Social determinants of disparities in weight among US children and adolescents
Rossen LM , Talih M . Ann Epidemiol 2014 24 (10) 705-713 e2 PURPOSE: To explore whether contextual variables attenuate disparities in weight among 18,639 US children and adolescents aged 2 to 18 years participating in the National Health and Nutrition Examination Survey, 2001 to 2010. METHODS: Disparities were assessed using the Symmetrized Renyi Index, a new measure that summarizes disparities in the severity of a disease, as well as the prevalence, across multiple population groups. Propensity score subclassification was used to ensure covariate balance between racial and ethnic subgroups and account for individual-level and contextual covariates. RESULTS: Before propensity score subclassification, significant disparities were evident in the prevalence of overweight and/or obesity and the degree of excess weight among overweight/obese children and adolescents. After propensity score subclassification, racial/ethnic disparities in the prevalence and severity of excess weight were completely attenuated within matched groups, indicating that racial and ethnic differences were explained by social determinants such as neighborhood socioeconomic and demographic factors. CONCLUSIONS: The limited overlap in covariate distributions between various racial/ethnic subgroups warrants further attention in disparities research. The attenuation of disparities within matched groups suggests that social determinants such as neighborhood socioeconomic factors may engender disparities in weight among US children and adolescents. |
Socioeconomic and demographic predictors of selected cardiovascular risk factors among adults living in Pohnpei, Federated States of Micronesia
Hosey GM , Samo M , Gregg EW , Padden D , Bibb SG . BMC Public Health 2014 14 (1) 895 BACKGROUND: The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia. METHODS: We used data from the cross-sectional World Health Organization's STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25-64 years). RESULTS: In general, we found that higher education (≥13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29-0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34-0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29-4.43, p < 0.001). Among women, paid employment nearly doubled the odds of daily tobacco use (OR: 1.72, CI: 1.08-2.73, p = 0.006) than unemployment. For all participants, income > $10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43-3.51, p = 0.003), versus lower-income (<$5,000). Men had over twice the odds of high BP (OR: 2.01, CI: 1.43-2.83, p < 0.001) than women. Paid employment nearly doubled the odds of central obesity with the magnitude of association increasing by more than 20% adjusted for sex and age. Men reporting paid employment had three times the odds of central obesity (OR: 3.00, CI: 1.56-5.78, p < 0.001) than those unemployed. CONCLUSION: Our analysis revealed associations between socioeconomic position and selected CVD risk factors, which varied by risk-factor, sex and age characteristics, and direction of association. The 2002 Pohnpei dataset provides country-level baseline information; further population health surveillance might define trends. Stronger country-level data might help decision-makers tailor population-based prevention strategies. |
Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009
Houston KA , Henley SJ , Li J , White MC , Richards TB . Lung Cancer 2014 86 (1) 22-8 OBJECTIVE: The examination of lung cancer by histology type is important for monitoring population trends that have implications for etiology and prevention, screening and clinical diagnosis, prognosis and treatment. We provide a comprehensive description of recent histologic lung cancer incidence rates and trends in the USA using combined population-based registry data for the entire nation. MATERIALS AND METHODS: Histologic lung cancer incidence data was analyzed from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Standardized rates and trends were calculated for men and women by age, race/ethnicity, and U.S. Census region. Rate ratios were examined for differences in rates between men and women, and annual percent change was calculated to quantify changes in incidence rates over time. RESULTS: Trend analysis demonstrate that overall rates have decreased, but incidence has remained stable for women aged 50 or older. Adenocarcinoma and squamous cell carcinoma were the two most common histologic subtypes. Adenocarcinoma rates continued to increase in men and women, and squamous cell rates increased in women only. All histologic subtype rates for white women exceeded rates for black women. Histologic rates for black men exceeded those for white men, except for small cell carcinoma. The incidence rate for Hispanics was nearly half the rate for blacks and whites. CONCLUSION: The continuing rise in incidence of lung adenocarcinoma, the rise of squamous cell cancer in women, and differences by age, race, ethnicity and region points to the need to better understand factors acting in addition to, or in synergy with, cigarette smoking that may be contributing to observed differences in lung cancer histology. |
Characteristics and survival of end stage renal disease (ESRD) patients with spina bifida in the United States Renal Data System (USRDS)
Ouyang L , Bolen J , Valdez R , Joseph D , Baum MA , Thibadeau J . J Urol 2014 193 (2) 558-64 PURPOSE: We described the characteristics, treatments, and survival of persons with spina bifida (SB) who developed end stage renal disease (ESRD) from 2004 through 2008 in the United States Renal Data System (USRDS). MATERIALS AND METHODS: We used ICD-9-CM code 741.* to identify persons with SB from hospital inpatient data (1977-2010) and physician and facility claims (2004-2008). We constructed a 5:1 comparison group of ESRD patients without SB matched by age at first ESRD service, gender, and race/ethnicity. We assessed their risk of mortality and of renal transplant while on dialysis using multivariate cause-specific proportional hazards survival analyses. We also compared their survival after their first renal transplant from first ESRD service to August 2011. RESULTS: We identified 439 ESRD patients with SB, who on average developed ESRD at younger ages than patients without SB (41 vs. 62 years, P<0.001) and urological issues were the most common primary cause of their ESRD. Compared to ESRD patients without SB, patients with SB had similar mortality hazard on dialysis and after a transplant. But ESRD patients without SB were more likely to undergo renal transplantation than patients with SB (hazard ratio=1.51, 95% CI=1.13-2.03). Hospitalizations related to urinary tract infections (UTIs) were positively associated with risk of death on dialysis for ESRD patients with SB (hazard ratio=1.42, 95% CI=1.33-1.53). CONCLUSIONS: SB was not associated with elevated mortality among ESRD patients on dialysis or after a renal transplant. Proper urological and bladder management for patients with SB, particularly for adults, is imperative. |
Demographic factors associated with overuse of Pap testing
Kepka D , Breen N , King JB , Meissner HI , Roland KB , Benard VB , Saraiya M . Am J Prev Med 2014 47 (5) 629-33 BACKGROUND: Since 2003, U.S. Preventive Services Task Force guidelines recommend against Pap testing for women without a cervix following a hysterectomy and those aged >65 years. Few population-based studies have investigated factors associated with overuse of Pap testing in the U.S. PURPOSE: To evaluate patient characteristics associated with overuse of Pap testing. METHODS: A cross-sectional study was conducted using data from the 2010 National Health Interview Survey (NHIS) for women aged ≥30 years. NHIS is a nationally representative survey that employs a random, stratified, multi-stage cluster sampling design. In 2010, the NHIS administered a Cancer Control Supplement with questions on cervical cancer screening and hysterectomy status. Conducted in 2011-2013, all analyses account for the stratification and clustering of data within the complex NHIS survey design. Multivariate logistic regression models were used in all analyses. RESULTS: Among women who have undergone a hysterectomy, younger age, Hispanic and black race/ethnicity, exceeding 400% of poverty level, and private health insurance coverage were significantly associated with receipt of a recent Pap test since hysterectomy. Among women aged >65 years, non-Hispanic white ethnicity, higher education level, exceeding 400% of poverty level, and no hysterectomy were significantly associated with receipt of a recent Pap test. CONCLUSIONS: Targeted efforts to reduce unnecessary testing among older women and women with a hysterectomy in compliance with clinical recommendations for cervical cancer prevention are needed. Specific attention should be paid to privately insured women with incomes above 400% of the federal poverty level. |
Recent population expansions of hepatitis B virus in the United States.
Ramachandran S , Purdy MA , Xia GL , Campo DS , Dimitrova ZE , Teshale EH , Teo CG , Khudyakov YE . J Virol 2014 88 (24) 13971-80 The recent epidemic history of hepatitis B virus (HBV) infections in the United States is complex, as indicated by current disparity in HBV genotype distribution between acute and chronic hepatitis B cases and rapid decline in hepatitis B incidence since the 1990s. We report temporal changes in genetic composition of the HBV population using whole-genome sequences (n=179) from acute hepatitis B cases (n=1206) identified through the Sentinel County Surveillance for Acute Hepatitis (1998-2006). HBV belonged mainly to subtypes A2 (75%) and D3 (18%), with times of their most recent common ancestors being, respectively, 1979 and 1987, respectively. A2 underwent rapid population expansions in ca. 1995 and ca. 2002, coinciding with transient rises in acute hepatitis B notification rates among adults; D3 underwent expansion in ca. 1998. A2 strains from cases identified after 2002, compared to those before 2002, tended to cluster phylogenetically, indicating selective expansion of specific strains, and were significantly reduced in genetic diversity (p = 0.001) and frequency of drug-resistance mutations (p = 0.001). The expansion of genetically close HBV A2 strains was associated with risk of infection among male homosexuals (p = 0.03). Incident HBV strains circulating in the US were recent in origin, and restricted in genetic diversity. Disparate transmission dynamics among phylogenetic lineages affected the genetic composition of HBV populations and their capacity to maintain drug-resistance mutations. The tendency of selectively expanding HBV strains to be transmitted among male homosexuals highlights the need to improve hepatitis B vaccination coverage among at-risk adults. IMPORTANCE: Hepatitis B virus (HBV) remains an important cause of acute and chronic liver disease globally, and in the United States. Genetic analysis of HBV whole genomes from cases of acute hepatitis B identified from 1998-2006 in the United States showed dominance of genotype A2 (75%), followed by D3 (18%). Strains of both subtypes were recent in origin and underwent rapid population expansions from 1995-2000, indicating increase in transmission rate for certain HBV strains during a period of decline in the reported incidence of acute hepatitis B in the US. HBV A2 strains from a particular cluster that experienced the most recent population expansion were more commonly detected among men who have sex with men. Vaccination needs to be stepped up to protect persons who remain at risk of HBV infection. |
Quantification of rifapentine, a potent anti-tuberculosis drug, from dried blood spot samples using liquid chromatographic-tandem mass spectrometric analysis
Parsons TL , Marzinke MA , Hoang T , Bliven-Sizemore E , Weiner M , Mac Kenzie W , Dorman SE , Dooley KE . Antimicrob Agents Chemother 2014 58 (11) 6747-57 Quantifying anti-tuberculosis drug concentrations in multinational trials currently requires collection of modest blood volumes, centrifugation, aliquoting of plasma, freezing, and keeping samples frozen during shipping. We prospectively enrolled healthy individuals into Tuberculosis Trials Consortium Study 29B, a Phase I dose escalation study of rifapentine, a rifamycin under evaluation in tuberculosis treatment trials. We developed a liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method for quantification of rifapentine in whole blood from dried blood spots (DBS) to facilitate pharmacokinetic/pharmacodynamic analyses in trials. Paired plasma and whole blood samples were collected by venipuncture; whole blood was spotted on Whatman 903(R) cards. Methods were optimized for plasma and then validated for DBS. The analytical measuring range was 50 to 80,000 ng/ml in whole blood DBS. Analytes were stable on cards for 11 weeks with desiccant at room temperature protected from light. Method concordance for paired plasma and whole blood DBS samples was determined after correcting for participant hematocrit or population-based estimates of bias from Bland-Altman plots. The application of either correction factor resulted in excellent correlation between plasma and whole blood DBS (Passing-Bablok regression corrected for hematocrit; y=0.98x+356). Concentrations of rifapentine may be determined from whole blood DBS collected via venipuncture after normalization to account for dilutional effects of red blood cells; additional studies are focused on the application of this methodology to capillary blood collected by finger stick. Simplicity of processing, storage, shipping and low blood volume makes whole blood DBS attractive for rifapentine pharmacokinetic evaluations, especially in international and pediatric trials. |
Effectiveness of the U.S. National HIV Testing Day campaigns in promoting HIV testing: evidence from CDC-funded HIV testing sites, 2010
Van Handel M , Mulatu MS . Public Health Rep 2014 129 (5) 446-54 OBJECTIVES: We assessed if HIV testing and diagnoses increased during the week of National HIV Testing Day (NHTD) and if characteristics of people who were tested varied compared with control weeks. METHODS: We analyzed HIV testing data from the 2010 National HIV Prevention Program Monitoring and Evaluation system to compare NHTD week (June 24-30, 2010) with two control weeks (January 7-13, 2010, and August 12-18, 2010) for the number of HIV testing events and new HIV-positive diagnoses, by demographics and other HIV-related variables. Characteristics associated with testing during NHTD week compared with control weeks were identified using Chi-square analyses. RESULTS: In 2010, an average of 15,000 more testing events were conducted and 100 more new HIV-positive diagnoses were identified during NHTD week than during the control weeks (p<0.001). Compared with control weeks, people tested during NHTD week were significantly less likely to be aged 20-29 years and non-Hispanic white and significantly more likely to be (1) aged ≥50 years, (2) non-Hispanic black or African American, (3) men who have sex with men, (4) low-risk heterosexuals, (5) tested with a rapid HIV test, or (6) tested in a non-health-care setting. CONCLUSION: In 2010, CDC-funded HIV testing events and new HIV-positive diagnoses increased during NHTD week compared with control weeks. HIV testing programs increased the use of rapid tests and returned a high percentage of test results. NHTD campaigns reached populations disproportionately affected by HIV and further expanded testing to people traditionally less likely to be tested. Incorporating strategies used during NHTD in programs conducted throughout the year may assist in increasing HIV testing and the number of HIV-positive diagnoses. |
Factors associated with adherence and concordance between measurement strategies in an HIV daily oral tenofovir/emtricitibine as pre-exposure prophylaxis (Prep) clinical trial, Botswana, 2007-2010
Kebaabetswe PM , Stirratt MJ , McLellan-Lemal E , Henderson FL , Gray SC , Rose CE , Williams T , Paxton LA . AIDS Behav 2014 19 (5) 758-69 This study examined study product adherence and its determinants in the Botswana oral pre-exposure prophylaxis efficacy trial. Among the 1,219 participants, the mean adherence by pill count and 3-day self-report was 94 % for each. In multivariable models, pill count adherence was significantly associated with adverse events (nausea, dizziness, vomiting) (RR 0.98 95 % CI 0.98-1.00; p = 0.03) and side effect concerns (RR 0.98 95 % CI 0.96-0.99; p = 0.01). Self-reported adherence was significantly associated with having an HIV-positive partner (RR 1.02 95 % CI 1.00-1.04; p = 0.02) and Francistown residence (RR 0.98 95 % CI 0.96, 0.99; p = 0.0001). Detectable drug concentrations showed modest associations with self-report and pill count adherence, and drug levels were higher among those self-reporting 100 % adherence than those reporting <100 %. Most common adherence barriers involved refill delays and other logistic challenges; cellphone alarm reminder use was the most common facilitator. |
Global tuberculosis: perspectives, prospects, and priorities
Frieden TR , Brudney KF , Harries AD . JAMA 2014 312 (14) 1393-4 Despite being nearly 100% curable, tuberculosis remains a major public health problem, representing the second leading cause of death from infectious diseases globally, with drug-resistant tuberculosis increasingly common. In 2012, an estimated 8.6 million people developed tuberculosis worldwide—a global incidence rate of 122 persons per 100 000 population—and 1.3 million people died. Incidence rates vary from high in southern Africa (550/100 000 population in Mozambique and Zimbabwe and 1000/100 000 population in South Africa) to fewer than 10/100 000 population in the United States, Canada, and most of Western Europe.1 Although the global prevalence of multidrug-resistant tuberculosis was estimated at 3.6% of newly diagnosed and 20.2% of previously treated patients, these rates were 20% to 35% for newly diagnosed cases and 50% to 69% for retreatment cases in the Russian Federation and some other former Soviet republics. | In sub-Saharan Africa, the tuberculosis epidemic is driven by HIV through both increased reactivation of latent tuberculosis infection and the increased risk of rapid development of disease soon after exposure to Mycobacterium tuberculosis because of HIV-induced immunodeficiency. There is lower tuberculosis incidence in Asia, but because Asia’s population is so much larger than Africa’s—more than 4 billion compared with about a billion—75% of the 5 million tuberculosis cases in the 22 highest-burden countries are in Asia. In these countries, crowding, poverty, and inadequate tuberculosis treatment completion rates contribute to the epidemic.2 |
Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence
Polis CB , Phillips SJ , Curtis KM , Westreich DJ , Steyn PS , Raymond E , Hannaford P , Turner AN . Contraception 2014 90 (4) 360-390 Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women's health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as "informative but with important limitations". Overall, data do not support an association between use of oral contraceptives and increased risk of HIV acquisition. Uncertainty persists regarding whether an association exists between depot-medroxyprogesterone acetate (DMPA) use and risk of HIV acquisition. Most studies suggested no significantly increased HIV risk with norethisterone enanthate (NET-EN) use, but when assessed in the same study, point estimates for NET-EN tended to be larger than for DMPA, though 95% confidence intervals overlapped substantially. No data have suggested significantly increased risk of HIV acquisition with use of implants, though data were limited. No data are available on the relationship between use of contraceptive patches, rings, or hormonal intrauterine devices and risk of HIV acquisition. Women choosing progestin-only injectable contraceptives such as DMPA or NET-EN should be informed of the current uncertainty regarding whether use of these methods increases risk of HIV acquisition, and like all women at risk of HIV, should be empowered to access and use condoms and other HIV preventative measures. Programs, practitioners, and women urgently need guidance on how to maximize health with respect to avoiding both unintended pregnancy and HIV given inconclusive or limited data for certain HC methods. |
Increases in HIV testing among men who have sex with men - National HIV Behavioral Surveillance System, 20 U.S. metropolitan statistical areas, 2008 and 2011
Cooley LA , Oster AM , Rose CE , Wejnert C , Le BC , Paz-Bailey G . PLoS One 2014 9 (9) e104162 In 2011, 62% of estimated new HIV diagnoses in the United States were attributed to male-to-male sexual contact (men who have sex with men, MSM); 39% of these MSM were black or African American. HIV testing, recommended at least annually by CDC for sexually active MSM, is an essential first step in HIV care and treatment for HIV-positive individuals. A variety of HIV testing initiatives, designed to reach populations disproportionately affected by HIV, have been developed at both national and local levels. We assessed changes in HIV testing behavior among MSM participating in the National HIV Behavioral Surveillance System in 2008 and 2011. We compared the percentages tested in the previous 12 months in 2008 and 2011, overall and by race/ethnicity and age group. In unadjusted analyses, recent HIV testing increased from 63% in 2008 to 67% in 2011 overall (P<0.001), from 63% to 71% among black MSM (P<0.001), and from 63% to 75% among MSM of other/multiple races (P<0.001); testing did not increase significantly for white or Hispanic/Latino MSM. Multivariable model results indicated an overall increase in recent HIV testing (adjusted prevalence ratio [aPR] = 1.07, P<0.001). Increases were largest for black MSM (aPR = 1.12, P<0.001) and MSM of other/multiple races (aPR = 1.20, P<0.001). Among MSM aged 18-19 years, recent HIV testing was shown to increase significantly among black MSM (aPR = 1.20, P = 0.007), but not among MSM of other racial/ethnic groups. Increases in recent HIV testing among populations most affected by HIV are encouraging, but despite these increases, improved testing coverage is needed to meet CDC recommendations. |
Total and methyl mercury in whole blood measured for the first time in the U.S. population: NHANES 2011-2012
Mortensen ME , Caudill SP , Caldwell KL , Ward CD , Jones RL . Environ Res 2014 134C 257-264 BACKGROUND: Despite the public health and toxicologic interest in methyl mercury (MeHg) and ethyl mercury (EHg), these mercury species have been technically difficult to measure in large population studies. METHODS: Using NHANES 2011-2012 data, we calculated reference ranges and examined demographic factors associated with specific mercury species concentrations and the ratio of MeHg to THg. We conducted several multiple regression analyses to examine factors associated with MeHg concentrations and also with the ratio of MeHg to THg. RESULTS: Asians had the highest geometric mean concentrations for MeHg, 1.58microg/L (95% CI 1.29, 1.93) and THg, 1.86microg/L (1.58, 2.19), followed by non-Hispanic blacks with MeHg, 0.52microg/L (0.39, 0.68) and THg, 0.68microg/L (0.54, 0.85). Greater education attainment in adults and male sex were associated with higher MeHg and THg concentrations. Race/ethnicity, age, and sex were significant predictors of MeHg concentrations, which increased with age and were highest in Asians in all age categories, followed by non-Hispanic blacks. Mexican Americans had the lowest adjusted MeHg concentrations. The ratio of MeHg to THg was highest in Asians, varied by racial/ethnic group, and increased with age in a non-linear fashion. The amount of increase in the MeHg to THg ratio with age depended on the initial ratio, with a greater increase as age increased. Of the overall population, 3.05% (95% CI 1.77, 4.87) had MeHg concentrations >5.8microg/L (a value that corresponds to the U.S. EPA reference dose). The prevalence was highest in Asians at 15.85% (95% CI 11.85, 20.56), increased with age, reaching a maximum of 9.26% (3.03, 20.42) at ages 60-69 years. Females 16-44 years old had a 1.76% (0.82-3.28) prevalence of MeHg concentrations >5.8microg/L. CONCLUSIONS: Asians, males, older individuals, and adults with greater educational attainment had higher MeHg concentrations. The ratio of MeHg to THg varied with racial/ethnic group, increased with age, and was nonlinear. U.S. population reference values for MeHg and the ratio of MeHg to THg can assist in more precise assessment of public health risk from MeHg consumed in seafood. |
Prenatal phthalate and early childhood bisphenol A exposures increase asthma risk in inner-city children
Whyatt RM , Rundle AG , Perzanowski MS , Just AC , Donohue KM , Calafat AM , Hoepner L , Perera FP , Miller RL . J Allergy Clin Immunol 2014 We previously reported that inner-city childhood asthma was associated independently with measures of early childhood exposure to bisphenol A (BPA)1and prenatal, but not childhood, exposures to di-n-butyl phthalate (DnBP) and butylbenzyl phthalate (BBzP).2 Here we evaluate whether these two classes of endocrine disrupting chemicals (EDCs) interact to increase risk of asthma. |
Changes in serum concentrations of maternal poly- and perfluoroalkyl substances over the course of pregnancy and predictors of exposure in a multiethnic cohort of Cincinnati, Ohio pregnant women during 2003-2006
Kato K , Wong LY , Chen A , Dunbar C , Webster GM , Lanphear BP , Calafat AM . Environ Sci Technol 2014 48 (16) 9600-8 Data on predictors of gestational exposure to poly- and perfluoroalkyl substances (PFASs) in the United States are limited. To fill in this gap, in a multiethnic cohort of Ohio pregnant women recruited in 2003-2006, we measured perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA), and six additional PFASs in maternal serum at approximately 16 weeks gestation (N = 182) and delivery (N = 78), and in umbilical cord serum (N = 202). We used linear regression to examine associations between maternal serum PFASs concentrations and demographic, perinatal, and lifestyle factors. PFASs concentrations in maternal sera and in their infants' cord sera were highly correlated (Spearman rank correlation coefficients = 0.73-0.95). In 71 maternal-infant dyads, unadjusted geometric mean (GM) concentrations (95% confidence interval) (in mug/L) in maternal serum at delivery of PFOS [8.50 (7.01-9.58)] and PFOA [3.43 (3.01-3.90)] were significantly lower than at 16 weeks gestation [11.57 (9.90-13.53], 4.91 (4.32-5.59), respectively], but higher than in infants' cord serum [3.32 (2.84-3.89), 2.85 (2.51-3.24), respectively] (P < 0.001). Women who were parous, with a history of previous breastfeeding, black, or in the lowest income category had significantly lower PFOS and PFOA GM concentrations than other women. These data suggest transplacental transfer of PFASs during pregnancy and nursing for the first time in a U.S. birth cohort. |
Differences in healthy life expectancy for the US population by sex, race/ethnicity and geographic region: 2008
Chang MH , Molla MT , Truman BI , Athar H , Moonesinghe R , Yoon PW . J Public Health (Oxf) 2014 37 (3) 470-9 BACKGROUND: Healthy life expectancy (HLE) varies among demographic segments of the US population and by geography. To quantify that variation, we estimated the national and regional HLE for the US population by sex, race/ethnicity and geographic region in 2008. METHODS: National HLEs were calculated using the published 2008 life table and the self-reported health status data from the National Health Interview Survey (NHIS). Regional HLEs were calculated using the combined 2007-09 mortality, population and NHIS health status data. RESULTS: In 2008, HLE in the USA varied significantly by sex, race/ethnicity and geographical regions. At 25 years of age, HLE for females was 47.3 years and approximately 2.9 years greater than that for males at 44.4 years. HLE for non-Hispanic white adults was 2.6 years greater than that for Hispanic adults and 7.8 years greater than that for non-Hispanic black adults. By region, the Northeast had the longest HLE and the South had the shortest. CONCLUSIONS: The HLE estimates in this report can be used to monitor trends in the health of populations, compare estimates across populations and identify health inequalities that require attention. |
Molecular and phenotypic characterization of Vibrio navarrensis isolates associated with human illness.
Gladney LM , Tarr CL . J Clin Microbiol 2014 52 (11) 4070-4 We characterized 18 Vibrio isolates, including 15 recovered from human clinical specimens and found that they clustered with two previously characterized V. navarrensis isolates in a phylogenetic analysis. Four of the 18 strains may represent a new Vibrio species, distinct from V. navarrensis. The potential role of V. navarrensis in human disease needs further investigation. |
Beyond public health genomics: proposals from an international working group.
Boccia S , Mc Kee M , Adany R , Boffetta P , Burton H , Cambon-Thomsen A , Cornel MC , Gray M , Jani A , Maria Knoppers B , Khoury MJ , Meslin EM , Van Duijn CM , Villari P , Zimmern R , Cesario A , Puggina A , Colotto M , Ricciardi W . Eur J Public Health 2014 24 (6) 877-9 Advances in genomics have crucial implications for public health, offering new ways of differentiating individuals and groups within populations that go beyond the measures normally used by public health professionals, such as gender, age, socio-economic status, physiological measurements or clinical biomarkers.1 While public health has traditionally been concerned with interventions at a population level, genomic medicine seems to promote a vision for health care that encourages individualism rather than collectivism.2 This tension is apparent in weighing up its consequences. Thus, it may bring benefits in stratifying individuals according to genetic risk, enabling better targeting of preventive and therapeutic interventions. But it may also have harmful consequences undermining the imperative to tackle social and environmental determinants of disease and the collective provision of health care potentially leading to overdiagnosis/overtreatment; it may fragment the risk pooling that underpins social solidarity; and it may increase the probability of stigmatization and discrimination. | Consequently, the public health community, with its commitment to equity, must take the opportunity to engage with genomic knowledge, ensuring that it advances the population’s health. These issues were explored in January 2014 at the inaugural meeting of an international working group on ‘Beyond Public Health Genomics’, convening leading experts in genomics, public health, clinical sciences, systems medicine, law and bioethics, from many disciplines and countries, at the Università Cattolica del Sacro Cuore in Rome. Its goal, inspired by the 2005 Bellagio statement on public health genomics, defined as the ‘responsible and effective translation of genome-based discovery into population health,3 was to generate high value-based proposals to foster the evidence base for implementing genomic discoveries in public health policy and practice, and to ensure necessary action while accounting for the challenge of needing to fund these workstreams in the current environment of diminishing resources. |
Surveillance for respiratory health care-associated infections among inpatients in 3 Kenyan hospitals, 2010-2012
Ndegwa LK , Katz MA , McCormick K , Nganga Z , Mungai A , Emukule G , Kollmann MK , Mayieka L , Otieno J , Breiman RF , Mott JA , Ellingson K . Am J Infect Control 2014 42 (9) 985-90 BACKGROUND: Although health care-associated infections are an important cause of morbidity and mortality worldwide, the epidemiology and etiology of respiratory health care-associated infections (rHAIs) have not been documented in Kenya. In 2010, the Ministry of Health, Kenya Medical Research Institute, and Centers for Disease Control and Prevention initiated surveillance for rHAIs at 3 hospitals. METHODS: At each hospital, we surveyed intensive care units (ICUs), pediatric wards, and medical wards to identify patients with rHAIs, defined as any hospital-onset (≥3 days after admission) fever (≥38 degrees C) or hypothermia (<35 degrees C) with concurrent signs or symptoms of acute respiratory infection. Nasopharyngeal and oropharyngeal specimens were collected from these patients and tested by real-time reverse transcription polymerase chain reaction for influenza and 7 other viruses. RESULTS: From April 2010-September 2012, of the 379 rHAI cases, 60.7% were men and 57.3% were children <18 years old. The overall incidence of rHAIs was 9.2 per 10,000 patient days, with the highest incidence in the ICUs. Of all specimens analyzed, 45.7% had at least 1 respiratory virus detected; 92.2% of all positive viral specimens were identified in patients <18 years old. CONCLUSION: We identified rHAIs in all ward types under surveillance in Kenyan hospitals. Viruses may have a substantial role in these infections, particularly among pediatric populations. Further research is needed to refine case definitions and understand rHAIs in ICUs. |
Trends in childhood influenza vaccination coverage-U.S., 2004-2012
Santibanez TA , Lu PJ , O'Halloran A , Meghani A , Grabowsky M , Singleton JA . Public Health Rep 2014 129 (5) 417-27 OBJECTIVE: We compared estimates of childhood influenza vaccination coverage by health status, age, and racial/ethnic group across eight consecutive influenza seasons (2004 through 2012) based on two survey systems to assess trends in childhood influenza vaccination coverage in the U.S. METHODS: We used National Health Interview Survey (NHIS) and National Immunization Survey-Flu (NIS-Flu) data to estimate receipt of at least one dose of influenza vaccination among children aged 6 months to 17 years based on parental report. We computed estimates using Kaplan-Meier survival analysis methods. RESULTS: Based on the NHIS, overall influenza vaccination coverage with at least one dose of influenza vaccine among children increased from 16.2% during the 2004-2005 influenza season to 47.1% during the 2011-2012 influenza season. Children with health conditions that put them at high risk for complications from influenza had higher influenza vaccination coverage than children without these health conditions for all the seasons studied. In seven of the eight seasons studied, there were no significant differences in influenza vaccination coverage between non-Hispanic black and non-Hispanic white children. Influenza vaccination coverage estimates for children were slightly higher based on NIS-Flu data compared with NHIS data for the 2010-2011 and 2011-2012 influenza seasons (4.1 and 4.4 percentage points higher, respectively); both NIS-Flu and NHIS estimates had similar patterns of decreasing vaccination coverage with increasing age. CONCLUSIONS: Although influenza vaccination coverage among children continued to increase, by the 2011-2012 influenza season, only slightly less than half of U.S. children were vaccinated against influenza. Much improvement is needed to ensure all children aged ≥6 months are vaccinated annually against influenza. |
Notes from the field: reports of expired live attenuated influenza vaccine being administered - United States, 2007-2014
Haber P , Schembri CP , Lewis P , Hibbs B , Shimabukuro T . MMWR Morb Mortal Wkly Rep 2014 63 (35) 773 Annual influenza vaccination is recommended for all persons aged ≥6 months. Two vaccine types are approved in the United States, injectable inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV), which is administered intranasally. Influenza vaccine typicaly becomes widely available beginning in late summer or early fall. IIV has a standard expiration date of June 30 for any given influenza season (July 1 through June 30 of the following year). In contrast, after release for distribution, LAIV generally has an 18-week shelf life (Christopher Ambrose, MedImmune, personal communication, 2014). Because of its relatively short shelf life, LAIV might be more likely than IIV to be administered after its expiration date. To assess that hypothesis, CDC analyzed reports to the Vaccine Adverse Event Reporting System (VAERS) of expired LAIV administered during July 1, 2007, through June 30, 2014. |
Pain in adolescent girls receiving human papillomavirus vaccine with concomitantly administered vaccines
Walter EB , Kemper AR , Dolor RJ , Dunne EF . Pediatr Infect Dis J 2014 34 (2) 200-2 Using the Faces Pain Scale-Revised, we assessed injection site pain 10 minutes post-vaccination in young females randomized to receive either HPV4 before or after concomitantly administered vaccines. While, pain was modestly greater after HPV4 injection than after other vaccines, the pain intensity after HPV4 injection was significantly less in those who received HPV4 before receiving other concomitant vaccines. |
Comprehensive analysis and selection of anthrax vaccine adsorbed immune correlates of protection in rhesus macaques
Chen L , Schiffer JM , Dalton S , Sabourin CL , Niemuth NA , Plikaytis BD , Quinn CP . Clin Vaccine Immunol 2014 21 (11) 1512-20 Humoral and cell mediated immune correlates of protection (COP) for inhalation anthrax in a rhesus macaque (Macaca mulatta) model were determined. Immunological and survival data were from 114 vaccinated and 23 control animals exposed to Bacillus anthracis spores at 12, 30 or 52 months after the first vaccination. Vaccinated animals received a 3-dose intramuscular priming series (0, 1, 6 months; 3-IM) of anthrax vaccine adsorbed (AVA, BioThrax). Immune responses were modulated by administering a range of vaccine dilutions. Together with vaccine dilution dose and the interval between first vaccination and challenge, each of 80 immune response variables to anthrax toxin protective antigen (PA) at every available study time point was analyzed as a potential COP by logistic regression penalized by Least Absolute Shrinkage and Selection Operator (LASSO) or elastic net. Anti-PA IgG at the last available time point before challenge ('Last') and lymphocyte stimulation index (SI) at months 2 and 6 were identified consistently as COP. Anti-PA IgG and lethal toxin neutralization activity (TNA) at month 6 and month 7 ('Peak') and the frequency of IFN-gamma secreting cells at month 6 also had statistically significant positive correlations with survival. The ratio of IL-4 mRNA to IFN-gamma mRNA at month 6 also had a statistically significant correlation with survival. TNA had lower COP accuracy than anti-PA IgG. Following 3-IM priming with AVA, the anti-PA IgG responses at the time of exposure or at month 7 were practicable and accurate metrics for correlating vaccine induced immunity with protection against inhalation anthrax. |
Disparities in influenza vaccination coverage among women with live-born infants: PRAMS surveillance during the 2009-2010 influenza season
Ahluwalia IB , Ding H , Harrison L , D'Angelo D , Singleton JA , Bridges C . Public Health Rep 2014 129 (5) 408-16 OBJECTIVES: Vaccination during pregnancy significantly reduces the risk of influenza illness among pregnant women and their infants up to 6 months of age; however, many women do not get vaccinated. We examined disparities in vaccination coverage among women who delivered a live-born infant during the 2009-2010 influenza season, when two separate influenza vaccinations were recommended. METHODS: Pregnancy Risk Assessment Monitoring System (PRAMS) data from 29 states and New York City, collected during the 2009-2010 influenza season, were used to examine uptake of seasonal (unweighted n=27,153) and pandemic influenza A(H1N1)pdm09 (pH1N1) (n=27,372) vaccination by racially/ethnically diverse women who delivered a live-born infant from September 1, 2009, through May 31, 2010. RESULTS: PRAMS data showed variation in seasonal and pH1N1 influenza vaccination coverage among women with live-born infants by racial/ethnic group. For seasonal influenza vaccination, coverage was 50.5% for non-Hispanic white, 30.2% for non-Hispanic black, 42.1% for Hispanic, and 48.2% for non-Hispanic other women. For pH1N1, vaccination coverage was 41.4% for non-Hispanic white, 25.5% for non-Hispanic black, 41.1% for Hispanic, and 43.3% for non-Hispanic other women. Compared with non-Hispanic white women, non-Hispanic black women had lower seasonal (crude prevalence ratio [cPR] = 0.60, 95% confidence interval [CI] 0.55, 0.64) and pH1N1 (cPR=0.62, 95% CI 0.57, 0.67) vaccination coverage; these disparities diminished but remained after adjusting for provider recommendation or offer for influenza vaccination, insurance status, and demographic factors (seasonal vaccine: adjusted PR [aPR] = 0.80, 95% CI 0.74, 0.86; and pH1N1 vaccine: aPR=0.75, 95% CI 0.68, 0.82). CONCLUSION: To reduce disparities in influenza vaccination uptake by pregnant women, targeted efforts toward providers and interventions focusing on pregnant and postpartum women may be needed. |
Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization - National Intimate Partner and Sexual Violence Survey, United States, 2011
Breiding MJ , Smith SG , Basile KC , Walters ML , Chen J , Merrick MT . MMWR Surveill Summ 2014 63 Suppl 8 (8) 1-18 PROBLEM/CONDITION: Sexual violence, stalking, and intimate partner violence are public health problems known to have a negative impact on millions of persons in the United States each year, not only by way of immediate harm but also through negative long-term health impacts. Before implementation of the National Intimate Partner and Sexual Violence Survey (NISVS) in 2010, the most recent detailed national data on the public health burden from these forms of violence were obtained from the National Violence against Women Survey conducted during 1995-1996. This report examines sexual violence, stalking, and intimate partner violence victimization using data from 2011. The report describes the overall prevalence of sexual violence, stalking, and intimate partner violence victimization; racial/ethnic variation in prevalence; how types of perpetrators vary by violence type; and the age at which victimization typically begins. For intimate partner violence, the report also examines a range of negative impacts experienced as a result of victimization, including the need for services. REPORTING PERIOD: January-December, 2011. DESCRIPTION OF SYSTEM: NISVS is a national random-digit-dial telephone survey of the noninstitutionalized English- and Spanish-speaking U.S. population aged ≥18 years. NISVS gathers data on experiences of sexual violence, stalking, and intimate partner violence among adult women and men in the United States by using a dual-frame sampling strategy that includes both landline and cellular telephones. The survey was conducted in 50 states and the District of Columbia; in 2011, the second year of NISVS data collection, 12,727 interviews were completed, and 1,428 interviews were partially completed. RESULTS: In the United States, an estimated 19.3% of women and 1.7% of men have been raped during their lifetimes; an estimated 1.6% of women reported that they were raped in the 12 months preceding the survey. The case count for men reporting rape in the preceding 12 months was too small to produce a statistically reliable prevalence estimate. An estimated 43.9% of women and 23.4% of men experienced other forms of sexual violence during their lifetimes, including being made to penetrate, sexual coercion, unwanted sexual contact, and noncontact unwanted sexual experiences. The percentages of women and men who experienced these other forms of sexual violence victimization in the 12 months preceding the survey were an estimated 5.5% and 5.1%, respectively. An estimated 15.2% of women and 5.7% of men have been a victim of stalking during their lifetimes. An estimated 4.2% of women and 2.1% of men were stalked in the 12 months preceding the survey. With respect to sexual violence and stalking, female victims reported predominantly male perpetrators, whereas for male victims, the sex of the perpetrator varied by the specific form of violence examined. Male rape victims predominantly had male perpetrators, but other forms of sexual violence experienced by men were either perpetrated predominantly by women (i.e., being made to penetrate and sexual coercion) or split more evenly among male and female perpetrators (i.e., unwanted sexual contact and noncontact unwanted sexual experiences). In addition, male stalking victims also reported a more even mix of males and females who had perpetrated stalking against them. The lifetime and 12-month prevalences of rape by an intimate partner for women were an estimated 8.8% and 0.8%, respectively; an estimated 0.5% of men experienced rape by an intimate partner during their lifetimes, although the case count for men reporting rape by an intimate partner in the preceding 12 months was too small to produce a statistically reliable prevalence estimate. An estimated 15.8% of women and 9.5% of men experienced other forms of sexual violence by an intimate partner during their lifetimes, whereas an estimated 2.1% of both men and women experienced these forms of sexual violence by a partner in the 12 months before taking the survey. Severe physical violence by an intimate partner (including acts such as being hit with something hard, being kicked or beaten, or being burned on purpose) was experienced by an estimated 22.3% of women and 14.0% of men during their lifetimes and by an estimated 2.3% of women and 2.1% of men in the 12 months before taking the survey. Finally, the lifetime and 12-month prevalence of stalking by an intimate partner for women was an estimated 9.2% and 2.4%, respectively, while the lifetime and 12-month prevalence for men was an estimated 2.5% and 0.8%, respectively. Many victims of sexual violence, stalking, and intimate partner violence were first victimized at a young age. Among female victims of completed rape, an estimated 78.7% were first raped before age 25 years (40.4% before age 18 years). Among male victims who were made to penetrate a perpetrator, an estimated 71.0% were victimized before age 25 years (21.3% before age 18 years). In addition, an estimated 53.8% of female stalking victims and 47.7% of male stalking victims were first stalked before age 25 years (16.3% of female victims and 20.5% of male victims before age 18 years). Finally, among victims of contact sexual violence, physical violence, or stalking by an intimate partner, an estimated 71.1% of women and 58.2% of men first experienced these or other forms of intimate partner violence before age 25 years (23.2% of female victims and 14.1% of male victims before age 18 years). INTERPRETATION: A substantial proportion of U.S. female and male adults have experienced some form of sexual violence, stalking, or intimate partner violence at least once during their lifetimes, and the sex of perpetrators varied by the specific form of violence examined. In addition, a substantial number of U.S. adults experienced sexual violence, stalking, or intimate partner violence during the 12 months preceding the 2011 survey. Consistent with previous studies, the overall pattern of results suggest that women, in particular, are heavily impacted over their lifetime. However, the results also indicate that many men experience sexual violence, stalking, and, in particular, physical violence by an intimate partner. Because of the broad range of short- and long-term consequences known to be associated with these forms of violence, the public health burden of sexual violence, stalking, and intimate partner violence is substantial. Results suggest that these forms of violence frequently are experienced at an early age because a majority of victims experienced their first victimization before age 25 years, with a substantial proportion experiencing victimization in childhood or adolescence. PUBLIC HEALTH ACTION: Because a substantial proportion of sexual violence, stalking, and intimate partner violence is experienced at a young age, primary prevention of these forms of violence must begin early. Prevention efforts should take into consideration that female sexual violence and stalking victimization is perpetrated predominately by men and that a substantial proportion of male sexual violence and stalking victimization (including rape, unwanted sexual contact, noncontact unwanted sexual experiences, and stalking) also is perpetrated by men. CDC seeks to prevent these forms of violence with strategies that address known risk factors for perpetration and by changing social norms and behaviors by using bystander and other prevention strategies. In addition, primary prevention of intimate partner violence is focused on the promotion of healthy relationship behaviors and other protective factors, with the goal of helping adolescents develop these positive behaviors before their first relationships. The early promotion of healthy relationships while behaviors are still relatively modifiable makes it more likely that young persons can avoid violence in their relationships. |
Incidents of potential public health significance identified using national surveillance of US poison center data (2008-2012)
Law RK , Sheikh S , Bronstein A , Thomas R , Spiller HA , Schier JG . Clin Toxicol (Phila) 2014 52 (9) 1-6 BACKGROUND: The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers conduct national surveillance on data collected by US poison centers to identify incidents of potential public health significance (IPHS). The overarching goals of this collaboration are to improve CDC's national surveillance capacity for public health threats, identify early markers of public health incidents and enhance situational awareness. The National Poison Data System (NPDS) is used as a surveillance system to automatically identify data anomalies. PURPOSE: To characterize data anomalies and IPHS captured by national surveillance of poison center data over 5 years. METHODS: Data anomalies are identified through three surveillance methodologies: call-volume, clinical effect, and case-based. Anomalies are reviewed by a team of epidemiologists and clinical toxicologists to determine IPHS using standardized criteria. The authors reviewed IPHS identified by these surveillance activities from 2008 through 2012. RESULTS: Call-volume surveillance identified 384 IPHS; most were related to gas and fume exposures (n = 229; 59.6%) with the most commonly implicated substance being carbon monoxide (CO) (n = 92; 22.8%). Clinical-effect surveillance identified 138 IPHS; the majority were related to gas and fume exposures (n = 58; 42.0%) and gastrointestinal complaints (n = 84; 16.2%), and the most commonly implicated substance was CO (n = 20; 14.4%). Among the 11 case-based surveillance definitions, the botulism case definition yielded the highest percentage of identified agent-specific illness. CONCLUSIONS: A small proportion of data anomalies were designated as IPHS. Of these, CO releases were the most frequently reported IPHS and gastrointestinal syndromes were the most commonly reported illness manifestations. poison center data surveillance may be used as an approach to identify exposures, illnesses, and incidents of importance at the national and state level. |
A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years
Pan L , Li R , Park S , Galuska DA , Sherry B , Freedman DS . Pediatrics 2014 134 Suppl 1 S29-35 OBJECTIVE: To examine whether sugar-sweetened beverage (SSB) intake during infancy predicts obesity at age 6 years. METHODS: We included 1189 children who participated in the Infant Feeding Practices Study II in 2005-2007 and were followed up at 6 years in 2012. Children's weight and height were measured by mothers. Obesity was defined as gender-specific BMI-for-age ≥95th percentile. We used logistic regression to estimate the associations of any SSB intake and age at SSB introduction before 12 months and mean SSB intake during ages 10 to 12 months with obesity at 6 years controlling for baseline characteristics. RESULTS: The obesity prevalence at 6 years among children who consumed SSBs during infancy was twice as high as that among non-SSB consumers (17.0% vs 8.6%). The adjusted odds of obesity at 6 years was 71% higher for any SSB intake and 92% higher for SSB introduction before 6 months compared with no SSB intake during infancy. Children who consumed SSBs ≥3 times per week during ages 10 to 12 months had twice the odds of obesity compared with those who consumed no SSBs in this period. However, among children who consumed SSBs, the odds of obesity at 6 years did not differ by age at SSB introduction during infancy or by mean weekly SSB intake during ages 10 to 12 months. CONCLUSIONS: Children who consumed SSBs during infancy had higher odds of obesity at 6 years than non-SSB consumers. SSB consumption during infancy may be a risk factor for obesity in early childhood. Whether unmeasured behaviors contributed to the association is unclear. |
Methods for the year 6 follow-up study of children in the Infant Feeding Practices Study II
Fein SB , Li R , Chen J , Scanlon KS , Grummer-Strawn LM . Pediatrics 2014 134 Suppl 1 S4-S12 OBJECTIVE: We describe methods used in the Year 6 Follow-Up (Y6FU) of children who participated in the Infant Feeding Practices Study II (IFPSII). This study consists of a questionnaire administered 6 years after the IFPSII to characterize the health, development, and diet quality of the children. METHODS: The Y6FU sample was a subset of those who participated in IFPSII. The IFPSII participants were drawn from a national consumer opinion panel; neither the IFPSII nor the Y6FU sample is nationally representative. The Y6FU sampling frame included all qualified participants who answered at least the first postnatal questionnaire. One questionnaire was administered by mail in 2012, and nonrespondents were contacted for a telephone interview. Survey topics included measures of health, development, diet, physical activity, screen time, and family medical history. We attempted to contact 2958 mothers and obtained completed questionnaires from 1542, a response rate of 52.1%. We conducted 2 sample evaluations, 1 comparing respondents and nonrespondents on data from IFPSII and the other comparing Y6FU respondents with 6-year-old participants in the National Survey of Children's Health. RESULTS: Y6FU mothers are more likely to be white, married, older, and of higher education and income than both nonresponders and nationally representative mothers. Comparisons also revealed health-related differences and similarities. CONCLUSIONS: Although not nationally representative, the Y6FU provides a valuable database because of its wide coverage of diet and health issues and its unique ability to link early feeding patterns with outcomes at age 6 years. |
Fruit and vegetable intake during infancy and early childhood
Grimm KA , Kim SA , Yaroch AL , Scanlon KS . Pediatrics 2014 134 Suppl 1 S63-9 OBJECTIVES: To examine the association of timing of introduction and frequency of fruit and vegetable intake during infancy with frequency of fruit and vegetable intake at age 6 years in a cohort of US children. METHODS: We analyzed data on fruit and vegetable intake during late infancy, age of fruit and vegetable introduction, and frequency of fruit and vegetable intake at 6 years from the Infant Feeding Practices Study II and the Year 6 Follow-Up (Y6FU) Study. We determined the percent of 6-year-old children consuming fruits and vegetables less than once per day and examined associations with infant fruit and vegetable intake using logistic regression modeling, controlling for multiple covariates (n = 1078). RESULTS: Based on maternal report, 31.9% of 6-year-old children consumed fruit less than once daily and 19.0% consumed vegetables less than once daily. In adjusted analyses, children who consumed fruits and vegetables less than once daily during late infancy had increased odds of eating fruits and vegetables less than once daily at age 6 years (fruit, adjusted odds ratio: 2.48; vegetables, adjusted odds ratio: 2.40). Age of introduction of fruits and vegetables was not associated with intake at age 6 years. CONCLUSIONS: Our study suggests that infrequent intake of fruits and vegetables during late infancy is associated with infrequent intake of these foods at 6 years of age. These findings highlight the importance of infant feeding guidance that encourages intake of fruits and vegetables and the need to examine barriers to fruit and vegetable intake during infancy. |
Infant feeding and long-term outcomes: results from the year 6 follow-up of children in the Infant Feeding Practices Study II
Grummer-Strawn LM , Li R , Perrine CG , Scanlon KS , Fein SB . Pediatrics 2014 134 Suppl 1 S1-3 In 1986, the late David Barker described a link between intrauterine growth and ischemic heart disease,1 originating a field of medical and anthropological research known as the fetal origins of health and disease. More recently, the field has expanded to also consider the long-term effects of early postnatal nutrition on long-term health, now known as the developmental origins of health and disease (DOHaD).2 Evidence on the long-term consequences of infant diet is expanding rapidly. In this Pediatrics supplement, we present new data available from a follow-up study of children at age 6 years who were previously included in the longitudinal Infant Feeding Practices Study II (IFPS II), sponsored by the US Food and Drug Administration and the Centers for Disease Control and Prevention.3,4 Not all the articles in this supplement directly address DOHaD hypotheses, but they provide additional context to understanding the longitudinal associations between early feeding and subsequent outcomes. | Because of the depth of detail they provide, the IFPS II and its year 6 follow-up present a unique opportunity to examine the association of infant feeding with later health outcomes and behaviors. By following infants almost monthly from the third trimester of pregnancy to the age of 12 months, the IFPS II provides detailed information on changes in infant feeding that cannot be accurately captured through retrospective recall. The mothers of these infants were recontacted 6 years later to provide information on diet, health, and developmental outcomes. A large number of potentially confounding factors are available in both IFPS II and year 6 follow-up to reduce the chances that the associations discovered are not merely spurious. |
Adherence to breastfeeding guidelines and maternal weight 6 years after delivery
Sharma AJ , Dee DL , Harden SM . Pediatrics 2014 134 Suppl 1 S42-9 OBJECTIVES: There is a dearth of information on the long-term maternal effects of breastfeeding. The objective of this study was to examine adherence to breastfeeding recommendations of exclusive breastfeeding for ≥4 months and continuation of breastfeeding for ≥1 year and maternal weight retention 6 years after delivery. METHODS: Using data from the Infant Feeding Practices Study II (IFPS II), we categorized women by the degree to which they met breastfeeding recommendations. Mothers' self-reported weight 6 years after delivery (IFPS Year 6 Follow-Up) was compared with self-reported prepregnancy weight from IFPS II. Using linear regression models, adjusting for covariates, we examined associations between breastfeeding recommendation adherence and weight retention. RESULTS: Of the 726 women in our study, 17.9% never breastfed. Among those who initiated breastfeeding, 29.0% breastfed exclusively for ≥4 months, and 20.3% breastfed exclusively for ≥4 months and continued breastfeeding for ≥12 months. Prepregnancy BMI modified the association between breastfeeding recommendation adherence and weight retention. Adjusting for covariates, we found no association between breastfeeding recommendations adherence and weight retention among normal and overweight mothers. Among obese mothers, there was a significant linear trend (P = .03), suggesting that those who fully adhered to breastfeeding recommendations retained less weight (-8.0 kg) than obese women who never breastfed. CONCLUSIONS: This study suggests that improving adherence to breastfeeding recommendations may help reduce long-term maternal weight retention among obese mothers. Larger studies, with diverse populations and similar longitudinal designs, are needed to explore this relationship. |
The association of sugar-sweetened beverage intake during infancy with sugar-sweetened beverage intake at 6 years of age
Park S , Pan L , Sherry B , Li R . Pediatrics 2014 134 Suppl 1 S56-62 OBJECTIVES: To examine whether sugar-sweetened beverage (SSB) intake during infancy predicts SSB intake at 6 years of age. METHODS: A longitudinal cohort analysis of 1333 US children was conducted by using data from the 2005-2007 Infant Feeding Practices Study II and the 2012 Follow-Up Study at 6 years of age. The exposure variables were maternal-reported SSB intakes during infancy. The outcome variable was maternal-reported SSB intake at age 6 years. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for associations of SSB intake during infancy with consuming SSBs ≥1 time/day at 6 years old after controlling for baseline child's and parent's characteristics. RESULTS: Based on maternal recall, approximately one-fifth of children consumed SSBs at least 1 time/day at age 6 years. Adjusted odds of consuming SSBs at age 6 years ≥1 time/day was significantly associated with any SSB intake during infancy (aOR, 2.22 vs none), age at SSB introduction (aOR, 2.33 for age ≥6 months and 2.01 for age <6 months vs never), and mean SSB intake during age 10 to 12 months (aOR, 2.72 for 1 to <2 times/week and 2.57 for ≥3 times/week vs none). CONCLUSIONS: SSB intake during infancy significantly increased the likelihood of consuming SSBs ≥1 time/day at 6 years of age. Our findings suggest that infancy may be an important time for mothers to establish healthy beverage practices for their children and these findings can be used to inform intervention efforts to reduce SSB intake among children. |
Bottle-feeding practices during early infancy and eating behaviors at 6 years of age
Li R , Scanlon KS , May A , Rose C , Birch L . Pediatrics 2014 134 Suppl 1 S70-7 BACKGROUND: Evidence suggests an association of breastfeeding with a maternal feeding style (MFS) that is less controlling than formula feeding, which, in turn, may improve a child's self-regulation of eating. This study examines associations of bottle-feeding practices during infancy with MFS and children's eating behavior (CEB) at 6 years old. METHODS: We linked data from the Infant Feeding Practices Study II to the Year 6 Follow-Up, which include 8 MFS and CEB measures adapted from previous validated instruments. Bottle-feeding practices during the first 6 months estimated by using the Infant Feeding Practices Study II were bottle-feeding intensity (BFI), mother's encouragement of infant to finish milk in the bottle, and infant finishing all milk in the bottle. Adjusted odds ratios (aORs) for associations of bottle-feeding practices with MFS and CEB at 6 years old were calculated by using multivariable logistic regressions controlling for sociodemographic characteristics and other feeding practices (N = 1117). RESULTS: Frequent bottle emptying encouraged by mothers during infancy increased odds of mothers encouraging their child to eat all the food on their plate (aOR: 2.37; 95% confidence interval [CI]: 1.65-3.41] and making sure their child eats enough (aOR: 1.62; 95% CI: 1.14-2.31) and of children eating all the food on their plate at 6 years old (aOR: 2.01; 95% CI: 1.05-3.83). High BFI during early infancy also increased the odds of mothers being especially careful to ensure their 6-year-old eats enough. CONCLUSIONS: Bottle-feeding practices during infancy may have long-term effects on MFS and CEB. Frequent bottle emptying encouraged by mothers and/or high BFI during early infancy increased the likelihood of mothers pressuring their 6-year-old child to eat and children's low satiety responsiveness. |
Breastfeeding and later psychosocial development of children at 6 years of age
Lind JN , Li R , Perrine CG , Schieve LA . Pediatrics 2014 134 Suppl 1 S36-41 OBJECTIVE: To examine the association of breastfeeding duration with psychosocial development at 6 years of age. METHODS: We analyzed data from the 2005-2007 Infant Feeding Practices Study II and its 2012 Year 6 Follow-Up (N = 1442). Our breastfeeding duration variable combined overall and exclusive breastfeeding reported during infancy (never breastfed, breastfed <6 months, breastfed ≥6 months + exclusive breastfeeding <3 months, and breastfed ≥6 months + exclusive breastfeeding ≥3 months). Maternal responses to the Strengths and Difficulties Questionnaire were used to create our child psychosocial outcome domains (emotional symptoms, conduct problems, hyperactivity, peer problems, prosocial behavior, and total difficulties). Separate multivariable logistic regression models controlling for maternal sociodemographic characteristics, maternal mental health, and child characteristics were used to assess the likelihood of having difficulties on the 6 domains based on breastfeeding duration. RESULTS: Compared with children who were never breastfed, those who were breastfed for ≥6 months and exclusively breastfed for ≥3 months had decreased odds of difficulties with emotional symptoms (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.27-0.99), conduct problems (OR: 0.24; 95% CI: 0.10-0.54), and total difficulties (OR: 0.39; 95% CI: 0.18-0.85) before adjustment. These associations were no longer significant after adjustment. CONCLUSIONS: Although in our unadjusted analyses we observed significant associations between breastfeeding duration and later psychosocial development, including decreased odds of emotional, conduct, and total difficulties at 6 years of age, these findings were no longer detectable after adjusting for the many potential confounding factors that play a role in psychosocial development. |
Breastfeeding and risk of infections at 6 years
Li R , Dee D , Li CM , Hoffman HJ , Grummer-Strawn LM . Pediatrics 2014 134 Suppl 1 S13-20 BACKGROUND: Previous studies have shown that breastfeeding is associated with reductions in the risk of common infections among infants; however, whether breastfeeding confers longer term protection is inconclusive. METHODS: We linked data from the 2005-2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old. Multivariable logistic regression was used, controlling for sociodemographic variables, to examine associations of initiation, duration, exclusivity of breastfeeding, timing of supplementing breastfeeding with formula, and breast milk intensity (proportion of milk feedings that were breast milk from age 0-6 months) with maternal reports of infection (cold/upper respiratory tract, ear, throat, sinus, pneumonia/lung, and urinary) and sick visits in the past year among 6-year-olds (N = 1281). RESULTS: The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between breastfeeding and colds/upper respiratory tract, lung, or urinary tract infections. Prevalence of ear, throat, and sinus infections and number of sick visits differed according to breastfeeding duration, exclusivity, and timing of supplementing breastfeeding with formula (P < .05). Among children ever breastfed, children breastfed for ≥9 months had lower odds of past-year ear (adjusted odds ratio [aOR]: 0.69 [95% confidence interval (95% CI): 0.48-0.98]), throat (aOR: 0.68 [95% CI: 0.47-0.98]), and sinus (aOR: 0.47 [95% CI: 0.30-0.72]) infections compared with those breastfed >0 to <3 months. High breast milk intensity (>66.6%) during the first 6 months was associated with lower odds of sinus infection compared with low breast milk intensity (<33.3%) (aOR: 0.53 [95% CI: 0.35-0.79]). CONCLUSIONS: This prospective longitudinal study suggests that breastfeeding may protect against ear, throat, and sinus infections well beyond infancy. |
Breastfeeding duration is associated with child diet at 6 years
Perrine CG , Galuska DA , Thompson FE , Scanlon KS . Pediatrics 2014 134 Suppl 1 S50-5 BACKGROUND AND OBJECTIVE: Breastfeeding has been associated with early infant food preferences, but less is known about how breastfeeding is associated with later child diet. The objective of this study was to assess whether any and exclusive breastfeeding duration are associated with child diet at 6 years. METHODS: We linked data from the Infant Feeding Practices Study II and Year 6 Follow-Up. We used approximately monthly questionnaires throughout infancy to calculate any and exclusive breastfeeding duration (n = 1355). We calculated median daily frequency of intake of water, milk, 100% juice, fruits, vegetables, sugar-sweetened beverages, sweets, and savory snacks at 6 years from a dietary screener and examined frequency of consumption of each food or beverage group by any and exclusive breastfeeding duration. We used separate multivariable logistic regression models to calculate odds of consuming more than the median daily frequency of intake of food or beverage items, adjusting for confounders. RESULTS: Intake of milk, sweets, and savory snacks at 6 years was not associated with any or exclusive breastfeeding duration in unadjusted analyses. Frequency of consumption of water, fruits, and vegetables was positively associated, and intake of sugar-sweetened beverages was inversely associated with any and exclusive breastfeeding duration in adjusted models; 100% juice consumption was inversely associated with exclusive breastfeeding duration only. CONCLUSIONS: Among many other health benefits, breastfeeding is associated with a number of healthier dietary behaviors at age 6. The association between breastfeeding and child diet may be an important factor to consider when examining associations between breastfeeding and child obesity and chronic diseases. |
Differences in risk factors for second and third degree hypospadias in the National Birth Defects Prevention Study
Woud SG , Rooij IA , Gelder MM , Olney RS , Carmichael SL , Roeleveld N , Reefhuis J . Birth Defects Res A Clin Mol Teratol 2014 100 (9) 703-11 BACKGROUND: Hypospadias is a frequent birth defect with three phenotypic subtypes. With data from the National Birth Defects Prevention Study, a large, multi-state, population-based, case-control study, we compared risk factors for second and third degree hypospadias. METHODS: A wide variety of data on maternal and pregnancy-related risk factors for isolated second and third degree hypospadias was collected by means of computer-assisted telephone interviews to identify potential etiological differences between the two phenotypes. Logistic regression was used to calculate odds ratios including a random effect by study center. RESULTS: In total, 1547 second degree cases, 389 third degree cases, and 5183 male controls were included in our study. Third degree cases were more likely to have a non-Hispanic black or Asian/Pacific Islander mother, be delivered preterm, have a low birth weight, be small for gestational age, and be conceived with fertility treatments than second degree cases and controls. Associations with both second and third degree hypospadias were observed for maternal age, family history, parity, plurality, and hypertension during pregnancy. Risk estimates were generally higher for third degree hypospadias except for family history. CONCLUSION: Most risk factors were associated with both or neither phenotype. Therefore, it is likely that the underlying mechanism is at least partly similar for both phenotypes. However, some associations were different between second and third degree hypospadias, and went in opposite directions for second and third degree hypospadias for Asian/Pacific Islander mothers. Effect estimates for subtypes of hypospadias may be over- or underestimated in studies without stratification by phenotype. |
Simulated effects head movement on contact pressures between headforms and N95 filtering facepiece respirators-part 1: headform model and validation
Lei Z , Ji X , Li N , Yang J , Zhuang Z , Rottach D . Ann Occup Hyg 2014 58 (9) 1175-85 In a respirator fit test, a subject is required to perform a series of exercises that include moving the head up and down and rotating the head left and right. These head movements could affect respirator sealing properties during the fit test and consequently affect fit factors. In a model-based system, it is desirable to have similar capability to predict newly designed respirators. In our previous work, finite element modeling (FEM)-based contact simulation between a headform and a filtering facepiece respirator was carried out. However, the headform was assumed to be static or fixed. This paper presents the first part of a series study on the effect of headform movement on contact pressures-a new headform with the capability to move down (flexion), up (extension), and rotate left and right-and validation. The newly developed headforms were validated for movement by comparing the simulated cervical vertebrae rotation angles with experimental results from the literature. |
Simulated effects of head movement on contact pressures between headforms and N95 filtering facepiece respirators part 2: simulation
Lei Z , Ji X , Li N , Yang J , Zhuang Z , Rottach D . Ann Occup Hyg 2014 58 (9) 1186-99 Finite element (FE) filtering facepiece respirators (FFRs) were developed and mated to the new headforms with a cervical spine model. The FFRs from three manufacturers included three sizing systems: (i) a single one-size-fits all, (ii) an FFR with two sizes (S/M and M/L), and (iii) an FFR with three sizes (S, L/M, XL). Finite element method (FEM) simulations of 16 headform and respirator combinations (5 headforms and 6 respirators) were used to examine maximum contact pressure changes for five cases: static head, flexion, extension, left rotation, and right rotation. For each of the 16 headform and respirator combinations, maximum contact pressures of the static headform and motile headforms were compared using t-tests. Significant differences on the maximum contact pressures were found in the extension, left rotation and right rotation at the nose (P < 0.005), the left rotation at the top of right cheek (P = 0.03), and the extension at the bottom of left/right cheek (P = 0.01). When separately considering each headform and each FFR manufacturer, the effects of the four head movement cases on the nose maximum contact pressure changes were observed in the simulations with all five headforms and all FFR manufacturers. The effects of the left and right rotations on the chin maximum contact pressure changes were observed in the simulations with the small headform. It was also found that the use of a nose clip could reduce the impact of the head left/right rotations on nose maximum contact pressure changes. In addition, head movements changed pressure contours of the key nose area. Caused by the head movements, the maximum contact pressure changes may affect seal quality, and the increase of the maximum contact pressures could reduce the facial comfort level. |
Evaluation of leakage from fume hoods using tracer gas, tracer nanoparticles and nanopowder handling test methodologies
Dunn KH , Tsai CS , Woskie SR , Bennett JS , Garcia A , Ellenbecker MJ . J Occup Environ Hyg 2014 11 (10) D164-73 The most commonly reported control used to minimize workplace exposures to nanomaterials is the chemical fume hood. Studies have shown, however, that significant releases of nanoparticles can occur when materials are handled inside fume hoods. This study evaluated the performance of a new commercially available nano fume hood using three different test protocols. Tracer gas, tracer nanoparticle, and nanopowder handling protocols were used to evaluate the hood. A static test procedure using tracer gas (sulfur hexafluoride) and nanoparticles as well as an active test using an operator handling nanoalumina were conducted. A commercially available particle generator was used to produce sodium chloride tracer nanoparticles. Containment effectiveness was evaluated by sampling both in the breathing zone (BZ) of a mannequin and operator as well as across the hood opening. These containment tests were conducted across a range of hood face velocities (60, 80, and 100 ft/min) and with the room ventilation system turned off and on. For the tracer gas and tracer nanoparticle tests, leakage was much more prominent on the left side of the hood (closest to the room supply air diffuser) although some leakage was noted on the right side and in the BZ sample locations. During the tracer gas and tracer nanoparticle tests, leakage was primarily noted when the room air conditioner was on for both the low and medium hood exhaust airflows. When the room air conditioner was turned off, the static tracer gas tests showed good containment across most test conditions. The tracer gas and nanoparticle test results were well correlated showing hood leakage under the same conditions and at the same sample locations. The impact of a room air conditioner was demonstrated with containment being adversely impacted during the use of room air ventilation. The tracer nanoparticle approach is a simple method requiring minimal setup and instrumentation. However, the method requires the reduction in background concentrations to allow for increased sensitivity. |
Evaluation of some potential chemical exposure risks during flowback operations in unconventional oil and gas extraction: preliminary results
Esswein EJ , Snawder J , King B , Breitenstein M , Alexander-Scott M , Kiefer M . J Occup Environ Hyg 2014 11 (10) D174-84 Approximately 562,000 workers were employed in the U.S. oil and gas extraction industry in 2012; nearly half of those workers were employed by well servicing companies, which include companies that conduct hydraulic fracturing and flowback operations. To understand possible risks for chemical exposures in modern oil and gas extraction operations, the National Institute for Occupational Safety and Health (NIOSH) initiated the Field Effort to Assess Chemical Exposures in Oil and Gas Workers. Initial research identified exposure risks for respirable crystalline silica during hydraulic fracturing as an occupational health hazard. This report describes industrial hygiene sampling during flowback operations at six unconventional oil and gas extraction sites in Colorado and Wyoming during spring and summer 2013. The results are considered preliminary; additional exposure assessments are needed to better understand the range of possible exposures, risk factors, and controls during flowback operations. | |
Fatal meningococcal disease in a laboratory worker - California, 2012
Sheets CD , Harriman K , Zipprich J , Louie JK , Probert WS , Horowitz M , Prudhomme JC , Gold D , Mayer L . MMWR Morb Mortal Wkly Rep 2014 63 (35) 770-2 Occupationally acquired meningococcal disease is rare. Adherence to recommendations for safe handling of Neisseria meningitidis in the laboratory greatly reduces the risk for transmission to laboratory workers. A California microbiologist developed fatal serogroup B meningococcal disease after working with N. meningitidis patient isolates in a research laboratory (laboratory A). The California Department of Public Health (CDPH), the local health department, the California Division of Occupational Safety and Health (CalOSHA), and the federal Occupational Safety and Health Administration (OSHA) collaborated on an investigation of laboratory A, which revealed several breaches in recommended laboratory practice for safe handling of N. meningitidis, including manipulating cultures on the bench top. Additionally, laboratory workers had not been offered meningococcal vaccine in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations and CalOSHA Aerosol Transmissible Diseases Standard requirements. In accordance with OSHA and CalOSHA regulations, laboratory staff members must receive laboratory biosafety training and use appropriate personal protective equipment, and those who routinely work with N. meningitidis isolates should receive meningococcal vaccine. |
Human and animal evidence supports lower occupational exposure limits for poorly-soluble respirable particles: letter to the editor re: 'low-toxicity dusts: current exposure guidelines are not sufficiently protective' by Cherrie, Brosseau, Hay and Donaldson
Kuempel ED , Attfield MD , Stayner LT , Castranova V . Ann Occup Hyg 2014 58 (9) 1205-8 We commend the overall evaluation by Cherrie et al. (2013) of the current occupational exposure limits (OELs) for respirable poorly-soluble low toxicity (PSLT) particles. As described in that paper, the epidemiological studies provide compelling evidence that exposure to PSLT at the current OELs has been associated with adverse health effects, including pulmonary fibrosis and lung function deficits. In contrast to Cherrie et al. (2013), we discuss here that the chronic inhalation studies in animals also provide evidence of the adverse pulmonary effects of PSLT. | For example, we would like to clarify or correct the following statements (p. 688, 2nd column): | (1) …the phenomenon of rat lung overload has little relevance for human lung response at high lung burden of low-toxicity dust. | This statement is not entirely supported by the scientific evidence. While it is correct that differences have been observed in the rat and human lung clearance and retention kinetics for respirable particles, these differences have been well described, and can be accounted for, using lung dosimetry models in humans (Kuempel et al., 2001a,b; Gregoratto et al., 2010, 2011) and rats (Tran et al., 1999, 2000; Anjilvel and Asgharian, 1995). Because of the slower pulmonary clearance in humans, particles can build up in the lungs at exposures below those that would cause overloading in rats (Snipes, 1989; Kuempel et al., 2000; Kuempel and Tran, 2002). This build up is associated with the movement of particles into the alveolar interstitium of the mammalian lungs (Nikula et al., 1997, 2001). Only at overloading do the particle lung burdens in rats reach the higher levels that have been reported in coal miners, i.e., up to 10 mg g−1 lungs or more in rats (Morrow, 1988; Muhle et al., 1990; Bellmann et al., 1991; Oberdörster et al., 1992) and in humans (Attfield et al., 1994; Kuempel et al., 1997; Tran and Buchanan, 2000). |
Assessment of respirable crystalline silica analysis using proficiency analytical testing results from 2003-2013
Harper M , Sarkisian K , Andrew M . J Occup Environ Hyg 2014 11 (10) D157-63 Analysis of Proficiency Analytical Testing (PAT) results between 2003 and 2013 suggest that the variation in respirable crystalline silica analysis is much smaller today than it was in the period 1990-1998, partly because of a change in sample production procedure and because the colorimetric method has been phased out, although quality improvements in the x-ray diffraction (XRD) or infrared (IR) methods may have also played a role. There is no practical difference between laboratories using XRD or IR methods or between laboratories which are accredited or those which are not. Reference laboratory means (assigned values) are not different from the means of all participants across the current range of mass loading, although there is a small difference in variance in the ratios of all participants to reference laboratory means based on method because the reference laboratories are much more likely to use XRD than are the others. Matrix interference does not lead to biases or substantially larger variances for either XRD or IR methods. Data from proficiency test sample analyses that include results from poorly performing laboratories should not be used to determine the validity of a method. PAT samples are not produced below 40 mug and variance may increase with lower masses, although this is not particularly predictable. PAT data from lower mass loadings will be required to evaluate analytical performance if exposure limits are lowered without change in sampling method. Task-specific exposure measurements for periods shorter than a full shift typically result in lower mass loadings and the quality of these analyses would also be better assured from being within the range of PAT mass loadings. High flow rate cyclones, whose performance has been validated, can be used to obtain higher mass loadings in environments of lower concentrations or where shorter sampling times are desired. |
Absence of putative artemisinin resistance mutations among Plasmodium falciparum in Sub-Saharan Africa: a molecular epidemiologic study.
Taylor SM , Parobek CM , DeConti DK , Kayentao K , Coulibaly SO , Greenwood BM , Tagbor H , Williams J , Bojang K , Njie F , Desai M , Kariuki S , Gutman J , Mathanga DP , Mårtensson A , Ngasala B , Conrad MD , Rosenthal PJ , Tshefu AK , Moormann AM , Vulule JM , Doumbo OK , Ter Kuile FO , Meshnick SR , Bailey JA , Juliano JJ . J Infect Dis 2014 211 (5) 680-8 Plasmodium falciparum parasites that are resistant to artemisinins have been detected in Southeast Asia. Resistance is associated with several polymorphisms in the parasite's K13-propeller gene. The molecular epidemiology of these artemisinin-resistant genotypes in African parasite populations is unknown. We developed an assay to quantify rare polymorphisms in parasite populations using a pooled deep-sequencing approach to score allele frequencies, validated it using mixtures of laboratory parasite strains, and then employed it to screen over 1,100 African P. falciparum infections collected since 2002 from 14 sites across sub-Saharan Africa. We found no mutations in African parasite populations that are associated with artemisinin resistance in Southeast Asian parasites. However, we observed 15 coding mutations, including 12 novel mutations, and limited allele sharing between parasite populations, consistent with a large reservoir of naturally-occurring K13-propeller variation. Though polymorphisms associated with artemisinin resistance in P. falciparum in Southeast Asia are not prevalent in sub-Saharan Africa, numerous K13-propeller coding polymorphisms circulate in Africa. Although their distributions do not support a widespread selective sweep for an artemisinin resistant phenotype, the impact of these mutations on artemisinin susceptibility is unknown and will require further characterization. Rapid, scalable molecular surveillance offers a useful adjunct in tracking and containing artemisinin resistance. |
Age-specific malaria mortality rates in the KEMRI/CDC Health and Demographic Surveillance System in western Kenya, 2003-2010
Desai M , Buff AM , Khagayi S , Byass P , Amek N , van Eijk A , Slutsker L , Vulule J , Odhiambo FO , Phillips-Howard PA , Lindblade KA , Laserson KF , Hamel MJ . PLoS One 2014 9 (9) e106197 Recent global malaria burden modeling efforts have produced significantly different estimates, particularly in adult malaria mortality. To measure malaria control progress, accurate malaria burden estimates across age groups are necessary. We determined age-specific malaria mortality rates in western Kenya to compare with recent global estimates. We collected data from 148,000 persons in a health and demographic surveillance system from 2003-2010. Standardized verbal autopsies were conducted for all deaths; probable cause of death was assigned using the InterVA-4 model. Annual malaria mortality rates per 1,000 person-years were generated by age group. Trends were analyzed using Poisson regression. From 2003-2010, in children <5 years the malaria mortality rate decreased from 13.2 to 3.7 per 1,000 person-years; the declines were greatest in the first three years of life. In children 5-14 years, the malaria mortality rate remained stable at 0.5 per 1,000 person-years. In persons ≥15 years, the malaria mortality rate decreased from 1.5 to 0.4 per 1,000 person-years. The malaria mortality rates in young children and persons aged ≥15 years decreased dramatically from 2003-2010 in western Kenya, but rates in older children have not declined. Sharp declines in some age groups likely reflect the national scale up of malaria control interventions and rapid expansion of HIV prevention services. These data highlight the importance of age-specific malaria mortality ascertainment and support current strategies to include all age groups in malaria control interventions. |
Knowledge Management and E-Learning
Costarides MV . Health Promot Pract 2014 15 (6) 790-794 The book Knowledge Management and E-Learning, which is intended for both scholars and practitioners, provides a historical perspective on the evolution of online learning and discusses the potential impact of implementing e-learning initiatives. Chapter authors also discuss the importance of technology in propelling learner contributions through a well-designed technologic platform or learning management system. Knowledge management specialists and e-learning advocates can gain insight into the expectations of adult learners and in how to use technology to develop effective training programs through the many illustrations of contemporary learning theories in practice. |
Developing new federal guidelines on family planning for the United States
Gavin L , Moskosky S . Contraception 2014 90 (3) 207-10 In April 2014, the US Centers for Disease Control and Prevention (CDC) and the HHS Office of Population Affairs (OPA) published clinical recommendations for providing family planning services, titled Providing Quality Family Planning Services (QFP) [1]. The recommendations were developed jointly and the collaboration drew on the strengths of both agencies. CDC has a long-standing history of developing evidence-based recommendations for clinical care, and OPA’s Title X Family Planning Program has served as the national leader in direct family planning service delivery since the Title X program was established in 1970. The publication of QFP should help take the field of family planning another step closer to the ultimate goal of helping individuals and couples achieve their desired number and spacing of healthy children. | The recommendations were published at a time when there are substantial challenges to Americans’ reproductive health. One-half (49%) of the 6.7 million pregnancies each year (3.2 million) are unintended [2]. In 2006–2010, 6.7 million women aged 15–44 years had impaired fecundity (that is, had an impaired ability to get pregnant or carry a baby to term), and 1.5 million married women aged 15–44 years were infertile (that is, were unable to get pregnant after at least 12 consecutive months of unprotected sex with their husband/partner) [3]. Approximately one of every eight pregnancies in the United States results in preterm birth, and infant mortality rates remain high relative to other developed countries [4–6]. By using contraceptive services to space births and by offering preconception health services as part of family planning, the health of the infant — as well as the woman and man — can be improved [7–14]. |
Functional profile of a novel modulator of serotonin, dopamine, and glutamate neurotransmission
Snyder GL , Vanover KE , Zhu H , Miller DB , O'Callaghan JP , Tomesch J , Li P , Zhang Q , Krishnan V , Hendrick JP , Nestler EJ , Davis RE , Wennogle LP , Mates S . Psychopharmacology (Berl) 2014 232 (3) 605-21 RATIONALE: Schizophrenia remains among the most prevalent neuropsychiatric disorders, and current treatment options are accompanied by unwanted side effects. New treatments that better address core features of the disease with minimal side effects are needed. OBJECTIVES: As a new therapeutic approach, 1-(4-fluoro-phenyl)-4-((6bR, 10aS)-3-methyl-2,3,6b,9,10,10a-hexahydro-1H,7H-pyrido[3',4':4,5]pyrrolo[1,2,3-de] quinoxalin-8-yl)-butan-1-one (ITI-007) is currently in human clinical trials for the treatment of schizophrenia. Here, we characterize the preclinical functional activity of ITI-007. RESULTS: ITI-007 is a potent 5-HT2A receptor ligand (K i = 0.5 nM) with strong affinity for dopamine (DA) D2 receptors (K i = 32 nM) and the serotonin transporter (SERT) (K i = 62 nM) but negligible binding to receptors (e.g., H1 histaminergic, 5-HT2C, and muscarinic) associated with cognitive and metabolic side effects of antipsychotic drugs. In vivo it is a 5-HT2A antagonist, blocking (+/-)-2,5-dimethoxy-4-iodoamphetamine hydrochloride (DOI)-induced headtwitch in mice with an inhibitory dose 50 (ID50) = 0.09 mg/kg, per oral (p.o.), and has dual properties at D2 receptors, acting as a postsynaptic D2 receptor antagonist to block D-amphetamine hydrochloride (D-AMPH) hyperlocomotion (ID50 = 0.95 mg/kg, p.o.), yet acting as a partial agonist at presynaptic striatal D2 receptors in assays measuring striatal DA neurotransmission. Further, in microdialysis studies, this compound significantly and preferentially enhances mesocortical DA release. At doses relevant for antipsychotic activity in rodents, ITI-007 has no demonstrable cataleptogenic activity. ITI-007 indirectly modulates glutamatergic neurotransmission by increasing phosphorylation of GluN2B-type N-methyl-D-aspartate (NMDA) receptors and preferentially increases phosphorylation of glycogen synthase kinase 3beta (GSK-3beta) in mesolimbic/mesocortical dopamine systems. CONCLUSION: The combination of in vitro and in vivo activities of this compound support its development for the treatment of schizophrenia and other psychiatric and neurologic disorders. |
Prevalence of smokefree home rules - United States, 1992-1993 and 2010-2011
King BA , Patel R , Babb SD . MMWR Morb Mortal Wkly Rep 2014 63 (35) 765-9 Exposure to secondhand smoke (SHS) from cigarettes causes an estimated 41,000 deaths among nonsmoking U.S. adults each year and an estimated $5.6 billion annually in lost productivity caused by premature death. In a 2006 report, the Surgeon General concluded that there is no risk-free level of exposure to SHS. Although an increasing proportion of the population is covered by state or local comprehensive smokefree laws that prohibit tobacco smoking in all indoor public places and worksites, including restaurants and bars, millions of nonsmokers continue to be exposed to SHS in areas not covered by smokefree laws or policies, including homes. The home is the primary source of SHS exposure for children and a major source of exposure for nonsmoking adults. To assess progress toward increasing the proportion of households with smokefree home rules, CDC analyzed the most recent data from the Tobacco Use Supplement to the Current Population Survey. Households were considered to have a smokefree home rule if all adult respondents aged ≥18 years in the household reported that no one was allowed to smoke anywhere inside the home at any time. The analysis found that the national prevalence of smokefree home rules increased from 43.0% during 1992-1993 to 83.0% during 2010-2011. Over the same period, the national prevalence of smokefree home rules increased from 56.7% to 91.4% among households with no adult cigarette smokers and from 9.6% to 46.1% among households with at least one adult smoker. Enhanced implementation of evidence-based interventions (e.g., comprehensive smokefree laws, voluntary smokefree home rules, smokefree multiunit housing policies, and initiatives to educate the public about the health effects of SHS) is warranted to further reduce SHS exposure in the United States. |
Gradual reduction of cigarette consumption as a cessation strategy: prevalence, correlates, and relationship with quitting
Schauer GL , Malarcher AM , Babb SD . Nicotine Tob Res 2014 17 (5) 530-8 INTRODUCTION: Gradually reducing cigarette consumption is an approach used to quit smoking, but has not been widely studied at a population level. The purpose of this study was to assess the prevalence and demographic characteristics of U.S. adult smokers who tried to reduce to quit, and the relationship between reducing and successful quitting. METHODS: Data came from 12,571 adults in the 2010-2011 U.S. Tobacco Use Supplement to the Current Population Survey who tried to quit smoking in the past year. Frequencies and percentages were used to assess prevalence of reducing to quit; bivariate and multiple logistic regression models were used to assess correlates of reducing to quit and successful past year cessation. Analyses were conducted in SAS-callable SUDAAN. RESULTS: Among adults who tried to quit smoking in the past year, 43.0% (n=5,444) tried reducing to quit. Compared to those who tried to quit without reducing consumption, those reducing to quit had a significantly higher prevalence of using counseling or medication (40.2% vs. 25.0%). In adjusted multivariable models, females (vs. males), blacks (vs. whites), current some day smokers (vs. every day smokers), and those who used counseling had greater odds of trying to reduce to quit. Reducing to quit was negatively associated with successful past-year quitting (AOR=0.59, 95% CI: 0.48, 0.72). CONCLUSION: Reducing to quit is a common cessation strategy and, in these analyses, was associated with lower cessation success rates. More research on reducing to quit in a real-world setting is needed before widely recommending it as a cessation strategy. |
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