 (9) 1578-81 Across the United States, antimicrobial drug-resistant infections affect a diverse population, and effective interventions require concerted efforts across various public health and clinical programs. Since its onset in 1994, the Centers for Disease Control and Prevention Emerging Infections Program has provided robust and timely data on antimicrobial drug-resistant infections that have been used to inform public health action across a spectrum of partners with regard to many highly visible antimicrobial drug-resistance threats. These data span several activities within the Program, including respiratory bacterial infections, health care-associated infections, and some aspects of foodborne diseases. These data have contributed to estimates of national burden, identified populations at risk, and determined microbiological causes of infection and their outcomes, all of which have been used to inform national policy and guidelines to prevent antimicrobial drug-resistant infections. |
First case of tricuspid valve endocarditis caused by Gemella bergeri
Pachirat O , Watt G , Pussadhamma B . Case Rep Med 2015 2015 704785 Gemella bergeri is a Gram-positive cocci species arranged in pairs and composes the normal flora of oral cavity, digestive and urinary tract. Several species of Gemella are known to cause endocarditis. Here, we report the first case in Thailand of G. bergeri endocarditis whose blood culture was negative using routine methods but was positive by PCR identification of bacteria in the affected valve. A 37-year-old male presented with prolonged fever, weight loss, and dyspnea on exertion. By transthoracic echocardiography, he was suspected of having infective endocarditis of the tricuspid valve. The patient underwent tricuspid valve repair and vegetectomy. Routine hospital blood cultures were negative but G. bergeri was identified by PCR/sequencing of the heart valve tissue. |
Improving accuracy of influenza-associated hospitalization rate estimates
Millman AJ , Reed C , Kirley PD , Aragon D , Meek J , Farley MM , Ryan P , Collins J , Lynfield R , Baumbach J , Zansky S , Bennett NM , Fowler B , Thomas A , Lindegren ML , Atkinson A , Finelli L , Chaves SS . Emerg Infect Dis 2015 21 (9) 1595-601 Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza-associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003-2008 to approximately 70% during 2009-2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3-50.5 for children <18 years of age, 3.0-30.3 for adults 18-64 years, and 13.6-181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were approximately 15% higher for children <18 years, approximately 20% higher for adults 18-64 years, and approximately 55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates. |
Incidence of medically attended influenza during pandemic and post-pandemic seasons through the Influenza Incidence Surveillance Project, 2009-13
Fowlkes A , Steffens A , Temte J , Lonardo SD , McHugh L , Martin K , Rubino H , Feist M , Davis C , Selzer C , Lojo J , Oni O , Kurkjian K , Thomas A , Boulton R , Bryan N , Lynfield R , Biggerstaff M , Finelli L . Lancet Respir Med 2015 3 (9) 709-718 BACKGROUND: Since the introduction of pandemic influenza A (H1N1) to the USA in 2009, the Influenza Incidence Surveillance Project has monitored the burden of influenza in the outpatient setting through population-based surveillance. METHODS: From Oct 1, 2009, to July 31, 2013, outpatient clinics representing 13 health jurisdictions in the USA reported counts of influenza-like illness (fever including cough or sore throat) and all patient visits by age. During four years, staff at 104 unique clinics (range 35-64 per year) with a combined median population of 368 559 (IQR 352 595-428 286) attended 35 663 patients with influenza-like illness and collected 13 925 respiratory specimens. Clinical data and a respiratory specimen for influenza testing by RT-PCR were collected from the first ten patients presenting with influenza-like illness each week. We calculated the incidence of visits for influenza-like illness using the size of the patient population, and the incidence attributable to influenza was extrapolated from the proportion of patients with positive tests each week. FINDINGS: The site-median peak percentage of specimens positive for influenza ranged from 58.3% to 77.8%. Children aged 2 to 17 years had the highest incidence of influenza-associated visits (range 4.2-28.0 per 1000 people by year), and adults older than 65 years had the lowest (range 0.5-3.5 per 1000 population). Influenza A H3N2, pandemic H1N1, and influenza B equally co-circulated in the first post-pandemic season, whereas H3N2 predominated for the next two seasons. Of patients for whom data was available, influenza vaccination was reported in 3289 (28.7%) of 11 459 patients with influenza-like illness, and antivirals were prescribed to 1644 (13.8%) of 11 953 patients. INTERPRETATION: Influenza incidence varied with age groups and by season after the pandemic of 2009 influenza A H1N1. High levels of influenza virus circulation, especially in young children, emphasise the need for additional efforts to increase the uptake of influenza vaccines and antivirals. FUNDING: US Centers for Disease Control and Prevention. |
Associations between meteorological parameters and influenza activity in Berlin (Germany), Ljubljana (Slovenia), Castile and Leon (Spain) and Israeli districts
Soebiyanto RP , Gross D , Jorgensen P , Buda S , Bromberg M , Kaufman Z , Prosenc K , Socan M , Vega Alonso T , Widdowson MA , Kiang RK . PLoS One 2015 10 (8) e0134701 BACKGROUND: Studies in the literature have indicated that the timing of seasonal influenza epidemic varies across latitude, suggesting the involvement of meteorological and environmental conditions in the transmission of influenza. In this study, we investigated the link between meteorological parameters and influenza activity in 9 sub-national areas with temperate and subtropical climates: Berlin (Germany), Ljubljana (Slovenia), Castile and Leon (Spain) and all 6 districts in Israel. METHODS: We estimated weekly influenza-associated influenza-like-illness (ILI) or Acute Respiratory Infection (ARI) incidence to represent influenza activity using data from each country's sentinel surveillance during 2000-2011 (Spain) and 2006-2011 (all others). Meteorological data was obtained from ground stations, satellite and assimilated data. Two generalized additive models (GAM) were developed, with one using specific humidity as a covariate and another using minimum temperature. Precipitation and solar radiation were included as additional covariates in both models. The models were adjusted for previous weeks' influenza activity, and were trained separately for each study location. RESULTS: Influenza activity was inversely associated (p<0.05) with specific humidity in all locations. Minimum temperature was inversely associated with influenza in all 3 temperate locations, but not in all subtropical locations. Inverse associations between influenza and solar radiation were found in most locations. Associations with precipitation were location-dependent and inconclusive. We used the models to estimate influenza activity a week ahead for the 2010/2011 period which was not used in training the models. With exception of Ljubljana and Israel's Haifa District, the models could closely follow the observed data especially during the start and the end of epidemic period. In these locations, correlation coefficients between the observed and estimated ranged between 0.55 to 0.91and the model-estimated influenza peaks were within 3 weeks from the observations. CONCLUSION: Our study demonstrated the significant link between specific humidity and influenza activity across temperate and subtropical climates, and that inclusion of meteorological parameters in the surveillance system may further our understanding of influenza transmission patterns. |
Border lookout: enhancing tuberculosis control on the United States-Mexico border
DeSisto C , Broussard K , Escobedo M , Borntrager D , Alvarado-Ramy F , Waterman S . Am J Trop Med Hyg 2015 93 (4) 747-51 We evaluated the use of federal public health intervention tools known as the Do Not Board and Border Lookout (BL) for detecting and referring infectious or potentially infectious land border travelers with tuberculosis (TB) back to treatment. We used data about the issuance of BL from April 2007 to September 2013 to examine demographics and TB laboratory results for persons on the list (N = 66) and time on the list before being located and achieving noninfectious status. The majority of case-patients were Hispanic and male, with a median age of 39 years. Most were citizens of the United States or Mexico, and 30.3% were undocumented migrants. One-fifth had multidrug-resistant TB. Nearly two-thirds of case-patients were located and treated as a result of being placed on the list. However, 25.8% of case patients, primarily undocumented migrants, remain lost to follow-up and remain on the list. For this highly mobile patient population, the use of this novel federal travel intervention tool facilitated the detection and treatment of infectious TB cases that were lost to follow-up. |
Cultivation of an adaptive domestic network for surveillance and evaluation of emerging infections
Pinner RW , Lynfield R , Hadler JL , Schaffner W , Farley MM , Frank ME , Schuchat A . Emerg Infect Dis 2015 21 (9) 1499-509 Accomplishments of this program have provided numerous dividends and might benefit areas outside infectious diseases. |
Characterizing the insecticide resistance of Anopheles gambiae in Mali
Cisse MB , Keita C , Dicko A , Dengela D , Coleman J , Lucas B , Mihigo J , Sadou A , Belemvire A , George K , Fornadel C , Beach R . Malar J 2015 14 (1) 327 BACKGROUND: The impact of indoor residual spraying (IRS) and long-lasting insecticide nets (LLINs), key components of the national malaria control strategy of Mali, is threatened by vector insecticide resistance. The objective of this study was to assess the level of insecticide resistance in Anopheles gambiae sensu lato populations from Mali against four classes of insecticide recommended for IRS: organochlorines (OCs), pyrethroids (PYs), carbamates (CAs) and organophosphates (OPs). Characterization of resistance was done in 13 sites across southern Mali and assessed presence and distribution of physiological mechanisms that included target-site modifications: knockdown resistance (kdr) and altered acetycholinesterase (AChE), and/or metabolic mechanisms: elevated esterases, glutathione S-transferases (GSTs), and monooxygenases. METHODS: The World Health Organization (WHO) tube test was used to determine phenotypic resistance of An. gambiae s.l. to: dichlorodiphenyltrichloroethane (DDT) (OC), deltamethrin (PY), lambda-cyhalothrin (PY), bendiocarb (CA), and fenitrothion (OP). Identification of sibling species and presence of the ace-1 (R) and Leu-Phe kdr, resistance-associated mutations, were determined using polymerase chain reaction (PCR) technology. Biochemical assays were conducted to detect increased activity of GSTs, oxidases and esterases. RESULTS: Populations tested showed high levels of resistance to DDT in all 13 sites, as well as increased resistance to deltamethrin and lambda-cyhalothrin in 12 out of 13 sites. Resistance to fenitrothion and bendiocarb was detected in 1 and 4 out of 13 sites, respectively. Anopheles coluzzii, An. gambiae sensu stricto and Anopheles arabiensis were identified with high allelic frequencies of kdr in all sites where each of the species were found (13, 12 and 10 sites, respectively). Relatively low allelic frequencies of ace-1 (R) were detected in four sites where this assessment was conducted. Evidence of elevated insecticide metabolism, based on oxidase, GSTs and esterase detoxification, was also documented. CONCLUSION: Multiple insecticide-resistance mechanisms have evolved in An. coluzzii, An. gambiae s.s. and An. arabiensis in Mali. These include at least two target site modifications: kdr, and ace-1 (R) , as well as elevated metabolic detoxification systems (monooxygenases and esterases). The selection pressure for resistance could have risen from the use of these insecticides in agriculture, as well as in public health. Resistance management strategies, based on routine resistance monitoring to inform insecticide-based malaria vector control in Mali, are recommended. |
Relationship between vapor intrusion and human exposure to trichloroethylene
Archer NP , Bradford CM , Villanacci JF , Crain NE , Corsi RL , Chambers DM , Burk T , Blount BC . J Environ Sci Health A Tox Hazard Subst Environ Eng 2015 50 (13) 1-9 Trichloroethylene (TCE) in groundwater has the potential to volatilize through soil into indoor air where it can be inhaled. The purpose of this study was to determine whether individuals living above TCE-contaminated groundwater are exposed to TCE through vapor intrusion. We examined associations between TCE concentrations in various environmental media and TCE concentrations in residents. For this assessment, indoor air, outdoor air, soil gas, and tap water samples were collected in and around 36 randomly selected homes; blood samples were collected from 63 residents of these homes. Additionally, a completed exposure survey was collected from each participant. Environmental and blood samples were analyzed for TCE. Mixed model multiple linear regression analyses were performed to determine associations between TCE in residents' blood and TCE in indoor air, outdoor air, and soil gas. Blood TCE concentrations were above the limit of quantitation (LOQ; ≥ 0.012 microg L-1) in 17.5% of the blood samples. Of the 36 homes, 54.3%, 47.2%, and >84% had detectable concentrations of TCE in indoor air, outdoor air, and soil gas, respectively. Both indoor air and soil gas concentrations were statistically significantly positively associated with participants' blood concentrations (P = 0.0002 and P = 0.04, respectively). Geometric mean blood concentrations of residents from homes with indoor air concentrations of >1.6 microg m-3 were approximately 50 times higher than geometric mean blood TCE concentrations in participants from homes with no detectable TCE in indoor air (P < .0001; 95% CI 10.4-236.4). This study confirms the occurrence of vapor intrusion and demonstrates the magnitude of exposure from vapor intrusion of TCE in a residential setting. |
Epidemiology and ecology of opportunistic premise plumbing pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa
Falkinham JO , Hilborn ED , Arduino MJ , Pruden A , Edwards MA . Environ Health Perspect 2015 123 (8) 749-58 BACKGROUND: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa are opportunistic premise plumbing pathogens (OPPPs) that persist and grow in household plumbing, habitats they share with humans. Infections caused by these OPPPs involve individuals with preexisting risk factors and frequently require hospitalization. OBJECTIVES: The objectives of this report are to alert professionals of the impact of OPPPs, the fact that 30% of the population may be exposed to OPPPs, and the need to develop means to reduce OPPP exposure. We herein present a review of the epidemiology and ecology of these three bacterial OPPPs, specifically to identify common and unique features. METHODS: A Water Research Foundation-sponsored workshop gathered experts from across the United States to review the characteristics of OPPPs, identify problems, and develop a list of research priorities to address critical knowledge gaps with respect to increasing OPPP-associated disease. DISCUSSION: OPPPs share the common characteristics of disinfectant resistance and growth in biofilms in water distribution systems or premise plumbing. Thus, they share a number of habitats with humans (e.g., showers) that can lead to exposure and infection. The frequency of OPPP-infected individuals is rising and will likely continue to rise as the number of at-risk individuals is increasing. Improved reporting of OPPP disease and increased understanding of the genetic, physiologic, and structural characteristics governing the persistence and growth of OPPPs in drinking water distribution systems and premise plumbing is needed. CONCLUSIONS: Because broadly effective community-level engineering interventions for the control of OPPPs have yet to be identified, and because the number of at-risk individuals will continue to rise, it is likely that OPPP-related infections will continue to increase. However, it is possible that individuals can take measures (e.g., raise hot water heater temperatures and filter water) to reduce home exposures. |
Green infrastructure, ecosystem services, and human health
Coutts C , Hahn M . Int J Environ Res Public Health 2015 12 (8) 9768-98 Contemporary ecological models of health prominently feature the natural environment as fundamental to the ecosystem services that support human life, health, and well-being. The natural environment encompasses and permeates all other spheres of influence on health. Reviews of the natural environment and health literature have tended, at times intentionally, to focus on a limited subset of ecosystem services as well as health benefits stemming from the presence, and access and exposure to, green infrastructure. The sweeping influence of green infrastructure on the myriad ecosystem services essential to health has therefore often been underrepresented. This survey of the literature aims to provide a more comprehensive picture-in the form of a primer-of the many simultaneously acting health co-benefits of green infrastructure. It is hoped that a more accurately exhaustive list of benefits will not only instigate further research into the health co-benefits of green infrastructure but also promote consilience in the many fields, including public health, that must be involved in the landscape conservation necessary to protect and improve health and well-being. |
Confidence interval estimation for pooled-sample biomonitoring from a complex survey design
Caudill SP . Environ Int 2015 85 40-45 The National Centers for Disease Control and Prevention (CDC) is using a weighted pooled-sample design to characterize concentrations of persistent organic pollutants (POPs) in the U.S. POPULATION: Historically, this characterization has been based on individual measurements of these compounds in body fluid or tissue from representative samples of the population using stratified multistage selection. Pooling samples before making analytical measurements reduces the costs of biomonitoring by reducing the number of analyses. Pooling samples also allows for larger sample volumes which can result in fewer left censored results. But because samples are pooled across the sampling design cells of the original survey, direct calculation of the design effects needed for accurate standard error and confidence interval (CI) estimation is not possible. So in this paper I describe a multiple imputation (MI) method for calculating design effects associated with pooled-sample estimates. I also evaluate the method presented, by simulating NHANES individual sample data from which artificial pools are created for use in a comparison of pooled-sample estimates with estimates based on individual samples. To further illustrate and evaluate the method proposed in this paper I present geometric mean and various percentile estimates along with their 95% CIs for two chemical compounds from NHANES 2005-2006 pooled samples and compare them to individual-sample based estimates from NHANES 1999-2004. |
Alexander Duncan Langmuir
Schultz MG , Schaffner W . Emerg Infect Dis 2015 21 (9) 1635-1637 Alex Langmuir was born in Santa Monica, California, and grew up in New Jersey. His uncle, Irving Langmuir, a physicist and chemist, won the Nobel Prize in Chemistry in 1932. At Harvard College, Alex Langmuir tried to follow in his uncle’s footsteps, but he found that the mathematics of advanced physics was beyond him and thus decided to pursue a career in medicine. He received his AB (cum laude) in 1931 from Harvard and his MD in 1935 from Cornell University Medical College. As a college student, Langmuir was inspired by Massachusetts Commissioner of Health George Hoyt Bigelow to enter the field of public health. His first 2 jobs were with the New York State Health Department; he began as a medical consultant and then became an assistant district health officer in Albany. After graduating with an MPH from the Johns Hopkins School of Hygiene and Public Health in 1940, Langmuir became a deputy commissioner of health in Westchester County, New York. His family was dismayed that he chose a career in public health rather than clinical medicine, but Langmuir expressed in his later years that his time in local public health taught him lessons that were fundamental to his achievements. From 1942 to 1946, he served as an epidemiologist with the Armed Forces Epidemiologic Board’s Commission on Acute Respiratory Diseases, stimulating his lifelong interest in influenza. In 1946, Langmuir returned to Johns Hopkins University as an associate professor of epidemiology. However, by 1949 he was restive in academia and was attracted to the challenge of becoming the first chief epidemiologist of the newly established Communicable Disease Center (now the Centers for Disease Control and Prevention [CDC]) in Atlanta, Georgia, a position he held for over 20 years. When Langmuir retired from CDC, he became a visiting professor of epidemiology at Harvard Medical School and, later, a visiting professor of epidemiology at Johns Hopkins School of Hygiene and Public Health. He wrote extensively on all phases of epidemiology and public health surveillance on a global basis and was recognized internationally as an assertive public health authority. |
Foodborne Diseases Active Surveillance Network - 2 decades of achievements, 1996-2015
Henao OL , Jones TF , Vugia DJ , Griffin PM . Emerg Infect Dis 2015 21 (9) 1529-36 The Foodborne Diseases Active Surveillance Network (FoodNet) provides a foundation for food safety policy and illness prevention in the United States. FoodNet conducts active, population-based surveillance at 10 US sites for laboratory-confirmed infections of 9 bacterial and parasitic pathogens transmitted commonly through food and for hemolytic uremic syndrome. Through FoodNet, state and federal scientists collaborate to monitor trends in enteric illnesses, identify their sources, and implement special studies. FoodNet's major contributions include establishment of reliable, active population-based surveillance of enteric diseases; development and implementation of epidemiologic studies to determine risk and protective factors for sporadic enteric infections; population and laboratory surveys that describe the features of gastrointestinal illnesses, medical care-seeking behavior, frequency of eating various foods, and laboratory practices; and development of a surveillance and research platform that can be adapted to address emerging issues. The importance of FoodNet's ongoing contributions probably will grow as clinical, laboratory, and informatics technologies continue changing rapidly. |
Telomere length and age-at-menopause in the US
Shenassa ED , Rossen LM . Maturitas 2015 82 (2) 215-21 OBJECTIVES: Age-at-menopause and leukocyte telomere length (LTL) are both associated with biologic aging. Therefore, it would be reasonable to hypothesize that LTL may also serve as a marker for reproductive aging as shorter LTL may be associated with earlier age-at-menopause. METHODS: We analyzed data from 799 post-menopausal (ages 41-85) participants in the National Health and Nutrition Examination Survey (1999-2002), a nationally representative sample of U.S. women. RESULTS: Controlling for behavioral, socio-demographic, and health-related determinants of menopause, we found that among non-Hispanic white women, an increase of one standard deviation in LTL was associated with a 0.43 year higher reported age-at-menopause. Among Mexican-Americans, an increase of one standard deviation in LTL was associated with a 1.56 year earlier menopause. There was no significant association between LTL and age-at-menopause among non-Hispanic black women. CONCLUSIONS: Our main finding is evidence of a strong interaction by race/ethnicity in the association between LTL and age-at-menopause. This evidence does not support the hypothesis that shorter LTL is a predictor of earlier age-at-menopause, as the magnitude and direction of the associations between LTL and age-at-menopause varied across racial/ethnic groups. |
Communicating science: the role of Centers for Disease Control and Prevention's field-based Epidemic Intelligence Service officers, 2009-2014
Coronado F , Chen GM , Smith CK , Glynn MK . J Public Health Manag Pract 2015 22 (4) 403-8 CONTEXT: A highly skilled public health workforce is needed for responding to health threats, and that workforce must be able to communicate its scientific findings effectively. OBJECTIVE: We evaluated the scientific communication effectiveness of the Centers for Disease Control and Prevention's (CDC's) field-based Epidemic Intelligence Service officers (EISOs). DESIGN: A descriptive analysis of all scientific information products produced and submitted for institutional clearance by CDC's field-based EISOs during 2009-2014. MAIN OUTCOME MEASURE(S): The number of abstracts, journal manuscripts, Morbidity and Mortality Weekly Reports (MMWRs), and other information products approved by CDC during 2009-2014; the number of those products published; and of those published, the number cited in the scientific literature. RESULTS: During 2009-2014, a total of 152 field-based EISOs produced 835 scientific information products, including 437 abstracts, 261 manuscripts, and 103 MMWRs. The majority of scientific information products submitted for clearance were abstracts (52.3%), and infectious diseases (75.3%) constituted the majority of topics. Among the 103 MMWRs and 261 manuscripts cleared, 88 (85%) and 199 (76%) were published, respectively, with the majority also infectious disease-related. The 199 published manuscripts were cited in the scientific literature 2415 times, and the 88 published MMWRs were cited 1249 times. Field-based EISOs published their work in 74 different peer-reviewed medical and public health journals, with 54% published in journals with impact factors of 1 to 5. CONCLUSIONS: Field-based EISOs' publications are a measurable marker that reflects proficiency in epidemiology, written communication, and professionalism, and those publications are a direct reflection of EISOs' contribution to local and state health departments. Our study establishes a baseline for future evaluations of publication outcome of scientific information products by EISOs. Information released by EISOs provides health professionals with the scientific knowledge necessary for improving their practice and helps CDC achieve a broader societal, environmental, cultural, and economic impact. |
Targeted assessment for prevention of healthcare-associated infections: a new prioritization metric
Soe MM , Gould CV , Pollock D , Edwards J . Infect Control Hosp Epidemiol 2015 36 (12) 1-6 OBJECTIVE: To develop a method for calculating the number of healthcare-associated infections (HAIs) that must be prevented to reach a HAI reduction goal and identifying and prioritizing healthcare facilities where the largest reductions can be achieved. SETTING Acute care hospitals that report HAI data to the Centers for Disease Control and Prevention's National Healthcare Safety Network. METHODS: The cumulative attributable difference (CAD) is calculated by subtracting a numerical prevention target from an observed number of HAIs. The prevention target is the product of the predicted number of HAIs and a standardized infection ratio goal, which represents a HAI reduction goal. The CAD is a numeric value that if positive is the number of infections to prevent to reach the HAI reduction goal. We calculated the CAD for catheter-associated urinary tract infections for each of the 3,639 hospitals that reported such data to National Healthcare Safety Network in 2013 and ranked the hospitals by their CAD values in descending order. RESULTS: Of 1,578 hospitals with positive CAD values, preventing 10,040 catheter-associated urinary tract infections at 293 hospitals (19%) with the highest CAD would enable achievement of the national 25% catheter-associated urinary tract infection reduction goal. CONCLUSION: The CAD is a new metric that facilitates ranking of facilities, and locations within facilities, to prioritize HAI prevention efforts where the greatest impact can be achieved toward a HAI reduction goal. |
Evaluating epidemiology and improving surveillance of infections associated with health care, United States
Magill SS , Dumyati G , Ray SM , Fridkin SK . Emerg Infect Dis 2015 21 (9) 1537-42 The Healthcare-Associated Infections Community Interface (HAIC), launched in 2009, is the newest major activity of the Emerging Infections Program. The HAIC activity addresses population- and laboratory-based surveillance for Clostridium difficile infections, candidemia, and multidrug-resistant gram-negative bacilli. Other activities include special projects: the multistate Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey and projects that evaluate new approaches for improving surveillance. The HAIC activity has provided information about the epidemiology and adverse health outcomes of health care-associated infections and antimicrobial drug use in the United States and informs efforts to improve patient safety through prevention of these infections. |
Immunocompromised travelers: demographic characteristics, travel destinations, and pretravel health care from the U.S. Global TravEpiNet Consortium
Schwartz BS , Rosen J , Han PV , Hynes NA , Hagmann SH , Rao SR , Jentes ES , Ryan ET , LaRocque RC . Am J Trop Med Hyg 2015 93 (5) 1110-1116 An increasing number of immunocompromised individuals are pursuing international travel, and a better understanding of their international travel patterns and pretravel health care is needed. We evaluated the clinical features, itineraries, and pretravel health care of 486 immunocompromised international travelers seen at Global TravEpiNet sites from January 2009 to June 2012. We used bivariate analyses and logistic regressions using random intercept models to compare demographic and travel characteristics, vaccines administered, and medications prescribed for immunocompromised travelers versus 30,702 immunocompetent travelers. Immunocompromised travelers pursued itineraries that were largely similar to those of immunocompetent travelers, with nearly one-third of such travelers visiting countries with low human development indices. Biological agents, including tumor necrosis factor blockers, were commonly used immunosuppressive medications among immunocompromised travelers. A strong collaboration between travel-medicine specialists, primary care doctors, and specialist physicians is needed to prepare immunocompromised people for international travel. Incorporating routine questioning and planning regarding travel into the primary care visits of immunocompromised people may be useful. |
Usage of quadrivalent influenza vaccine among children in the United States, 2013-14
Rodgers L , Pabst LJ , Zhu L , Chaves SS . Vaccine 2015 33 (48) 6517-8 Annual influenza vaccination is recommended for everyone ≥6 months in the U.S. During the 2013-14 influenza season, in addition to trivalent influenza vaccines, quadrivalent vaccines were available, protecting against two influenza A and two influenza B viruses. We analyzed 1,976,443 immunization records from six sentinel sites to compare influenza vaccine usage among children age 6 months-18 years. A total of 983,401 (49.8%) influenza vaccine doses administered were trivalent and 920,333 (46.6%) were quadrivalent (unknown type: 72,709). Quadrivalent vaccine administration varied by age and was least frequent among those <2 years of age. |
Vaccination coverage among children in kindergarten - United States, 2014-15 school year
Seither R , Calhoun K , Knighton CL , Mellerson J , Meador S , Tippins A , Greby SM , Dietz V . MMWR Morb Mortal Wkly Rep 2015 64 (33) 897-904 State and local jurisdictions require children to be vaccinated before starting school to maintain high vaccination coverage and protect schoolchildren from vaccine-preventable diseases. State vaccination requirements, which include school vaccination and exemption laws and health department regulations, permit medical exemptions for students with a medical contraindication to receiving a vaccine or vaccine component and may allow nonmedical exemptions for religious reasons or philosophic beliefs. To monitor state and national vaccination coverage and exemption levels among children attending kindergarten, CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs. This report describes vaccination coverage estimates in 49 states and the District of Columbia (DC) and vaccination exemption estimates in 46 states and DC that reported the number of children with at least one exemption among kindergartners during the 2014-15 school year. Median vaccination coverage* was 94.0% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 94.2% for the local requirements for diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and 93.6% for 2 doses of varicella vaccine among the 39 states and DC with a 2-dose requirement. The median percentage of any exemptionsdagger was 1.7%. Although statewide vaccination coverage among kindergartners was high during the 2014-15 school year, geographic pockets of low vaccination coverage and high exemption levels can place children at risk for vaccine-preventable diseases. Appropriate school vaccination coverage assessments can help immunization programs identify clusters of low coverage and develop partnerships with schools and communities to ensure that children are protected from vaccine-preventable diseases. |
Lessons learned from making and implementing vaccine recommendations in the U.S
Walton LR , Orenstein WA , Pickering LK . Am J Prev Med 2015 49 S406-11 After publication of certain vaccine recommendations made by the Advisory Committee on Immunization Practices, several unexpected events have occurred during implementation of these recommendations. These have included changes in recommendations following adverse events involved with a particular vaccine and the conferral of community protection as an offshoot of vaccination of a specific population. Vaccine shortages and hesitancy have also been proven impediments to full implementation, and vaccine recommendations have not gone unaffected by either public perception of a vaccine or by cost considerations. |
National, state, and selected local area vaccination coverage among children aged 19-35 months - United States, 2014
Hill HA , Elam-Evans LD , Yankey D , Singleton JA , Kolasa M . MMWR Morb Mortal Wkly Rep 2015 64 (33) 889-896 The reduction in morbidity and mortality associated with vaccine-preventable diseases in the United States has been described as one of the 10 greatest public health achievements of the first decade of the 21st century. A recent analysis concluded that routine childhood vaccination will prevent 322 million cases of disease and about 732,000 early deaths among children born during 1994-2013, for a net societal cost savings of $1.38 trillion. The National Immunization Survey (NIS) has monitored vaccination coverage among U.S. children aged 19-35 months since 1994. This report presents national, regional, state, and selected local area vaccination coverage estimates for children born from January 2011 through May 2013, based on data from the 2014 NIS. For most vaccinations, there was no significant change in coverage between 2013 and 2014. The exception was hepatitis A vaccine (HepA), for which increases were observed in coverage with both ≥1 and ≥2 doses. As in previous years, <1% of children received no vaccinations. National coverage estimates indicate that the Healthy People 2020 target* of 90% was met for ≥3 doses of poliovirus vaccine (93.3%), ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.5%), ≥3 doses of hepatitis B vaccine (HepB) (91.6%), and ≥1 dose of varicella vaccine (91.0%). Coverage was below target for ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP), the full series of Haemophilus influenzae type b (Hib) vaccine, hepatitis B (HepB) birth dose,dagger ≥4 doses pneumococcal conjugate vaccine (PCV), ≥2 doses of HepA, the full series of rotavirus vaccine, and the combined vaccine series. section sign Examination of coverage by child's race/ethnicity revealed lower estimated coverage among non-Hispanic black children compared with non-Hispanic white children for several vaccinations, including DTaP, the full series of Hib, PCV, rotavirus vaccine, and the combined series. Children from households classified as below the federal poverty level had lower estimated coverage for almost all of the vaccinations assessed, compared with children living at or above the poverty level. Significant variation in coverage by state paragraph sign was observed for several vaccinations, including HepB birth dose, HepA, and rotavirus. High vaccination coverage must be maintained across geographic and sociodemographic groups if progress in reducing the impact of vaccine-preventable diseases is to be sustained. |
Childhood immunizations: first-time expectant mothers' knowledge, beliefs, intentions, and behaviors
Weiner JL , Fisher AM , Nowak GJ , Basket MM , Gellin BG . Am J Prev Med 2015 49 S426-34 INTRODUCTION: This study focused on how first-time mothers decide or intend to decide with respect to the recommended childhood immunization schedule. METHODS: This was the baseline survey of a larger longitudinal survey. Data were collected between June and September 2014 from 200 first-time mothers in their second trimester of pregnancy to examine vaccine-related knowledge, perceptions, intentions, and information-seeking behavior. RESULTS: Data were analyzed between January and June 2015. Seventy-five percent planned to have their child receive all the vaccinations consistent with the recommended childhood immunization schedule. Although participants expressed interest in childhood vaccine information, most had not received information directly from a primary care provider. One third reported receiving such information from their obstetrician/gynecologist but only about half of those were "very satisfied" with the information they received. About 70% indicated they were not familiar with the recommended vaccination schedule and number of routinely recommended vaccines. Familiarity with common vaccine education messages varied widely. Women who indicated they were planning to delay one or more recommended vaccinations were most likely to rely on Internet searches for childhood vaccine information. CONCLUSIONS: Overall, respondents had relatively positive beliefs and perceptions regarding childhood vaccines, which were associated with intentions to get their newborn vaccinated as recommended. However, most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge and favorably impact vaccination decisions. |
Sentinel events predicting later unwanted sex among girls: a national survey in Haiti, 2012
Sumner SA , Marcelin LH , Cela T , Mercy JA , Lea V , Kress H , Hillis SD . Child Abuse Negl 2015 50 49-55 Sexual violence against children is a significant global public health problem, yet limited studies exist from low-resource settings. In Haiti we conducted the country's first, nationally representative survey focused on childhood violence to help inform the development of a national action plan for violence against children. The Haiti Violence Against Children Survey was a household-level, multistage, cluster survey among youth age 13-24. In this analysis we sought to determine whether sexual violence sentinel events (unwanted sexual touching or unwanted attempted sex) were predictive of later unwanted, completed, penetrative sex in Haiti. We also sought to explore characteristics of sentinel events and help-seeking behavior among Haitian children. Multivariable logistic regression was used to test associations between sentinel events and later unwanted, completed, penetrative sex. Overall, 1,457 females reported on experiences of sexual violence occurring in childhood (before age 18). A sentinel event occurred in 40.4% of females who experienced subsequent unwanted completed sex. Females experiencing a sentinel event were approximately two and a half times more likely to experience later unwanted completed sex (adjusted odds ratio=2.40, p=.004) compared to individuals who did not experience a sentinel event. The mean lag time from first sentinel event to first unwanted completed sex was 2.3 years. Only half (54.6%) of children experiencing a sentinel event told someone about their experience of sexual violence. Among children, sentinel events occur frequently before later acts of completed unwanted sex and may represent a useful point of intervention. Reporting of sexual violence by children in Haiti is low and can be improved to better act on sentinel events. |
Substance use and physical dating violence: the role of contextual moderators
Reyes HL , Foshee VA , Tharp AT , Ennett ST , Bauer DJ . Am J Prev Med 2015 49 (3) 467-75 INTRODUCTION: Theoretic models suggest that associations between substance use and dating violence perpetration may vary in different social contexts, but few studies have examined this proposition. The current study examined whether social control and violence in the neighborhood, peer, and family contexts moderate the associations between substance use (heavy alcohol use, marijuana, and hard drug use) and adolescent physical dating violence perpetration. METHODS: Adolescents in the eighth, ninth, and tenth grades completed questionnaires in 2004 and again four more times until 2007 when they were in the tenth, 11th, and 12th grades. Multilevel analysis was used to examine interactions between each substance and measures of neighborhood, peer, and family social control and violence as within-person (time-varying) predictors of physical dating violence perpetration across eighth through 12th grade (N=2,455). Analyses were conducted in 2014. RESULTS: Physical dating violence perpetration increased at time points when heavy alcohol and hard drug use were elevated; these associations were weaker when neighborhood social control was higher and stronger when family violence was higher. Also, the association between heavy alcohol use and physical dating violence perpetration was weaker when teens had more-prosocial peer networks and stronger when teens' peers reported more physical dating violence. CONCLUSIONS: Linkages between substance use and physical dating violence perpetration depend on substance use type and levels of contextual violence and social control. Prevention programs that address substance use-related dating violence should consider the role of social contextual variables that may condition risk by influencing adolescents' aggression propensity. |
Taking stock of behavioral measures of adolescent dating violence
Smith J , Mulford C , Latzman NE , Tharp AT , Niolon PH , Blachman-Demner D . J Aggress Maltreat Trauma 2015 24 (6) 674-692 The past 2 decades have witnessed an increase in dating violence awareness and research. As the field evolves, it is critical to examine the definition and measurement of adolescent dating violence. This article summarizes the behavioral measures of adolescent dating violence used in the field. Based on a review of the literature and federally funded studies, we identified 48 different measures. The most commonly used measures were the Conflict Tactics Scale–2, the Safe Dates Scale, and the Conflict in Adolescent Dating Relationship Inventory, which all examine aspects of psychological, physical, and sexual violence. Researchers also adapted or created their own measures. This article concludes with a discussion of developments for consideration as the field moves forward. |
Why psychopathy matters: implications for public health and violence prevention
Reidy DE , Kearns MC , DeGue S , Lilienfeld SO , Massetti G , Kiehl KA . Aggress Violent Behav 2015 24 214-225 Psychopathy is an early-appearing risk factor for severe and chronic violence. The violence largely attributable to psychopathy constitutes a substantial portion of the societal burden to the public health and criminal justice systems, and thus necessitates significant attention from prevention experts. Yet, despite a vast base of research in psychology and criminology, the public health approach to violence has generally neglected to consider this key variable. Fundamentally, the public health approach to violence prevention is focused on achieving change at the population level to provide the most benefit to the maximum number of people. Increasing attention to the individual-level factor of psychopathy in public health could improve our ability to reduce violence at the community and societal levels. We conclude that the research literature on psychopathy points to a pressing need for a broad-based public health approach with a focus on primary prevention. Further, we consider how measuring psychopathy in public health research may benefit violence prevention, and ultimately society, in general. |
Masculine discrepancy stress, substance use, assault and injury in a survey of US men
Reidy DE , Berke DS , Gentile B , Zeichner A . Inj Prev 2015 22 (5) 370-4 To understand and ultimately prevent injury and behavioural health outcomes associated with masculinity, we assessed the influence of masculine discrepancy stress (stress that occurs when men perceive themselves as falling short of the traditional gender norms) on the propensity to engage in stereotypically masculine behaviours (eg, substance use, risk taking and violence) as a means of demonstrating masculinity. Six-hundred men from the USA were recruited via Amazon's Mechanical Turk (MTurk) online data collection site to complete surveys assessing self-perceptions of gender role discrepancy and consequent discrepancy stress, substance use/abuse, driving while intoxicated (DWI) and violent assaults. Negative binomial regression analyses indicated significant interactive effects wherein men high on gender role discrepancy and attendant discrepancy stress reported significantly more assaults with a weapon (B=1.01; SE=0.63; IRR=2.74; p=0.05) and assaults causing injury (B=1.01; SE=0.51; IRR=2.74; p<0.05). There was no association of discrepancy stress to substance abuse, but there was a protective effect of gender role discrepancy for DWI among men low on discrepancy stress (B=-1.19, SE=0.48; IRR=0.30; p=0.01). These findings suggest that gender role discrepancy and associated discrepancy stress, in particular, represent important injury risk factors and that prevention of discrepancy stress may prevent acts of violence with the greatest consequences and costs to the victim, offender and society. |
Predicting adolescent dating violence perpetration: role of exposure to intimate partner violence and parenting practices
Latzman NE , Vivolo-Kantor AM , Holditch Niolon P , Ghazarian SR . Am J Prev Med 2015 49 (3) 476-82 INTRODUCTION: Exposure to adult intimate partner violence (IPV) places youth at risk for a range of outcomes, including perpetration of adolescent dating violence (ADV). However, there is variability in the effect of IPV exposure, as many youth who are exposed to IPV do not go on to exhibit problems. Thus, research is needed to examine contextual factors, such as parenting practices, to more fully explain heterogeneity in outcomes and better predict ADV perpetration. The current research draws from a multisite study to investigate the predictive power of IPV exposure and parenting practices on subsequent ADV perpetration. METHODS: Participants included 417 adolescents (48.7% female) drawn from middle schools in high-risk, urban communities. IPV exposure, two types of parenting practices (positive parenting/involvement and parental knowledge of their child's dating), and five types of ADV perpetration (threatening behaviors, verbal/emotional abuse, relational abuse, physical abuse, and sexual abuse) were assessed at baseline (2012) and approximately 5 months later (2013) via adolescent report. Analyses (conducted in 2015) used a structural equation modeling approach. RESULTS: Structural models indicated that IPV exposure was positively related only to relational abuse at follow-up. Further, adolescents who reported parents having less knowledge of dating partners were more likely to report perpetrating two types of ADV (physical and verbal/emotional abuse) at follow-up. Analyses did not demonstrate any significant interaction effects. CONCLUSIONS: Results fill a critical gap in understanding of important targets to prevent ADV in middle school and highlight the important role that parents may play in ADV prevention. |
Examining explanations for the link between bullying perpetration and physical dating violence perpetration: do they vary by bullying victimization?
Foshee VA , Benefield TS , McNaughton Reyes HL , Eastman M , Vivolo-Kantor AM , Basile KC , Ennett ST , Faris R . Aggress Behav 2015 42 (1) 66-81 This short-term longitudinal study examined whether the association between bullying perpetration and later physical dating violence perpetration and mediators of that association (via anger, depression, anxiety, and social status), varied depending on level of bullying victimization. Differences have been noted between those who bully but are not victims of bullying, and those who are both bullies and victims. These differences may influence dating violence risk and the explanations for why bullying leads to dating violence. Data were from dating adolescents in three rural counties who completed self-administered questionnaires in the fall semester of grades 8-10 and again in the spring semester. The sample (N = 2,414) was 44.08% male and 61.31% white. Bullying perpetration in the fall semester predicted physical dating violence perpetration in the spring semester when there was no bullying victimization, but not when there was any bullying victimization. Bullying perpetration was positively associated with anger at all levels of bullying victimization and with social status when there was no or low amounts of victimization; it was negatively associated with social status at high levels of victimization. Bullying victimization was positively associated with anger, depression, and anxiety at all levels of bullying perpetration. Anger mediated the association between bullying perpetration and dating violence, regardless of level of victimization; depression, anxiety, and social status did not mediate the association at any level of bullying victimization. The findings have implications for dating violence prevention efforts and for future research on the link between bullying and dating violence. |
A first look at gender inequality as a societal risk factor for dating violence
Gressard LA , Swahn MH , Tharp AT . Am J Prev Med 2015 49 (3) 448-57 INTRODUCTION: One of ten U.S. high school students is a victim of adolescent dating violence (ADV). Understanding ADV risk factors guides prevention efforts; however, research examining community- and societal-level risk factors is scant. Societal gender inequality is a known risk factor for violence against women, but has yet to be explored in relation to ADV. This study aims to determine whether the Gender Inequality Index (GII) correlates with levels of physical and sexual ADV victimization across U.S. states. METHODS: State-representative prevalence rates of self-reported physical and sexual ADV victimization were obtained from the 2013 Youth Risk Behavior Survey. The state GII includes five indicators: (1) maternal mortality; (2) adolescent birth rate; (3) government representation; (4) educational attainment; and (5) labor force participation. Pearson correlation coefficients determined the association between physical and sexual ADV victimization, the GII, and GII indicators. Analyses were conducted in August 2014. RESULTS: Among U.S. states, the prevalence of physical ADV victimization in 2013 ranged from 7.0% to 14.8%, and the prevalence of sexual ADV victimization ranged from 7.8% to 13.8%. The GII was significantly associated with the state prevalence of female physical ADV victimization (r=0.48, p<0.01) but not female sexual ADV victimization. Neither physical nor sexual male ADV victimization was associated with the GII. CONCLUSIONS: This exploratory study suggests that gender inequality may be a societal-level risk factor for female physical ADV victimization. As ADV prevention strategies are implemented at the state level, further research examining the effect of gender inequality on ADV is needed. |
Helmets for Kids: evaluation of a school-based helmet intervention in Cambodia
Ederer DJ , Bui TV , Parker EM , Roehler DR , Sidik M , Florian MJ , Kim P , Sim S , Ballesteros MF . Inj Prev 2015 22 (1) 52-8 OBJECTIVE: This paper analyses helmet use before and after implementing Helmets for Kids, a school-based helmet distribution and road safety programme in Cambodia. METHODS: Nine intervention schools (with a total of 6721 students) and four control schools (with a total of 3031 students) were selected using purposive sampling to target schools where students were at high risk of road traffic injury. Eligible schools included those where at least 50% of students commute to school on bicycles or motorcycles, were located on a national road (high traffic density), had few or no street signs nearby, were located in an area with a history of crash injuries and were in a province where other Cambodia Helmet Vaccine Initiative activities occur. Programme's effectiveness at each school was measured through preintervention and postintervention roadside helmet observations of students as they arrived or left school. Research assistants conducted observations 1-2 weeks preintervention, 1-2 weeks postintervention, 10-12 weeks postintervention and at the end of the school year (3-4 months postintervention). RESULTS: In intervention schools, observed student helmet use increased from an average of 0.46% at 1-2 weeks preintervention to an average of 87.9% at 1-2 weeks postintervention, 83.5% at 10-12 weeks postintervention and 86.5% at 3-4 months postintervention, coinciding with the end of the school year. Increased helmet use was observed in children commuting on bicycle or motorcycle, which showed similar patterns of helmet use. Helmet use remained between 0.35% and 0.70% in control schools throughout the study period. CONCLUSIONS: School-based helmet use programmes that combine helmet provision and road safety education might increase helmet use among children. |
Adolescent dating violence in context
Mercy JA , Teten Tharp A . Am J Prev Med 2015 49 (3) 441-4 The quality of our relationships lies at the heart of our health and well-being. The relationships we have with our romantic partners, our children, other family members, friends, coworkers, and even casual acquaintances shape our lives in profound ways. Romantic relationships are perhaps among the most central in shaping the contour of our lives. Violence, of course, severely undermines and, in many cases, can destroy these relationships that are so important to our health and well-being. Understanding and preventing adolescent dating violence (ADV) is critical because it represents the first outward manifestation of violence in the context of romantic relationships that a girl or boy directly experiences. As such, what we do as a society to address ADV sets the stage for the extent to which violence continues to be a part of teen romantic relationships as well as for future population levels of intimate partner violence Figure 1. |
Beyond the individual level: novel approaches and considerations for multilevel adolescent dating violence prevention
Rothman EF , Bair-Merritt MH , Tharp AT . Am J Prev Med 2015 49 (3) 445-7 Adolescent dating violence (ADV), which is also referred to as teen dating violence and dating aggression, is physical, sexual, or psychological/emotional violence within a dating relationship, as well as stalking; it can occur in person or electronically and may occur between current or former dating partners.1 ADV has emerged as a serious public health problem, and its prevention has become a leading priority in the U.S. Each year, approximately 10% and 20% of high school– attending boys and girls, respectively, are physically or sexually assaulted by a romantic partner.2 Estimates of psychological dating aggression vary; recent, nationally representative data suggest that as many as 30% of youth are verbally or emotionally assaulted by a partner at some point during adolescence.3,4 The sequelae of ADA victimization can be severe, long-lasting, and costly. Consequences of ADA can include injury, depression, substance use, sexually transmitted infections, unhealthy eating, and increased risk for future re-victimization and perpetration.5–11 | Despite a movement in public health to focus on factors and prevention strategies that occur beyond the individual level of the social ecology,12 the bulk of research on ADV has examined individual-level risk factors and interventions. For example, a recently published systematic review of longitudinal risk factors for ADA perpetration identified 59 different risk and protective factors across 20 studies.13 Of the identified factors, 36 were at the individual level of the social ecology and 23 were at the interpersonal level. Notably, prior to this theme issue publication, no longitudinal study had assessed the impact of neighborhood- or societal-level factors on ADV, representing a critical gap in the literature. |
Performance of a Real Time PCR for leishmaniasis diagnosis using a L. (L.) infantum hypothetical protein as target in canine samples.
Colombo FA , Pereira-Chioccola VL , da Silva Meira C , Motoie G , Gava R , Hiramoto RM , de Almeida ME , da Silva AJ , Cutolo AA , Menz I . Exp Parasitol 2015 157 156-62 Visceral leishmaniasis represents an important public health issue in different parts of the world, requiring that measures be put in place to control the spread of the disease worldwide. The canine leishmaniasis diagnosis is not easy based on clinical signs, since dogs may not develop the infection with recognizable signs. Thus, the laboratorial diagnosis is essential to ascertain the incidence and prevalence of canine leishmaniasis especially in areas with major control efforts. Although, the diagnosis can be performed by the use of different approaches, the molecular methods such as PCR have become an indispensable tool for leishmaniases diagnosis. A TaqMan assay for real-time PCR (Linj31-qPCR) was developed to determine the parasite occurrence in clinical cases of leishmaniasis. The assay targets a L. (L.) infantum hypothetical protein region. The specificity of the assay was verified by using Leishmania World Health Organization reference strains including parasites belonging to subgenus L. (Leishmania), subgenus L. (Viannia), other Leishmania species and Trypanosoma cruzi. The sensitivity was verified by using isolates of L. (L.) amazonensis and L. (L.) infantum. The usefulness of the assay for diagnosis was ascertained by testing 277 samples from dogs in regions endemic for visceral and/or cutaneous leishmaniasis and from regions in which leishmaniasis was not endemic in Sao Paulo State, Brazil. Diagnosis of canine visceral leishmaniasis (CVL) was determined on these animals by conventional PCR and three serological tests. The dog samples were divided into four groups. I, dogs with CVL (n=101); II, dogs with other diseases and without CVL (n=97); III, dogs with American cutaneous leishmaniasis (n=7), and, IV, dogs without CVL (n=72) from areas where leishmaniasis was not endemic as control group. Results indicated that Linj31-qPCR was able to identify parasites belonging to subgenus L. (Leishmania) with no cross-amplification with other parasite subgenera. The Linj31-qPCR detected Leishmania parasites DNA in 98% of samples from Group I. In conclusion this methodology can be used as routine diagnostic tools to detect parasites from subgenus Leishmania. |
Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae.
Chea N , Bulens SN , Kongphet-Tran T , Lynfield R , Shaw KM , Vagnone PS , Kainer MA , Muleta DB , Wilson L , Vaeth E , Dumyati G , Concannon C , Phipps EC , Culbreath K , Janelle SJ , Bamberg WM , Guh AY , Limbago B , Kallen AJ . Emerg Infect Dis 2015 21 (9) 1611-6 Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority. A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non-CP-CRE could help prevention efforts. To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >1 carbapenem at US Emerging Infections Program sites. We determined the number of non-CP isolates that met (false positives) and CP isolates that did not meet (false negatives) the Centers for Disease Control and Prevention CRE definition in use during our study: 30% (94/312) of CRE had carbapenemase genes, and 21% (14/67) of Klebsiella pneumoniae carbapenemase-producing Klebsiella isolates had been misclassified as non-CP. A new definition requiring resistance to 1 carbapenem rarely missed CP strains, but 55% of results were false positive; adding the modified Hodge test to the definition decreased false positives to 12%. This definition should be considered for use in carbapenemase-producing CRE surveillance and prevention. |
Fast Technology Analysis (FTA) Enables Identification of Species and Genotypes of Latent Microsporidia Infections in Healthy Native Cameroonians.
Ndzi ES , Asonganyi T , Nkinin MB , Xiao L , Didier ES , Bowers LC , Nkinin SW , Kaneshiro ES . J Eukaryot Microbiol 2015 63 (2) 146-52 Several enteric microsporidia species have been detected in humans and other vertebrates and their identifications at the genotype level are currently being elucidated. As advanced methods, reagents, and disposal kits for detecting and identifying pathogens become commercially available, it is important to test them in settings other than in laboratories with "state-of-the-art" equipment and well-trained staff members. In the present study, we sought to detect microsporidia DNA preserved and extracted from FTA (fast technology analysis) cards spotted with human fecal suspensions obtained from Cameroonian volunteers living in the capital city of Yaounde to preclude the need for employing spore-concentrating protocols. Further, we tested whether amplicon nucleotide sequencing approaches could be used on small aliquots taken from the cards to elucidate the diversity of microsporidia species and strains infecting native residents. Of 196 samples analyzed, 12 (6.1%) were positive for microsporidia DNA; Enterocytozoon bieneusi (Type IV and KIN-1), Encephalitozoon cuniculi, and Encephalitozoon intestinalis were identified. These data demonstrate the utility of the FTA cards in identifying genotypes of microsporidia DNA in human fecal samples that may be applied to field testing for prevalence studies. This article is protected by copyright. All rights reserved. |
Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance.
Langley G , Besser J , Iwamoto M , Lessa FC , Cronquist A , Skoff TH , Chaves S , Boxrud D , Pinner RW , Harrison LH . Emerg Infect Dis 2015 21 (9) 1582-8 The Centers for Disease Control and Prevention Emerging Infections Program (EIP) network conducts population-based surveillance for pathogens of public health importance. Central to obtaining estimates of disease burden and tracking microbiological characteristics of these infections is accurate laboratory detection of pathogens. The use of culture-independent diagnostic tests (CIDTs) in clinical settings presents both opportunities and challenges to EIP surveillance. Because CIDTs offer better sensitivity than culture and are relatively easy to perform, their use could potentially improve estimates of disease burden. However, changes in clinical testing practices, use of tests with different sensitivities and specificities, and changes to case definitions make it challenging to monitor trends. Isolates are still needed for performing strain typing, antimicrobial resistance testing, and identifying other molecular characteristics of organisms. In this article, we outline current and future EIP activities to address issues associated with adoption of CIDTs, which may apply to other public health surveillance. |
Comparison of Phenotypic and Genotypic Approaches to Capsule Typing of Neisseria meningitidis by Use of Invasive and Carriage Isolate Collections.
Jones CH , Mohamed N , Rojas E , Andrew L , Hoyos J , Hawkins JC , McNeil LK , Jiang Q , Mayer LW , Wang X , Gilca R , De Wals P , Pedneault L , Eiden J , Jansen KU , Anderson AS . J Clin Microbiol 2015 54 (1) 25-34 Neisseria meningitidis serogroup B (MnB) is a leading cause of bacterial meningitidis; however, as opposed to the disease state, MnB is most commonly associated with asymptomatic carriage in the nasopharyngeal cavity. Two vaccines are now licensed for the prevention of MnB disease; an additional possible benefit of these vaccines could be to indirectly protect against disease by disrupting nasopharyngeal carriage, e.g. herd protection. To investigate this potential, accurate diagnostic approaches are required to characterize MnB carriage isolates. In contrast to invasive meningococcal disease (IMD) isolates that can readily be serogrouped, carriage isolates often lack capsule expression making standard phenotypic assays untenable for strain characterization. Several antibody based methods were evaluated for their ability to serogroup isolates and compared to two genotyping methods (real-time PCR (rt-PCR) and whole genome sequencing (WGS) to identify which approach might most accurately ascertain the polysaccharide group associated with carriage isolates. WGS and rt-PCR were in agreement for 99% of IMD isolates, including those carrying coding sequences for MnB, MnC, MnW, and MnY, and the phenotypic methods correctly identified serogroups for between 69 and 98% of IMD isolates. In contrast, only 47% of carriage isolates were groupable by genotypic methods due to mutations within the capsule operon, and of the isolates identified by genotypic methods, ≤43% were serogroupable by any of the phenotypic methods tested. These observations highlight the difficulties in serogrouping and capsular genogrouping meningococcal carriage isolates. Based on our findings, WGS is the most suitable approach for the characterization of meningococcal carriage isolates. |
Review and evaluation of hand-arm coordinate systems for measuring vibration exposure, biodynamic responses, and hand forces
Dong RG , Sinsel EW , Welcome DE , Warren C , Xu XS , McDowell TW , Wu JZ . Saf Health Work 2015 6 (3) 159-73 The hand coordinate systems for measuring vibration exposures and biodynamic responses have been standardized, but they are not actually used in many studies. This contradicts the purpose of the standardization. The objectives of this study were to identify the major sources of this problem, and to help define or identify better coordinate systems for the standardization. This study systematically reviewed the principles and definition methods, and evaluated typical hand coordinate systems. This study confirms that, as accelerometers remain the major technology for vibration measurement, it is reasonable to standardize two types of coordinate systems: a tool-based basicentric (BC) system and an anatomically based biodynamic (BD) system. However, these coordinate systems are not well defined in the current standard. Definition of the standard BC system is confusing, and it can be interpreted differently; as a result, it has been inconsistently applied in various standards and studies. The standard hand BD system is defined using the orientation of the third metacarpal bone. It is neither convenient nor defined based on important biological or biodynamic features. This explains why it is rarely used in practice. To resolve these inconsistencies and deficiencies, we proposed a revised method for defining the realistic handle BC system and an alternative method for defining the hand BD system. A fingertip-based BD system for measuring the principal grip force is also proposed based on an important feature of the grip force confirmed in this study. |
Use of Enterococcus faecalis and Bacillus atrophaeus as surrogates to establish and maintain laboratory proficiency for concentration of water samples using ultrafiltration
Mapp L , Klonicki P , Takundwa P , Hill VR , Schneeberger C , Knee J , Raynor M , Hwang N , Chambers Y , Miller K , Pope M . J Microbiol Methods 2015 118 133-42 The U.S. Environmental Protection Agency's (EPA) Water Laboratory Alliance (WLA) currently uses ultrafiltration (UF) for concentration of biosafety level 3 (BSL-3) agents from large volumes (up to 100-L) of drinking water prior to analysis. Most UF procedures require comprehensive training and practice to achieve and maintain proficiency. As a result, there was a critical need to develop quality control (QC) criteria. Because select agents are difficult to work with and pose a significant safety hazard, QC criteria were developed using surrogates, including Enterococcus faecalis and Bacillus atrophaeus. This article presents the results from the QC criteria development study and results from a subsequent demonstration exercise in which E. faecalis was used to evaluate proficiency using UF to concentrate large volume drinking water samples. Based on preliminary testing EPA Method 1600 and Standard Methods 9218, for E. faecalis and B. atrophaeus respectively, were selected for use during the QC criteria development study. The QC criteria established for Method 1600 were used to assess laboratory performance during the demonstration exercise. Based on the results of the QC criteria study E. faecalis and B. atrophaeus can be used effectively to demonstrate and maintain proficiency using ultrafiltration. |
Molecular strain typing and characterisation of toxigenic Clostridium difficile
Dingle TC , MacCannell DR . Methods in Microbiology 2015 42 329-357 At the turn of the century, a shift in incidence of Clostridium difficile infection occurred with the emergence of a novel, more virulent strain of C. difficile. It became apparent that strain typing was critical to our understanding of the epidemiology and transmission of the disease. Over the past 25 years, C. difficile strain typing methods have developed from phenotypic to genotypic techniques, each with their own advantages and disadvantages. Unfortunately, with the advent of polymerase chain reaction for C. difficile diagnosis, many clinical laboratories no longer perform anaerobic culture of the organism, and therefore routine strain typing for surveillance or detection of hospital outbreaks is rarely performed. Even among reference laboratories that do perform strain typing of C. difficile, standardisation of methods and inter-laboratory exchange of data continues to be problematic. Herein, an overview of molecular strain typing methods for C. difficile is provided, along with specific applications and limitations of each technique. In addition, current efforts to standardise laboratory protocols and a review of recent studies are discussed. |
Performance evaluation of the CHEMBIO DPP(R) (dual path platform) HIV-1/2 assay in early and established infections
Masciotra S , Price KA , Sprinkle P , Wesolowski L , Owen SM . J Clin Virol 2015 70 97-100 BACKGROUND: The availability of more accurate point-of-care technology could increase the number of persons aware of their HIV status. The DPP((R)) HIV-1/2 assay is the first dual path platform rapid test (RT) approved in the U.S. that also received the Clinical Laboratory Improvement Amendments (CLIA) waiver for use with oral fluid and fingerstick and venous whole blood. OBJECTIVE: To evaluate the performance of the DPP((R)) HIV-1/2 assay with plasma specimens. STUDY DESIGN: Sensitivity and specificity of the assay were calculated from 696 HIV-1 groups M (B and non-B subtypes) and O and HIV-2 (groups A and B) specimens and 505 HIV-negative specimens, respectively. Analysis of the assay performance in HIV-1 early infections was assessed by estimating the relative sensitivity of the RT before the Western blot (WB) becomes positive using a 50% cumulative frequency analysis and by comparing the reactivity with other Food and Drug Administration (FDA)-approved RTs. RESULTS: The sensitivity for established infection was 100% for HIV-1 and 100% for HIV-2. The specificity was 100%. The DPP((R)) HIV-1/2 assay performs similarly to most antibody-based RT approved by FDA in early HIV-1 infections. CONCLUSIONS: The DPP((R)) technology showed no significant improvement for detecting early infections over other lateral-flow RTs used in the U.S. Without more data on the DPP((R)) HIV-1/2 assay, especially from whole blood and oral fluid specimens collected during the early phase of infection, its performance as point-of-care technology remains to be assessed. |
Effect of carbon nanotubes upon emissions from cutting and sanding carbon fiber-epoxy composites
Heitbrink WA , Lo LM . J Nanopart Res 2015 17 (8) 335 Carbon nanotubes (CNTs) are being incorporated into structural composites to enhance material strength. During fabrication or repair activities, machining nanocomposites may release CNTs into the workplace air. An experimental study was conducted to evaluate the emissions generated by cutting and sanding on three types of epoxy-composite panels: Panel A containing graphite fibers, Panel B containing graphite fibers and carbon-based mat, and Panel C containing graphite fibers, carbon-based mat, and multi-walled CNTs. Aerosol sampling was conducted with direct-reading instruments, and filter samples were collected for measuring elemental carbon (EC) and fiber concentrations. Our study results showed that cutting Panel C with a band saw did not generate detectable emissions of fibers inspected by transmission electron microscopy but did increase the particle mass, number, and EC emission concentrations by 20–80 % compared to Panels A and B. Sanding operation performed on two Panel C resulted in fiber emission rates of 1.9 × 108 and 2.8 × 106 fibers per second (f/s), while no free aerosol fibers were detected from sanding Panels A and B containing no CNTs. These free CNT fibers may be a health concern. However, the analysis of particle and EC concentrations from these same samples cannot clearly indicate the presence of CNTs, because extraneous aerosol generation from machining the composite epoxy material increased the mass concentrations of the EC. |
Generation of monoclonal antibodies against dengue virus type 4 and identification of enhancing epitopes on envelope protein
Tang CT , Liao MY , Chiu CY , Shen WF , Chiu CY , Cheng PC , Chang GJ , Wu HC . PLoS One 2015 10 (8) e0136328 The four serotypes of dengue virus (DENV1-4) pose a serious threat to global health. Cross-reactive and non-neutralizing antibodies enhance viral infection, thereby exacerbating the disease via antibody-dependent enhancement (ADE). Studying the epitopes targeted by these enhancing antibodies would improve the immune responses against DENV infection. In order to investigate the roles of antibodies in the pathogenesis of dengue, we generated a panel of 16 new monoclonal antibodies (mAbs) against DENV4. Using plaque reduction neutralization test (PRNT), we examined the neutralizing activity of these mAbs. Furthermore, we used the in vitro and in vivo ADE assay to evaluate the enhancement of DENV infection by mAbs. The results indicate that the cross-reactive and poorly neutralizing mAbs, DD11-4 and DD18-5, strongly enhance DENV1-4 infection of K562 cells and increase mortality in AG129 mice. The epitope residues of these enhancing mAbs were identified using virus-like particle (VLP) mutants. W212 and E26 are the epitope residues of DD11-4 and DD18-5, respectively. In conclusion, we generated and characterized 16 new mAbs against DENV4. DD11-4 and D18-5 possessed non-neutralizing activities and enhanced viral infection. Moreover, we identified the epitope residues of enhancing mAbs on envelope protein. These results may provide useful information for development of safe dengue vaccine. |
Interlaboratory evaluation of cellulosic acid-soluble internal air sampling capsules for multi-element analysis
Andrews RN , Feng HA , Ashley K . J Occup Environ Hyg 2015 13 (1) 1-28 An interlaboratory study was carried out to evaluate the use of acid-soluble cellulosic air sampling capsules for their suitability in the measurement of trace elements in workplace atmospheric samples. These capsules are used as inserts to perform closed-face cassette sample collection for occupational exposure monitoring. The interlaboratory study was performed in accordance with NIOSH guidelines that describe statistical procedures for evaluating measurement accuracy of air monitoring methods. The performance evaluation materials used consisted of cellulose acetate capsules melded to mixed-cellulose ester filters that were dosed with multiple elements from commercial standard aqueous solutions. The cellulosic capsules were spiked with the following 33 elements of interest in workplace air monitoring: Ag, Al, As, Ba, Be, Ca, Cd, Co, Cr, Cu, Fe, In, K, La, Li, Mg, Mn, Mo, Ni, P, Pb, Sb, Se, Sn, Sr, Te, Ti, Tl, V, W, Y, Zn, Zr. The elemental loading levels were certified by an accredited provider of certified reference materials. Triplicates of media blanks and multielement-spiked capsules at three different elemental loadings were sent to each participating laboratory; the elemental loading levels were not revealed to the laboratories. The volunteer participating laboratories were asked to prepare the samples by acid dissolution and to analyze aliquots of extracted samples by inductively coupled plasma atomic emission spectrometry in accordance with NIOSH methods. It was requested that the study participants report their analytical results in units of mug of each target element per internal capsule sample. For the majority of the elements investigated (30 out of 33), the study accuracy estimates obtained satisfied the NIOSH accuracy criterion (A < 25%). This investigation demonstrates the utility of acid-soluble internal sampling capsules for multielement analysis by atomic spectrometry. |
Congenital adrenal hyperplasia cases identified by newborn screening in one- and two-screen states.
Held PK , Shapira SK , Hinton CF , Jones E , Hannon WH , Ojodu J . Mol Genet Metab 2015 116 (3) 133-8 There is no clear consensus among state newborn screening programs on whether routine second screening of newborns identifies clinically relevant cases of congenital adrenal hyperplasia. This retrospective study evaluated laboratory practices, along with biochemical and medical characteristics of congenital adrenal hyperplasia (CAH) cases (1) detected on the first newborn screen in one-screen compared to two-screen states, and (2) detected on the first versus the second screen in the two-screen states, to determine the effectiveness of a second screen. A total of 374 confirmed cases of CAH from 2 one-screen states and 5 two-screen states were included in this study. Demographic data and diagnostic information on each reported case were collected and analyzed. Additionally, laboratory data, including screening methodologies and algorithms, were evaluated. The one-screen states reported 99 cases of CAH out of 1,740,586 (1 in 17,500) newborns screened: 88 (89%) identified on the first screen and 5 (5%) identified on the targeted second screen. The two-screen states reported 275 cases of CAH out of 2,629,627 (1 in 9500) newborns screened: 165 (60%) identified on the first screen and 99 (36%) identified on the second screen. Using a multivariate model, the only significant predictor of whether a case was identified on the first or the second screen in the two-screen states was the type of CAH. Compared with classical salt-wasting CAH, classical simple virilizing and non-classical CAH cases were less likely to be detected on the first versus the second screen. The routine second newborn screen is important for identifying children with CAH, particularly simple virilizing and non-classical forms, which might otherwise not be captured through a single screen. |
The role of socio-economic status and perinatal factors in racial disparities in the risk of cerebral palsy
Durkin MS , Maenner MJ , Benedict RE , Van Naarden Braun K , Christensen D , Kirby RS , Wingate M , Yeargin-Allsopp M . Dev Med Child Neurol 2015 57 (9) 835-43 AIM: To determine whether racial disparities in cerebral palsy (CP) risk among US children persist after controlling for socio-economic status (SES) (here indicated by maternal education) and perinatal risk factors. METHOD: A population-based birth cohort study was conducted using the Autism and Developmental Disabilities Monitoring Network surveillance and birth data for 8-year-old children residing in multi-county areas in Alabama, Georgia, Missouri, and Wisconsin between 2002 and 2008. The birth cohort comparison group included 458 027 children and the case group included 1570 children with CP, 1202 with available birth records. chi(2) tests were performed to evaluate associations and logistic regression was used to calculate relative risks (RR) and adjusted odds ratios (OR) with 95% confidence intervals (CI). RESULTS: The risk of spastic CP was more than 50% higher for black versus white children (RR 1.52, 95% CI 1.33-1.73), and this greater risk persisted after adjustment for SES (OR 1.35, 95% CI 1.18-1.55), but not after further adjustment for preterm birth and size for gestational age. The protective effect of maternal education remained after adjustment for race/ethnicity and perinatal factors. INTERPRETATION: Maternal education appears to independently affect CP risk but does not fully explain existing racial disparities in CP prevalence in the US. |
Single newborn screen or routine second screening for primary congenital hypothyroidism
Shapira SK , Hinton CF , Held PK , Jones E , Hannon WH , Ojodu J . Mol Genet Metab 2015 116 (3) 125-32 Routine second screening of most newborns at 8-14days of life for a panel of newborn conditions occurs in 12 U.S. states, while newborns in the other states typically undergo only a single routine newborn screen. The study objective was to evaluate screening consequences for primary congenital hypothyroidism (CH) in one- and two-screen states according to laboratory practices and medical or biochemical characteristics of screen-positive cases. Individual-level medical and biochemical data were retrospectively collected and analyzed for 2251 primary CH cases in one-screen (CA, WI) and two-screen (AL, DE, MD, OR, TX) states. Aggregate data were collected and analyzed for medical and biochemical characteristics of all screened newborns in the states. Among the states evaluated in this study, the detection rate of primary CH was higher in the one-screen states. In the two-screen states, 11.5% of cases were detected on the second screen. In multivariate analyses, only race/ethnicity was a significant predictor of cases identified on the first versus second screen, which likely reflects a physiologic difference in primary CH presentation. Newborn screening programs must heed the potential for newborns with CH not being detected by a single screen, particularly newborns of certain races/ethnicities. If the two-screen states converted to a single screen using their current algorithms, newborns currently identified on the routine second screen would presumably not be detected, resulting in probable delayed diagnosis and treatment. However, based on the one-screen state experiences, with appropriate modifications in screening method and algorithm, the two-screen states might convert to single screen operation for CH without loss in performance. |
The Newborn Screening Quality Assurance Program at the Centers for Disease Control and Prevention: thirty-five year experience assuring newborn screening laboratory quality
De Jesus VR , Mei JV , Cordovado SK , Cuthbert CD . Int J Neonatal Screen 2015 1 (1) 13-26 Newborn screening is the largest genetic testing effort in the United States and is considered one of the ten great public health achievements during the first 10 years of the 21st century. For over 35 years, the Newborn Screening Quality Assurance Program (NSQAP) at the US Centers for Disease Control and Prevention has helped NBS laboratories ensure that their testing does not delay diagnosis, minimizes false-positive reports, and sustains high-quality testing performance. It is a multi-component program that provides comprehensive quality assurance services for dried blood spot testing. The NSQAP, the Biochemical Mass Spectrometry Laboratory (BMSL), the Molecular Quality Improvement Program (MQIP) and the Newborn Screening Translation Research Initiative (NSTRI), aid screening laboratories achieve technical proficiency and maintain confidence in their performance while processing large volumes of specimens daily. The accuracy of screening tests could be the difference between life and death for many babies; in other instances, identifying newborns with a disorder means that they can be treated and thus avoid life-long disability or severe cognitive impairment. Thousands of newborns and their families have benefited from reliable and accurate testing that has been accomplished by a network of screening laboratories and the NSQAP, BMSL, MQIP and NSTRI. |
An overview of the CDC's Community-Based Breastfeeding Supplemental Cooperative Agreement
Rutledge G , Ayers DR , MacGowan C , Murphy P . J Hum Lact 2015 31 (4) 571-6 Although breastfeeding is on the rise in the United States (US), rates of breastfeeding still fall short of national objectives.1,2 Whereas 79% of infants born in 2011 initiated breastfeeding, only 49% were breastfeeding at 6 months and 27% at 12 months, compared to the national objectives of 81.9%, 60.6%, and 34.1%, respectively.1,2 Within this context, the United States has seen an increase in the number of Baby-Friendly hospitals.3 In 2013, 7.15% of US live births occurred in Baby-Friendly designated facilities, compared to 1.79% of live births in 2007.1 Hospitals and birthing facilities must implement the Ten Steps to Successful Breastfeeding and abide by the provisions of the International Code of Marketing of Breast-Milk Substitutes to receive and retain Baby-Friendly designation.3 A number of studies have been conducted to evaluate the implementation and effectiveness of the Baby-Friendly Initiatives in the United States, and they found that full implementation of Baby-Friendly policies was associated with increased breastfeeding rates.4-6 Although there have been increases in the total number of Baby-Friendly designated hospitals in the United States, evaluation studies also indicate challenges with implementing Step 10—foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.7-9 The challenges most frequently reported with implementing this step included hospitals not facilitating peer counseling for breastfeeding mothers, lack of referral systems to other agencies that provide postpartum breastfeeding support, and hospitals not having control of the services outside of the hospital.7-9 | Community-based support strategies that have demonstrated effective results in initiation of breastfeeding include breastfeeding-friendly maternity care practices in clinical settings,10 breastfeeding education and professional support for health care professionals,11-13 support for breastfeeding in the workplace,14 peer support programs,11 and access to breastfeeding information for new mothers.15 Evidence from international Breastfeeding-Friendly Community Initiatives indicates that maximizing existing resources in the government and working through nongovernmental organizations already implementing community-level activities can achieve significant increases in breastfeeding initiation and exclusivity over large populations.16,17 |
In which states are physician assistants or nurse practitioners more likely to work in primary care?
Hing E , Hsiao CJ . JAAPA 2015 28 (9) 46-53 OBJECTIVE: Examine availability of physician assistants (PAs) or nurse practitioners (NPs) in primary care physician practices by state and by state PA and NP scope-of-practice laws. METHODS: Availability of PAs and NPs in primary care practices was examined in multivariate analysis using a 2012 state-based, nationally representative survey of office-based physicians. Covariates included practice characteristics, state, and in a separate model, PA and NP scope-of-practice variables. RESULTS: After controlling for practice characteristics, higher use of PAs and NPs was found in three states (Minnesota, Montana, and South Dakota). In a separate model, higher use of PAs or NPs was associated with favorable PA scope-of-practice laws, but not with NP scope-of-practice laws. CONCLUSIONS: Higher availability of PAs or NPs was associated with favorable PA scope-of-practice laws. Lack of association between PA or NP availability and NP scope-of-practice laws requires further investigation. |
Analysis of gob gas venthole production performances for strata gas control in longwall mining
Karacan CO . Int J Rock Mech Min Sci 2015 79 9-18 Longwall mining of coal seams affects a large area of overburden by deforming it and creating stress-relief fractures, as well as bedding plane separations, as the mining face progresses. Stress-relief fractures and bedding plane separations are recognized as major pathways for gas migration from gas-bearing strata into sealed and active areas of the mines. In order for strata gas not to enter and inundate the ventilation system of a mine, gob gas ventholes (GGVs) can be used as a methane control measure. The aim of this paper is to analyze production performances of GGVs drilled over a longwall panel. These boreholes were drilled to control methane emissions from the Pratt group of coals due to stress-relief fracturing and bedding plane separations into a longwall mine operating in the Mary Lee/Blue Creek coal seam of the Upper Pottsville Formation in the Black Warrior Basin, Alabama. During the course of the study, Pratt coal's reservoir properties were integrated with production data of the GGVs. These data were analyzed by using material balance techniques to estimate radius of influence of GGVs, gas-in-place and coal pressures, as well as their variations during mining.The results show that the GGVs drilled to extract gas from the stress-relief zone of the Pratt coal interval is highly effective in removing gas from the Upper Pottsville Formation. The radii of influence of the GGVs were in the order of 330-380. m, exceeding the widths of the panels, due to bedding plane separations and stress relieved by fracturing. Material balance analyses indicated that the initial pressure of the Pratt coals, which was around 648. KPa when longwall mining started, decreased to approximately 150. KPa as the result of strata fracturing and production of released gas. Approximately 70% of the initial gas-in-place within the area of influence of the GGVs was captured during a period of one year. |
School-level practices to increase availability of fruits, vegetables, and whole grains, and reduce sodium in school meals - United States, 2000, 2006, and 2014
Merlo C , Brener N , Kann L , McManus T , Harris D , Mugavero K . MMWR Morb Mortal Wkly Rep 2015 64 (33) 905-908 Students consume up to half of their daily calories at school, often through the federal school meal programs (e.g., National School Lunch Program) administered by the U.S. Department of Agriculture (USDA). In 2012, USDA published new required nutrition standards for school meals.* These standards were the first major revision to the school meal programs in >15 years and reflect current national dietary guidance and Institute of Medicine recommendations to meet students' nutrition needs. The standards require serving more fruits, vegetables, and whole grains and gradually reducing sodium content over 10 years. To examine the prevalence of school-level practices related to implementation of the nutrition standards, CDC analyzed data from the 2000, 2006, and 2014 School Health Policies and Practices Study (SHPPS) on school nutrition services practices related to fruits, vegetables, whole grains, and sodium. Almost all schools offered whole grain foods each day for breakfast and lunch, and most offered two or more vegetables and two or more fruits each day for lunch. The percentage of schools implementing practices to increase availability of fruits and vegetables and decrease sodium content in school meals increased from 2000-2014. However, opportunities exist to increase the percentage of schools nationwide implementing these practices. |
Styrene-associated health outcomes at a windblade manufacturing plant
McCague AB , Cox-Ganser JM , Harney JM , Alwis KU , Blount BC , Cummings KJ , Edwards N , Kreiss K . Am J Ind Med 2015 58 (11) 1150-9 BACKGROUND: Health risks of using styrene to manufacture windblades for the green energy sector are unknown. METHODS: Using data collected from 355 (73%) current windblade workers and regression analysis, we investigated associations between health outcomes and styrene exposure estimates derived from urinary styrene metabolites. RESULTS: The median current styrene exposure was 53.6 mg/g creatinine (interquartile range: 19.5-94.4). Color blindness in men and women (standardized morbidity ratios 2.3 and 16.6, respectively) was not associated with exposure estimates, but was the type previously reported with styrene. Visual contrast sensitivity decreased and chest tightness increased (odds ratio 2.9) with increasing current exposure. Decreases in spirometric parameters and FeNO, and increases in the odds of wheeze and asthma-like symptoms (odds ratios 1.3 and 1.2, respectively) occurred with increasing cumulative exposure. CONCLUSIONS: Despite styrene exposures below the recommended 400 mg/g creatinine, visual and respiratory effects indicate the need for additional preventative measures in this industry. |
Ultrafine and respirable particle exposure during vehicle fire suppression
Evans DE , Fent KW . Environ Sci Process Impacts 2015 17 (10) 1749-59 Vehicle fires are a common occurrence, yet few studies have reported exposures associated with burning vehicles. This article presents an assessment of firefighters' potential for ultrafine and respirable particle exposure during vehicle fire suppression training. Fires were initiated within the engine compartment and passenger cabins of three salvaged vehicles, with subsequent water suppression by fire crews. Firefighter exposures were monitored with an array of direct reading particle and air quality instruments. A flexible metallic duct and blower drew contaminants to the instrument array, positioned at a safe distance from the burning vehicles, with the duct inlet positioned at the nozzle operator's shoulder. The instruments measured the particle number, active surface area, respirable particle mass, photoelectric response, aerodynamic particle size distributions, and air quality parameters. Although vehicle fires were suppressed quickly (<10 minutes), firefighters may be exposed to short duration, high particle concentration episodes during fire suppression, which are orders of magnitude greater than the ambient background concentration. . . Passenger cabin fires were a greater potential source of exposure than engine compartment fires. The wind direction and the relative position of the fire crew to the stationary burning vehicle played a primary role in fire crews' potential for exposure. We recommend that firefighters wear self-contained breathing apparatus during all phases of the vehicle fire response to significantly reduce their potential for particulate, vapor, and gaseous exposures. |
Exposure estimation and interpretation of occupational risk: enhanced information for the occupational risk manager
Waters M , McKernan L , Maier A , Jayjock M , Schaeffer V , Brosseau L . J Occup Environ Hyg 2015 12 Suppl 1 0 The fundamental goal of this paper is to describe, define and analyze the components of the risk characterization process for occupational exposures. Current methods are described for the probabilistic characterization of exposure, including newer techniques that have increasing applications for assessing data from occupational exposure scenarios. In addition, since the probability of health effects reflects variability in the exposure estimate as well as the dose-response curve - the integrated considerations of variability surrounding both components of the risk characterization provide greater information to the occupational hygienist. Probabilistic tools provide a more informed view of exposure as compared to use of discrete point estimates for these inputs to the risk characterization process. Active use of such tools for exposure and risk assessment will lead to a scientifically supported worker health protection program. Understanding the bases for an occupational risk assessment, focusing on important sources of variability and uncertainty enables characterizing occupational risk in terms of a probability - rather than a binary decision of acceptable risk or unacceptable risk. A critical review of existing methods highlights several conclusions: 1.) exposure estimates and the dose-response are impacted by both variability and uncertainty and a well-developed risk characterization reflects and communicates this consideration, 2.) occupational risk is probabilistic in nature and most accurately considered as a distribution, not a point estimate, 3.) occupational hygienists have a variety of tools available to incorporate concepts of risk characterization into occupational health and practice. |
A demonstration project in New York and Virginia: retrofitting cost-effective roll-over protective structures (CROPS) on tractors
Hard DL , McKenzie EA Jr , Cantis D , May J , Sorensen J , Bayes B , Madden E , Wyckoff S , Stone B , Maass J . J Agric Saf Health 2015 21 (3) 173-185 The NIOSH cost-effective roll-over protective structure (CROPS) demonstration project sought to determine whether three prototype roll-over protective structures (ROPS) designed to be retrofitted on Ford 8N, Ford 3000, Ford 4000, and Massey Ferguson 135 tractors could be installed in the field and whether they would be acceptable by the intended end users (farmers). There were a total of 50 CROPS demonstrators (25 in New York and 25 in Virginia), with 45 observers attending the New York CROPS demonstrations and 36 observers attending the Virginia CROPS demonstrations, for a total of 70 participants in New York and 61 in Virginia. The oldest retrofitted tractors were 77 to 62 years old, while the newest retrofitted tractors were 40 to 37 years old. The most frequently retrofitted tractor in the CROPS demonstration project was a Ford 3000 series tractor (n = 19; 38%), followed by Ford 4000 (n = 11; 22%), Massey Ferguson 135 (n = 11; 22%), and Ford 8N (n = 9; 18%). A major issue of CROPS retrofitting was the rear wheel fenders. The effort involved in disassembling the fenders (removing the old bolts was often faster by cutting them with a torch), modifying the fender mounting brackets, and then reinstalling the fenders with the CROPS generally required the most time. In addition, various other semi-permanent equipment attachments, such as frontend loaders, required additional time and effort to fit with the CROPS. Demonstrators were asked to rank the reasons why they had not retrofitted their tractors with ROPS until they had enrolled in the CROPS demonstration program. ROPS "cost too much" was ranked as the primary reason for participants in both states (80% for New York and 88% for Virginia). The second highest ranked reasons were "ROPS wasn't available" for Virginia (80%) and "hassle to find ROPS" for New York (69%). The third highest ranked reasons were "not enough time to find ROPS" for New York (67%) and "hassle to find ROPS" for Virginia (79%). All demonstrators and observers indicated that they were glad to have participated in the CROPS project. |
Deposition of graphene nanomaterial aerosols in human upper airways
Su WC , Ku BK , Kulkarni P , Cheng YS . J Occup Environ Hyg 2015 13 (1) 1-34 Graphene nanomaterials have attracted wide attention in recent years on their application to state-of-the-art technology due to their outstanding physical properties. On the other hand, the nanotoxicity of graphene materials also has rapidly become a serious concern especially in occupational health. Graphene naomaterials inevitably could become airborne in the workplace during manufacturing processes. The inhalation and subsequent deposition of graphene nanomaterial aerosols in the human respiratory tract could potentially result in adverse health effects to exposed workers. Therefore, investigating the deposition of graphene nanomaterial aerosols in the human airways is an indispensable component of an integral approach to graphene occupational health. For this reason, this study carried out a series of airway replica deposition experiments to obtain original experimental data for graphene aerosol airway deposition. In this study, graphene aerosols were generated, size classified, and delivered into human airway replicas (nasal and oral-to-lung airways). The deposition fraction and deposition efficiency of graphene aerosol in the airway replicas were obtained by a novel experimental approach. The experimental results acquired showed that the fractional deposition of graphene aerosols in airway sections studied were all less than 4%, and the deposition efficiency in each airway section was generally lower than 0.03. These results indicate that the majority of the graphene nanomaterial aerosols inhaled into the human respiratory tract could easily penetrate through the head airways as well as the upper part of the tracheobronchial airways and then transit down to the lower lung airways, where undesired biological responses might be induced. |
Anti-malarial prescription practices among children admitted to six public hospitals in Uganda from 2011 to 2013
Sserwanga A , Sears D , Kapella BK , Kigozi R , Rubahika D , Staedke SG , Kamya M , Yoon SS , Chang MA , Dorsey G , Mpimbaza A . Malar J 2015 14 (1) 331 BACKGROUND: In 2011, Uganda's Ministry of Health switched policy from presumptive treatment of malaria to recommending parasitological diagnosis prior to treatment, resulting in an expansion of diagnostic services at all levels of public health facilities including hospitals. Despite this change, anti-malarial drugs are often prescribed even when test results are negative. Presented is data on anti-malarial prescription practices among hospitalized children who underwent diagnostic testing after adoption of new treatment guidelines. METHODS: Anti-malarial prescription practices were collected as part of an inpatient malaria surveillance program generating high quality data among children admitted for any reason at government hospitals in six districts. A standardized medical record form was used to collect detailed patient information including presenting symptoms and signs, laboratory test results, admission and final diagnoses, treatments administered, and final outcome upon discharge. RESULTS: Between July 2011 and December 2013, 58,095 children were admitted to the six hospitals (hospital range 3294-20,426).A total of 56,282 (96.9 %) patients were tested for malaria, of which 26,072 (46.3 %) tested positive (hospital range 5.9-57.3 %). Among those testing positive, only 84 (0.3 %) were first tested after admission and 295 of 30,389 (1.0 %) patients who tested negative at admission later tested positive. Of 30,210 children with only negative test results, 11,977 (39.6 %) were prescribed an anti-malarial (hospital range 14.5-53.6 %). The proportion of children with a negative test result who were prescribed an anti-malarial fluctuated over time and did not show a significant trend at any site with the exception of one hospital where a steady decline was observed. Among those with only negative test results, children 6-12 months of age (aOR 3.78; p < 0.001) and those greater than 12 months of age (aOR 4.89; p < 0.001) were more likely to be prescribed an anti-malarial compared to children less than 6 months of age. Children with findings suggestive of severe malaria were also more likely to be prescribed an anti-malarial after a negative test result (aOR 1.98; p < 0.001). CONCLUSIONS: Despite high testing rates for malaria at all sites, prescription of anti-malarials to patients with negative test results remained high, with the exception of one site where a steady decline occurred. |
Active transportation surveillance - United States, 1999-2012
Whitfield GP , Paul P , Wendel AM . MMWR Surveill Summ 2015 64 1-17 PROBLEM/CONDITION: Physical activity is a health-enhancing behavior, and most U.S. adults do not meet the 2008 Physical Activity Guidelines for Americans. Active transportation, such as by walking or bicycling, is one way that persons can be physically active. No comprehensive, multiyear assessments of active transportation surveillance in the United States have been conducted. PERIOD COVERED: 1999-2012. DESCRIPTION OF SYSTEMS: Five surveillance systems assess one or more components of active transportation. The American Community Survey and the National Household Travel Survey (NHTS) both assess the mode of transportation to work in the past week. From these systems, the proportion of respondents who reported walking or bicycling to work can be calculated. NHTS and the American Time Use Survey include 1-day assessments of trips or activities. With that information, the proportion of respondents who report any walking or bicycling for transportation can be calculated. The National Health and Nutrition Examination Survey and the National Health Interview Survey both assess recent (i.e., in the past week or past month) habitual physical activity behaviors, including those performed during active travel. From these systems, the proportion of respondents who report any recent habitual active transportation can be calculated. RESULTS: The prevalence of active transportation as the primary commute mode to work in the past week ranged from 2.6% to 3.4%. The 1-day assessment indicated that the prevalence of any active transportation ranged from 10.5% to 18.5%. The prevalence of any habitual active transportation ranged from 23.9% to 31.4%. No consistent trends in active transportation across time periods and surveillance systems were identified. Among systems, active transportation was usually more common among men, younger respondents, and minority racial/ethnic groups. Among education groups, the highest prevalence of active transportation was usually among the least or most educated groups, and active transportation tended to be more prevalent in densely populated, urban areas. INTERPRETATION: Active transportation is assessed in a wide variety of ways in multiple surveillance systems. Different assessment techniques and construct definitions result in widely discrepant estimates of active transportation; however, some consistent patterns were detected across covariates. Although each type of assessment (i.e., transportation to work, single day, and habitual behavior) measures a different active transportation component, all can be used to monitor population trends in active transportation participation. PUBLIC HEALTH ACTION: An understanding of the strengths, limitations, and lack of comparability of active transportation assessment techniques is necessary to correctly evaluate findings from the various surveillance systems. When used appropriately, these systems can be used by public health and transportation professionals to monitor population participation in active transportation and plan and evaluate interventions that influence active transportation. |
Menstrual needs and associations with sexual and reproductive risks in rural Kenyan females: a cross-sectional behavioral survey linked with HIV prevalence
Phillips-Howard PA , Otieno G , Burmen B , Otieno F , Odongo F , Odour C , Nyothach E , Amek N , Zielinski-Gutierrez E , Odhiambo F , Zeh C , Kwaro D , Mills LA , Laserson KF . J Womens Health (Larchmt) 2015 24 (10) 801-11 BACKGROUND: Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs. METHODS: Responses from 3418 menstruating females aged 13-29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures. RESULTS: Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls <15 years old depending on makeshift items. Two-thirds of females with no education relied on traditional items. Having attended secondary school increased the odds of using commercial pads among married (adjusted odds ratios [AOR] 4.8, 95% confidence interval [CI] 3.25-7.12) and single females (AOR 2.17, 95% CI 1.04-4.55). Married females had lower odds of pad use if they reported early (<12 years of age) compared with later (≥18 years) sexual debut (64% vs. 78%, AOR 0.45, 95% CI 0.21-0.97). Two-thirds of pad users received them from sexual partners. Receipt was lower among married females if partners were violent (AOR 0.67, 95% CI 0.53-0.85). Receipt among single females was higher if they had two or more sexual partners in the past year (AOR 2.11, 95% CI 1.04-4.29). Prevalence of engaging in sex for money to buy pads was low (1.3%); however, 10% of 15-year-olds reported this, with girls ≤15 having significantly higher odds compared with females over 15 (AOR 2.84, 95% CI 0.89-9.11). The odds of having transactional sex for pads was higher among females having two or more partners in the past 12 months (AOR 4.86, 95% CI 2.06-11.43). CONCLUSIONS: Menstrual needs of impoverished females in rural LMICs settings likely leads to increased physical and sexual harms. Studies are required to strengthen knowledge and to evaluate interventions to reduce these harms. |
Aligning the work of two U.S. Task Forces on behavioral counseling recommendations
Grossman DC , Elder RW . Am J Prev Med 2015 49 S174-83 This paper highlights the collaboration and alignment between topics and recommendations related to behavioral counseling interventions from the U.S. Preventive Services Task Force (USPSTF) and Community Preventive Services Task Force (CPSTF). Although the scope and mandates of the USPSTF and CPSTF differ, there are many similarities in the methods and approaches used to select topics and make recommendations to their key stakeholders. Behavioral counseling recommendations represent an important domain for both Task Forces, given the importance of behavior change in promoting healthful lifestyles. This paper explores opportunities for greater alignment between the two Task Forces and compares and contrasts the groups and their current approaches to making recommendations that involve behavioral counseling interventions. Opportunities to enhance behavioral counseling preventive services through closer coordination when developing and disseminating recommendations as well as future collaboration between the USPSTF and CPSTF are discussed. |
Polycyclic aromatic hydrocarbons in the mainstream smoke of popular U.S. cigarettes
Vu AT , Taylor KM , Holman MR , Ding YS , Hearn B , Watson CH . Chem Res Toxicol 2015 28 (8) 1616-26 The mainstream smoke yields of 14 polycyclic aromatic hydrocarbons (PAHs) were determined for 50 commercial U.S. cigarettes using a validated GC/MS method with the International Organization of Standardization (ISO) and Canadian Intense (CI) smoking machine regimens. PAH mainstream smoke deliveries vary widely among the commercial cigarettes with the ISO smoking regimen primarily because of differing filter ventilation. The more abundant, lower molecular weight PAHs such as naphthalene, fluorene, and phenanthrene predominantly comprise the total PAH yields. In contrast, delivery yields of high molecular weight PAHs such as benzo[b]fluoranthene, benzo[e]pyrene, benzo[k]fluoranthene, and benzo[a]pyrene (BaP) are much lower. Comparative analysis of PAHs deliveries shows brand specific differences. Correlation analysis shows strong positive associations between BaP and most of the other PAHs as well as total PAHs. The results suggest that BaP may be a representative marker for other PAH constituents in cigarette smoke generated from similarly blended tobacco, particularly those PAHs with similar molecular weights and chemical structures. |
Protobacco media exposure and youth susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US youth
Fulmer EB , Neilands TB , Dube SR , Kuiper NM , Arrazola RA , Glantz SA . PLoS One 2015 10 (8) e0134734 PURPOSE: Youth are exposed to many types of protobacco influences, including smoking in movies, which has been shown to cause initiation. This study investigates associations between different channels of protobacco media and susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US middle and high school students. METHODS: By using data from the 2012 National Youth Tobacco Survey, structural equation modeling was performed in 2013. The analyses examined exposure to tobacco use in different channels of protobacco media on smoking susceptibility, experimentation, and current tobacco use, accounting for perceived peer tobacco use. RESULTS: In 2012, 27.9% of respondents were never-smokers who reported being susceptible to trying cigarette smoking. Cigarette experimentation increased from 6.3% in 6th grade to 37.1% in 12th grade. Likewise, current tobacco use increased from 5.2% in 6th grade to 33.2% in 12th grade. Structural equation modeling supported a model in which current tobacco use is associated with exposure to static advertising through perception of peer use, and by exposure to tobacco use depicted on TV and in movies, both directly and through perception of peer use. Exposure to static advertising appears to directly increase smoking susceptibility but indirectly (through increased perceptions of peer use) to increase cigarette experimentation. Models that explicitly incorporate peer use as a mediator can better discern the direct and indirect effects of exposure to static advertising on youth tobacco use initiation. CONCLUSIONS: These findings underscore the importance of reducing youth exposure to smoking in TV, movies, and static advertising. |
The influence of estimated retail tobacco sale price increase on smokers' smoking habit in Jiangxi province, China: a cross-sectional study
Wang R , Zhu L , Yan W , Zeng G , Engelgau M . Tob Induc Dis 2015 13 (1) 25 INTRODUCTION: China is the biggest tobacco producer and consumer in the world. Raising cigarette taxes and increasing tobacco retail prices have been prove as effective strategies to reduce tobacco consumption and the prevalence of smoking in western countries. But in China, it is uncertain how an increase of cigarette retail price will influence the tobacco consumption. METHODS: From April to July, 2012, we selected 4025 residents over 15 years by a three stage random sampling in four cities, Jiangxi Province, China. We conducted interviews of their current smoking habits and how they would change their smoking behavior if tobacco retail prices increase. RESULTS: Overall, the prevalence of smoking is 27 % (47 % for male, 3.1 % for female). 15 % of smokers have tried to quit smoking in the past but all relapsed (168/1088), and over 50 % of current smokers do not want to quit, The average cigarette price per pack is 1.1 USD (range = 0.25-5.0). If retail cigarette prices increases by 50 %, 45 % of smokers say they will smoke fewer cigarettes, 20 % will change to cheaper brands and 5 % will attempt to quit smoking. Smokers who have intention to quit smoking are more sensitive to retail cigarette price increase. With retail cigarette price increases, more smokers will attempt to quit smoking. CONCLUSION: Chinese smokers will change their smoking habits if tobacco retail prices increase. Consequently the Chinese government should enact tobacco laws which increase the retail cigarette price. The implementation of new tobacco laws could result in lowering the prevalence of smoking. Meanwhile, price increase measures need to apply to all cigarette brands to avoid smokers switching cigarettes to cheaper brands. |
Injuries from methamphetamine-related chemical incidents - five states, 2001-2012
Melnikova N , Orr MF , Wu J , Christensen B . MMWR Morb Mortal Wkly Rep 2015 64 (33) 909-912 Methamphetamine (meth), a highly addictive drug, can be illegally manufactured using easily acquired chemicals; meth production can cause fires, explosions, injuries, and environmental contamination. To analyze injury incidence and trends, data on 1,325 meth-related chemical incidents reported to the Agency for Toxic Substances and Disease Registry's (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system and National Toxic Substance Incidents Program (NTSIP) by the five participating states (Louisiana, Oregon, Utah, New York, and Wisconsin) with complete information during 2001-2012 were examined. The findings suggested that meth-related chemical incidents increased with the drug's popularity (2001-2004), declined with legislation limiting access to precursor chemicals (2005-2007), and increased again as drug makers circumvented precursor restrictions (2008-2012). Seven percent of meth-related chemical incidents resulted in injuries to 162 persons, mostly members of the general public (97 persons, including 26 children) and law enforcement officials (42). Recent trends suggest a need for efforts to protect the general public, particularly children and law enforcement officials. Because individual state legislative actions can result in increased illegal meth production in neighboring states, a regional approach to prevention is recommended. |
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