Relationship between migraine history and breast cancer risk among premenopausal and postmenopausal women
Li CI , Mathes RW , Malone KE , Daling JR , Bernstein L , Marchbanks PA , Strom BL , Simon MS , Press MF , Deapen D , Burkman RT , Folger SG , McDonald JA , Spirtas R . Cancer Epidemiol Biomarkers Prev 2009 18 (7) 2030-4 Both migraine and breast cancer are hormonally mediated diseases, and it is biologically plausible that women with a history of migraine may have a reduced breast cancer risk. However, this relationship has only been assessed in a single relatively small study that was unable to assess the effect of migraine triggers, which are also well-established breast cancer risk factors (e.g., use of alcohol and exogenous hormones), on the inverse association observed. Utilizing data on 4,568 breast cancer cases and 4,678 controls who participated in a multicenter population-based case-control study in the United States, we evaluated the association between migraine history and breast cancer risk using unconditional logistic regression. Migraine history data were obtained from structured in-person interviews. Women with a history of migraine had a reduced risk of breast cancer [odds ratio, 0.74; 95% confidence interval (CI), 0.66-0.82]. This risk did not differ by menopausal status, age at migraine diagnosis, use of prescription migraine medications, or when analyses were restricted to women who avoided various migraine triggers (including alcohol, exogenous hormones, and smoking). These data support a previous finding that a history of migraine may be associated with a reduced risk of breast cancer. It extends the prior report in observing that this relationship holds for both premenopausal and postmenopausal women and is independent of exposure to common migraine triggers. |
Trends in the prevalence of low risk factor burden for cardiovascular disease among United States adults
Ford ES , Li C , Zhao G , Pearson WS , Capewell S . Circulation 2009 120 (13) 1181-8 BACKGROUND: Cohorts consistently show that individuals with low levels of cardiovascular risk factors experience low rates of subsequent cardiovascular events. Our objective was to examine the prevalence and trends in low risk factor burden for cardiovascular disease among adults in the US population. METHODS AND RESULTS:-We used data from adults 25 to 74 years of age who participated in 4 national surveys. We created an index of low risk from the following variables: not currently smoking, total cholesterol <5.17 mmol/L (<200 mg/dL) and not using cholesterol-lowering medications, systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg and not using antihypertensive medications, body mass index <25 kg/m(2), and not having been previously diagnosed with diabetes mellitus. The age-adjusted prevalence of low risk factor burden increased from 4.4% during 1971 to 1975 to 10.5% during 1988 to 1994 before decreasing to 7.5% during 1999 to 2004 (P for nonlinear trend <0.001). The patterns were similar for men and women, although the prevalence among women exceeded that among men in each survey (P<0.001 for each survey). In addition, whites had a significantly higher prevalence of low risk factor burden than blacks during each survey except during 1976 to 1980 (1971 to 1975, 1988 to 1994, 1999 to 2004: P<0.001; 1976 to 1980: P=0.154). Furthermore, a larger percentage of whites had a low risk factor burden than Mexican Americans during 1988 to 1994 (P<0.001) and 1999 to 2004 (P=0.001). CONCLUSIONS: The prevalence of low risk factor burden for cardiovascular disease is low. The progress that had been made during the 1970s and 1980s reversed in recent decades. |
Celebrating 10 years of the National Comprehensive Cancer Control Program, 1998 to 2008
Major A , Stewart SL . Prev Chronic Dis 2009 6 (4) A133 In 2008, the Division of Cancer Prevention and Control of the Centers for Disease Control and Prevention (CDC) celebrated the first 10 years of the National Comprehensive Cancer Control Program (NCCCP). This program was created by a group of public health professionals who recognized that a more collaborative approach was necessary to reduce the burden of cancer in the United States. They believed that coordination among the various sectors involved in cancer control would improve prevention, early detection, treatment, quality of care, and survival. We present a summary of how the movement began, the NCCCP's accomplishments, the program's collaboration with the National Partnership for Comprehensive Cancer Control, and current initiatives in the program. We also discuss the vision for the future of this program. |
Control of risk factors among people with diagnosed diabetes, by lower extremity disease status
Dorsey RR , Eberhardt MS , Gregg EW , Geiss LS . Prev Chronic Dis 2009 6 (4) A114 INTRODUCTION: We examined the control of modifiable risk factors among a national sample of diabetic people with and without lower extremity disease (LED). METHODS: The sample from the 1999-2004 National Health and Nutrition Examination Survey consisted of 948 adults aged 40 years or older with diagnosed diabetes and who had been assessed for LED. LED was defined as peripheral arterial disease (ankle-brachial index <0.9), peripheral neuropathy (> or = 1 insensate area), or presence of foot ulcer. Good control of modifiable risk factors, based on American Diabetes Association recommendations, included being a nonsmoker and having the following measurements: hemoglobin A1c (HbA1c) less than 7%, systolic blood pressure less than or equal to 130 mm Hg, diastolic blood pressure less than or equal to 80 mm Hg, high-density lipoprotein (HDL) cholesterol greater than 50 mg/dL, and body mass index (BMI) between 18.5 kg/m(2) and 24.9 kg/m(2). RESULTS: Diabetic people with LED were less likely than were people without LED to have recommended levels of HbA1c (39.3% vs 53.5%) and HDL cholesterol (29.7% vs 41.1%), but there were no differences in systolic or diastolic blood pressure, BMI classification, or smoking status between people with and without LED. Control of some risk factors differed among population subgroups. Notably, among diabetic people with LED, non-Hispanic blacks were more likely to have improper control of HbA1c (adjusted odds ratio [AOR] = 2.0; 95% confidence interval [CI], 1.1-3.9), systolic blood pressure (AOR = 1.9; 95% CI, 1.1-3.2), and diastolic blood pressure (AOR = 2.6; 95% CI, 1.1-5.8), compared with non-Hispanic whites. CONCLUSION: Control of 2 of 6 modifiable risk factors was worse in diabetic adults with LED compared with diabetic adults without LED. Among diabetic people with LED, non-Hispanic blacks had worse control of 3 of 6 risk factors compared with non-Hispanic whites. |
Endometrial cancer risk among younger, overweight women
Thomas CC , Wingo PA , Dolan MS , Lee NC , Richardson LC . Obstet Gynecol 2009 114 (1) 22-7 OBJECTIVE: To examine the risk for endometrial cancer among overweight women using the World Health Organization's clinical definitions of obesity based on body mass index (BMI). METHODS: Conducted in the early 1980s, the Cancer and Steroid Hormone study was a multicenter, population-based, case-control study of breast, ovarian, and endometrial cancers among women aged 20-54 years. Participants for the case group (n=421) were identified through cancer registries and had histologically confirmed endometrial cancer. Participants for the control group (n=3,159) were chosen by random-digit dialing methods in the same regions as those in the case group. Those in the case and control groups responded to the same questions during in-person interviews. Unconditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The relationship between endometrial cancer and BMI (calculated as weight [kg]/[height (m)]) was modified by age at last menstrual period (LMP). Of women who were younger than 45 years at LMP, those with BMIs of at least 35.0 had a greater risk of endometrial cancer (56%, 30/54) than did those with normal BMIs (4%, 59/1,492, adjusted OR 21.7, 95% CI 11.3-41.7). Of women age 45 or older at LMP, those with BMIs of at least 35.0 also had a greater risk (40%, 24/60) than did those with normal BMIs (14%, 168/1,235, adjusted OR 3.7, 95% CI 2.0-6.6). Women younger than 45 years at LMP and those with BMIs of at least 25.0 at 18 years and as adults (25%, 31/123) had an approximately sixfold increased risk (adjusted OR 5.8, 95% CI 3.4-9.8) compared with those with normal BMIs at 18 and as adults (4%, 58/1,460). CONCLUSION: Very obese women aged 20-54 years have an elevated endometrial cancer risk, which appears heightened by early menopause. LEVEL OF EVIDENCE: II. |
Evidence-based interventions and screening recommendations for colorectal cancer in comprehensive cancer control plans: a content analysis
Townsend JS , Richardson LC , Steele CB , White DE . Prev Chronic Dis 2009 6 (4) A127 INTRODUCTION: Colorectal cancer is the third most commonly diagnosed cancer and third leading cause of cancer death in the United States. The extent to which Comprehensive Cancer Control (CCC) programs in states, tribal governments and organizations, territories, and Pacific Island jurisdictions address evidence-based recommendations and interventions for colorectal cancer in their CCC plans is largely unknown. METHODS: We downloaded CCC plans posted on the Cancer Control PLANET Web site for review. We searched the plans for key terms, identifying potential evidence-based content surrounding colorectal cancer prevention and early detection. Content was abstracted for further review and classification. RESULTS: Of 55 plans reviewed, 54 (98%) referred to evidence-based recommendations or interventions for colorectal cancer or indicated they intended to refer to the evidence base when developing programs. More than 57% (n = 31) of programs referred to the American Cancer Society guidelines, 41% (n = 22) referred to the United States Preventive Services Task Force, and 11% (n = 6) referred to the Guide to Community Preventive Services. Few programs mentioned Research Tested Intervention Programs (n = 1), National Cancer Institute's Physician Data Query (n = 4), Cochrane Reviews (n = 2), or Put Prevention Into Practice (n = 2) in reference to evidence-based interventions for colorectal cancer prevention. CONCLUSION: Most CCC programs discussed either evidence-based screening guidelines or interventions in their cancer plans, although many mentioned this information exclusively as background information. We recommend that program planners be trained to locate evidence-based interventions and use consistent common language to describe them in their plans. CCC program planners should be encouraged to conduct and publish intervention studies. |
Influence of reproductive factors on mortality after epithelial ovarian cancer diagnosis
Robbins CL , Whiteman MK , Hillis SD , Curtis KM , McDonald JA , Wingo PA , Kulkarni A , Marchbanks PA . Cancer Epidemiol Biomarkers Prev 2009 18 (7) 2035-41 INTRODUCTION: Although many studies have examined the influence of reproductive factors on ovarian cancer risk, few have investigated their effect on ovarian cancer survival. We examined the prognostic influence of reproductive factors on survival after ovarian cancer diagnosis. METHODS: We conducted a longitudinal analysis of 410 women, ages 20 to 54 years, who participated in the 1980 to 1982 Cancer and Steroid Hormone study as incident ovarian cancer cases. We obtained their vital status by linking Cancer and Steroid Hormone records with Surveillance, Epidemiology, and End Results data. We used the Kaplan-Meier approach to estimate survival probabilities and Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). RESULTS: During a median follow-up of 9.2 years, 212 women died. Of the reproductive factors examined, only age at menarche and number of lifetime ovulatory cycles (LOC) relative to age significantly predicted ovarian cancer survival. Risk for death was higher among women with highest number of LOC compared with those having fewest LOC (HR, 1.67; 95% CI, 1.20-2.33). Women with fewest LOC had the highest 15-year survival (56.7%; 95% CI, 47.8-64.6%), and women with the highest LOC had the poorest (33.3%; 95% CI, 25.3-41.5%). Women whose age at menarche was <12 years had a higher risk of death compared with women whose menses began at > or =14 years (HR, 1.51; 95% CI, 1.02-2.24). CONCLUSIONS: We found that high LOC and early age at menarche were associated with decreased survival after ovarian cancer. |
Limited utility of name-based tuberculosis contact investigations among persons using illicit drugs: results of an outbreak investigation
Asghar RJ , Patlan DE , Miner MC , Rhodes HD , Solages A , Katz DJ , Beall DS , Ijaz K , Oeltmann JE . J Urban Health 2009 86 (5) 776-80 Persons named by a patient with tuberculosis (TB) are the focus of traditional TB contact investigations. However, patients who use illicit drugs are often reluctant to name contacts. Between January 2004 and May 2005, 18 isoniazid-resistant TB cases with matching Mycobacterium tuberculosis genotypes (spoligotypes) were reported in Miami; most patients frequented crack houses and did not name potentially infected contacts. We reviewed medical records and re-interviewed patients about contacts and locations frequented to describe transmission patterns and make recommendations to control TB in this population. Observed contacts were not named but were encountered at the same crack houses as the patients. Contacts were evaluated for latent TB infection with a tuberculosis skin test (TST). All 18 patients had pulmonary TB. Twelve (67%) reported crack use and 14 (78%) any illicit drug use. Of the 187 contacts evaluated, 91 (49%) were named, 16 (8%) attended a church reported by a patient, 61 (33%) used a dialysis center reported by a patient, and 19 (10%) were observed contacts at local crack houses. Compared to named contacts, observed contacts were eight times as likely to have positive TST results (relative risk = 7.8; 95% confidence interval = 3.8-16.1). Dialysis center and church contacts had no elevated risk of a positive TST result. Testing observed contacts may provide a higher yield than traditional name-based contact investigations for tuberculosis patients who use illicit drugs or frequent venues characterized by illicit drug use. |
National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States
Verani JR , Lorick SA , Yoder JS , Beach MJ , Braden CR , Roberts JM , Conover CS , Chen S , McConnell KA , Chang DC , Park BJ , Jones DB , Visvesvara GS , Roy SL , AcanthamoebaKeratitis Investigation Team . Emerg Infect Dis 2009 15 (8) 1236-42 An outbreak of Acanthamoeba keratitis, a rare, potentially blinding, corneal infection, was detected in the United States in 2007; cases had been increasing since 2004. A case-control study was conducted to investigate the outbreak. We interviewed 105 case-patients from 30 states and 184 controls matched geographically and by contact lens use. Available contact lenses, cases, solutions, and corneal specimens from case-patients were cultured and tested by molecular methods. In multivariate analyses, case-patients had significantly greater odds of having used Advanced Medical Optics Complete Moisture Plus (AMOCMP) solution (odds ratio 16.9, 95% confidence interval 4.8-59.5). AMOCMP manufacturing lot information was available for 22 case-patients, but none of the lots were identical. Three unopened bottles of AMOCMP tested negative for Acanthamoeba spp. Our findings suggest that the solution was not intrinsically contaminated and that its anti-Acanthamoeba efficacy was likely insufficient. Premarket standardized testing of contact lens solutions for activity against Acanthamoeba spp. is warranted. |
Patterns of single and multiple claims of epididymitis among young privately-insured males in the United States, 2001 to 2004
Bohm MK , Gift TL , Tao G . Sex Transm Dis 2009 36 (8) 490-2 Epididymitis is characterized by unilateral pain and swelling in the scrotum, testicle, or epididymis, and is usually accompanied by urethritis.1,2 This condition may occur as a result of infection, systemic disease, or a physiological condition.2 Experts believe that the syndrome of acute epididymitis among sexually active males under the age of 35 most often results from untreated sexually transmitted infections, especially Chlamydia trachomatis and Neisseria gonorrhoeae.1,3 Chronic epididymitis, although more rare, also occurs in this young age group, and may or may not be associated with persistent infections (untreated infections or relapse following treatment failure) or reinfections (a new infection caused by the same or different organism). Some cases are not associated with an identified pathogen at all. The diagnosis and management of these conditions have improved in recent years, which has led to some decrease in morbidity and possibly to prevention of recurrences.4 Nonetheless, the literature on acute and chronic epididymitis is limited, and our understanding of its etiology and epidemiology is still incomplete. Knowledge of patterns of recurrence could be used to further enhance rescreening strategies for this syndrome. |
Prevalence of cervical cancer screening of HIV-infected women in the United States
Oster AM , Sullivan PS , Blair JM . J Acquir Immune Defic Syndr 2009 51 (4) 430-6 BACKGROUND: HIV-infected women are at increased risk of cervical cytologic abnormalities. HIV treatment guidelines recommend annual Papanicolaou (Pap) tests for HIV-infected women. We assessed screening prevalence and associated factors among HIV-infected women. METHODS: We used data collected during 2000-2004 in an interview study of HIV-infected persons in 18 states. We performed logistic regression to describe factors associated with not having an annual Pap test. RESULTS: Of 2417 women, 556 (23.0%) did not report receiving a Pap test during the past year. Not having a Pap test was associated with increasing age [adjusted odds ratio (AOR) = 1.3 per 10 years, 95% confidence interval (CI): 1.1 to 1.4] and most recent CD4 count of <200 cells per microliter (AOR = 1.6, CI: 1.1 to 2.1) or unknown (AOR = 1.4, CI: 1.1 to 1.7; both vs. CD4 count of >or=200 cells/microL). Odds of a missed Pap test increased for women whose most recent pelvic exam was not performed at their usual source of HIV care (AOR = 2.6, CI: 2.1 to 3.2). CONCLUSIONS: Nearly 1 in 4 women did not receive an annual Pap test. HIV care providers should ensure that HIV-infected women receive annual Pap tests, recognizing that missed Pap tests are more likely among older women and women with low CD4 cell counts. Integrating HIV and gynecologic care and educating clinicians about recommendations may increase screening. |
Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature
Hosenfeld CB , Workowski KA , Berman S , Zaidi A , Dyson J , Mosure D , Bolan G , Bauer HM . Sex Transm Dis 2009 36 (8) 478-89 Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting. |
Substitution of moxifloxacin for isoniazid during intensive phase treatment of pulmonary tuberculosis
Dorman SE , Johnson JL , Goldberg S , Muzanye G , Padayatchi N , Bozeman L , Heilig CM , Bernardo J , Choudhri S , Grosset JH , Guy E , Guyadeen P , Leus MC , Maltas G , Menzies D , Nuermberger EL , Villarino M , Vernon A , Chaisson RE , Tuberculosis Trials Consortium . Am J Respir Crit Care Med 2009 180 (3) 273-80 RATIONALE: Moxifloxacin has potent activity against Mycobacterium tuberculosis in vitro and in a mouse model of antituberculosis (TB) chemotherapy, but data regarding its activity in humans are limited. OBJECTIVES: Our objective was to compare the antimicrobial activity and safety of moxifloxacin versus isoniazid during the first 8 weeks of combination therapy for pulmonary TB. METHODS: Adults with sputum smear-positive pulmonary TB were randomly assigned to receive either moxifloxacin 400 mg plus isoniazid placebo, or isoniazid 300 mg plus moxifloxacin placebo, administered 5 days/week for 8 weeks, in addition to rifampin, pyrazinamide, and ethambutol. All doses were directly observed. Sputum was collected for culture every 2 weeks. The primary outcome was negative sputum culture at completion of 8 weeks of treatment. MEASUREMENTS AND MAIN RESULTS: Of 433 participants enrolled, 328 were eligible for the primary efficacy analysis. Of these, 35 (11%) were HIV positive, 248 (76%) had cavitation on baseline chest radiograph, and 213 (65%) were enrolled at African sites. Negative cultures at Week 8 were observed in 90/164 (54.9%) participants in the isoniazid arm, and 99/164 (60.4%) in the moxifloxacin arm (P = 0.37). In multivariate analysis, cavitation and enrollment at an African site were associated with lower likelihood of Week-8 culture negativity. The proportion of participants who discontinued assigned treatment was 31/214 (14.5%) for the moxifloxacin group versus 22/205 (10.7%) for the isoniazid group (RR, 1.35; 95% CI, 0.81, 2.25). CONCLUSIONS: Substitution of moxifloxacin for isoniazid resulted in a small but statistically nonsignificant increase in Week-8 culture negativity. |
West Nile virus from blood donors, vertebrates, and mosquitoes, Puerto Rico, 2007
Hunsperger EA , McElroy KL , Bessoff K , Colon C , Barrera R , Munoz-Jordan JL . Emerg Infect Dis 2009 15 (8) 1298-300 West Nile virus (WNV) was isolated from a human blood donor, a dead falcon, and mosquitoes in Puerto Rico in 2007. Phylogenetic analysis of the 4 isolates suggests a recent introduction of lineage I WNV that is closely related to WNV currently circulating in North America. |
Coping with HIV: Caribbean people in the United Kingdom
Anderson M , Elam G , Solarin I , Gerver S , Fenton K , Easterbrook P . Qual Health Res 2009 19 (8) 1060-75 Although Caribbean people in the United Kingdom are increasingly being affected by HIV/AIDS, there has been no examination of how they are coping with the illness. We investigate the coping strategies of HIV-positive Caribbean people using in-depth interviews with a purposively selected group of 25 residents of South London. The main coping strategies were more cognitive than behavioral: restricted disclosure, submersion, faith, and positive reappraisal. These strategies were intertwined in complex ways, and most were rooted in contextual factors, particularly cultural ones. Themes of loss, silence, and reinvention suffused respondents' narratives. Interventions should consider the high degree of stigmatization of HIV/AIDS in the Caribbean community, reluctance to disclose, the likelihood of an initial severe reaction to diagnosis, and external stressors. HIV-positive Caribbean people who are coping well could serve as mentors and role models for poor copers and newly diagnosed patients; establishing Caribbean-specific support groups might also assist coping. |
Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus
Hancock K , Veguilla V , Lu X , Zhong W , Butler EN , Sun H , Liu F , Dong L , Devos JR , Gargiullo PM , Brammer TL , Cox NJ , Tumpey TM , Katz JM . N Engl J Med 2009 361 (20) 1945-52 BACKGROUND: A new pandemic influenza A (H1N1) virus has emerged, causing illness globally, primarily in younger age groups. To assess the level of preexisting immunity in humans and to evaluate seasonal vaccine strategies, we measured the antibody response to the pandemic virus resulting from previous influenza infection or vaccination in different age groups. METHODS: Using a microneutralization assay, we measured cross-reactive antibodies to pandemic H1N1 virus (2009 H1N1) in stored serum samples from persons who either donated blood or were vaccinated with recent seasonal or 1976 swine influenza vaccines. RESULTS: A total of 4 of 107 persons (4%) who were born after 1980 had preexisting cross-reactive antibody titers of 40 or more against 2009 H1N1, whereas 39 of 115 persons (34%) born before 1950 had titers of 80 or more. Vaccination with seasonal trivalent inactivated influenza vaccines resulted in an increase in the level of cross-reactive antibody to 2009 H1N1 by a factor of four or more in none of 55 children between the ages of 6 months and 9 years, in 12 to 22% of 231 adults between the ages of 18 and 64 years, and in 5% or less of 113 adults 60 years of age or older. Seasonal vaccines that were formulated with adjuvant did not further enhance cross-reactive antibody responses. Vaccination with the A/New Jersey/1976 swine influenza vaccine substantially boosted cross-reactive antibodies to 2009 H1N1 in adults. CONCLUSIONS: Vaccination with recent seasonal nonadjuvanted or adjuvanted influenza vaccines induced little or no cross-reactive antibody response to 2009 H1N1 in any age group. Persons under the age of 30 years had little evidence of cross-reactive antibodies to the pandemic virus. However, a proportion of older adults had preexisting cross-reactive antibodies. Copyright 2009 Massachusetts Medical Society. |
Early repeat chlamydia trachomatis and neisseria gonorrhoeae infections among heterosexual men
Kissinger PJ , Reilly K , Taylor SN , Leichliter JS , Rosenthal S , Martin DH . Sex Transm Dis 2009 36 (8) 498-500 Chlamydia trachomatis (CT) and neisseria gonorrhoeae (GC) are the 2 most common sexually transmitted infections in the United States.1 Among women, repeated infections with CT and GC are associated with serious reproductive outcomes such as pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility.2-6 Because men often spontaneously clear infection7,8 and do not have the same adverse outcomes as women, less attention has been paid to repeated infections among men. However, the burden of repeat infections among men is high. The average repeat infection rates of CT and GC among men (11% and 7%)9 are close to those reported among women (10.7% and 3.6%).10 Repeatedly infected men are reservoirs of infection for women,11,12 thus preventing repeat infections among men is an important public health measure. Understanding whether these repeat infections result from reexposure to a baseline partner, infection from a new partner, or treatment failure is important in understanding the most effective interventions. | Centers for Disease Control and Prevention (CDC) suggests expedited partner treatment (EPT) or the provision of medication or prescriptions for index persons to deliver to their sex partners if there is concern that their partner will not seek care.13 The basic assumption of this approach is that most repeat infections are due to reexposure and treating the source of exposure will reduce the repeat infection. Although the efficacy of EPT for preventing repeat infections among men has been demonstrated in several studies, repeat infection rates among men given EPT remain high (10%–14%).14,15 This suggests that, among men, some of the repeat infections may be due to factors other than reexposure and that rescreening in addition to the provision of EPT may be needed. |
Effect of a point-of-use water treatment and safe water storage intervention on diarrhea in infants of HIV-infected mothers
Harris JR , Greene SK , Thomas TK , Ndivo R , Okanda J , Masaba R , Nyangau I , Thigpen MC , Hoekstra RM , Quick RE . J Infect Dis 2009 200 (8) 1186-93 To reduce mother-to-child transmission of human immunodeficiency virus (HIV) in resource-poor settings, the World Health Organization recommends exclusive breast-feeding for 6 months, followed by rapid weaning if replacement feeding is affordable, feasible, available, safe, and sustainable. In the Kisumu Breastfeeding Study (trial registration: Clinicaltrials.gov identifier NCT00146380 ), infants of HIV-infected mothers who received antiretroviral therapy experienced high rates of diarrhea at weaning. To address this problem, mothers in the Kisumu Breastfeeding Study were given safe water storage vessels, hygiene education, and bleach for household water treatment. We compared the incidence of diarrhea in infants enrolled before (cohort A) and after (cohort B) implementation of the intervention. Cohort B infants experienced less diarrhea than cohort A infants, before and after weaning ([Formula: see text] and [Formula: see text], respectively); however, during the weaning period, there were no differences in the frequency of diarrhea between cohorts ([Formula: see text]). Testing of stored water in cohort B homes indicated high adherence (monthly range, 80%-95%) to recommended chlorination practices. Among infants who were weaned early, provision of safe water may be insufficient to prevent weaning-associated diarrhea. |
Five-year outcomes of the China National Free Antiretroviral Treatment Program
Zhang F , Dou Z , Ma Y , Zhao Y , Liu Z , Bulterys M , Chen RY . Ann Intern Med 2009 151 (4) 241-51, W-52 BACKGROUND: China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included more than 52 000 patients. OBJECTIVE: To report 5-year outcomes on adult mortality and immunologic treatment failure rates and risk factors. DESIGN: Open cohort analysis of a prospectively collected, observational database. SETTING: China. PATIENTS: All patients in the national treatment database from June 2002 to August 2008. Patients were excluded if they had not started triple therapy or had missing treatment regimen information. INTERVENTION: Antiretroviral therapy according to Chinese national treatment guidelines. MEASUREMENTS: Mortality rate and immunologic treatment failure rate, according to World Health Organization criteria. RESULTS: Of 52 191 patients, 48 785 were included. Median age was 38 years, 58% were men, 53% were infected through plasma or blood, and the median baseline CD4 cell count was 0.118x10(9) cells/L. Mortality was greatest during the first 3 months of treatment (22.6 deaths per 100 person-years) but decreased to a steady rate of 4 to 5 deaths per 100 person-years after 6 months and maintained this rate over the subsequent 4.5 years. The strongest mortality risk factors were a baseline CD4 cell count less than 0.050x10(9) cells/L (adjusted hazard ratio [HR] compared with a count>or=0.200x10(9) cells/L, 3.3 [95% CI, 2.9 to 3.8]) and having 4 to 5 baseline symptom categories (adjusted HR compared with no baseline symptom categories, 3.4 [CI, 2.9 to 4.0]). Treatment failure was determined among 31 070 patients with 1 or more follow-up CD4 cell counts. Overall, treatment failed for 25% of patients (12.0 treatment failures per 100 person-years), with the cumulative treatment failure rate increasing to 50% at 5 years. Limitation: Immunologic treatment failure does not necessarily correlate well with virologic treatment failure. CONCLUSION: The National Free Antiretroviral Treatment Program reduced mortality among adult patients in China with AIDS to rates similar to those of other low- or middle-income countries. A cumulative immunologic treatment failure rate of 50% after 5 years, due to the limited availability of second-line regimens, is of great concern. |
Gonococcal, chlamydia, and syphilis infection positivity among MSM attending a large primary care clinic, Boston, 2003 to 2004
Mimiaga MJ , Helms DJ , Reisner SL , Grasso C , Bertrand T , Mosure DJ , Weinstock H , McLean C , Mayer KH . Sex Transm Dis 2009 36 (8) 507-11 BACKGROUND: In the past decade, increases in syphilis and rectal gonorrhea have been reported among men who have sex with men (MSM) in the United States; however, limited sexually transmitted disease (STD) positivity data are available on MSM who receive their healthcare from primary care or general medical clinics. The current study sought to elucidate STD positivity in asymptomatic MSM seen at the largest primary care clinic for MSM in New England and to describe STD test positivity by reason for STD testing. METHODS: As part of the Centers for Disease Control and Prevention's MSM Prevalence Monitoring Project, all medical visits between 2003 and 2004 (n = 21,927) among MSM attending Fenway Community Health (Boston) were reviewed. The prevalence of positive STD tests (chlamydia, gonorrhea, and syphilis reactivity) was determined and analyzed by demographic characteristics, HIV status, symptoms, and reason for testing. RESULTS: Overall, 23.4% of MSM visits included STD testing during the observation period. Their mean age was 39 years (range: 18-65 years); 84% were white, 5% were black, and 5% were Hispanic. Sixty-five percent of MSM tested were asymptomatic with 7% of asymptomatic MSM testing positive for at least one STD. STD prevalence varied by reason for STD testing: 4.4% of MSM routinely screened had at least one STD, compared to 6.9% of MSM who reported having high risk sex in the preceding 3 months, and 17% of MSM reporting an exposure to an STD. Among all asymptomatic MSM tested, 1.0% had urethral gonorrhea; 1.7% had pharyngeal gonorrhea; 5.6% had rectal gonorrhea; 2.2% had urethral chlamydia; and 4.3% were seroreactive for syphilis. CONCLUSIONS: Rectal gonorrhea and syphilis seropositivity were frequently diagnosed in asymptomatic MSM; STD prevalence was highest in MSM tested due to an STD exposure or reporting high-risk sex, underscoring the need to promote routine screening in high risk MSM populations. |
Integration of insecticide-treated net distribution into routine immunization services in Malawi: a pilot study
Mathanga DP , Luman ET , Campbell CH , Silwimba C , Malenga G . Trop Med Int Health 2009 14 (7) 792-801 OBJECTIVES: To determine the feasibility of distributing insecticide-treated nets (ITNs) through routine immunization services, to increase ownership and use of ITNs among high-risk groups, whereas maintaining or improving timely completion of routine vaccinations. METHODS: Free ITNs were provided with timely completion of routine vaccinations in two intervention districts in southern Malawi for 15 months. Cross-sectional baseline and follow-up household surveys were conducted in the two intervention districts and one control district. RESULTS: Insecticide-treated nets utilization among children aged 12-23 months roughly doubled in the two intervention districts and did not change in the control district. Timely vaccination coverage increased in all three districts. The percentage of children aged 12-23 months who were both fully vaccinated by 12 months and slept under an ITN the night prior to the interview increased from 10-14% at baseline to 40-44% at follow-up in the intervention districts (P < 0.001), but did not change significantly in the control district. CONCLUSIONS: This study is the first to evaluate the provision of free ITNs at completion of a child's primary vaccination series, demonstrating that such a linkage is both feasible and can result in improved coverage with the combined services. Additional studies are needed to determine whether such a model is effective in other countries, and whether integration of other health services with immunization delivery could also be synergistic. |
The need for computerized tracking systems for resource-limited settings: the example of Georgetown, Guyana
Basavaraju SV , Pitman JP , Henry N , McEwan C , Harry C , Hasbrouck L , Marum L . Transfus Med 2009 19 (3) 149-51 Blood services in industrialized countries routinely use computerized tracking systems, the merits of which are described extensively in the literature. Such systems ease blood utilization review, enhance safety and improve tracking (Dohnalek et al., 2004; Davies et al., 2006; Dzik, 2007). Computerized blood-use modelling and prediction systems are typically used in developed nations to forecast demand (Katz et al., 1983; Sirelson & Brodheim, 1991; Nightingale et al., 2003). Because of financial and logistical challenges, such systems are uncommon in resource-limited settings, where blood services rely on manual, paper-based methods, or simple electronic tools (e.g., Microsoft Excel). Here we highlight the specific challenges faced by a blood service in a resource-limited setting and describe future options for low-cost, scalable computerized systems for developing countries. | In Guyana, blood is collected, screened and distributed by the National Blood Transfusion Service (NBTS), a branch of the Guyana Ministry of Health. Approximately 80% of all blood collected by NBTS is distributed to the Georgetown Public Hospital Corporation (GPHC), Guyana's only tertiary-care referral centre. For record keeping, NBTS collects daily information on blood (whole blood and blood products) units requested, cross-matched units issued and units returned unused in three paper-based registers. In October 2007, NBTS instituted an expanded paper-based Blood Request Form (BRF), which, for the first time, allowed NBTS to match patient data from the wards with blood centre data from the three registers. Properly completed BRFs, which are submitted by physicians, are now required for NBTS to dispense blood. NBTS files BRFs in three folders labelled as follows: (1) cancelled before preparation by NBTS; (2) prepared and retrieved by ward and (3) prepared but not retrieved by ward. In December 2007, NBTS conducted a preliminary internal review of November 2007 (the first complete month in which BRFs were used) records. This review suggested that nearly 60% of all blood units requested by GPHC were not delivered by NBTS. In January 2008, NBTS requested technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to conduct a rapid and focused assessment to investigate the extent of this apparent blood shortage. The investigation focused on the blood-ordering process at GPHC, the NBTS system to track GPHC requests and the distribution and flow of blood units. In conjunction with NBTS, CDC conducted a retrospective review and descriptive analysis of NBTS records for November 2007. The review tracked blood request information through the paper-based system of registers and folders. Data were extracted from the sources described above: BRFs filed in the three folders and entries in the three data registers. |
Challenges and priorities for surveillance of stillbirths: a report on two workshops
Duke CW , Correa A , Romitti PA , Martin J , Kirby RS . Public Health Rep 2009 124 (5) 652-9 Stillbirths, those with and without birth defects, are an important public health topic. The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention conducted two workshops during April and July 2005. Both workshops explored the challenges of conducting surveillance of stillbirths. Workshop participants considered an approach that added the surveillance of stillbirths, those with and without birth defects, as part of existing population-based birth defects surveillance programs in Iowa and Atlanta. The workshops addressed three key aspects for expanding birth defects programs to conduct active, population-based surveillance on stillbirths: (1) case identification and ascertainment, (2) data collection, and (3) data use and project evaluation. Participants included experts in pediatrics, obstetrics, epidemiology, maternal-fetal medicine, perinatology and pediatric pathology, midwifery, as well as practicing clinicians and pathologists. Expanding existing birth defects surveillance programs to include information of stillbirths could potentially enhance the data available on fetal death reports and also could benefit such programs by improving the ascertainment of birth defects. |
Cross-sectional survey methods to assess retrospectively mortality in humanitarian emergencies
Cairns KL , Woodruff BA , Myatt M , Bartlett L , Goldberg H , Roberts L . Disasters 2009 33 (4) 503-21 Since the rates and causes of mortality are critical indicators of the overall health of a population, it is important to evaluate mortality even where no complete vital statistics reporting exists. Such settings include humanitarian emergencies. Experience in cross-sectional survey methods to assess retrospectively crude, age-specific, and maternal mortality in stable settings has been gained over the past 40 years, and methods appropriate to humanitarian emergencies have been developed. In humanitarian emergencies, crude and age-specific mortality can be gauged using methods based on the enumeration of individuals resident in randomly selected households-frequently referred to as a household census. Under-five mortality can also be assessed through a modified prior birth history method in which a representative sample of reproductive-aged women are questioned about dates of child births and deaths. Maternal mortality can be appraised via the initial identification of maternal deaths in the study population and a subsequent investigation to determine the cause of each death. |
Hunting with lead: association between blood lead levels and wild game consumption
Iqbal S , Blumenthal W , Kennedy C , Yip FY , Pickard S , Flanders WD , Loringer K , Kruger K , Caldwell KL , Jean Brown M . Environ Res 2009 109 (8) 952-9 BACKGROUND: Wild game hunting is a popular activity in many regions of the United States. Recently, the presence of lead fragments in wild game meat, presumably from the bullets or shot used for hunting, has raised concerns about health risks from meat consumption. OBJECTIVE: This study examined the association between blood lead levels (PbB) and wild game consumption. METHODS: We recruited 742 participants, aged 2-92 years, from six North Dakota cities. Blood lead samples were collected from 736 persons. Information on socio-demographic background, housing, lead exposure source, and types of wild game consumption (i.e., venison, other game such as moose, birds) was also collected. Generalized estimating equations (GEE) were used to determine the association between PbB and wild game consumption. RESULTS: Most participants reported consuming wild game (80.8%) obtained from hunting (98.8%). The geometric mean PbB were 1.27 and 0.84mug/dl among persons who did and did not consume wild game, respectively. After adjusting for potential confounders, persons who consumed wild game had 0.30mug/dl (95% confidence interval: 0.16-0.44mug/dl) higher PbB than persons who did not. For all game types, recent (<1 month) wild game consumption was associated with higher PbB. PbB was also higher among those who consumed a larger serving size (≥2oz vs. <2oz); however, this association was significant for 'other game' consumption only. CONCLUSIONS: Participants who consumed wild game had higher PbB than those who did not consume wild game. Careful review of butchering practices and monitoring of meat-packing processes may decrease lead exposure from wild game consumption. |
Comparative effectiveness research and genomic medicine: an evolving partnership for 21st century medicine.
Khoury MJ , Rich EC , Randhawa G , Teutsch SM , Niederhuber J . Genet Med 2009 11 (10) 707-11 The American Recovery and Reinvestment Act has provided resources for comparative effectiveness research that will lead to evidence-based decisions about health and health care choices. Some have voiced concerns that evidence-based comparative effectiveness research principles are only relevant to "average" patients and not as much to individuals with unique combinations of genes, exposures and disease outcomes, intrinsic to genomic medicine. In this commentary, we argue that comparative effectiveness research and genomic medicine not only can and should coexist but also they will increasingly benefit from each other. The promise and success of genomic medicine will depend on rigorous comparative effectiveness research methods to compare outcomes for genome-based applications in practice to traditional non-genome-based approaches. In addition, the success of comparative effectiveness research will depend on developing new methods and clinical research infrastructures to integrate genome-based personalized perspectives into point of care decisions by patients and providers. There is a need to heal the apparent schism between genomic medicine and comparative effectiveness research to enhance knowledge-driven practice of medicine in the 21st century. |
Healthcare-associated hepatitis C virus transmission among patients in an abdominal organ transplant center
Thompson ND , Hellinger WC , Kay RS , Cohen L , Ragan P , Voss RA , Bacalis LP , Xia G , Keating MR , Dickson RC , Hughes CB , Williams IT , Perz JF . Transpl Infect Dis 2009 11 (4) 324-9 BACKGROUND: De novo hepatitis C virus (HCV) infection among transplant patients is rarely recognized but can have severe consequences. We investigated the scope, source, and mode of HCV transmission within a transplant center after incident HCV infection was identified in 2 patients who had liver transplantation in late 2006. METHODS: Patients were interviewed, and transplant logs, medical records, and staff practices were reviewed to identify opportunities for HCV transmission. Infection via receipt of blood or organs was evaluated. Molecular epidemiology was used to determine the relatedness between persons with incident and chronic HCV infection. RESULTS: HCV from infected blood or organ donors was ruled out. Among the 308 patients who underwent transplant in 2006, no additional incident HCV infections were identified. Eighty-five (28%) had pre-transplant chronic HCV infection; 13 were considered possible HCV source patients based upon shared days on the inpatient unit, nursing assignment, or invasive procedures in common with incident HCV case-patients. Viral isolates from 1 HCV source patient and 1 incident case-patient were found to be highly related by quasispecies analysis, confirming patient-to-patient HCV transmission. Possible modes of transmission identified were the improper use of multidose vials, sharing of blood-contaminated glucometers, and touch contamination. CONCLUSION: Sporadic transmission or endemic levels of HCV transmission might be overlooked in a setting with high HCV prevalence, such as liver transplant units, where multiple, repeated opportunities for patient-to-patient HCV transmission can occur. Surveillance through pre- and post-transplant screening is necessary to identify incident HCV infection in this setting. Constant, meticulous attention must be paid to maintaining aseptic technique and good infection control practices to eliminate HCV transmission opportunities. |
Update: Vaccines for women, adolescence through adulthood
Akinsanya-Beysolow I , Wolfe CS . J Womens Health (Larchmt) 2009 18 (8) 1101-8 Recommendations for routine vaccination of adolescents and adults are continually evolving; new vaccines are licensed, and ongoing studies lead to updated recommendations for existing vaccines. Although vaccination is important for both sexes, some recent developments are particularly relevant for women and girls. Human papillomavirus (HPV) vaccine, licensed in 2006, is the first vaccine administered exclusively to women. Another recently licensed vaccine, adult and adolescent tetanus-diphtheria-acellular pertussis (Tdap), is especially important for women who plan to become pregnant and for new mothers to help prevent pertussis disease in infants who are too young to be vaccinated themselves. Other vaccines, such as influenza and rubella, are also important for pregnant women. Several vaccine safety issues are of particular relevance to women, namely, the theoretical risk of administering live vaccines during pregnancy and data suggesting that adolescent females might be at higher risk for syncope following vaccination. Obstetrician-gynecologists are the primary, and sometimes only, contact with the healthcare system for many adolescent and adult women and, as such, are uniquely positioned to provide vaccination services to the country's female population. Vaccine costs, storage and handling requirements, lack of access to immunization information systems (also known as vaccine registries), and unfamiliarity with current recommendations are potential obstacles to ensuring that all adolescent females and women are appropriately vaccinated. Obstetrician-gynecologists can help reduce some of these obstacles by availing themselves of existing vaccination resources. |
Determining accurate vaccination coverage rates for adolescents: the National Immunization Survey-Teen 2006
Jain N , Singleton JA , Montgomery M , Skalland B . Public Health Rep 2009 124 (5) 642-51 Since 1994, the Centers for Disease Control and Prevention has funded the National Immunization Survey (NIS), a large telephone survey used to estimate vaccination coverage of U.S. children aged 19-35 months. The NIS is a two-phase survey that obtains vaccination receipt information from a random-digit-dialed survey, designed to identify households with eligible children, followed by a provider record check, which obtains provider-reported vaccination histories for eligible children. In 2006, the survey was expanded for the first time to include a national sample of adolescents aged 13-17 years, called the NIS-Teen. This article summarizes the methodology used in the NIS-Teen. In 2008, the NIS-Teen was expanded to collect state-specific and national-level data to determine vaccination coverage estimates. This survey provides valuable information to guide immunization programs for adolescents. |
Hepatitis B vaccination coverage among U.S. adolescents, National Immunization Survey-Teen, 2006
Jain N , Hennessey K . J Adolesc Health 2009 44 (6) 561-7 PURPOSE: To determine national estimates of hepatitis B vaccination among adolescents in the United States and factors associated with vaccination using provider-reported immunization histories. METHODS: Data were analyzed from the 2006 National Immunization Survey-Teen, a random-digit-dialed telephone survey sampling households with adolescents aged 13-17 years. Provider-reported immunization histories were obtained to determine hepatitis B vaccination coverage. RESULTS: The household response rate was 56.2% (n = 5468); provider data was obtained from 52.7% (n = 2882). Overall up-to-date hepatitis B vaccination coverage was 81.3%; older adolescents aged 15-17 years old had lower coverage than younger adolescents aged 13-14 years old, (77.6% vs. 87.1%, p < .05). More than half of the 13-14-year-olds had received vaccination before age 3 years, while 15-17-year-olds received vaccination throughout childhood. Factors associated with vaccination coverage among adolescents 13-14 years old included private health insurance coverage and having a parent-reported health care visit at age of 11-12 years. Factors associated with vaccination coverage among adolescents 15-17 years old included living in the Northeast, having a mother who was married, and having a parent-reported health care visit at 11-12 years. CONCLUSIONS: In 2006, adolescents 15-17 years old had lower hepatitis B vaccination coverage compared to those 13-14 years old. Younger adolescents likely benefited from universal recommendations in 1991 and received hepatitis B vaccination during early childhood. A healthcare visit at age 11-12 years has been recommended by professional organizations and was associated with hepatitis B vaccination in our survey. Parents and providers should routinely review adolescent immunizations. |
Kawasaki disease after vaccination: reports to the vaccine adverse event reporting system 1990-2007
Hua W , Izurieta HS , Slade B , Belay ED , Haber P , Tiernan R , Woo EJ , Iskander J , Braun MM , Ball R . Pediatr Infect Dis J 2009 28 (11) 943-7 BACKGROUND: Kawasaki disease (KD) is a multisystemic vasculitis primarily affecting children <5 years. A review of RotaTeq (rotavirus vaccine live) clinical trial data revealed higher, though not statistically significantly, KD rates among RotaTeq vaccines than placebo recipients. In June 2007, the RotaTeq label was revised accordingly. OBJECTIVES: To describe and assess KD reported to Vaccine Adverse Event Reporting System (VAERS) for all US licensed vaccines. METHODS: We reviewed all KD reports received by VAERS from 1990 through mid-October 2007. Cases were characterized by age, gender, onset interval, and vaccine type. Proportional reporting ratio (PRR) was used to evaluate KD reporting for each vaccine compared with all others. Reporting rates were calculated using number of doses distributed as denominator. RESULTS: Through October14, 2007, 107 KD reports were received by VAERS: 26 were categorized as classic cases, 19 atypical, 52 possible, and 10 were noncases. Of the 97 cases, 91% were children <5 years. There was no clustering of onset intervals after day 1 postvaccination. Before the RotaTeq label revision, the KD PRR was elevated only for Pediarix (DTaP, hepB, and IPV combined) but the KD reporting rate for Pediarix (0.59/100,000 person-years) was much lower than the background incidence rate (9-19/100,000 person-years) for children <5 years in the United States. After the revision, reporting of KD for RotaTeq was stimulated but the reporting rate for RotaTeq (1.47/100,000 person-years) was still much lower than the background rate. CONCLUSIONS: Our review does not suggest an elevated KD risk for RotaTeq or other vaccines. Continued postmarketing monitoring for KD is ongoing. |
Coercive first intercourse and unintended first births
Williams CM , Brett KM , Abma JC . Violence Vict 2009 24 (3) 351-63 Since research has shown that victims of violence are more likely to be involved in subsequent risky sexual behaviors, we hypothesized that coercive first intercourse would be associated with unintended first births. Using nationally representative data from the 2002 National Survey of Family Growth, we analyzed female respondents aged 18-44 years who reported a live birth (n = 4,136). Coercion was classified as none/minimal, mild, or significant based on self-report. In 2002, 13.7% of U.S. women aged 18-44 who had at least one live birth experienced mild coercion and 9.8% experienced significant coercion at first intercourse. Compared with women who experienced no coercion, the odds of reporting an unintended first birth was greater for women who experienced mild (OR: 1.9, 95% CI: 1.4-2.6) or significant coercion (OR: 2.3, 95% CI: 1.6-3.4). |
Rapid identification of vibrio parahaemolyticus by whole-cell matrix-assisted laser desorption ionization-time of flight mass spectrometry
Hazen TH , Martinez RJ , Chen Y , Lafon PC , Garrett NM , Parsons MB , Bopp CA , Sullards MC , Sobecky PA . Appl Environ Microbiol 2009 75 (21) 6745-56 Vibrio parahaemolyticus is a pathogenic marine bacterium that is the main causative agent of bacterial seafood borne gastroenteritis in the United States. An increase in the frequency of V. parahaemolyticus-related infections during the last decade has been attributed to the emergence of an O3:K6 pandemic clone in 1995. The diversity of the O3:K6 pandemic clone and serovariants has been examined using multiple molecular techniques including multilocus sequence analysis (MLSA), pulsed-field gel electrophoresis (PFGE), and group-specific PCR (GS-PCR) analysis. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has become a powerful tool for rapidly distinguishing between related bacterial species. In the current study we demonstrate the development of a whole-cell MALDI-TOF MS method for the identification of V. parahaemolyticus from other Vibrio spp. We identified 30 peaks that were present only in the spectra of the V. parahaemolyticus strains examined in this study that may be developed as MALDI-TOF MS biomarkers for identification of V. parahaemolyticus. We detected variation in the MALDI-TOF spectra of V. parahaemolyticus strains isolated from different geographical locations and at different times. The MALDI-TOF MS spectra of the V. parahaemolyticus strains examined were distinct from the other Vibrios examined including the closely related V. alginolyticus, V. harveyi, and V. campbellii. The results of this study demonstrate the first use of whole-cell MALDI-TOF MS analysis for the rapid identification of V. parahaemolyticus. |
Size-dependent effects of tungsten carbide-cobalt particles on oxygen radical production and activation of cell signaling pathways in murine epidermal cells
Ding M , Kisin ER , Zhao J , Bowman L , Lu Y , Jiang B , Leonard S , Vallyathan V , Castranova V , Murray AR , Fadeel B , Shvedova AA . Toxicol Appl Pharmacol 2009 241 (3) 260-8 Hard metal or cemented carbide consists of a mixture of tungsten carbide (WC) (85%) and metallic cobalt (Co) (5-15%). WC-Co is considered to be potentially carcinogenic to humans. However, no comparison of the adverse effects of nano-sized WC-Co particles is available to date. In the present study, we compared the ability of nano- and fine-sized WC-Co particles to form free radicals, and propensity to activate the transcription factors, AP-1 and NF-kappaB, along with stimulation of mitogen-activated protein kinase (MAPK) signaling pathways in a mouse epidermal cell line (JB6 P(+)). Our results demonstrated that nano-WC-Co generated a higher level of hydroxyl radicals, induced greater oxidative stress, as evidenced by a decrease of GSH levels, and caused faster JB6 P(+) cell growth/proliferation than observed after exposure of cells to fine-WC-Co. In addition, nano-WC-Co activated AP-1 and NF-kappaB more efficiently in JB6(+/+) cells, as compared to fine-WC-Co. Experiments using AP-1-luciferase reporter transgenic mice confirmed the activation of AP-1 by nano-WC-Co. Nano- and fine-sized WC-Co particles also stimulated MAPKs, including ERKs, p38, and JNKs with significantly higher potency of nano-WC-Co. Finally, co-incubation of the JB6(+/+) cells with N-acetyl-cysteine decreased AP-1 activation and phosphorylation of ERKs, p38 kinase and JNKs, thus suggesting that oxidative stress is involved in WC-Co-induced toxicity and AP-1 activation. |
Diagnostic performance and costs of Capilia TB for Mycobacterium tuberculosis complex identification from broth-based culture in Bangkok, Thailand
Ngamlert K , Sinthuwattanawibool C , McCarthy KD , Sohn H , Starks A , Kanjanamongkolsiri P , Anek-vorapong R , Tasaneeyapan T , Monkongdee P , Diem L , Varma JK . Trop Med Int Health 2009 14 (7) 748-53 OBJECTIVES: Broth-based culture (BBC) systems are increasingly being used to detect Mycobacterium tuberculosis complex (MTBC) in resource-limited. We evaluated the performance, time to detection and cost of the Capilia TB identification test from broth cultures positive for acid-fast bacilli (AFB) in Thailand. METHODS: From October-December 2007, broth cultures that grew AFB from specimens submitted by district TB clinics to the Bangkok city laboratory were tested for MTBC using Capilia TB and standard biochemical tests. Isolates that were identified as MTBC by biochemical tests but not by Capilia TB underwent repeat testing using Capilia TB, Accuprobe (Gen-Probe, San Diego, CA, USA) and sequencing. Costs of time, labour, infrastructure and consumables for all procedures were measured. RESULTS: Of 247 isolates evaluated, the sensitivity of Capilia TB was 97% and its true specificity 100% compared with biochemical testing. The median time from specimen receipt to confirmed MTBC identification was 20 days (range 7-53 days) for Capilia TB and 45 days (range 35-79 days) for biochemical testing (P < 0.01). Six isolates that were Capilia TB negative but positive by biochemical testing were confirmed as MTBC and mutations in the mpb64 gene were detected in all. The unit cost of using Capilia TB was 2.67 USD that of biochemical testing was 8.78 USD. CONCLUSIONS: In Thailand, Capilia TB had acceptable sensitivity and specificity, was lower in cost and had shorter turn-around times. Laboratories investing in BBC should consider Capilia TB for identification of MTBC, after validation of performance in their setting. |
Good performance of rapid prostate-specific antigen test for detection of semen exposure in women: implications for qualitative research
Hobbs MM , Steiner MJ , Rich KD , Gallo MF , Alam A , Rahman M , Menezes P , Chipato T , Warner L , Macaluso M . Sex Transm Dis 2009 36 (8) 501-6 BACKGROUND: Prostate-specific antigen (PSA) is a valid biomarker of semen exposure in women and has been used to assess reliability of self-reported sexual behavior as well as serve as a proxy measure for condom efficacy. Quantitative PSA tests are expensive and require specialized equipment. A simple, rapid, and inexpensive test for PSA would facilitate semen biomarker evaluation in a variety of research settings. This study evaluated the performance of a rapid PSA test compared with a quantitative assay to identify semen in vaginal swab specimens. METHODS: We tested 581 vaginal swabs collected from 492 women participating in 2 separate research studies in Bangladesh and Zimbabwe. PSA in vaginal secretions was detected using the quantitative IMx (Abbott Laboratories) assay and the ABAcard p30 (Abacus Diagnostics) rapid immunochromatographic strip test. RESULTS: The ABAcard test was 100% sensitive (95% confidence interval [CI], 98%-100%) and 96% specific (95% CI, 93%-97%) compared with the quantitative test in detecting >1.0 ng PSA/mL vaginal swab eluate. Rapid PSA results were semiquantitative and correlated well with PSA concentrations (kappa = 0.88; 95% CI, 0.85-0.90). CONCLUSION: Rapid PSA detection requires no instrumentation and can be performed easily and economically. Having rapid PSA results available immediately following interview provides opportunities to explore discrepancies between the objective marker of recent semen exposure and self-reported behaviors. |
Impact of acute psychosocial stress on peripheral blood gene expression pathways in healthy men
Nater UM , Whistler T , Lonergan W , Mletzko T , Vernon SD , Heim C . Biol Psychol 2009 82 (2) 125-32 We investigated peripheral blood mononuclear cell gene expression responses to acute psychosocial stress to identify molecular pathways relevant to the stress response. Blood samples were obtained from 10 healthy male subjects before, during and after (at 0, 30, and 60 min) a standardized psychosocial laboratory stressor. Ribonucleic acid (RNA) was extracted and gene expression measured by hybridization to a 20,000-gene microarray. Gene Set Expression Comparisons (GSEC) using defined pathways were used for the analysis. Forty-nine pathways were significantly changed from baseline to immediately after the stressor (p<0.05), implicating cell cycle, cell signaling, adhesion and immune responses. The comparison between stress and recovery (measured 30 min later) identified 36 pathways, several involving stress-responsive signaling cascades and cellular defense mechanisms. These results have relevance for understanding molecular mechanisms of the physiological stress response, and might be used to further study adverse health outcomes of psychosocial stress. |
Initiation of HAART at higher CD4 cell counts is associated with a lower frequency of antiretroviral drug resistance mutations at virologic failure
Uy J , Armon C , Buchacz K , Wood K , Brooks JT , Hops Investigators . J Acquir Immune Defic Syndr 2009 51 (4) 450-3 BACKGROUND: There are limited data on the risk of developing HIV drug resistance based on the CD4 cell count at which highly active antiretroviral therapy (HAART) is initiated. METHODS: We examined data from participants in the HIV Outpatient Study who initiated antiretroviral therapy with HAART in 1999 or later (when genotypic resistance testing became more commonly used in clinical practice and in the HIV Outpatient Study), achieved virologic suppression, and subsequently experienced virologic failure and received a genotypic assay for antiretroviral resistance mutations. We assessed the frequency of resistance mutations at virologic failure and the differences in the frequencies of mutations by the CD4 stratum at which HAART was initiated using the Cochran-Armitage exact test. RESULTS: Of 683 patients who achieved virologic suppression on a first HAART regimen, 243 had virologic failure and 78 of these had a genotype resistance test done. Among these patients, the frequency of any HIV resistance mutations was 50% among patients who started HAART at 0-199 CD4 cells per cubic millimeter or 200-349 CD4 cells per cubic millimeter compared with 22% among patients who started HAART at >or=350 CD4 cells per cubic millimeter (P = 0.062). The frequency of nucleoside reverse transcriptase inhibitor-associated mutations was 48%, 31%, and 11% among persons who initiated nucleoside reverse transcriptase inhibitor-containing HAART within these respective CD4 cell count strata (P = 0.005). We observed similar trends for nonnucleoside reverse transcriptase inhibitor-associated (P = 0.040) and protease inhibitor-associated (P = 0.063) mutations among persons initiating HAART containing these agents. CONCLUSIONS: Patients failing HAART that was initiated at <350 CD4 cells per cubic millimeter had higher frequencies of resistance mutations to the classes of antiretrovirals to which they had been exposed than failing patients who initiated at >or=350 CD4 cells per cubic millimeter. Initiating HAART at higher CD4 cell counts may decrease the risk of developing treatment-limiting antiretroviral resistance. |
Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society
Harden CL , Hopp J , Ting TY , Pennell PB , French JA , Hauser WA , Wiebe S , Gronseth GS , Thurman D , Meador KJ , Koppel BS , Kaplan PW , Robinson JN , Gidal B , Hovinga CA , Wilner AN , Vazquez B , Holmes L , Krumholz A , Finnell R , Le Guen C , American Academy of Neurology American Epilepsy Society . Neurology 2009 73 (2) 126-32 OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including the risk of pregnancy complications or other medical problems during pregnancy in WWE compared to other women, change in seizure frequency, the risk of status epilepticus, and the rate of remaining seizure-free during pregnancy. METHODS: A 20-member committee including general neurologists, epileptologists, and doctors in pharmacy evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and February 2008. RESULTS: For WWE taking antiepileptic drugs, there is probably no substantially increased risk (greater than two times expected) of cesarean delivery or late pregnancy bleeding, and probably no moderately increased risk (greater than 1.5 times expected) of premature contractions or premature labor and delivery. There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke. Seizure freedom for at least 9 months prior to pregnancy is probably associated with a high likelihood (84%-92%) of remaining seizure-free during pregnancy. RECOMMENDATIONS: Women with epilepsy (WWE) should be counseled that seizure freedom for at least 9 months prior to pregnancy is probably associated with a high rate (84%-92%) of remaining seizure-free during pregnancy (Level B). However, WWE who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery during pregnancy (Level C). |
Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society
Harden CL , Meador KJ , Pennell PB , Hauser WA , Gronseth GS , French JA , Wiebe S , Thurman D , Koppel BS , Kaplan PW , Robinson JN , Hopp J , Ting TY , Gidal B , Hovinga CA , Wilner AN , Vazquez B , Holmes L , Krumholz A , Finnell R , Hirtz D , Le Guen C , American Academy of Neurology American Epilepsy Society . Neurology 2009 73 (2) 133-41 OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy. METHODS: Systematic review of relevant articles published between January 1985 and June 2007. RESULTS: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. RECOMMENDATIONS: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C). |
Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): vitamin K, folic acid, blood levels, and breastfeeding: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society
Harden CL , Pennell PB , Koppel BS , Hovinga CA , Gidal B , Meador KJ , Hopp J , Ting TY , Hauser WA , Thurman D , Kaplan PW , Robinson JN , French JA , Wiebe S , Wilner AN , Vazquez B , Holmes L , Krumholz A , Finnell R , Shafer PO , Le Guen C , American Academy of Neurology American Epilepsy Society . Neurology 2009 73 (2) 142-9 OBJECTIVE: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy. METHODS: A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007. RESULTS: Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. RECOMMENDATIONS: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations. |
Prenatal cigarette smoking and smokeless tobacco use among Alaska native and white women in Alaska, 1996-2003
Kim SY , England L , Dietz PM , Morrow B , Perham-Hester KA . Matern Child Health J 2009 13 (5) 652-9 OBJECTIVE: To examine trends in prenatal cigarette smoking and smokeless tobacco use among Alaska Native (AN) and white women in Alaska. METHODS: Using 1996-2003 data from the population-based Pregnancy Risk Assessment Monitoring System, we determined trends in self-reported prenatal tobacco use among AN and white women and used chi-square tests and multiple variable logistic regression analysis to identify maternal factors associated with prenatal tobacco use. RESULTS: Over the study period, prevalence of any tobacco use during pregnancy declined by 27% among AN women (from 55.8 to 40.9%) (P < 0.0001) and by 17% among white women (from 18.8 to 15.6%) (P < 0.0001). In 2003, among AN women the prevalence of self-reported smokeless tobacco use was 16.9%, cigarette smoking was 25.7%, and any tobacco use was 40.9%; corresponding values for white women were 0.4, 15.0, and 15.6%, respectively. Western Alaska had the highest prevalence of tobacco use. CONCLUSION: The prevalence of tobacco use decreased between 1996 and 2003, but remained higher among AN women than white women, especially for smokeless tobacco. Support for cessation interventions targeting pregnant women should be made a public health priority in Alaska. |
Prepregnancy obesity prevalence in the United States, 2004-2005
Chu SY , Kim SY , Bish CL . Matern Child Health J 2009 13 (5) 614-20 OBJECTIVE: To provide a current estimate of the prevalence of prepregnancy obesity in the United States. METHODS: We analyzed 2004-2005 data from 26 states and New York City (n = 75,403 women) participating in the Pregnancy Risk Assessment Monitoring System, an ongoing, population-based surveillance system that collects information on maternal behaviors associated with pregnancy. Information was obtained from questionnaires self-administered after delivery or from linked birth certificates; prepregnancy body mass index was based on self-reported weight and height. Data were weighted to provide representative estimates of all women delivering a live birth in each particular state. RESULTS: In this study, about one in five women who delivered were obese; in some state, race/ethnicity, and Medicaid status subgroups, the prevalence was as high as one-third. State-specific prevalence varied widely and ranged from 13.9 to 25.1%. Black women had an obesity prevalence about 70% higher than white and Hispanic women (black: 29.1%; white: 17.4%; Hispanic: 17.4%); however, these race-specific rates varied notably by location. Obesity prevalence was 50% higher among women whose delivery was paid for by Medicaid than by other means (e.g., private insurance, cash, HMO). CONCLUSION: This prevalence makes maternal obesity and its resulting maternal morbidities (e.g., gestational diabetes mellitus) a common risk factor for a complicated pregnancy. |
Toxoplasmosis prevention and testing in pregnancy, survey of obstetrician-gynaecologists
Jones JL , Krueger A , Schulkin J , Schantz PM . Zoonoses Public Health 2009 57 (1) 27-33 Summary: Toxoplasmosis in pregnant women can lead to congenital disease with severe neurological and ocular complications in the foetus. In 2006, we surveyed US obstetrician-gynaecologists to determine their knowledge and practices about toxoplasmosis prevention and testing. Questionnaires were mailed (four mailings) to a random sample of 1200 of the 33 354 members of the American College of Obstetricians and Gynecologists (ACOG). Of the 1200 surveyed, 502 (42%) responded. The respondents were similar to all ACOG members by gender, region of the country and practice type (P > 0.5), and age (respondents were slightly younger, mean 46 years versus 47 years). To prevent toxoplasmosis, most respondents indicated that they counsel pregnant women about cat litter (99.6%), but fewer counselled about eating undercooked meat (77.6%), handling raw meat (67.4%), gardening (65.4%) or washing fruits and vegetables (34.2%). Many (73.2%) respondents were not aware that some Toxoplasma IgM tests have had a high false positive rate, and most (91.2%) had not heard of the avidity test, which can help determine the timing of Toxoplasma gondii infection in relation to pregnancy. There is a need for more education about T. gondii serological testing, particularly the Toxoplasma avidity test. US obstetrician-gynaecologists are providing beneficial counselling to their patients, but could provide more information about undercooked meat and soil risks. |
The challenge of infant mortality: have we reached a plateau?
MacDorman MF , Mathews TJ . Public Health Rep 2009 124 (5) 670-81 OBJECTIVES: Infant mortality is a major indicator of the health of a nation. We analyzed recent patterns and trends in U.S. infant mortality, with an emphasis on two of the greatest challenges: (1) persistent racial and ethnic disparities and (2) the impact of preterm and low birthweight delivery. METHODS: Data from the national linked birth/infant death datasets were used to compute infant mortality rates per 100,000 live births by cause of death (COD), and per 1,000 live births for all other variables. Infant mortality rates and other measures of infant health were analyzed and compared. Leading and preterm-related CODs, and international comparisons of infant mortality rates were also examined. RESULTS: Despite the rapid decline in infant mortality during the 20th century, the U.S. infant mortality rate did not decline from 2000 to 2005, and declined only marginally in 2006. Racial and ethnic disparities in infant mortality have persisted and increased, as have the percentages of preterm and low birthweight deliveries. After decades of improvement, the infant mortality rate for very low birthweight infants remained unchanged from 2000 to 2005. Infant mortality rates from congenital malformations and sudden infant death syndrome declined; however, rates for preterm-related CODs increased. The U.S. international ranking in infant mortality fell from 12th place in 1960 to 30th place in 2005. CONCLUSIONS: Infant mortality is a complex and multifactorial problem that has proved resistant to intervention efforts. Continued increases in preterm and low birthweight delivery present major challenges to further improvement in the infant mortality rate. |
Developmental regression in children with an autism spectrum disorder identified by a population-based surveillance system
Wiggins LD , Rice CE , Baio J . Autism 2009 13 (4) 357-74 This study evaluated the phenomenon of autistic regression using population-based data. The sample comprised 285 children who met the autism spectrum disorder (ASD) case definition within an ongoing surveillance program. Results indicated that children with a previously documented ASD diagnosis had higher rates of autistic regression than children who met the ASD surveillance definition but did not have a clearly documented ASD diagnosis in their records (17-26 percent of surveillance cases). Most children regressed around 24 months of age and boys were more likely to have documented regression than girls. Half of the children with regression had developmental concerns noted prior to the loss of skills. Moreover, children with autistic regression were more likely to show certain associated features, including cognitive impairment.These data indicate that some children with ASD experience a loss of skills in the first few years of life and may have a unique symptom profile. |
The hypothalamus-pituitary-testis axis in boys during the first six months of life: a comparison of cryptorchidism and hypospadias cases with controls
Pierik FH , Deddens JA , Burdorf A , de Muinck Keizer-Schrama SM , Jong FH , Weber RF . Int J Androl 2009 32 (5) 453-61 It is inconclusive whether the feedback mechanisms of the hypothalamus-pituitary-testis (HTP) axis are already established in the first 6 months of life, partly due to the dramatic changes in HPT-axis hormone levels over this period. Moreover, it is unclear whether these hormone levels are aberrant in boys with cryptorchidism or hypospadias, and therefore predictive for future fertility. We studied the regulation mechanisms of the HTP axis, and the effect of age, in boys 1-6 months of age. Secondly, we studied testicular function - as reflected by HPT hormones - in newborns with cryptorchidism or hypospadias. Sera from a population sample of infants with cryptorchidism (n = 43), hypospadias (n = 41) and controls (n = 113) were analyzed for inhibin B, anti-Mullerian hormone (AMH), testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and sex hormone binding globulin (SHBG). LH, testosterone, non-shbg-bound testosterone (NSBT), and AHM levels showed significant age-related trends. After age-correction, a negative correlation between FSH and inhibin B was observed (r = -0.43). The only significant group-differences were lower testosterone and NSBT levels in cryptorchidism cases, with a mean testosterone of 1.8 and 2.6 nmol/L and a mean NSBT of 0.48 and 0.70 nmol/L for cryptorchidism cases and controls, respectively. The higher levels of LH, testosterone, and NSBT in boys born pre-term or with a low birthweight indicate that abnormal prenatal development may determine postnatal testis function. Our results support the hypothesis that the inhibin B - FSH feedback loop is already functional before puberty. The lower testosterone and NSBT levels indicate that disturbed Leydig cell function can already be detected early after birth in cryptorchid boys. |
A pilot respiratory health assessment of nail technicians: symptoms, lung function, and airway inflammation
Reutman SR , Rohs AM , Clark JC , Johnson BC , Sammons DL , Toennis CA , Robertson SA , Mackenzie BA , Lockey JE . Am J Ind Med 2009 52 (11) 868-75 BACKGROUND: Recent surveys suggest nail technicians, particularly artificial nail applicators, have increased respiratory symptoms and asthma risk. METHODS: We examined lung function (n = 62) and a marker of airway inflammation, i.e., exhaled nitric oxide (ENO) (n = 43), in a subset of nail technician and control participants in a pilot health assessment. RESULTS: Bivariate analysis of technicians demonstrated that job latency was inversely correlated with FEV1 percent predicted (FEV1PP) (r = -0.34, P = 0.03) and FVCPP (r = -0.32, P = 0.05). Acrylic gel contact hours were inversely correlated with FEV1PP (r = -0.38, P = 0.02) and FVCPP (r = -0.47, P = 0.003). Current smoking was inversely and significantly (P ≤ 0.05) associated with ENO in bivariate analysis. Log 10 ENO levels were directly correlated with job latency (P = 0.012) and gel nail application (P = 0.026) in multivariable analyses. CONCLUSIONS: These positive pilot respiratory test results warrant additional future investigation. Am. J. Ind. Med. (c) 2009 Wiley-Liss, Inc. |
Engineered nanoparticle respiratory exposure and potential risks for cardiovascular toxicity: predictive tests and biomarkers
Simeonova PP , Erdely A . Inhal Toxicol 2009 21 68-73 The most attractive properties of engineered nanomaterials for technological applications, including their small size, large surface area, and high reactivity, are also the main factors for their potential toxicity. Based on ambient ultrafine particle research, it is predicted that nanosized particles may have deeper pulmonary deposition, higher biological activity, and a tendency for extrapulmonary translocation compared to larger particles. In this regard, nanoparticle exposure, by direct or indirect mechanisms, may lead to unexpected distant responses, involving the immune system, cardiovascular system, liver, kidney, and brain. The systemic effects may induce or modify the progression of existing diseases such as cardiovascular disease. Current experimental toxicity evaluation of engineered nanomaterials, specifically carbon nanotubes, demonstrated that deposition of these materials in the lung leads to inflammation and fibrosis. The local toxicity is associated with cardiovascular effects related to atherosclerosis. Although translocation of carbon nanotubes into the systemic circulation is hypothetically possible, there is no current evidence to support this hypothesis. However, studies pointed out that carbon nanotube-induced lung inflammation results in a release of inflammatory mediators and activation of blood cells which can contribute to cardiovascular adverse effects. Furthermore, complex protein and gene expression blood analysis can help in development of biomarkers for application in human screening of nanoparticle exposure. Future studies to evaluate the systemic effects of carbon nanotube exposure under workplace or environmental exposure paradigms should be conducted. |
Injury and adaptive mechanisms in skeletal muscle
Cutlip RG , Baker BA , Hollander M , Ensey J . J Electromyogr Kinesiol 2009 19 (3) 358-72 Work-related musculoskeletal disorders (MSD) are a major concern in the United States. Overexertion and repetitive motion injuries dominate reporting of lost-time MSD incidents. Over the past three decades, there has been much study on contraction-induced skeletal muscle injury. The effect of the biomechanical loading signature that includes velocity, range of motion, the number of repetitions, force, work-rest cycle, and exposure duration has been studied. More recently, the effect of aging on muscle injury susceptibility and regeneration has been studied. This review will focus on contraction-induced skeletal muscle injury, the effects of repetitions, range of motion, work-rest cycles, and aging on injury susceptibility and regenerative and adaptive pathways. The different physiological phenomena responsive to overt muscle injury versus adaptation will be distinguished. The inherent capability of skeletal muscle to adapt to mechanical loading, given the appropriate exposure signature will also be discussed. Finally, we will submit that repeated high-intensity mechanical loading is a desirable means to attenuate the effects of sarcopenia, and may be the most effective and appealing mode of physical activity to counteract the effects often observed with musculo-skeletal dysfunction in the workplace. |
Effects of diesel exhaust aftertreatment devices on concentrations and size distribution of aerosols in underground mine air
Bugarski AD , Schnakenberg Jr GH , Hummer JA , Cauda E , Janisko SJ , Patts LD . Environ Sci Technol 2009 43 (17) 6737-43 Three types of uncatalyzed diesel particulate filter (DPF) systems, three types of high-temperature disposable filter elements (DFEs), and one diesel oxidation catalytic converter (DOC) were evaluated in underground mine conditions for their effects on the concentrations and size distributions of diesel aerosols. Those effects were compared with the effects of a standard muffler. The experimental work was conducted directly in an underground environment using a unique diesel laboratory developed in an underground experimental mine. The DPF systems reduced total mass of aerosols in the mine air approximately 10-fold for light-load and 20-fold or more for high-load test conditions. The DFEs offered similar reductions in aerosol mass concentrations. The efficiency of the new DFEs significantly increased with accumulation of operating time and buildup of diesel particulate matter in the porous structure of the filter elements. A single laundering process did not exhibit substantial effects on performance of the filter element. The effectiveness of DPFs and DFEs in removing aerosols by number was strongly influenced by engine operating mode. The concentrations of nucleation mode aerosols in the mine air were found to be substantially higher for both DPFs and DFEs when the engine was operated at high-load modes than at low-load modes. The effects of the DOC on mass and number concentrations of aerosols in mine air were relatively minor when compared to those of the DPF and DFE systems. copyright 2009 American Chemical Society. |
Exercise and health-related quality of life in older community-dwelling adults: a meta-analysis of randomized controlled trials
Kelley GA , Kelley KS , Hootman JM , Jones DL . J Appl Gerontol 2009 28 (3) 369-94 The authors used the meta-analytic approach to examine the effects of physical activity on health-related quality of life (HRQOL) in older community-dwelling adults. A random-effects model was used for all primary analyses. Of the 257 studies screened, 11 randomized controlled trials representing 13 groups and 617 men and women (324 physical activity, 293 control), all older than 50, were included. Overall, a significant (small to moderate) standardized effect size improvement was found for physical function as a result of physical activity (Hedges's g = 0.41, 95% confidence interval [CI] = 0.19, 0.64, p < .001). This was equivalent to a common language effect size of 62% and an odds ratio of 2.14 (95% CI = 1.42, 3.24). No significant differences were found for the other nine HRQOL outcomes. Although additional research is needed, results suggest that physical activity improves self-reported physical function, a component of HRQOL, in older community-dwelling adults. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract). |
Incentives to encourage participation in the national public health accreditation model: a systematic investigation
Davis MV , Cannon MM , Corso L , Lenaway D , Baker EL . Am J Public Health 2009 99 (9) 1705-11 OBJECTIVES: We sought to identify the incentives most likely to encourage voluntary participation in the national public health accreditation model. METHODS: We reviewed existing incentives, held meetings with key informants, and conducted a survey of state and local public health agency representatives. The survey was sent to all state health departments and a sample of local health departments. Group-specific differences in survey responses were examined. RESULTS: Survey response rates were 51% among state health department representatives and 49% among local health department representatives. Both state health department and local health department respondents rated financial incentives for accredited agencies, financial incentives for agencies considering accreditation, and infrastructure and quality improvement as important incentives. State health department respondents also indicated that grant administration and grant application would encourage their participation in the national accreditation model, and local health department respondents also noted that technical assistance and training would encourage their participation. CONCLUSIONS: Incentives to encourage participation of state and local agencies in the national voluntary accreditation model should include financial support as well as support for agency infrastructure and quality improvements. Several initiatives are already under way to support agency infrastructure and quality improvement, but financial support incentives have yet to be developed. |
Progestogen-only contraceptive use in obese women
Curtis KM , Ravi A , Gaffield ML . Contraception 2009 80 (4) 346-54 BACKGROUND: The objective of this systematic review is to determine whether obese women who use progestogen-only contraceptives are more likely to experience weight gain or serious adverse events as compared to nonobese users. STUDY DESIGN: We searched PubMed for all articles (in all languages) published in peer-reviewed journals from database inception through October 2008, for evidence relevant to obesity and progestogen-only contraceptives. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. RESULTS: From 579 articles, we identified nine studies fitting our selection criteria. Evidence from five studies suggests that among adult women, baseline weight or body mass index is not associated with weight gain among depot medroxyprogesterone acetate (DMPA) users (Level II-2, Fair). Evidence from three studies suggests that among adolescent women, overweight or obese DMPA users may gain more weight than normal weight DMPA users or overweight/obese nonusers (Level II-2, Fair). Evidence from one small study of Norplant users showed no differences in weight gain by baseline weight (Level II-3, Poor). We did not identify studies of other progestogen-only contraceptive methods that examined weight change by baseline weight, nor did we identify studies that reported on any serious adverse events by baseline weight. CONCLUSIONS: Adolescent DMPA users who are obese may gain more weight than normal weight users. This observation was not seen in adult DMPA users or adolescent Norplant users. |
When can a woman have repeat progestogen-only injectables--depot medroxyprogesterone acetate or norethisterone enantate?
Paulen ME , Curtis KM . Contraception 2009 80 (4) 391-408 BACKGROUND: Currently, there is a generally accepted 2-week grace period for women returning early/late for reinjection of either depot medroxyprogesterone acetate (DMPA) or norethisterone enantate (NET-EN). This systematic review evaluates the evidence regarding return to fertility and ovulation after injection of a progestogen-only contraceptive. STUDY DESIGN: We searched the PubMed database to identify all relevant evidence published in peer-reviewed journals from database inception through November 2008 regarding timing of fertility and return to ovulation after the last injection of DMPA or NET-EN. RESULTS: We identified 20 articles, 10 on DMPA use, eight on NET-EN use and two examining both types of injectables. Six studies examining time to pregnancy after discontinuing DMPA or NET-EN reported that pregnancy rates during the currently recommended 2-week grace period were zero or very low. Studies of return to ovulation indicated a wide variation in time to ovulation post-injection with the majority ranging from 15-49 weeks from the last injection (for DMPA) and 4.9-24.3 weeks from the last injection (for NET-EN). Limitations of this body of evidence include small sample sizes, lack of data on the main outcome of interest (time to pregnancy) and inconsistency in measurement of ovulation, a surrogate measurement for pregnancy risk. CONCLUSION: Studies evaluating time to pregnancy after last injection of DMPA or NET-EN reported extremely low pregnancy rates during the 2-week interval following the reinjection date; extremely low pregnancy rates for DMPA were also reported for 4 weeks following the reinjection date. Studies of return to ovulation after last injection of DMPA generally found that the earliest ovulation did not occur until several months after the last injection while studies of NET-EN reported ovulations around (or even before) the time for reinjection. |
Sexual networks are diverse and complex: prevalence of relationships bridging population subgroups in the Seattle Sex Survey
Spicknall IH , Aral SO , Holmes KK , Foxman B . Sex Transm Dis 2009 36 (8) 465-72 GOAL: To better understand how and how often individuals bridge demographic groups in their sex partnerships, and to describe the epidemiologic characteristics of bridging and associations with history of sexually transmitted infection (STI). METHODS: We describe the frequency of different hypothetical sexual bridging types among men and women aged 18 to 39 participating in a random digit dialing survey conducted in 2003 to 2004, and the associations of bridging behavior with risk factors for and self-reported history of STI. RESULTS: Of the 1013 participants who described their 2 most recent sexual partnerships, 753 (74%), were classified as a bridge of some type. Education bridges were most prevalent (46%), followed by spatial (34%), age (29%), race (24%), and gender bridges (3%). CONCLUSIONS: Sexual networks are diverse and complex, and there are multiple potential paths for infection flow. |
Social and behavioral correlates of sexually transmitted infection- and HIV-discordant sexual partnerships in Bushwick, Brooklyn, New York
Khan MR , Bolyard M , Sandoval M , Mateu-Gelabert P , Krauss B , Aral SO , Friedman SR . J Acquir Immune Defic Syndr 2009 51 (4) 470-85 INTRODUCTION: The Centers for Disease Control and Prevention (CDC) advise repeat HIV testing for partners of HIV-infected persons; injection drug users and their sex partners; individuals with recent multiple partnerships and their sex partners; those involved in sex trade; and men who have sex with men. Additional social and behavioral variables may be useful for identifying priority populations. METHODS: We analyzed data collected during a social network study conducted in a Brooklyn, NY, neighborhood to identify social and behavioral characteristics of respondents (N = 343) involved in HIV-discordant, herpes simplex virus-2- discordant, and chlamydia-discordant partnerships. RESULTS: HIV partnership discordance was associated with injection drug use but was generally not associated with sexual behaviors including multiple partnerships and sex trade. Herpes simplex virus-2 and chlamydia partnership discordance were associated with multiple partnerships, sex trade, and same sex partnership history. Additional correlates of sexually transmitted infection (STI)/HIV-discordant partnerships included older age (>or=25 years), noninjection drug use, and incarceration history. Analyses suggested that screening tools composed of CDC-recommended sexual risk and injection drug indicators plus indicators of older age, noninjection drug use, and incarceration were more effective in identifying STI/HIV priority populations than tools composed of CDC indicators alone. CONCLUSIONS: Screening tools that include social and behavioral indicators may improve STI/HIV case-finding effectiveness. |
BirthStats: rates of cesarean delivery, and unassisted and assisted vaginal delivery, United States, 1996, 2000, and 2006
Menacker F , Martin JA . Birth 2009 36 (2) 167 The rise in the rate of birhs by cesarean delivery has been accompanied by a decrease in the rate of vaginal delivery and in the use of forceps or vacuum extraction, methods that are used to assist vaginal delivery (i.e., assisted vaginal delivery). Between 1996 and 2006, birhs by cesarean delivery rose by 50 percent, from 20.7 to 31.1 percent. At the same time, the rate of assisted vaginal delivery declined from 11.8 to 6.6 percent and the rate of unassisted vaginal birhs fell from 67.5 to 62.3 percent. The pace of these changes accelerated between 2000 and 2006. | The decline in the rate of vaginal delivery (both assisted and unassisted) may reflect changes in obstetric training and practice patterns, as well as the continuing debate on the immediate and long-term risks and benefits of vaginal versus cesarean birh for both the mother and infant. | This analysis was prepared by Fay Menacker, DrPH, CPNP, and Joyce A. Martin, MPH, of the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA. |
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