Activities of daily living, chronic medical conditions, and health-related quality of life in older adults
Barile JP , Thompson WW , Zack MM , Krahn GL , Horner-Johnson W , Haffer SC . J Ambul Care Manage 2012 35 (4) 293-304 This study investigated associations between chronic medical conditions, activities of daily living (ADL), and health-related quality of life (HRQOL). Our findings suggest that the number of ADL limitations reported by older adults is associated with their HRQOL. Findings from our analyses also suggest that the association between having multiple comorbid conditions and HRQOL is stronger for those with no ADL limitations than those with at least some limitations. These data will aid practitioners in determining the relative importance of chronic medical conditions and ADL limitations on HRQOL and demonstrate how ADL limitations and comorbid conditions may differentially impact HRQOL. |
Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions
Chitnis AS , Caruthers PS , Rao AK , Lamb J , Lurvey R , Beau De Rochars V , Kitchel B , Cancio M , Torok TJ , Guh AY , Gould CV , Wise ME . Infect Control Hosp Epidemiol 2012 33 (10) 984-92 OBJECTIVE: To describe a Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission. DESIGN, SETTING, AND PATIENTS: Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH). METHODS: Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009-July 2011. Biweekly CRE prevalence surveys were conducted during July 2010-July 2011, and interventions to prevent transmission were implemented, including education and auditing of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the bla(KPC) gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates. RESULTS: Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received beta-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related. CONCLUSION: CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach. |
Fatal pneumonia due to influenza virus infection diagnosed by conventional and real-time PCR from blood postmortem specimen
de Paiva TM , Saggioro F , Santos CL , Russo DH , Susuki A , Benega MA , Santos KC , da Silva DB , Smith CB . J Clin Virol 2012 55 (1) 85-6 According to the literature, pneumonia diagnosis relies on the assessment of clinical samples such induced sputum, bronchoscopic lower respiratory tract washes or direct lung needle aspirates. Sometimes, none of these antemortem specimens are able to be collected from cases of very severe pneumonia in which the patients die during or soon after admission, leaving an important gap in our knowledge of causes of fatal pneumonia.1, 3, 4 We would like to inform that two cases of fatal pneumonia, due to influenza virus infection, was diagnosed by conventional and real-time polymerase chain reaction (PCR) from blood sample postmortem. On 29 June 2006 the Institute Adolfo Lutz, São Paulo, Brazil, received a postmortem blood sample from a 3-year-old child living is Ribeirão Preto city, state of São Paulo. According to her parents on 24 June 2006 she presented with mild influenza-like symptoms, and died on 26 June 2006. | RNA was isolated from the blood sample by using the ‘QIAamp Viral RNA Mini Kit’ (QIAGEN, Santa Clarita, CA, USA) according to the manufacturers instructions. Following influenza virus investigation by one-step RT-PCR (Reverse – Transcriptase Polimerase Chain Reaction) technique using Universal Type A, Universal Type B and specific primers to virus strains H1, H3 and H5 kindly provided by the Centers Disease Control and Prevention (CDC), Georgia, Atlanta. |
Investigation of hepatitis B virus and human immunodeficiency virus transmission among severely mentally ill residents at a long term care facility
Jasuja S , Thompson ND , Peters PJ , Khudyakov YE , Patel MT , Linchangco P , Thai HT , Switzer WM , Shankar A , Heneine W , Hu DJ , Moorman AC , Gerber SI . PLoS One 2012 7 (8) e43252 BACKGROUND: A high prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections have been reported among persons with severe mental illness. In October, 2009, the Cook County Department of Public Health (CCDPH) initiated an investigation following notification of a cluster of HBV infections among mentally ill residents at a long term care facility (LTCF). METHODS: LTCF staff were interviewed and resident medical records were reviewed. Residents were offered testing for HBV, HCV, and HIV. Serum specimens from residents diagnosed with HBV or HIV infection were sent to the Centers for Disease Control and Prevention (CDC) for analysis. RESULTS: Eleven newly diagnosed HBV infections were identified among mentally ill residents at the LTCF. Of these 11 infections, 4 serum specimens were available for complete HBV genome sequencing; all 4 genomes were found to be closely related. Four newly diagnosed HIV infections were identified within this same population. Upon molecular analysis, 2 of 4 HIV sequences from these new infections were found to be nearly identical and formed a tight phylogenetic cluster. CONCLUSIONS: HBV and HIV transmission was identified among mentally ill residents of this LTCF. Continued efforts are needed to prevent bloodborne pathogen transmission among mentally ill residents in LTCFs. |
Animal models of antiretroviral prophylaxis for HIV prevention
Garcia-Lerma JG , Heneine W . Curr Opin HIV AIDS 2012 7 (6) 505-13 PURPOSE OF REVIEW: Oral and topical pre-exposure prophylaxis (PrEP) with antiretroviral drugs are novel biomedical interventions recently found to prevent HIV transmission among high-risk populations. In this review, we outline lessons learned from animal studies and discuss next steps in preclinical PrEP research including the study of new PrEP modalities, pharmacologic correlates of protection, and biological factors that may modulate PrEP efficacy. RECENT FINDINGS: Studies using macaque or humanized mice models of mucosal simian immunodeficiency virus (SIV), HIV, or simian/human immunodeficiency virus (SHIV) transmission have provided efficacy data against rectal and vaginal infection. A multitude of oral and topical PrEP regimens including drugs such as tenofovir (TFV), tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) were tested against either wild-type or drug-resistant viruses. These models have also helped define prophylactic windows of protection of nondaily dosing and are being used increasingly to study pharmacokinetic and pharmacodynamic relationships. SUMMARY: As human data from PrEP trials validate animal models or help fine tune them, it is expected that these models will play increasingly important roles in PrEP development as the field extends into new drug classes and combinations, episodic dosing, and novel long-acting drug formulations. By providing both efficacy and pharmacologic information these models can define correlates and mechanisms of protection, inform dose selection, and advance the most promising PrEP candidates and dosing modalities. |
Road traffic noise: annoyance, sleep disturbance, and public health implications
Kim M , Chang SI , Seong JC , Holt JB , Park TH , Ko JH , Croft JB . Am J Prev Med 2012 43 (4) 353-360 BACKGROUND: The WHO has recognized environmental noise as harmful pollution that causes adverse psychosocial and physiologic effects (i.e., annoyance and sleep disturbance) on human health. In Europe, noise-related health studies have been actively conducted, but the U.S. has lagged behind in this research field. PURPOSE: This research predicted ambient levels of road traffic noise for a highly urbanized area: Fulton County GA. Assessment was made of noise impacts on the population, focusing on annoyance and sleep disturbance. Methods All the data sets were collected during 2009-2011, and data analysis was performed in 2010-2011. The study used a sound-propagation model for noise-level prediction and derived noise-impact indicators for annoyance and sleep disturbance from exposure-response models. Then, annoyed and sleep-disturbed populations were predicted with the use of each noise-impact indicator. RESULTS: It was predicted that 109,967 people would be at risk of being highly annoyed, with 19,621 people at risk for high sleep disturbance for Fulton County GA. Noise-impact indicators such as the percentage of those who were highly annoyed and who had high levels of sleep disturbance were expected to be valuable metrics to compare noise equity among urban communities. CONCLUSIONS: Many residents of the greater Atlanta area may be exposed to noise levels that put them at risk of being highly annoyed or having high levels of sleep disturbance. These results, if generalized to other urban areas with high levels of road traffic, indicate that it may be important for the public's health to update existing noise-related policies or develop new ones to control and abate noise concerns in urban communities. |
Evaluation of individual-based and group-based exposure estimation of microbial agents in health effects associated with a damp building
Cho SJ , Cox-Ganser JM , Kreiss K , Park JH . J Expo Sci Environ Epidemiol 2012 23 (4) 409-15 We evaluated attenuation in linear associations between microbial exposure and respiratory symptoms occurring when individual measurements of microbial agents were used for estimating employees' exposure compared with group means. Symptoms, which improved when away from the building (building-related, BR), and measurements of culturable fungi, ergosterol, and endotoxin in floor dust were obtained between 2001 and 2007 from four cross-sectional studies on occupants of a water-damaged building. We compared odds ratios from longitudinal health effect models using individual measurements at employees' workstations with those using floor (group) means. Estimated odds for BR respiratory symptoms in group-based analyses increased by 2 to 5 times compared with those from individual-based analyses for culturable fungi and ergosterol, although they were less precise. For endotoxin, we found substantially increased and significant odds in group-based analyses, while we found no associations in individual-based analyses for various symptoms. Our study suggested that the building floor was useful in constructing exposure groups for microbial agents in this water-damaged building for epidemiologic analysis. Our study showed that group-average exposure estimation provides less attenuated associations between exposures to microbial agents and health in damp indoor environments where measurement error and intrinsic temporal variability are often large. (Journal of Exposure Science and Environmental Epidemiology advance online publication, 12 September 2012; doi:10.1038/jes.2012.89.) |
Surveillance definitions of infections in long-term care facilities: revisiting the McGeer Criteria
Stone ND , Ashraf MS , Calder J , Crnich CJ , Crossley K , Drinka PJ , Gould CV , Juthani-Mehta M , Lautenbach E , Loeb M , Maccannell T , Malani PN , Mody L , Mylotte JM , Nicolle LE , Roghmann MC , Schweon SJ , Simor AE , Smith PW , Stevenson KB , Bradley SF . Infect Control Hosp Epidemiol 2012 33 (10) 965-77 Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections. |
Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003-2008
Okoroh EM , Hooper WC , Atrash HK , Yusuf HR , Boulet SL . Am J Obstet Gynecol 2012 207 (5) 377 e1-8 OBJECTIVE: We sought to determine prevalence and likelihood of venous thromboembolism (VTE) among women with and without polycystic ovary syndrome (PCOS). STUDY DESIGN: We performed a cross-sectional analysis using Thomson Reuters MarketScan Commercial databases for the years 2003 through 2008. The association between VTE and PCOS among women aged 18-45 years was assessed using age-stratified multivariable logistic regression models. RESULTS: Prevalence of VTE per 100,000 was 374.2 for PCOS women and 193.8 for women without PCOS. Compared with women without PCOS, those with PCOS were more likely to have VTE (adjusted odds ratio [aOR] 18-24 years, 3.26; 95% confidence interval [CI], 2.61-4.08; aOR 25-34 years, 2.39; 95% CI, 2.12-2.70; aOR 35-45 years, 2.05; 95% CI, 1.84-2.38). A protective association (odds ratio, 0.8; 95% CI, 0.73-0.98) with oral contraceptive use was noted for PCOS women. CONCLUSION: PCOS might be a predisposing condition for VTE, particularly among women aged 18-24 years. Oral contraceptive use might be protective. |
Device-associated infection rates, device utilization, and antimicrobial resistance in long-term acute care hospitals reporting to the National Healthcare Safety Network, 2010
Chitnis AS , Edwards JR , Ricks PM , Sievert DM , Fridkin SK , Gould CV . Infect Control Hosp Epidemiol 2012 33 (10) 993-1000 OBJECTIVE: To evaluate national data on healthcare-associated infections (HAIs), device utilization, and antimicrobial resistance in long-term acute care hospitals (LTACHs). DESIGN AND SETTING: Comparison of data from LTACHs and from medical and medical-surgical intensive care units (ICUs) in short-stay acute care hospitals reporting to the National Healthcare Safety Network (NHSN) during 2010. METHODS: Rates of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP) as well as device utilization ratios were calculated. For each HAI, pathogen profiles and antimicrobial resistance prevalence were evaluated. Comparisons were made using Poisson regression and the Mood median and chi(2) tests. RESULTS: In 2010, 104 LTACHs reported CLABSIs and 57 reported CAUTIs and VAP to the NHSN. Median CLABSI rates in LTACHs (1.25 events per 1,000 device-days reported; range, 0.0-5.96) were comparable to rates in major teaching ICUs and were higher than those in other ICUs. CAUTI rates in LTACHs (median, 2.61; range, 0.0-9.92) were higher and VAP rates (median, 0.0; range, 0.0-3.29) were generally lower than those in ICUs. Central line utilization in LTACHs was higher than that in ICUs, whereas urinary catheter and ventilator utilization was lower. Methicillin resistance among Staphylococcus aureus CLABSIs (83%) and vancomycin resistance among Enterococcus faecalis CAUTIs (44%) were higher in LTACHs than in ICUs. Multidrug resistance among Pseudomonas aeruginosa CAUTIs (25%) was higher in LTACHs than in most ICUs. CONCLUSIONS: CLABSIs and CAUTIs associated with multidrug-resistant organisms present a challenge in LTACHs. Continued HAI surveillance with pathogen-level data can guide prevention efforts in LTACHs. |
Direct and indirect effects of rotavirus vaccination: comparing predictions from transmission dynamic models
Pitzer VE , Atkins KE , de Blasio BF , Van Effelterre T , Atchison CJ , Harris JP , Shim E , Galvani AP , Edmunds WJ , Viboud C , Patel MM , Grenfell BT , Parashar UD , Lopman BA . PLoS One 2012 7 (8) e42320 Early observations from countries that have introduced rotavirus vaccination suggest that there may be indirect protection for unvaccinated individuals, but it is unclear whether these benefits will extend to the long term. Transmission dynamic models have attempted to quantify the indirect protection that might be expected from rotavirus vaccination in developed countries, but results have varied. To better understand the magnitude and sources of variability in model projections, we undertook a comparative analysis of transmission dynamic models for rotavirus. We fit five models to reported rotavirus gastroenteritis (RVGE) data from England and Wales, and evaluated outcomes for short- and long-term vaccination effects. All of our models reproduced the important features of rotavirus epidemics in England and Wales. Models predicted that during the initial year after vaccine introduction, incidence of severe RVGE would be reduced 1.8-2.9 times more than expected from the direct effects of the vaccine alone (28-50% at 90% coverage), but over a 5-year period following vaccine introduction severe RVGE would be reduced only by 1.1-1.7 times more than expected from the direct effects (54-90% at 90% coverage). Projections for the long-term reduction of severe RVGE ranged from a 55% reduction at full coverage to elimination with at least 80% coverage. Our models predicted short-term reductions in the incidence of RVGE that exceeded estimates of the direct effects, consistent with observations from the United States and other countries. Some of the models predicted that the short-term indirect benefits may be offset by a partial shifting of the burden of RVGE to older unvaccinated individuals. Nonetheless, even when such a shift occurs, the overall reduction in severe RVGE is considerable. Discrepancies among model predictions reflect uncertainties about age variation in the risk and reporting of RVGE, and the duration of natural and vaccine-induced immunity, highlighting important questions for future research. |
Heme oxygenase-1 gene promoter polymorphism is associated with reduced incidence of acute chest syndrome among children with sickle cell disease.
Bean CJ , Boulet SL , Ellingsen D , Pyle ME , Barron-Casella EA , Casella JF , Payne AB , Driggers J , Trau HA , Yang G , Jones K , Ofori-Acquah SF , Hooper WC , Debaun MR . Blood 2012 120 (18) 3822-8 Sickle cell disease (SCD) is a common hemolytic disorder with a broad range of complications, including vaso-occlusive episodes, acute chest syndrome (ACS), pain, and stroke. Heme oxygenase-1 (gene HMOX1; protein HO-1) is the inducible, rate-limiting enzyme in the catabolism of heme and might attenuate the severity of outcomes from vaso-occlusive and hemolytic crises. A (GT)(n) dinucleotide repeat located in the promoter region of the HMOX1 gene is highly polymorphic, with long repeat lengths linked to decreased activity and inducibility. We examined this polymorphism to test the hypothesis that short alleles are associated with a decreased risk of adverse outcomes (hospitalization for pain or ACS) among a cohort of 942 children with SCD. Allele lengths varied from 13 to 45 repeats and showed a trimodal distribution. Compared with children with longer allele lengths, children with two shorter alleles (4%; ≤25 repeats) had lower rates of hospitalization for ACS (incidence rate ratio 0.28, 95% confidence interval: 0.10-0.81), after adjusting for sex, age, asthma, percentage of fetal hemoglobin and alpha-globin gene deletion. No relationship was identified between allele lengths and pain rate. We provide evidence that genetic variation in HMOX1 is associated with decreased rates of hospitalization for ACS, but not pain. This study is registered at www.ClinicalTrails.gov (NCT00072761). |
Increased risk of venous thromboembolism is associated with genetic variation in heme oxygenase-1 in Blacks.
Bean CJ , Boulet SL , Ellingsen D , Trau H , Ghaji N , Hooper WC , Austin H . Thromb Res 2012 130 (6) 942-7 BACKGROUND: Venous thromboembolism (VTE) affects as many as 1 in 1000 individuals in the United States. Although Blacks are disproportionately affected by VTE, few genetic risk factors have been identified in this population. The inducible heme oxygenase-1 (HMOX1) gene encodes a key cytoprotective enzyme with anti-inflammatory, antioxidant and anticoagulant activity acting in the vascular system. A (GT)(n) microsatellite located in the promoter of the HMOX1 gene influences the level of response. METHODS AND RESULTS: Using the Genetic Attributes and Thrombosis Epidemiology (GATE) study, we examined the association between HMOX1 repeat length and VTE events in 883 Black and 927 White patients and matched controls. We found no association between HMOX1 genotypes and VTE in Whites. However, in Black patients, carrying two long (L) alleles (≥34 repeats) was significantly associated with provoked (odds ratio (OR) 1.86, 95% confidence interval (CI): 1.19-2.90) or recurrent (OR 3.13, 95% CI: 1.77-5.53) VTE events. CONCLUSIONS: We have demonstrated for the first time an association between genetic variation in HMOX1, and VTE in Blacks. Our results support a key role for the heme oxygenase system in protecting patients at increased risk for thrombosis and suggest a potential mechanism for targeted screening and intervention. |
Evolution of highly pathogenic avian influenza (H5N1) virus populations in Vietnam between 2007 and 2010.
Nguyen T , Rivailler P , Davis CT , Thi Hoa D , Balish A , Hoang Dang N , Jones J , Thi Vui D , Simpson N , Thu Huong N , Shu B , Loughlin R , Ferdinand K , Lindstrom SE , York IA , Klimov A , Donis RO . Virology 2012 432 (2) 405-16 We report on the genetic analysis of 213 highly pathogenic avian influenza (HPAI) H5N1 viruses isolated from poultry in Vietnam between 2007 and 2010. Phylogenetic analyses of the viral genomes revealed 38 distinct viral genotypes, 29 were novel and 9 were reported in Vietnam or neighboring countries in recent years. Viruses from only six genotypes persisted beyond one season or year. Thus, most reassortant viruses were transient, suggesting that such genotypes lacked significant fitness advantages. Viruses with clade 2.3.2.1 HA were re-introduced into Vietnam in 2009 and their prevalence rose steeply towards the end of 2010. Clade 2.3.4-like viruses (genotype V) were predominant in northern Vietnam and caused the majority of zoonotic infections, whereas clade 1.1 (genotype Z) viruses were only detected in the Mekong delta region, in southern Vietnam. Antigenic analysis of representative viruses from the four clades indicated substantial drift. |
Critical role of an antiviral stress granule containing RIG-I and PKR in viral detection and innate immunity.
Onomoto K , Jogi M , Yoo JS , Narita R , Morimoto S , Takemura A , Sambhara S , Kawaguchi A , Osari S , Nagata K , Matsumiya T , Namiki H , Yoneyama M , Fujita T . PLoS One 2012 7 (8) e43031 Retinoic acid inducible gene I (RIG-I)-like receptors (RLRs) function as cytoplasmic sensors for viral RNA to initiate antiviral responses including type I interferon (IFN) production. It has been unclear how RIG-I encounters and senses viral RNA. To address this issue, we examined intracellular localization of RIG-I in response to viral infection using newly generated anti-RIG-I antibody. Immunohistochemical analysis revealed that RLRs localized in virus-induced granules containing stress granule (SG) markers together with viral RNA and antiviral proteins. Because of similarity in morphology and components, we termed these aggregates antiviral stress granules (avSGs). Influenza A virus (IAV) deficient in non-structural protein 1 (NS1) efficiently generated avSGs as well as IFN, however IAV encoding NS1 produced little. Inhibition of avSGs formation by removal of either the SG component or double-stranded RNA (dsRNA)-dependent protein kinase (PKR) resulted in diminished IFN production and concomitant enhancement of viral replication. Furthermore, we observed that transfection of dsRNA resulted in IFN production in an avSGs-dependent manner. These results strongly suggest that the avSG is the locus for non-self RNA sensing and the orchestration of multiple proteins is critical in the triggering of antiviral responses. |
Multilocus sequence subtyping and genetic structure of Cryptosporidium muris and Cryptosporidium andersoni.
Wang R , Jian F , Zhang L , Ning C , Liu A , Zhao J , Feng Y , Qi M , Wang H , Lv C , Zhao G , Xiao L . PLoS One 2012 7 (8) e43782 In this study, nine C. muris and 43 C. andersoni isolates from various animals in China were subtyped by a multilocus sequence typing (MLST) tool. DNA sequence analyses showed the presence of 1-2 subtypes of C. muris and 2-6 subtypes of C. andersoni at each of the four loci (MS1, MS2, MS3, and MS16), nine of which represented new subtypes. Altogether, two C. muris and 10 C. andersoni MLST subtypes were detected. Linkage disequilibrium analysis indicated although the overall population structure of the two parasites was clonal, the Chinese C. andersoni in cattle has an epidemic structure. Three and two clusters were produced in the C. muris and C. andersoni populations by Structure 2.3.3 analysis, with Chinese C. muris and C. andersoni substructures differing from other countries. Thus, this study suggested the prevalence of C. andersoni in China is not attributed to the introduction of dairy cattle. More studies involving more genetic loci and systematic sampling are needed to better elucidate the population genetic structure of C. muris and C. andersoni in the world and the genetic basis for the difference in host specificity among the two most common gastric parasites. |
HIV disclosure and subsequent sexual behaviors among men who have sex with men who meet online
St De Lore J , Thiede H , Cheadle A , Goldbaum G , Carey JW , Hutcheson RE , Jenkins RA , Golden MR . J Homosex 2012 59 (4) 592-609 To assess HIV disclosure discussions and related sexual behaviors among men who have sex with men (MSM) who meet sex partners online, 28 qualitative interviews with Seattle-area MSM were analyzed using grounded theory methods and themes and behavior patterns were identified. MSM found a greater ease in communicating and could prescreen partners through the Internet. However, no consistent relationship was found between HIV disclosure and subsequent behaviors: some were safer based on disclosure while perceived HIV status led others to risky behaviors. Interventions need to promote accurate disclosure while acknowledging its limitations and the need for men to self-protect. |
News media outreach and newspaper coverage of tobacco control
Pederson LL , Nelson DE , Babb S , London J , Promoff G , Pechacek T . Health Promot Pract 2012 13 (5) 642-7 INTRODUCTION: Little is known about the impact of media outreach on news media coverage of tobacco control. METHODS: Media outreach data were obtained from the Centers for Disease Control and Prevention's Office on Smoking and Health (CDC/OSH) from 2003 to 2006; one to six types of outreach activities for 50 scientific publications were performed during 35 discrete time periods. The authors analyzed quantitatively and qualitatively 205 newspaper articles generated based on the CDC/OSH scientific publications. RESULTS: Media coverage of specific CDC/OSH-related tobacco themes was highest for disparities (100%) and tobacco statistics (98%). More outreach activities increased the likelihood of moderate pickup of the number of themes in newspaper articles (odds ratio = 2.0, 95% confidence interval = 1.5-2.8), but there appeared to be a ceiling effect. Certain types of outreach were more strongly associated with front page and headline coverage. CONCLUSIONS: The extent and type of outreach were associated with increased newspaper coverage but the relationship is not necessarily straightforward. Additional research is needed to better understand relationships between scientific findings, outreach, and news media coverage of tobacco. |
Genetic variation in the Plasmodium falciparum circumsporozoite protein in India and its relevance to RTS,S malaria vaccine.
Zeeshan M , Alam MT , Vinayak S , Bora H , Tyagi RK , Alam MS , Choudhary V , Mittra P , Lumb V , Bharti PK , Udhayakumar V , Singh N , Jain V , Singh PP , Sharma YD . PLoS One 2012 7 (8) e43430 RTS,S is the most advanced malaria vaccine candidate, currently under phase-III clinical trials in Africa. This Plasmodium falciparum vaccine contains part of the central repeat region and the complete C-terminal T cell epitope region (Th2R and Th3R) of the circumsporozoite protein (CSP). Since naturally occurring polymorphisms at the vaccine candidate loci are critical determinants of the protective efficacy of the vaccines, it is imperative to investigate these polymorphisms in field isolates. In this study we have investigated the genetic diversity at the central repeat, C-terminal T cell epitope (Th2R and Th3R) and N-terminal T cell epitope regions of the CSP, in P. falciparum isolates from Madhya Pradesh state of India. These isolates were collected through a 5-year prospective study aimed to develop a well-characterized field-site for the future evaluation of malaria vaccine in India. Our results revealed that the central repeat (63 haplotypes, n = 161) and C-terminal Th2R/Th3R epitope (24 haplotypes, n = 179) regions were highly polymorphic, whereas N-terminal non-repeat region was less polymorphic (5 haplotypes, n = 161) in this population. We did not find any evidence of the role of positive natural selection in maintaining the genetic diversity at the Th2R/Th3R regions of CSP. Comparative analysis of the Th2R/Th3R sequences from this study to the global isolates (n = 1160) retrieved from the GenBank database revealed two important points. First, the majority of the sequences ( approximately 61%, n = 179) from this study were identical to the Dd2/Indochina type, which is also the predominant Th2R/Th3R haplotype in Asia ( approximately 59%, n = 974). Second, the Th2R/Th3R sequences in Asia, South America and Africa are geographically distinct with little allele sharing between continents. In conclusion, this study provides an insight on the existing polymorphisms in the CSP in a parasite population from India that could potentially influence the efficacy of RTS,S vaccine in this region. |
Strategies to alleviate original antigenic sin responses to influenza viruses
Kim JH , Davis WG , Sambhara S , Jacob J . Proc Natl Acad Sci U S A 2012 109 (34) 13751-6 Original antigenic sin is a phenomenon wherein sequential exposure to closely related influenza virus variants reduces antibody (Ab) response to novel antigenic determinants in the second strain and, consequently, impairs the development of immune memory. This could pose a risk to the development of immune memory in persons previously infected with or vaccinated against influenza. Here, we explored strategies to overcome original antigenic sin responses in mice sequentially exposed to two closely related hemagglutinin 1 neuraminidase 1 (H1N1) influenza strains A/PR/8/34 and A/FM/1/47. We found that dendritic cell-activating adjuvants [Bordetella pertussis toxin (PT) or CpG ODN or a squalene-based oil-in-water nanoemulsion (NE)], upon administration during the second viral exposure, completely protected mice from a lethal challenge and enhanced neutralizing-Ab titers against the second virus. Interestingly, PT and NE adjuvants when administered during the first immunization even prevented original antigenic sin in subsequent immunization without any adjuvants. As an alternative to using adjuvants, we also found that repeated immunization with the second viral strain relieved the effects of original antigenic sin. Taken together, our studies provide at least three ways of overcoming original antigenic sin. |
Vaccine administration decision making: the case of yellow fever vaccine
Lown BA , Chen LH , Wilson ME , Sisson E , Gershman M , Yanni E , Jentes ES , Hochberg NS , Hamer DH , Barnett ED . Clin Infect Dis 2012 55 (6) 837-43 BACKGROUND: Providers must counsel travelers to yellow fever (YF)-endemic areas, although risk estimates of disease and vaccine serious adverse events (SAEs) may be imprecise. The impact of risk information and patients' requests for participation in vaccine decisions on providers' recommendations is unknown. METHODS: Vaccine providers were surveyed regarding decisions for 4 patient scenarios before and after being presented information about risk of YF disease vs vaccine SAEs. Participants' theoretical attitudes were compared with actual responses to scenarios in which patients wanted to share vaccine decisions. Analyses were done by using chi(2) tests with significance level of .05. RESULTS: Forty-six percent of respondents made appropriate initial YF vaccine administration decisions for a pregnant woman, 73% for an immunosuppressed man, and 49% for an 8-month-old infant. After receiving scenario-specific information, 20%, 54%, and 23% of respondents respectively who initially responded incorrectly changed to a more appropriate decision. Thirty-one percent of participants made consistently appropriate decisions. Among participants who made ≥1 incorrect decision, 35.7% made no decision changes after receiving information. In the scenario in which either a decision to withhold or to administer vaccine was acceptable, 19% of respondents refused a patient's request for vaccine. CONCLUSIONS: Targeted information is necessary but insufficient to change the process of vaccine administration decision making. Providers need additional education to enable them to apply evidence, overcome cognitive decision-making errors, and involve patients in vaccine decisions. |
Prolonged tenofovir treatment of macaques infected with K65R reverse transcriptase mutants of SIV results in the development of antiviral immune responses that control virus replication after drug withdrawal
Van Rompay KK , Trott KA , Jayashankar K , Geng Y , Labranche CC , Johnson JA , Landucci G , Lipscomb J , Tarara RP , Canfield DR , Heneine W , Forthal DN , Montefiori D , Abel K . Retrovirology 2012 9 57 BACKGROUND: We reported previously that while prolonged tenofovir monotherapy of macaques infected with virulent simian immunodeficiency virus (SIV) resulted invariably in the emergence of viral mutants with reduced in vitro drug susceptibility and a K65R mutation in reverse transcriptase, some animals controlled virus replication for years. Transient CD8+ cell depletion or short-term tenofovir interruption within 1 to 5 years of treatment demonstrated that a combination of CD8+ cell-mediated immune responses and continued tenofovir therapy was required for sustained suppression of viremia. We report here follow-up data on 5 such animals that received tenofovir for 8 to 14 years. RESULTS: Although one animal had a gradual increase in viremia from 3 years onwards, the other 4 tenofovir-treated animals maintained undetectable viremia with occasional viral blips (≤ 300 RNA copies/ml plasma). When tenofovir was withdrawn after 8 to 10 years from three animals with undetectable viremia, the pattern of occasional episodes of low viremia (≤ 3600 RNA/ml plasma) continued throughout the 10-month follow-up period. These animals had low virus levels in lymphoid tissues, and evidence of multiple SIV-specific immune responses. CONCLUSION: Under certain conditions (i.e., prolonged antiviral therapy initiated early after infection; viral mutants with reduced drug susceptibility) a virus-host balance characterized by strong immunologic control of virus replication can be achieved. Although further research is needed to translate these findings into clinical applications, these observations provide hope for a functional cure of HIV infection via immunotherapeutic strategies that boost antiviral immunity and reduce the need for continuous antiretroviral therapy. |
Compared to subcutaneous tenofovir, oral tenofovir disoproxyl fumarate administration preferentially concentrates the drug into gut-associated lymphoid cells in simian immunodeficiency virus-infected macaques
Van Rompay KK , Babusis D , Abbott Z , Geng Y , Jayashankar K , Johnson JA , Lipscomb J , Heneine W , Abel K , Ray AS . Antimicrob Agents Chemother 2012 56 (9) 4980-4 To compare tissue-based pharmacokinetics and efficacy of oral tenofovir disoproxyl fumarate (TDF) versus subcutaneous tenofovir (TFV), macaques were treated for 2 weeks starting 1 week after simian immunodeficiency virus inoculation. Despite lower plasma TFV levels in the oral TDF arm, similar TFV diphosphate levels and antiviral activities were measured in lymphoid cells of most tissues. In intestinal tissues, however, oral TDF resulted in higher active drug levels, associated with lower virus levels and better immune preservation. |
Towards automatic diabetes case detection and ABCS protocol compliance assessment
Mishra NK , Son RY , Arnzen JJ . Clin Med Res 2012 10 (3) 106-21 OBJECTIVE: According to the American Diabetes Association, the implementation of the standards of care for diabetes has been suboptimal in most clinical settings. Diabetes is a disease that had a total estimated cost of $174 billion in 2007 for an estimated diabetes-affected population of 17.5 million in the United States. With the advent of electronic medical records (EMR), tools to analyze data residing in the EMR for healthcare surveillance can help reduce the burdens experienced today. This study was primarily designed to evaluate the efficacy of employing clinical natural language processing to analyze discharge summaries for evidence indicating a presence of diabetes, as well as to assess diabetes protocol compliance and high risk factors. METHODS: Three sets of algorithms were developed to analyze discharge summaries for: (1) identification of diabetes, (2) protocol compliance, and (3) identification of high risk factors. The algorithms utilize a common natural language processing framework that extracts relevant discourse evidence from the medical text. Evidence utilized in one or more of the algorithms include assertion of the disease and associated findings in medical text, as well as numerical clinical measurements and prescribed medications. RESULTS: The diabetes classifier was successful at classifying reports for the presence and absence of diabetes. Evaluated against 444 discharge summaries, the classifier's performance included macro and micro F-scores of 0.9698 and 0.9865, respectively. Furthermore, the protocol compliance and high risk factor classifiers showed promising results, with most F-measures exceeding 0.9. CONCLUSIONS: The presented approach accurately identified diabetes in medical discharge summaries and showed promise with regards to assessment of protocol compliance and high risk factors. Utilizing free-text analytic techniques on medical text can complement clinical-public health decision support by identifying cases and high risk factors. |
Molecular epidemiology of influenza A(H1N1)pdm09 viruses from Pakistan in 2009-2010.
Bashir Aamir U , Badar N , Mehmood MR , Nisar N , Suleman RM , Shaukat S , Sharif S , Kamran J , Zaidi SS , Kazi BM , Gubareva L , Xu X , Garten R , Klimov A . PLoS One 2012 7 (8) e41866 BACKGROUND: In early 2009, a novel influenza A(H1N1) virus that emerged in Mexico and United States rapidly disseminated worldwide. The spread of this virus caused considerable morbidity with over 18,000 recorded deaths. The new virus was found to be a reassortant containing gene segments from human, avian and swine influenza viruses. METHODS/RESULTS: The first case of human infection with A(H1N1)pdm09 in Pakistan was detected on 18(th) June 2009. Since then, 262 laboratory-confirmed cases have been detected during various outbreaks with 29 deaths (as of 31(st) August 2010). The peak of the epidemic was observed in December with over 51% of total respiratory cases positive for influenza. Representative isolates from Pakistan viruses were sequenced and analyzed antigenically. Sequence analysis of genes coding for surface glycoproteins HA and NA showed high degree of high levels of sequence identity with corresponding genes of regional viruses circulating South East Asia. All tested viruses were sensitive to Oseltamivir in the Neuraminidase Inhibition assays. CONCLUSIONS: Influenza A(H1N1)pdm09 viruses from Pakistan form a homogenous group of viruses. Their HA genes belong to clade 7 and show antigenic profile similar to the vaccine strain A/California/07/2009. These isolates do not show any amino acid changes indicative of high pathogenicity and virulence. It is imperative to continue monitoring of these viruses for identification of potential variants of high virulence or drug resistance. |
Molecular basis of electrophilic and oxidative defense: promises and perils of Nrf2.
Ma Q , He X . Pharmacol Rev 2012 64 (4) 1055-81 Induction of drug-metabolizing enzymes through the antioxidant response element (ARE)-dependent transcription was initially implicated in chemoprevention against cancer by antioxidants. Recent progress in understanding the biology and mechanism of induction revealed a critical role of induction in cellular defense against electrophilic and oxidative stress. Induction is mediated through a novel signaling pathway via two regulatory proteins, the nuclear factor erythroid 2-related factor 2 (Nrf2) and the Kelch-like erythroid cell-derived protein with CNC homology-associated protein 1 (Keap1). Nrf2 binds to Keap1 at a two site-binding interface and is ubiquitinated by the Keap1/cullin 3/ring box protein-1-ubiquitin ligase, resulting in a rapid turnover of Nrf2 protein. Electrophiles and oxidants modify critical cysteine thiols of Keap1 and Nrf2 to inhibit Nrf2 ubiquitination, leading to Nrf2 activation and induction. Induction increases stress resistance critical for cell survival, because knockout of Nrf2 in mice increased susceptibility to a variety of toxicity and disease processes. Collateral to diverse functions of Nrf2, genome-wide search has led to the identification of a plethora of ARE-dependent genes regulated by Nrf2 in an inducer-, tissue-, and disease-dependent manner to control drug metabolism, antioxidant defense, stress response, proteasomal degradation, and cell proliferation. The protective nature of Nrf2 could also be hijacked in a number of pathological conditions by means of somatic mutation, epigenetic alteration, and accumulation of disruptor proteins, promoting drug resistance in cancer and pathologic liver features in autophagy deficiency. The repertoire of ARE inducers has expanded enormously; the therapeutic potential of the inducers has been examined beyond cancer prevention. Developing potent and specific ARE inducers and Nrf2 inhibitors holds certain new promise for the prevention and therapy against cancer, chronic disease, and toxicity. |
Redox regulation by nuclear factor erythroid 2-related factor 2: gatekeeping for the basal and diabetes-induced expression of thioredoxin-interacting protein.
He X , Ma Q . Mol Pharmacol 2012 82 (5) 887-97 Nrf2 is a transcription factor activated by a range of oxidants and electrophiles. Transcriptional response to endogenous oxidative cues by Nrf2 plays an important role in mammalian redox physiology and oxidative pathology. Hyperglycemia induces oxidative stress in the heart where it leads to apoptosis and ultimately cardiomyopathy. Here we investigated the mechanism by which Nrf2 suppresses oxidative stress in diabetic mouse heart. Knockout (KO) of Nrf2 induced oxidative stress and apoptosis in KO heart; diabetes further increased oxidative damage. Pathway-focused gene array revealed that Nrf2 controls the expression of 24 genes in the heart, including the gene encoding thioredoxin interacting protein (TXNIP). Nrf2 suppressed the basal expression of Txnip in the heart and blocked induction of Txnip by high glucose by binding to an antioxidant response element (ARE, -1286 to -1276) of Txnip promoter. Binding of Nrf2 to ARE also suppressed the binding of MondoA to the carbohydrate response element with or without high glucose. TXNIP promoted ROS production and apoptosis by inhibiting thioredoxin. On the other hand, Nrf2 boosted thioredoxin activity by inhibiting Txnip. The findings revealed, for the first time, that Nrf2 is a key gate keeper of Txnip transcription, suppressing both its basal expression and MondoA-driven induction to control the thioredoxin redox signaling in diabetes. |
Measles virus IgG avidity assay for use in classification of measles vaccine failure in measles elimination settings
Mercader S , Garcia P , Bellini WJ . Clin Vaccine Immunol 2012 19 (11) 1810-7 In regions where endemic measles virus has been eliminated, diagnostic assays are needed to assist in correctly classifying measles cases irrespective of vaccination status. A measles IgG avidity assay was configured using a commercially available measles-specific IgG enzyme immunoassay by modifying the protocol to include three 5-minute washes with diethylamine (60mM, pH 10.25) following serum incubation; serum was serially diluted and results were expressed as end-titer avidity index. Receiver Operating Characteristic analysis was used for evaluation and validation, and to establish low (≤ 30%) and high (≥ 70%) end-titer avidity thresholds. Analysis of 319 serum specimens expected to contain either high or low avidity antibodies per clinical and epidemiological data indicated that this assay is highly accurate with an Area Under the Curve of 0.998 (95% CI: 0.978-1.000), sensitivity of 91.9% (95%CI: 83.2%-97.0%) and specificity of 98.4% (95%CI: 91.6%-100%). This assay is rapid (<2 hours) and precise (SD: 4%-7%). In 18 samples from an elimination setting outbreak, the assay identified 2 acute measles cases with low avidity results; both were IgM positive samples. Additionally, 11 patients (15 samples) with modified measles that were found to have high avidity IgG results were classified as secondary vaccine failures; one sample with an intermediate avidity result was not interpretable. In elimination settings, measles IgG avidity assays can complement existing diagnostic tools in confirming unvaccinated acute cases and, in conjunction with adequate clinical and epidemiologic investigation, aid in the classification of vaccine failure cases. |
Multicenter evaluation of a sequence-based protocol for subtyping Shiga toxins and standardizing stx nomenclature
Scheutz F , Teel LD , Beutin L , Pierard D , Buvens G , Karch H , Mellmann A , Caprioli A , Tozzoli R , Morabito S , Strockbine NA , Melton-Celsa AR , Sanchez M , Persson S , O'Brien AD . J Clin Microbiol 2012 50 (9) 2951-63 When Shiga toxin-producing Escherichia coli (STEC) strains emerged as agents of human disease, two types of toxin were identified: Shiga toxin type 1 (Stx1) (almost identical to Shiga toxin produced by Shigella dysenteriae type 1) and the immunologically distinct type 2 (Stx2). Subsequently, numerous STEC strains have been characterized that express toxins with variations in amino acid sequence, some of which confer unique biological properties. These variants were grouped within the Stx1 or Stx2 type and often assigned names to indicate that they were not identical in sequence or phenotype to the main Stx1 or Stx2 type. A lack of specificity or consistency in toxin nomenclature has led to much confusion in the characterization of STEC strains. Because serious outcomes of infection have been attributed to certain Stx subtypes and less so with others, we sought to better define the toxin subtypes within the main Stx1 and Stx2 types. We compared the levels of relatedness of 285 valid sequence variants of Stx1 and Stx2 and identified common sequences characteristic of each of three Stx/Stx1 and seven Stx2 subtypes. A novel, simple PCR subtyping method was developed, independently tested on a battery of 48 prototypic STEC strains, and improved at six clinical and research centers to test the reproducibility, sensitivity, and specificity of the PCR. Using a consistent schema for nomenclature of the Stx toxins and stx genes by phylogenetic sequence-based relatedness of the holotoxin proteins, we developed a typing approach that should obviate the need to bioassay each newly described toxin and that predicts important biological characteristics. |
Immunotoxicity and allergic potential induced by topical application of dimethyl carbonate (DMC) in a murine model
Anderson SE , Franko J , Anderson KL , Munson AE , Lukomska E , Meade BJ . J Immunotoxicol 2012 10 (1) 59-66 Dimethyl carbonate (DMC) is an industrial chemical, used as a paint and adhesive solvent, with the potential for significant increases in production. Using select immune function assays, the purpose of these studies was to evaluate the immunotoxicity of DMC following dermal exposure using a murine model. Following a 28-day exposure, DMC produced a significant decrease in thymus weight at concentrations of 75% and greater. No effects on body weight, hematological parameters (erythrocytes, leukocytes, and their differentials), or immune cell phenotyping (B-cells, T-cells, and T-cell sub-sets) were identified. The IgM antibody response to sheep red blood cell (SRBC) was significantly reduced in the spleen but not the serum. DMC was not identified to be an irritant and evaluation of the sensitization potential, conducted using the local lymph node assay (LLNA) at concentrations ranging from 50-100%, did not identify increases in lymphocyte proliferation. These results demonstrate that dermal exposure to DMC induces immune suppression in a murine model and raise concern about potential human exposure and the need for occupational exposure regulations. |
Differential mouse pulmonary dose- and time course-responses to titanium dioxide nanospheres and nanobelts
Porter DW , Wu N , Hubbs A , Mercer R , Funk K , Meng F , Li J , Wolfarth M , Battelli L , Friend S , Andrew M , Hamilton R , Sriram K , Yang F , Castranova V , Holian A . Toxicol Sci 2012 131 (1) 179-93 Three anatase titanium dioxide (TiO(2)) nanoparticles were prepared; nanospheres (NS), short nanobelts (NB1) and long nanobelts (NB2). These nanoparticles were used to investigate the effect of nanoparticle shape and length on lung toxicity. Mice were exposed (0-30 microg per mouse) by pharyngeal aspiration and pulmonary toxicity was assessed over a 112 day time course. Whole lung lavage data indicated that NB1- and NB2-exposed mice, but not NS-exposed mice, had significant dose- and time-dependent pulmonary inflammation and damage. Histopathological analyses at 112 days post-exposure determined no interstitial fibrosis in any NS-exposed mice, an increased incidence in 30 microg NB1-exposed mice, and significant interstitial fibrosis in 30 microg NB2-exposed mice. At 112 days post-exposure, lung burden of NS was decreased by 96.4% and NB2 by 80.5% from initial deposition levels. At 112 days post-exposure, enhanced dark field microscopy determined that alveolar macrophages were the dominant deposition site, but a fraction of NB1 and NB2 was observed in the alveolar interstitial spaces. For the 30 microg exposure groups at 112 days post-exposure, confocal microscopy and immunofluorescent staining demonstrated that retained NB2 but not NS were present in the interstitium subjacent to the terminal bronchiole near the normal location of the smallest lymphatic capillaries in the lung. These lymphatic capillaries play a critical role in particle clearance, and the accumulation of NB2, but not NS, suggests possible impaired lymphatic clearance by the high aspect ratio particles. In summary, our data indicate that TiO(2) nanoparticle shape alters pulmonary responses, with severity of responses being ranked as NS<NB1<NB2. |
Dried Plasmodium falciparum-infected samples as positive controls for malaria rapid diagnostic tests
Aidoo M , Patel JC , Barnwell JW . Malar J 2012 11 (1) 239 BACKGROUND: Rapid diagnostic tests (RDTs) are central to fulfilling the WHO's recommendation for parasitologic confirmation of all suspected cases of malaria. RDT performance may be compromised when exposed to the high temperature conditions typical of most malaria endemic regions. However, a systematic method to monitor RDT quality and performance in endemic countries is lacking at the present time. Current methods to monitor RDT performance in the field include comparing results from RDTs to diagnoses made by light microscopy and observing health workers perform tests. These methods are not substitutes for direct quality control. In this study, the suitability of dried Plasmodium falciparuminfected blood as quality control samples for malaria RDTs was evaluated. METHODS: Three cultured strains of P. falciparum at 200 and 2,000 parasites/mcl were tested on 10 brands of RDT. After baseline testing to determine initial reactivity, aliquots of parasite-infected blood were air dried, stored at 35 degreesC, room temperature (~25 degreesC) or 4 degreesC for one, four and 12 weeks and were then tested on the 10 RDTs after rehydration. Extended stability testing of dried blood stored at 4 degreesC was done using P. falciparum strain 3D7 at 1,000 and 2,000 parasites/mcl. RESULTS: All dried blood samples at 2,000 parasites/mcl retained reactivity (100 % sensitivity) at all three temperatures and time points for all nine RDT brands that detect histidine-rich protein-2 (HRP2). The dried blood samples with 200 parasites/mcl were detected by six of the nine HRP2-based RDTs at all storage temperatures and time points. The sensitivity for two of the three remaining HRP2-based RDTs was 100 % up to four weeks of storage at all temperatures but dropped to 87.5 % at week 12. Of the four RDTs that detect plasmodium lactate dehydrogenase (pLDH) in a pan-specific manner, alone or in combination with HRP2, the detection of pLDH in samples with 2,000 parasites/mcL was 100 % for two RDTs and 80 % for the other two RDTs. The mean level for detection of pLDH at 200 parasites/mcl was low (29 %), with a range of 0 % to100%, which was partly attributable to weak initial baseline reactivity. Reactivity of dried 3D7 at 1,000 and 2,000 parasites/mcl stored at 4 degreesC was retained at 100 % for up to 52 weeks for both HRP2 and pLDH. CONCLUSIONS: In the absence of native or recombinant positive control antigens, well-standardized P. falciparum-infected dried blood samples can be used as positive control samples for monitoring RDT performance, particularly with HRP2-detecting tests. |
Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age
Hinkle SN , Schieve LA , Stein AD , Swan DW , Ramakrishnan U , Sharma AJ . Int J Obes (Lond) 2012 36 (10) 1312-9 OBJECTIVE: Both underweight and obese mothers have an increased risk for adverse offspring outcomes. Few studies have examined the association between prepregnancy body mass index (BMI) and children's neurodevelopment. SUBJECTS: We used data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n=6850). Children were classified according to their mother's prepregnancy BMI (kg m(-2)) status: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class I (BMI 30.0-34.9), and obese class II and III (BMI ≥35.0). Children's age-adjusted mental development index (MDI) and psychomotor development index (PDI) T-scores (mean 50, s.d. 10) were obtained using a validated shortened version of the Bayley Scales of Infant Development-II at approximately 2 years of age. While adjusting for sociodemographics, we estimated the average MDI and PDI scores or the risk of delayed (<-1 s.d. vs >1 s.d.) mental or motor development, relative to children of normal weight mothers. RESULTS: Compared with children of normal weight mothers, MDI scores were lower among children of mothers of all other prepregnancy BMI categories, with the greatest adjusted difference among children of class II and III obese mothers (-2.13 (95% CI -3.32, -0.93)). The adjusted risk of delayed mental development was increased among children of underweight (risk ratio (RR) 1.36 (95% CI 1.04, 1.78)) and class II and III obese (RR 1.38 (95% CI 1.03, 1.84)) mothers. Children's PDI scores or motor delay did not differ by maternal prepregnancy BMI. CONCLUSION: In this nationally representative sample of 2-year-old US children, low and very-high maternal prepregnancy BMI were associated with increased risk of delayed mental development but not motor development. (International Journal of Obesity advance online publication, 11 September 2012; doi:10.1038/ijo.2012.143.) |
Cervical cancer screening in the US-Mexico border region: a binational analysis
Herrera DG , Schiefelbein EL , Smith R , Rojas R , Mirchandani GG , McDonald JA . Matern Child Health J 2012 16 Suppl 2 298-306 Cervical cancer mortality is high along the US-Mexico border. We describe the prevalence of a recent Papanicolaou screening test (Pap) among US and Mexican border women. We analyzed 2006 cross-sectional data from Mexico's National Survey of Health and Nutrition and the US Behavioral Risk Factor Surveillance System. Women aged 20-77 years in 44 US border counties (n = 1,724) and 80 Mexican border municipios (n = 1,454) were studied. We computed weighted proportions for a Pap within the past year by age, education, employment, marital status, health insurance, health status, risk behaviors, and ethnicity and adjusted prevalence ratios (APR) for the US, Mexico, and the region overall. Sixty-five percent (95 %CI 60.3-68.6) of US women and 32 % (95 %CI 28.7-35.2) of Mexican women had a recent Pap. US residence (APR = 2.01, 95 %CI 1.74-2.33), marriage (APR = 1.31, 95 %CI 1.17-1.47) and insurance (APR = 1.38, 95 %CI 1.22-1.56) were positively associated with a Pap test. Among US women, insurance and marriage were associated (APR = 1.21, 95 %CI 1.05-1.38 and 1.33, 95 %CI 1.10-1.61, respectively), and women aged 20-34 years were about 25 % more likely to have received a test than older women. Insurance and marriage were also positively associated with Pap testing among Mexican women (APR = 1.39, 95 %CI 1.17-1.64 and 1.50; 95 %CI 1.23-1.82, respectively), as were lower levels of education (≤8th grade or 9th-12th grade versus some college) (APR = 1.74; 95 %CI 1.21-2.52 and 1.60; 95 %CI 1.03-2.49, respectively). Marriage and insurance were associated with a recent Pap test on both sides of the border. Binational insurance coverage increases and/or cost reductions might bolster testing among unmarried and uninsured women, leading to earlier cervical cancer diagnosis and potentially lower mortality. |
Two functional reticulocyte binding-like (RBL) invasion ligands of zoonotic Plasmodium knowlesi exhibit differential adhesion to monkey and human erythrocytes
Semenya AA , Tran TM , Meyer EV , Barnwell JW , Galinski MR . Malar J 2012 11 228 BACKGROUND: Plasmodium knowlesi is a monkey malaria species that is becoming a serious public health concern infecting hundreds and perhaps thousands of humans in Southeast Asia. Invasion of erythrocytes by merozoites entails a cascade of molecular interactions. One step involves the adhesion of Plasmodium reticulocyte binding-like (RBL) proteins. Plasmodium knowlesi merozoites express only two RBL invasion ligands, known as Normocyte Binding Proteins (PkNBPXa and PkNBPXb). METHODS: Overlapping N-terminal regions of PkNBPXa and PkNBPXb were expressed in COS7 cells and tested for surface expression and adhesion to rhesus monkey erythrocytes. Subsequent tests to study specific receptor ligand interactions included adhesion to a panel of human and non-human primate erythrocytes, enzymatic treatment, and site directed mutagenesis. RESULTS: An N-terminal cysteine-rich region of PkNBPXb (PkNBPXb-II) exhibited specific adhesion to rhesus monkey erythrocytes. Mutation of four of five cysteines in PkNBPXb-II interfered with its surface expression on COS7 cells, suggesting disulphide bond conformation is critical for intracellular trafficking. Binding of PkNBPXb-II was abolished when rhesus erythrocytes were pre-treated with chymotrypsin, but not trypsin or neuraminidase. PkNBPXb-II also bound other Old World monkey species and gibbon erythrocytes. However, erythrocytes from other primate species including humans did not bind to PkNBPXb-II or native PkNBPXb. Importantly, unlike PkNBPXb, PkNBPXa bound human erythrocytes, and this binding was independent of the Duffy blood group determinant. CONCLUSIONS: The data reported here begins to clarify the functional domains of the P. knowlesi RBLs. A binding domain has been identified and characterized in PkNBPXb. Notably, this study demonstrates that unlike PkNBPXb, PkNBPXa can bind to human erythrocytes, suggesting that PkNBPXa may function as a ligand to enable the invasion of P. knowlesi merozoites into human cells. |
"What took you so long?" The impact of PEPFAR on the expansion of HIV testing and counseling services in Africa
Marum E , Taegtmeyer M , Parekh B , Mugo N , Lembariti S , Phiri M , Moore J , Cheng AS . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S63-9 HIV testing and counseling services in Africa began in the early 1990s, with limited availability and coverage. Fears of stigma and discrimination, complex laboratory systems, and lack of available care and treatment services hampered expansion. Use of rapid point-of-care tests, introduction of services to prevent mother-to-child transmission, and increasing provision of antiretroviral drugs were key events in the late 1990s and early 2000s that facilitated the expansion of HIV testing and counseling services. Innovations in service delivery included providing HIV testing in both clinical and community sites, including mobile and home testing. Promotional campaigns were conducted in many countries, and evolutions in policies and guidance facilitated expansion and uptake. Support from President's Emergency Plan for AIDS Relief and national governments, other donors, and the Global Fund for AIDS, Tuberculosis, and Malaria contributed to significant increases in the numbers of persons tested in many countries. Quality of both testing and counseling, limited number of health care workers, uptake by couples, and effectiveness of linkages and referral systems remain challenges. Expansion of antiretroviral treatment, especially in light of the evidence that treatment contributes to prevention of transmission, will require greater yet strategic coverage of testing services, especially in clinical settings and in combination with other high-impact HIV prevention strategies. Continued support from President's Emergency Plan for AIDS Relief, governments, and other donors is required for the expansion of testing needed to achieve international targets for the scale-up of treatment and universal access to knowledge of HIV status. |
Evaluation of a toolkit to introduce standing orders for influenza and pneumococcal vaccination in adults: a multimodal pilot project
Nowalk MP , Nutini J , Raymund M , Ahmed F , Albert SM , Zimmerman RK . Vaccine 2012 30 (41) 5978-82 BACKGROUND: Immunization of adults with influenza vaccine and pneumococcal polysaccharide vaccine remains lower than recommended levels. Standing order programs (SOPs) in which non-physician medical personnel are permitted to assess an adult patient's immunization status and administer vaccines without an individual physician order are a proven method of increasing adult vaccinations, yet they are used by less than one half of primary care physicians caring for adults. METHODS: Following a national survey of primary care physicians about barriers to SOPs for adult immunizations, a SOP toolkit was developed. After review by a panel of experts, the toolkit was pilot tested in three primary care practices in a health care network with the same electronic medical record (EMR) system and low adult vaccination rates. Practice staffs were trained in the use of SOPs and the toolkit at a group meeting. This study was designed to pilot-test and evaluate the toolkit with the express intention of improving it. Three methods were used to evaluate the toolkit: (1) direct observation and interviews of each practice's staff; (2) surveys of each practice's staff; and (3) influenza and pneumococcal polysaccharide vaccine (PPV) vaccination rates. RESULTS: The staffs at all sites were equally likely to find the presentations and toolkit useful and did not differ in their knowledge of using SOPs for vaccination. They expressed a common set of barriers to implementing SOPs despite using the toolkit, and provided ideas for improving implementation. One site viewed SOPs in general in a more negative light and expressed that SOPs unfairly increased their workload. Vaccination rates in this site did not differ from those of the control site. CONCLUSION: The evaluation suggested that the SOP toolkit should be expanded to include additional strategies to improve its applicability and effectiveness. |
Formal theory versus stakeholder theory: new insights from a tobacco-focused prevention program evaluation
Chen HT , Turner NC . Am J Eval 2012 33 (3) 395-413 Health promotion and social betterment program interventions are based on either formal theory from academia or stakeholder theory from stakeholders' observations and experiences in working with clients. Over time, formal theory-based interventions have acquired high prestige, while stakeholder theory-based interventions have been held in low esteem. Here we examine the assumption that formal theory-based interventions are superior to stakeholder-based interventions in addressing community problems. The article elaborates on these ideas via a case study of a community-based, environmental tobacco smoke prevention program evaluation. The authors conclude that although both types of interventions had their strengths and limitations in the real world, the stakeholder theory-based intervention was more viable and effective than the formal theory-based intervention in this case due to implementation reasons. Findings are useful in understanding these two intervention types, in developing better strategies to address community problems, and in advancing program theory and theory-driven evaluation. |
An analysis of content in comprehensive cancer control plans that address chronic hepatitis B and C virus infections as major risk factors for liver cancer
Momin B , Richardson L . J Community Health 2012 37 (4) 912-6 Chronic hepatitis B and hepatitis C virus (HBV and HCV) infections are among the leading causes of preventable death worldwide. Chronic viral hepatitis is the cause of most primary liver cancer, which is the third leading cause of cancer deaths globally and the ninth leading cause of cancer deaths in the United States. The extent to which comprehensive cancer control (CCC) programs in states, tribal governments and organizations, territories, and Pacific Island jurisdictions address chronic hepatitis B and/or hepatitis C infections as risk factors for liver cancer or recommend interventions for liver cancer prevention in their CCC plans remains unknown. We searched CCC plans for this information using the search tool at http://www.cdc.gov/cancer/ncccp/ to access the content of plans for this information. A combination of key search terms including "liver cancer", "hepatitis", "chronic alcohol", and "alcohol abuse" were used to identify potential content regarding liver cancer risk factors and prevention. Relevant content was abstracted for further review and classification. Of 66 (Although CDC funds 65 programs, one of the Pacific Island Jurisdiction grantees is the Federated States of Micronesia (FSM). This national program supports four FSM states, each of which submits a cancer plan to CDC for a total of 69 plans. During this time period, 66 plans were available on the website.) CCC plans, 27% (n = 18) addressed liver cancer using the above-mentioned search terms. In the 23 plans that addressed HBV and/or HCV, there were 25 goals, objectives, strategies, and outcomes aimed at reducing the incidence or prevalence of HBV and/or HCV infection. While nearly a third of CCC programs identify at least one goal, objective, strategy, outcome, or prevention program to reduce cancer burden in their CCC plans, few plans discuss specific actions needed to reduce the burden of liver cancer. |
Beyond indicators: advances in global HIV monitoring and evaluation during the PEPFAR era
Porter LE , Bouey PD , Curtis S , Hochgesang M , Idele P , Jefferson B , Lemma W , Myrick R , Nuwagaba-Biribonwoha H , Prybylski D , Souteyrand Y , Tulli T . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S120-6 Monitoring and evaluation (M&E) is fundamental to global HIV program implementation and has been a cornerstone of the President's Emergency Plan for AIDS Relief (PEPFAR). Rapid results were crucial to demonstrating feasibility and scalability of HIV care and treatment services early in PEPFAR. When national HIV M&E systems were nascent, the rapid influx of funds and the emergency expansion of HIV services contributed to the development of uncoordinated "parallel" information systems to serve donor demands for information. Close collaboration of PEPFAR with multilateral and national partners improved harmonization of indicators, standards, methods, tools, and reports. Concurrent PEPFAR investments in surveillance, surveys, program monitoring, health information systems, and human capacity development began to show signs of progress toward sustainable country-owned systems. Awareness of the need for and usefulness of data increased, far beyond discussions of indicators and reporting. Emphasis has turned toward ensuring the quality of data and using available data to improve the quality of care. Assessing progress toward an AIDS-free generation requires that the global community can measure the reduction of new HIV infections in children and adults and monitor the coverage, quality, and outcomes of highly efficacious interventions in combination. Building national M&E systems requires sustained efforts over long periods of time with effective leadership and coordination. PEPFAR, in close collaboration with its global and national partners, is well positioned to transform the successes and challenges associated with early rapid scale-up into future opportunities for sustainable, cost-effective, country-owned programs and systems. |
Voluntary medical male circumcision: an HIV prevention priority for PEPFAR
Reed JB , Njeuhmeli E , Thomas AG , Bacon MC , Bailey R , Cherutich P , Curran K , Dickson K , Farley T , Hankins C , Hatzold K , Justman J , Mwandi Z , Nkinsi L , Ridzon R , Ryan C , Bock N . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S88-95 As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. |
Smoking and health-related quality of life among U.S. adolescents
Dube SR , Thompson W , Homa DM , Zack MM . Nicotine Tob Res 2012 15 (2) 492-500 OBJECTIVE: Smoking continues to be a public health problem among youth. Developmentally, adolescence is a period marked by the vulnerability to initiate risk behaviors such as smoking. While studies have documented associations between smoking and poor health related quality of life (HRQOL) among adults, little is known about the association among adolescents. METHODS: Data on smoking and HRQOL from a sample of 4,848 adolescents aged 12-17 years from the 2001-2008 National Health and Nutrition Examination Surveys were analyzed. Smoking status (current, not current, and never) was determined using self-report data and serum cotinine levels. HRQOL was assessed based on self-reported physical and mental health in the last 30 days, activity limitations in the last 30 days, and general self-rated health. RESULTS: Compared with never smokers, adolescents who ever smoked reported more recent physically unhealthy days (p < .001), mentally unhealthy days (p < .0001), and activity limitation days (p < .01). Compared with never smokers, adolescents who ever smoked or who were current smokers were more likely to report ≥14 physically unhealthy days, ≥14 mentally unhealthy, ≥14 activity limitation days, and fair or poor health; not current smokers were also more likely than never smokers to report ≥14 days for being both physically unhealthy and mentally unhealthy. CONCLUSIONS: Among a nationally representative sample of adolescents, this study found strong associations between smoking and HRQOL measures. The relationship of smoking to self-reported activity limitations warrants attention and further research. The findings underscore the importance of addressing smoking and subjective well-being early in the lifespan. |
Identity and public health potential of Cryptosporidium spp. in water buffalo calves in Egypt
Amer S , Zidan S , Feng Y , Adamu H , Li N , Xiao L . Vet Parasitol 2012 191 123-7 Little is known about the diversity and public health significance of Cryptosporidium species in water buffaloes. In this study, we examined the distribution of Cryptosporidium spp. in water buffalo calves in Egypt. Rectal fecal specimens from 179 calves and 359 adults were screened microscopically for Cryptosporidium oocysts using modified Ziehl-Neelsen stain. Cryptosporidium spp. in 17 microscopy-positive specimens from calves were genotyped by DNA sequence analysis of the small-subunit rRNA gene, and Cryptosporidium parvum was subtyped by sequence analysis of the 60kDa glycoprotein gene. Cryptosporidium ryanae was found in 10 specimens and C. parvum in 7 specimens, with the former belonging to the newly identified C. ryanae buffalo variant and the latter belonging to the subtypes IIdA20G1 (in 5 specimens) and IIaA15G1R1 (in 2 specimens). The prevailing occurrence of C. ryanae and the subtype family IId of C. parvum and the absence of C. bovis and C. andersoni represent some features of Cryptosporidium transmission in water buffaloes in Egypt. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Behavior and Risk
- Health Communication and Education
- Immunity and Immunization
- Informatics
- Laboratory Sciences
- Maternal and Child Health
- Parasitic Diseases
- Program Evaluation
- Public Health Leadership and Management
- Substance Use and Abuse
- Veterinary Medicine
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure