Availability of the National Diabetes Prevention Program in United States counties, March 2017
Jayapaul-Philip B , Dai S , Kirtland K , Haslam A , Nhim K . Prev Chronic Dis 2018 15 E109 In the United States, 84.1 million adults are estimated to have prediabetes, a serious health condition in which blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes (1). Prediabetes increases the risk for type 2 diabetes, heart disease, and stroke (1). Through the Centers for Disease Control and Prevention (CDC)-led National Diabetes Prevention Program (National DPP), people with prediabetes can learn to make practical, real-life changes that can reduce their risk for developing type 2 diabetes by as much as 58% (71% for people aged ≥60 years) (1). CDC is working to expand the lifestyle change program (LCP) across the country, via the National DPP (2). Given the large number of people affected by prediabetes, CDC has several efforts to increase the availability of the National DPP LCP including Cooperative Agreements such as “Scaling the National Diabetes Prevention Program in Underserved Areas” (DP17-1705). We assessed the presence of publicly available in-person LCP classes, as of March 1, 2017, by diabetes incidence and socioeconomic status at the county level, because higher diabetes incidence and lower socioeconomic status are correlated (3) and may be useful in targeting type 2 diabetes prevention efforts. Organizations wanting to expand the availability of the LCP may use these maps to determine counties most in need of new programs. |
Effectiveness of clinical decision support based intervention in the improvement of care for adult sickle cell disease patients in primary care
Mainous AG3rd , Carek PJ , Lynch K , Tanner RJ , Hulihan MM , Baskin J , Coates TD . J Am Board Fam Med 2018 31 (5) 812-816 INTRODUCTION: Although most patients with rare diseases like sickle cell disease (SCD) are treated in the primary care setting, primary care physicians may find it challenging to keep abreast of medication improvements and complications associated with treatment for rare and complex diseases. The purpose of this study was to evaluate the effectiveness of a clinical decision support (CDS) -based intervention system for transfusional iron overload in adults with SCD to improve management in primary care. METHODS: An electronic medical record based clinical decision support system for potential transfusional iron overload in SCD patients in primary care was evaluated. The intervention was implemented in 3 family medicine clinics with a control group of 3 general internal medicine clinics. Data were collected in the 6 months before the intervention and 6 months after the intervention. There were 47 patients in the family medicine group and 24 in the general internal medicine group. RESULTS: There was no management change in the control group while the intervention group improved primary care management from 0% to 44% (P < .001). CONCLUSION: A CDS tool can improve management of SCD patients in primary care. |
Mean mid-arm circumference and blood pressure cuff sizes for US children, adolescents and adults: National Health and Nutrition Examination Survey, 2011-2016
Ostchega Y , Hughes JP , Nwankwo T , Zhang G . Blood Press Monit 2018 23 (6) 305-311 BACKGROUND: Measuring blood pressure (BP) requires an appropriate BP cuff size given measured mid-arm circumference (mid-AC). OBJECTIVE: To provide mid-AC means and percentiles for US population aged more than 3 years and examine the frequency distribution of mid-AC cuffed by Baum and Welch Allyn cuff systems. PATIENTS AND METHODS: The 2011-2016 National Health and Nutrition Examination Survey, a cross-sectional survey, was used to estimate mean mid-AC (n=24 723). RESULTS: Mean mid-AC did not differ from 2011 to 2016 (31.0 vs. 31.3 cm, P>0.05). During 2011-2016, mean mid-AC was greater for males than females (32.0 vs. 30.4 cm, P<0.001) and was largest among adults 40-49 years (34.0 cm). Non-Hispanic Black persons had the largest mean mid-AC (32.0 cm) and non-Hispanic Asian persons the smallest (28.4 cm). Increased BMI was associated with increased mean mid-AC for those 3-19 years (normal, 22.0 cm and obese, 31.5 cm, P<0.001) and more than 20 years (normal, 28.2 cm and obese, 37.8 cm, P<0.001). Among those aged 8-17 years, high BP status was associated with a larger mean mid-AC (normotensive 26.1 cm vs. high BP 28.2 cm, P=0.001). Among adults aged 18 years and older, hypertension status was associated with a larger mean mid-AC (normotensive 32.4 cm vs. hypertensive 34.2 cm, P<0.001). Among those aged 12-19 years, 13.0% required a Baum large cuff (35-46.9 cm mid-AC) and 21.7% required a Welch Allyn large cuff (32-39.9 cm mid-AC). Among those aged more than 20 years, 33.2% required a Baum large cuff, 48.2% required a Welch Allyn large cuff, 1.3% required a Baum extra-large cuff (44-66 cm mid-AC), and 9.5% required a Welch Allyn extra-large cuff (40-55 cm mid-AC). CONCLUSION: Currently, BP is obtained in clinic, pharmacy, home, and ambulatory setting using single or multiple cuffs. National Health and Nutrition Examination Survey mid-AC data should be considered for accurate cuffing avoiding cuff hypertension or hypotension. |
Million Hearts 2022: Small steps are needed for cardiovascular disease prevention
Wright JS , Wall HK , Ritchey MD . JAMA 2018 320 (18) 1857-1858 Despite decades-long improvement, recent evidence suggests that rates of myocardial infarction, stroke, and other cardiovascular disease (CVD) events have plateaued and are increasing among certain groups, including adults aged 35 to 64 years.1,2 These events are common, costly, and largely preventable. Million Hearts, a national initiative co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), was launched in 2012 with a 5-year aim to prevent 1 million acute cardiovascular events by improving key CVD risk factors. Projections using 2012–2014 data suggest that an estimated 500 000 events may have been prevented by 2016,3 although improvement in risk factors was slow. To accelerate progress, Million Hearts 2022 began in 2017 with new and refreshed partnerships and a strengthened framework. This Viewpoint reflects 2 recent CDC reports that together highlight the challenges and opportunities to improve the nation’s cardiovascular health. |
Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline
Ritchey MD , Gillespie C , Wozniak G , Shay CM , Thompson-Paul AM , Loustalot F , Hong Y . J Clin Hypertens (Greenwich) 2018 20 (10) 1377-1391 Application of the 2017 ACC/AHA Hypertension Guideline expands the number of US adults requiring blood pressure (BP) management. The authors use 2011-2014 NHANES data to describe the population groups most affected by the new guideline, compared with the previous JNC-7 guideline, and describe the previous interaction with the health care sector among those adults recommended new or intensified pharmacologic treatment and/or lifestyle modification. The 2017 Hypertension Guideline reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment of 133.7 million adults, including 57.8 million with uncontrolled BP recommended to initiate or intensify pharmacologic treatment and 50.5 million newly recommended lifestyle modification alone. An estimated 13.1 million (22.7%) adults recommended to initiate or intensify pharmacologic treatment, and 20.6 million (40.8%) adults newly recommended lifestyle modification alone report not having established health care linkages. Among the adults newly recommended lifestyle modification alone, the odds of reclassification from no recommended intervention, under JNC-7, to recommended lifestyle modification alone were lower for adults with established linkages to care (aOR: 0.78 [95% CI: 0.67-0.91]) compared to those without, decreased with increasing age, were greater for men (1.72 [1.52-1.94]) compared to women and were greater for obese adults (1.23 [1.00-1.53]) compared with normal or underweight adults. Application of the 2017 Hypertension Guideline increases the number and alters the distribution of US adults in need of initiating or intensifying BP treatment. This includes identifying millions of US adults who previously had limited interaction with health care and are now recommended new or intensified pharmacologic treatment and/or lifestyle modification. |
Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016
Dahlhamer J , Lucas J , Zelaya C , Nahin R , Mackey S , DeBar L , Kerns R , Von Korff M , Porter L , Helmick C . MMWR Morb Mortal Wkly Rep 2018 67 (36) 1001-1006 Chronic pain, one of the most common reasons adults seek medical care (1), has been linked to restrictions in mobility and daily activities (2,3), dependence on opioids (4), anxiety and depression (2), and poor perceived health or reduced quality of life (2,3). Population-based estimates of chronic pain among U.S. adults range from 11% to 40% (5), with considerable population subgroup variation. As a result, the 2016 National Pain Strategy called for more precise prevalence estimates of chronic pain and high-impact chronic pain (i.e., chronic pain that frequently limits life or work activities) to reliably establish the prevalence of chronic pain and aid in the development and implementation of population-wide pain interventions (5). National estimates of high-impact chronic pain can help differentiate persons with limitations in major life domains, including work, social, recreational, and self-care activities from those who maintain normal life activities despite chronic pain, providing a better understanding of the population in need of pain services. To estimate the prevalence of chronic pain and high-impact chronic pain in the United States, CDC analyzed 2016 National Health Interview Survey (NHIS) data. An estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalences of both chronic pain and high-impact chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents. These findings could be used to target pain management interventions. |
Low case finding among men and poor viral load suppression among adolescents are impeding Namibia's ability to achieve UNAIDS 90-90-90 Targets
Agolory S , de Klerk M , Baughman AL , Sawadogo S , Mutenda N , Pentikainen N , Shoopala N , Wolkon A , Taffa N , Mutandi G , Jonas A , Mengistu AT , Dzinotyiweyi E , Prybylski D , Hamunime N , Medley A . Open Forum Infect Dis 2018 5 (9) ofy200 Background: In 2015, Namibia implemented an Acceleration Plan to address the high burden of HIV (13.0% adult prevalence and 216 311 people living with HIV [PLHIV]) and achieve the UNAIDS 90-90-90 targets by 2020. We provide an update on Namibia's overall progress toward achieving these targets and estimate the percent reduction in HIV incidence since 2010. Methods: Data sources include the 2013 Namibia Demographic and Health Survey (2013 NDHS), the national electronic patient monitoring system, and laboratory data from the Namibian Institute of Pathology. These sources were used to estimate (1) the percentage of PLHIV who know their HIV status, (2) the percentage of PLHIV on antiretroviral therapy (ART), (3) the percentage of patients on ART with suppressed viral loads, and (4) the percent reduction in HIV incidence. Results: In the 2013 NDHS, knowledge of HIV status was higher among HIV-positive women 91.8% (95% confidence interval [CI], 89.4%-93.7%) than HIV-positive men 82.5% (95% CI, 78.1%-86.1%). At the end of 2016, an estimated 88.3% (95% CI, 86.3%-90.1%) of PLHIV knew their status, and 165 939 (76.7%) PLHIV were active on ART. The viral load suppression rate among those on ART was 87%, and it was highest among >/=20-year-olds (90%) and lowest among 15-19-year-olds (68%). HIV incidence has declined by 21% since 2010. Conclusions: With 76.7% of PLHIV on ART and 87% of those on ART virally suppressed, Namibia is on track to achieve UNAIDS 90-90-90 targets by 2020. Innovative strategies are needed to improve HIV case identification among men and adherence to ART among youth. |
Notes from the Field: Enterovirus A71 neurologic disease in children - Colorado, 2018
Messacar K , Burakoff A , Nix WA , Rogers S , Oberste MS , Gerber SI , Spence-Davizon E , Herlihy R , Dominguez SR . MMWR Morb Mortal Wkly Rep 2018 67 (36) 1017-1018 On May 10, 2018, the Colorado Department of Public Health and Environment (CDPHE) was notified by Children’s Hospital Colorado (CHCO) of an increase in pediatric cases of meningitis and encephalitis in which patients tested positive for enterovirus (EV). CDPHE surveillance data for May 2018 showed a 2.75-fold increase in encephalitis of unknown etiology compared with the 5-year (May 2013–2017) average; this coincided with a threefold rise in enterovirus/rhinovirus (EV/RV) detections from clinical testing at CHCO during the same period. Specimens from children with neurologic disease were tested by EV reverse transcription–polymerase chain reaction (RT-PCR) at CHCO and VP1 sequencing at CDC (1). As of August 26, 2018, EV-A71 was identified in 34 children with neurologic disease. This report describes the clinical, laboratory, and radiologic findings for the first 13 children identified with EV-A71 neurologic disease for whom complete information is available. |
Sexual risk behavior differences among sexual minority high school students - United States, 2015 and 2017
Rasberry CN , Lowry R , Johns M , Robin L , Dunville R , Pampati S , Dittus PJ , Balaji A . MMWR Morb Mortal Wkly Rep 2018 67 (36) 1007-1011 Sexual minority youths (i.e., those identifying as gay, lesbian, bisexual, or another nonheterosexual identity or reporting same-sex attraction or sexual partners) are at higher risk than youths who are not sexual minority youth (nonsexual minority youth) for negative health behaviors and outcomes, including human immunodeficiency virus (HIV) infection, other sexually transmitted diseases (STDs), pregnancy (1),* and related sexual risk behaviors (2). Less is known about sexual risk behavior differences between sexual minority youth subgroups. This is the first analysis of subgroup differences among sexual minority youths using nationally representative Youth Risk Behavior Survey (YRBS) data. CDC analyzed pooled data from the 2015 and 2017 cycles of the national YRBS, a cross-sectional, school-based survey assessing health behaviors among U.S. students in grades 9-12. Analyses examined differences in eight sexual risk behaviors between subgroups of sexual minority youths and nonsexual minority youths, as well as within sexual minority youths. Logistic regression models controlling for race/ethnicity and grade found that bisexual females and "not sure" males reported higher prevalences for many behaviors than did heterosexual students. For behavior-based subgroups, the largest number of differences were seen between students who had sexual contact with both sexes compared with students with only opposite-sex sexual contact. Findings highlight subgroup differences within sexual minority youths that could inform interventions to promote healthy behavior. |
A step forward in the treatment of influenza
Uyeki TM . N Engl J Med 2018 379 (10) 975-977 For many years, antiviral treatment of influenza has consisted of monotherapy with a neuraminidase inhibitor. The Food and Drug Administration (FDA) approved the neuraminidase inhibitors oseltamivir (oral administration) and zanamivir (oral inhalation) in 1999 and peramivir (intravenous administration) in late 2014. These drugs work by binding to the viral neuraminidase protein and interfering with the release of influenza virus particles from infected respiratory tract cells. Neuraminidase inhibitors are FDA-approved for the treatment of uncomplicated influenza within 2 days after onset in outpatients, on the basis of randomized, controlled trials, but they are also recommended for the treatment of patients with severe influenza, including hospitalized patients, by the Centers for Disease Control and Prevention and the World Health Organization.1,2 The adamantane antiviral drugs (amantadine and rimantadine) are approved for the treatment of influenza A virus infections but are not recommended, owing to a high prevalence of adamantane resistance among circulating influenza A viruses.1 |
Vulnerabilities associated with post-disaster declines in HIV-testing: Decomposing the impact of Hurricane Sandy
Thomas E , Ekperi L , LeBlanc TT , Adams EE , Wilt GE , Molinari NA , Carbone EG . PLoS Curr 2018 10 Introduction: Using Interrupted Time Series Analysis and generalized estimating equations, this study identifies factors that influence the size and significance of Hurricane Sandy's estimated impact on HIV testing in 90 core-based statistical areas from January 1, 2011 to December 31, 2013. Methods: Generalized estimating equations were used to examine the effects of sociodemographic and storm-related variables on relative change in HIV testing resulting from Interrupted Time Series analyses. Results: There is a significant negative relationship between HIV prevalence and the relative change in testing at all time periods. A one unit increase in HIV prevalence corresponds to a 35% decrease in relative testing the week of the storm and a 14% decrease in relative testing at week twelve. Building loss was also negatively associated with relative change for all time points. For example, a one unit increase in building loss at week 0 corresponds with an 8% decrease in the relative change in testing (p=0.0001) and a 2% at week twelve (p=0.001). Discussion: Our results demonstrate that HIV testing can be negatively affected during public health emergencies. Communities with high percentages of building loss and significant HIV disease burden should prioritize resumption of testing to support HIV prevention. |
Association of prenatal urinary concentrations of phthalates and bisphenol A and pubertal timing in boys and girls
Berger K , Eskenazi B , Kogut K , Parra K , Lustig RH , Greenspan LC , Holland N , Calafat AM , Ye X , Harley KG . Environ Health Perspect 2018 126 (9) 97004 BACKGROUND: Animal studies suggest that phthalates and bisphenol A (BPA), endocrine-disrupting chemicals found in many consumer products, may impact the timing of puberty. OBJECTIVES: We aimed to determine the association of prenatal exposure to high-molecular-weight phthalates and BPA with pubertal timing in boys and girls participating in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) longitudinal cohort study. METHODS: We quantified urinary concentrations of eight phthalate metabolites and BPA at two time points during pregnancy among participating mothers ([Formula: see text]) and conducted clinical Tanner staging of puberty on their children every 9 months between 9 and 13 y of age. We conducted accelerated failure time models and examined the role of child overweight/obese status in this association. RESULTS: The sum of urinary metabolites of di(2-ethylhexyl) phthalate [Formula: see text], monobenzyl phthalate (MBzP), and BPA were associated with later onset of at least one of the three outcomes assessed in girls (thelarche, pubarche, or menarche) and with earlier onset of at least one of the two outcomes assessed in boys (gondarche and pubarche). We found that monocarboxynonyl phthalate, monocarboxyoctyl phthalate, mono(3-carboxypropyl) phthalate, and BPA were associated with later pubarche and menarche mostly among normal-weight girls but not overweight/obese girls. MBzP was associated with later thelarche in all girls, and [Formula: see text] was associated with later thelarche and menarche in all girls. BPA and all phthalate biomarkers were associated with earlier gonadarche and pubarche in all boys as well as in overweight/obese boys when stratified by weight. Among normal-weight boys, associations with BPA were also inverse, whereas associations with phthalate metabolites were close to the null or positive. CONCLUSIONS: Several high-molecular-weight phthalates and BPA were associated with later puberty in girls and earlier puberty in boys included in the CHAMACOS cohort study. Childhood overweight/obesity may modify these associations. https://doi.org/10.1289/EHP3424. |
Public health agency responses and opportunities to protect against health impacts of climate change among US populations with multiple vulnerabilities
Hutchins SS , Bouye K , Luber G , Briseno L , Hunter C , Corso L . J Racial Ethn Health Disparities 2018 5 (6) 1159-1170 During the past several decades, unprecedented global changes in climate have given rise to an increase in extreme weather and other climate events and their consequences such as heavy rainfall, hurricanes, flooding, heat waves, wildfires, and air pollution. These climate effects have direct impacts on human health such as premature death, injuries, exacerbation of health conditions, disruption of mental well-being, as well as indirect impacts through food- and water-related infections and illnesses. While all populations are at risk for these adverse health outcomes, some populations are at greater risk because of multiple vulnerabilities resulting from increased exposure to risk-prone areas, increased sensitivity due to underlying health conditions, and limited adaptive capacity primarily because of a lack of economic resources to respond adequately. We discuss current governmental public health responses and their future opportunities to improve resilience of special populations at greatest risk for adverse health outcomes. Vulnerability assessment, adaptation plans, public health emergency response, and public health agency accreditation are all current governmental public health actions. Governmental public health opportunities include integration of these current responses with health equity initiatives and programs in communities. |
Prevalence and Molecular Characteristics of Clostridium difficile in Retail Meats, Food-Producing and Companion Animals, and Humans in Minnesota.
Shaughnessy MK , Snider T , Sepulveda R , Boxrud D , Cebelinski E , Jawahir S , Holzbauer S , Johnston BD , Smith K , Bender JB , Thuras P , Diez-Gonzalez F , Johnson JR . J Food Prot 2018 81 (10) 1635-1642 Community-associated Clostridium difficile infection (CA-CDI) now accounts for approximately 50% of CDI cases in central Minnesota; animals and meat products are potential sources. From November 2011 to July 2013, we cultured retail meat products and fecal samples from food-producing and companion animals in central Minnesota for C. difficile by using standard methods. The resulting 51 C. difficile isolates, plus 30 archived local veterinary C. difficile isolates and 208 human CA-CDI case isolates from central Minnesota (from 2012) from the Minnesota Department of Health, were characterized molecularly, and source groups were compared using discriminant analysis. C. difficile was recovered from 0 (0%) of 342 retail meat samples and 51 (9%) of 559 animal fecal samples. Overall, the 81 animal source isolates and 208 human source isolates were highly diverse genetically. Molecular traits segregated extensively in relation to animal versus human origin. Discriminant analysis classified 95% of isolates correctly by source group; only five (2.5%) human source isolates were classified as animal source. These data do not support meat products or food-producing and companion animals as important sources of CA-CDI in the central Minnesota study region. |
Chicken liver-associated outbreaks of campylobacteriosis and salmonellosis, United States, 2000-2016: Identifying opportunities for prevention
Lanier WA , Hale KR , Geissler AL , Dewey-Mattia D . Foodborne Pathog Dis 2018 15 (11) 726-733 Chicken liver has been implicated in several reported U.S. illness outbreaks, probably caused by inadequate cooking and pathogen contamination. To identify commonalities among these outbreaks that could represent targets for prevention, we describe chicken liver-associated U.S. outbreaks during 2000-2016 reported to the Food Safety and Inspection Service, to the Centers for Disease Control and Prevention, and in published literature. We identified 28 outbreaks (23 [82.1%] were campylobacteriosis only, 3 [10.7%] were salmonellosis only, and 2 [7.1%] were caused by both pathogens), with 18 (64.3%) occurring during 2014-2016. Common outbreak features included blended chicken liver dishes (e.g., pate; 24 [85.7%]), inadequate cooking (26 [92.8%]), and preparation in foodservice settings (e.g., sit-down restaurants; 25 [89.3%]). The increasing frequency of reported outbreaks highlights chicken liver as an important food safety problem. Public health partners should collaborate on prevention measures, including education on proper foodservice preparation of blended chicken liver dishes. |
HLBS-PopOmics: an online knowledge base to accelerate dissemination and implementation of research advances in population genomics to reduce the burden of heart, lung, blood, and sleep disorders.
Mensah GA , Yu W , Barfield WL , Clyne M , Engelgau MM , Khoury MJ . Genet Med 2018 21 (3) 519-524 Recent dramatic advances in multiomics research coupled with exponentially increasing volume, complexity, and interdisciplinary nature of publications are making it challenging for scientists to stay up-to-date on the literature. Strategies to address this challenge include the creation of online databases and warehouses to support timely and targeted dissemination of research findings. Although most of the early examples have been in cancer genomics and pharmacogenomics, the approaches used can be adapted to support investigators in heart, lung, blood, and sleep (HLBS) disorders research. In this article, we describe the creation of an HLBS population genomics (HLBS-PopOmics) knowledge base as an online, continuously updated, searchable database to support the dissemination and implementation of studies and resources that are relevant to clinical and public health practice. In addition to targeted searches based on the HLBS disease categories, cross-cutting themes reflecting the ethical, legal, and social implications of genomics research; systematic evidence reviews; and clinical practice guidelines supporting screening, detection, evaluation, and treatment are also emphasized in HLBS-PopOmics. Future updates of the knowledge base will include additional emphasis on transcriptomics, proteomics, metabolomics, and other omics research; explore opportunities for leveraging data sets designed to support scientific discovery; and incorporate advanced machine learning bioinformatics capabilities. |
High-quality health systems in the Sustainable Development Goals era: time for a revolution
Kruk ME , Gage AD , Arsenault C , Jordan K , Leslie HH , Roder-DeWan S , Adeyi O , Barker P , Daelmans B , Doubova SV , English M , Elorrio EG , Guanais F , Gureje O , Hirschhorn LR , Jiang L , Kelley E , Lemango ET , Liljestrand J , Malata A , Marchant T , Matsoso MP , Meara JG , Mohanan M , Ndiaye Y , Norheim OF , Reddy KS , Rowe AK , Salomon JA , Thapa G , Twum-Danso NAY , Pate M . Lancet Glob Health 2018 6 (11) e1196-e1252 Although health outcomes have improved in low-income and middle-income countries (LMICs) in the past several decades, a new reality is at hand. Changing health needs, growing public expectations, and ambitious new health goals are raising the bar for health systems to produce better health outcomes and greater social value. But staying on current trajectory will not suffice to meet these demands. What is needed are high-quality health systems that optimise health care in each given context by consistently delivering care that improves or maintains health, by being valued and trusted by all people, and by responding to changing population needs. Quality should not be the purview of the elite or an aspiration for some distant future; it should be the DNA of all health systems. Furthermore, the human right to health is meaningless without good quality care because health systems cannot improve health without it. |
Illness among US resident student travelers after return to the United States: A GeoSentinel Analysis, 2007-2017
Angelo KM , Haulman NJ , Terry AC , Leung DT , Chen LH , Barnett ED , Hagmann SHF , Hynes NA , Connor BA , Anderson S , McCarthy A , Shaw M , Van Genderen PJJ , Hamer DH . J Travel Med 2018 25 (1) BACKGROUND: The number of US students studying abroad more than tripled during the past 20 years. As study abroad programs' destinations diversify, students increasingly travel to resource-limited countries, placing them at risk for infectious diseases. Data describing infections acquired by US students while traveling internationally are limited. We describe illnesses among students who returned from international travel and suggest how to prevent illness among these travelers. METHODS: GeoSentinel is a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. This study included records of US resident student international travelers, 17-24 years old, who returned to the United States, had a confirmed travel-related illness at one of 15 US GeoSentinel sites during 2007-2017, and had a documented exposure region. Records were analyzed to describe demographic and travel characteristics and diagnoses. RESULTS: The study included 432 students. The median age was 21 years; 69% were female. More than 70% had a pre-travel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112; 26%). Students were most commonly exposed in India (44; 11%), Ecuador (28; 7%), Ghana (25; 6%), and China (24; 6%). The median duration of travel abroad was 40 days (range: 1-469) and presented to a GeoSentinel site a median of 8 days (range: 0-181) after travel; 98% were outpatients. Of 581 confirmed diagnoses, the most common diagnosis category was gastrointestinal (45%). Acute diarrhea was the most common gastrointestinal diagnosis (113 of 261; 43%). Thirty-one (7%) students had vector-borne diseases [14 (41%) malaria and 11 (32%) dengue]. Three had vaccine-preventable diseases (two typhoid; one hepatitis A); two had acute HIV. CONCLUSIONS: Students experienced travel-related infections, despite the majority having a pre-travel consultation. US students should receive pre-travel advice, vaccinations, and chemoprophylaxis to prevent gastrointestinal, vector-borne, sexually transmitted, and vaccine-preventable infections. |
Cost effectiveness of universal screening for HCV infection in the era of direct-acting, pangenotypic treatment regimens
Eckman MH , Ward JW , Sherman KE . Clin Gastroenterol Hepatol 2018 17 (5) 930-939 e9 BACKGROUND & AIMS: Most persons infected with hepatitis C virus (HCV) in the United States (US) were born from 1945 through 1965-testing is recommended for this cohort. However, HCV incidence is increasing among younger persons in many parts of the country and treatment is recommended for all adults with HCV infection. We aimed to estimate the cost effectiveness of universal 1-time screening for HCV infection in all adults living in the US and to determine the prevalence of HCV antibody above which HCV testing is cost-effective. METHODS: We developed a Markov state transition model to estimate the effects of universal, 1-time screening of adults 18 years or older in the US, compared with the current guideline-based strategy of screening adults born from 1945 through 1965. We compared potential outcomes of 1-time universal screening of adults or birth cohort screening followed by antiviral treatment of those with HCV infection vs no screening. We measured effectiveness with quality-adjusted life years (QALY), and costs with 2017 US dollars. RESULTS: Based on our model, universal 1-time screening of US residents with general population prevalence of HCV antibody greater than 0.07% cost less than $50,000/QALY compared with a strategy of no screening. Compared with 1-time birth cohort screening, universal 1-time screening and treatment cost $11,378/QALY gained. Universal screening was cost-effective compared with birth cohort screening when the prevalence of HCV antibody positivity was greater than 0.07% among adults not in the cohort born from 1945 through 1965. CONCLUSION: Using a Markov state transition model, we found a strategy of universal 1-time screening for chronic HCV infection to be cost-effective compared with either no screening or birth cohort-based screening alone. |
Estimation of direct healthcare costs of fungal diseases in the United States
Benedict K , Jackson BR , Chiller T , Beer KD . Clin Infect Dis 2018 68 (11) 1791-1797 Background: Fungal diseases range from relatively minor superficial and mucosal infections to severe, life-threatening systemic infections. Delayed diagnosis and treatment can lead to poor patient outcomes and high medical costs. The overall burden of fungal diseases in the United States is challenging to quantify because they are likely substantially underdiagnosed. Methods: To estimate total national direct medical costs associated with fungal diseases from a healthcare payer perspective, we used insurance claims data from the Truven Health MarketScan(R) 2014 Research Databases, combined with hospital discharge data from the 2014 Healthcare Cost and Utilization Project National Inpatient Sample and outpatient visit data from the 2005-2014 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. All costs were adjusted to 2017 dollars. Results: We estimate that fungal diseases cost more than $7.2 billion in 2017, including $4.5 billion from 75,055 hospitalizations and $2.6 billion from 8,993,230 outpatient visits. Hospitalizations for Candida infections (n=26,735, total cost $1.4 billion) and Aspergillus infections (n=14,820, total cost $1.2 billion) accounted for the highest total hospitalization costs of any disease. Over half of outpatient visits were for dermatophyte infections (4,981,444 visits, total cost $802 million), and 3,639,037 visits occurred for non-invasive candidiasis (total cost $1.6 billion). Conclusions: Fungal diseases impose a considerable economic burden on the healthcare system. Our results likely under-estimate their true costs because they are underdiagnosed. More comprehensive estimates of the public health impact of these diseases are needed to improve their recognition, prevention, diagnosis, and treatment. |
Medicaid coverage of guidelines-based asthma care across 50 states, the District of Columbia, and Puerto Rico, 2016-2017
Pruitt K , Yu A , Kaplan BM , Hsu J , Collins P . Prev Chronic Dis 2018 15 E110 Asthma affects more than 24 million Americans, including 6.2 million children. Although asthma cannot be cured, it can be effectively managed with care based on nationally recognized guidelines. Ensuring the availability and accessibility of guidelines-recommended treatments and services can help patients receive the most appropriate care. In this article, we describe the American Lung Association's Asthma Guidelines-Based Care Coverage Project (the Project) to determine the extent of asthma care coverage and associated barriers in state Medicaid programs - information that has been previously unavailable. The Project tracked coverage for 7 areas of guidelines-based asthma care and 9 barriers related to accessing care in Medicaid programs for all 50 states, the District of Columbia, and Puerto Rico. Results from the Project show a lack of consistent and comprehensive coverage across states, as well as coverage-related challenges to accessing asthma care within states. |
Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope.
Shenoy ES , Pierce VM , Walters MS , Moulton-Meissner H , Lawsin A , Lonsway D , Shugart A , McAllister G , Halpin AL , Zambrano-Gonzalez A , Ryan EE , Suslak D , DeJesus A , Barton K , Madoff LC , McHale E , DeMaria A , Hooper DC . Clin Infect Dis 2018 68 (8) 1327-1334 Background: Clinicians increasingly utilize polymyxins for treatment of serious infections caused by multidrug-resistant gram-negative bacteria. Emergence of plasmid-mediated, mobile colistin resistance genes creates potential for rapid spread of polymyxin resistance. We investigated the possible transmission of Klebsiella pneumoniae carrying mcr-1 via duodenoscope and report the first documented healthcare transmission of mcr-1-harboring bacteria in the United States. Methods: A field investigation, including screening targeted high-risk groups, evaluation of the duodenoscope, and genome sequencing of isolated organisms, was conducted. The study site included a tertiary care academic health center in Boston, Massachusetts, and extended to community locations in New England. Results: Two patients had highly related mcr-1-positive K. pneumoniae isolated from clinical cultures; a duodenoscope was the only identified epidemiological link. Screening tests for mcr-1 in 20 healthcare contacts and 2 household contacts were negative. K. pneumoniae and E. coli were recovered from the duodenoscope; neither carried mcr-1. Evaluation of the duodenoscope identified intrusion of biomaterial under the sealed distal cap; devices were recalled to repair this defect. Conclusions: We identified transmission of mcr-1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of an FDA-cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr-carrying bacteria in healthcare settings. |
Reactivation of Chagas disease among heart transplant recipients in the United States, 2012-2016
Gray AEB , La Hoz RM , Green JS , Vikram HR , Benedict T , Rivera H , Montgomery SP . Transpl Infect Dis 2018 20 (6) e12996 BACKGROUND: Heart transplantation has been shown to be a safe and effective intervention for progressive cardiomyopathy from chronic Chagas disease. However, in the presence of the immunosuppression required for heart transplantation, the likelihood of Chagas disease reactivation is significant. Reactivation may cause myocarditis resulting in allograft dysfunction and the rapid onset of congestive heart failure. Reactivation rates have been well documented in Latin America; however, there is a paucity of data regarding the risk in non-endemic countries. METHODS: We present our experience with 31 patients with chronic Chagas disease who underwent orthotopic heart transplantation in the United States from 2012-2016. Patients were monitored following a standard schedule. RESULTS: Nineteen of the 31 patients (61%) developed evidence of reactivation. Among the 19 patients, a majority (95%) were identified by laboratory monitoring using polymerase chain reaction testing. One patient was identified after the onset of clinical symptoms of reactivation. All subjects with evidence of reactivation were alive at follow-up (median: 60 weeks). CONCLUSIONS: Transplant programs in the United States are encouraged to implement a monitoring program for heart transplant recipients with Chagas disease. Our experience using a pre-emptive approach of monitoring for Chagas disease reactivation was effective at identifying reactivation before symptoms developed. This article is protected by copyright. All rights reserved. |
Continued occurrence of serotype 1 pneumococcal meningitis in two regions located in the meningitis belt in Ghana five years after introduction of 13-valent pneumococcal conjugate vaccine
Bozio CH , Abdul-Karim A , Abenyeri J , Abubakari B , Ofosu W , Zoya J , Ouattara M , Srinivasan V , Vuong JT , Opare D , Asiedu-Bekoe F , Lessa FC . PLoS One 2018 13 (9) e0203205 BACKGROUND: Increases in pneumococcal meningitis were reported from Ghanaian regions that lie in the meningitis belt in 2016-2017, despite introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in 2012 using a 3-dose schedule (6, 10, and 14 weeks). We describe pneumococcal meningitis epidemiology in the Ghanaian Northern and Upper West regions across two meningitis seasons. METHODS: Suspected meningitis cases were identified using World Health Organization standard definitions. Pneumococcal meningitis was confirmed if pneumococcus was the sole pathogen detected by polymerase chain reaction, culture, or latex agglutination in cerebrospinal fluid collected from a person with suspected meningitis during December 2015-March 2017. Pneumococcal serotyping was done using PCR. Annual age-specific pneumococcal meningitis incidence (cases per 100,000 population) was calculated, adjusting for suspected meningitis cases lacking confirmatory testing. FINDINGS: Among 153 pneumococcal meningitis cases, 137 (89.5%) were serotyped; 100 (73.0%) were PCV13-type, including 85 (62.0%) that were serotype 1, a PCV13-targeted serotype. Persons aged >/=5 years accounted for 96.7% (148/153) of cases. Comparing 2015-2016 and 2016-2017 seasons, the proportion of non-serotype 1 PCV13-type cases decreased from 20.0% (9/45) to 4.1% (3/74) (p = 0.008), whereas the proportion that was serotype 1 was stable (71.1% (32/45) vs. 58.1% (43/74); p = 0.16). Estimated adjusted pneumococcal meningitis incidence was 1.8 in children aged <5 years and ranged from 6.8-10.5 in older children and adults. CONCLUSIONS: High pneumococcal meningitis incidence with a large proportion of serotype 1 disease in older children and adults suggests infant PCV13 vaccination has not induced herd protection with this schedule in this high-transmission setting. |
Influenza vaccine effectiveness in the United States during the 2016-2017 season
Flannery B , Chung JR , Monto AS , Martin ET , Belongia EA , McLean HQ , Gaglani M , Murthy K , Zimmerman RK , Nowalk MP , Jackson ML , Jackson LA , Rolfes MA , Spencer S , Fry AM . Clin Infect Dis 2018 68 (11) 1798-1806 Background: In recent influenza seasons, the effectiveness of inactivated influenza vaccines against circulating A(H3N2) virus has been lower than against A(H1N1)pdm09 and B viruses, even when circulating viruses remained antigenically similar to vaccine components. Methods: During the 2016-2017 influenza season, vaccine effectiveness (VE) across age groups and vaccine types was examined among outpatients with acute respiratory illness at 5 US sites using a test-negative design that compared the odds of vaccination among reverse transcription polymerase chain reaction-confirmed influenza positives and negatives. Results: Among 7083 enrollees, 1342 (19%) tested positive for influenza A(H3N2), 648 (9%) were positive for influenza B (including B/Yamagata, n = 577) and 5040(71%) were influenza negative. Vaccine effectiveness was 40% (95% confidence interval [CI], 32% to 46%) against any influenza virus, 33% (95%CI, 23% to 41%) against influenza A(H3N2) viruses and 53% (95%CI, 43% to 61%) against influenza B viruses. Conclusions: The 2016-2017 influenza vaccines provided moderate protection against any influenza among outpatients, but were less protective against influenza A(H3N2) viruses than B viruses. Approaches to improving effectiveness against A(H3N2) viruses are needed. |
Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years
Troeger C , Khalil IA , Rao PC , Cao S , Blacker BF , Ahmed T , Armah G , Bines JE , Brewer TG , Colombara DV , Kang G , Kirkpatrick BD , Kirkwood CD , Mwenda JM , Parashar UD , Petri WA Jr , Riddle MS , Steele AD , Thompson RL , Walson JL , Sanders JW , Mokdad AH , Murray CJL , Hay SI , Reiner RC Jr . JAMA Pediatr 2018 172 (10) 958-965 Importance: Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years. Objectives: To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine. Design, Setting, and Participants: This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations. Exposure: Diarrhea due to rotavirus infection. Main Outcomes and Measures: Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country. Results: Rotavirus infection was responsible for an estimated 128500 deaths (95% uncertainty interval [UI], 104500-155600) among children younger than 5 years throughout the world in 2016, with 104733 deaths occurring in sub-Saharan Africa (95% UI, 83406-128842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28000 deaths (95% UI, 14600-46700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years. Conclusions and Relevance: Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection. |
Uptake and safety of Hepatitis B vaccination during pregnancy: A Vaccine Safety Datalink study
Groom HC , Irving SA , Koppolu P , Smith N , Vazquez-Benitez G , Kharbanda EO , Daley MF , Donahue JG , Getahun D , Jackson LA , Tse Kawai A , Klein NP , McCarthy NL , Nordin JD , Sukumaran L , Naleway AL . Vaccine 2018 36 (41) 6111-6116 INTRODUCTION: Hepatitis B virus (HBV) infection acquired during pregnancy can pose a risk to the infant at birth that can lead to significant and lifelong morbidity. Hepatitis B vaccine (HepB) is recommended for anyone at increased risk for contracting HBV infection, including pregnant women. Limited data are available on the safety of HepB administration during pregnancy. OBJECTIVES: To assess the frequency of maternal HepB receipt among pregnant women and evaluate the potential association between maternal vaccination and pre-specified maternal and infant safety outcomes. METHODS: We examined a retrospective cohort of pregnancies in the Vaccine Safety Datalink (VSD) resulting in live birth outcomes from 2004 through 2015. Eligible pregnancies in women aged 12-55years who were continuously enrolled from 6months pre-pregnancy to 6weeks postpartum in VSD integrated health systems were included. We compared pregnancies with HepB exposure to those with other vaccine exposures, and to those with no vaccine exposures. High-risk conditions for contracting HBV infection were identified up to one-year prior to or during the pregnancy using ICD-9 codes. Maternal and fetal adverse events were also evaluated according to maternal HepB exposure status. RESULTS: Among over 650,000 pregnancies in the study period, HepB was administered at a rate of 2.1 per 1000 pregnancies (n=1399), commonly within the first 5weeks of pregnancy. Less than 3% of the HepB-exposed group had a high-risk ICD-9 code indicating need for HepB; this was similar to the rate among HepB unvaccinated groups. There were no significant associations between HepB exposure during pregnancy and gestational hypertension, gestational diabetes, pre-eclampsia/eclampsia, cesarean delivery, pre-term delivery, low birthweight or small for gestational age infants. CONCLUSIONS: Most women who received maternal HepB did not have high-risk indications for vaccination. No increased risk for the adverse events that were examined were observed among women who received maternal HepB or their offspring. |
Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children
Lumba-Brown A , Yeates KO , Sarmiento K , Breiding MJ , Haegerich TM , Gioia GA , Turner M , Benzel EC , Suskauer SJ , Giza CC , Joseph M , Broomand C , Weissman B , Gordon W , Wright DW , Moser RS , McAvoy K , Ewing-Cobbs L , Duhaime AC , Putukian M , Holshouser B , Paulk D , Wade SL , Herring SA , Halstead M , Keenan HT , Choe M , Christian CW , Guskiewicz K , Raksin PB , Gregory A , Mucha A , Taylor HG , Callahan JM , DeWitt J , Collins MW , Kirkwood MW , Ragheb J , Ellenbogen RG , Spinks TJ , Ganiats TG , Sabelhaus LJ , Altenhofen K , Hoffman R , Getchius T , Gronseth G , Donnell Z , O'Connor RE , Timmons SD . JAMA Pediatr 2018 172 (11) e182853 Importance: Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. Objective: To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. Evidence Review: The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015. Findings: The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment. Conclusions and Relevance: This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations. |
Chronic pain among suicide decedents, 2003 to 2014: Findings from the National Violent Death Reporting System
Petrosky E , Harpaz R , Fowler KA , Bohm MK , Helmick CG , Yuan K , Betz CJ . Ann Intern Med 2018 169 (7) 448-455 Background: More than 25 million adults in the United States have chronic pain. Chronic pain has been associated with suicidality, but previous studies primarily examined nonfatal suicidal behaviors rather than suicide deaths associated with chronic pain or the characteristics of such deaths. Objective: To estimate the prevalence of chronic pain among suicide decedents in a large multistate sample and to characterize suicide decedents with and without chronic pain. Design: Retrospective analysis of National Violent Death Reporting System (NVDRS) data. The NVDRS links death certificate, coroner or medical examiner, and law enforcement data collected by investigators, who often interview informants who knew the decedent to gather information on precipitating circumstances surrounding the suicide. Information is abstracted by using standard coding guidance developed by the Centers for Disease Control and Prevention. Setting: 18 states participating in the NVDRS. Participants: Suicide decedents with and without chronic pain who died during 1 January 2003 to 31 December 2014. Measurements: Demographic characteristics, mechanism of death, toxicology results, precipitating circumstances (mental health, substance use, interpersonal problems, life stressors), and suicide planning and intent. Results: Of 123 181 suicide decedents included in the study, 10 789 (8.8%) had evidence of chronic pain, and the percentage increased from 7.4% in 2003 to 10.2% in 2014. More than half (53.6%) of suicide decedents with chronic pain died of firearm-related injuries and 16.2% by opioid overdose. Limitation: The results probably underrepresent the true percentage of suicide decedents who had chronic pain, given the nature of the data and how they were captured. Conclusion: Chronic pain may be an important contributor to suicide. Access to quality, comprehensive pain care and adherence to clinical guidelines may help improve pain management and patient safety. Primary Funding Source: None. |
Diagnosis and management of mild traumatic brain injury in children: A systematic review
Lumba-Brown A , Yeates KO , Sarmiento K , Breiding MJ , Haegerich TM , Gioia GA , Turner M , Benzel EC , Suskauer SJ , Giza CC , Joseph M , Broomand C , Weissman B , Gordon W , Wright DW , Moser RS , McAvoy K , Ewing-Cobbs L , Duhaime AC , Putukian M , Holshouser B , Paulk D , Wade SL , Herring SA , Halstead M , Keenan HT , Choe M , Christian CW , Guskiewicz K , Raksin PB , Gregory A , Mucha A , Taylor HG , Callahan JM , DeWitt J , Collins MW , Kirkwood MW , Ragheb J , Ellenbogen RG , Spinks TJ , Ganiats TG , Sabelhaus LJ , Altenhofen K , Hoffman R , Getchius T , Gronseth G , Donnell Z , O'Connor RE , Timmons SD . JAMA Pediatr 2018 172 (11) e182847 Importance: In recent years, there has been an exponential increase in the research guiding pediatric mild traumatic brain injury (mTBI) clinical management, in large part because of heightened concerns about the consequences of mTBI, also known as concussion, in children. The CDC National Center for Injury Prevention and Control's (NCIPC) Board of Scientific Counselors (BSC), a federal advisory committee, established the Pediatric Mild TBI Guideline workgroup to complete this systematic review summarizing the first 25 years of literature in this field of study. Objective: To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI. Evidence Review: Using a modified Delphi process, the authors selected 6 clinical questions on diagnosis, prognosis, and management or treatment of pediatric mTBI. Two consecutive searches were conducted on PubMed, Embase, ERIC, CINAHL, and SportDiscus. The first included the dates January 1, 1990, to November 30, 2012, and an updated search included December 1, 2012, to July 31, 2015. The initial search was completed from December 2012 to January 2013; the updated search, from July 2015 to August 2015. Two authors worked in pairs to abstract study characteristics independently for each article selected for inclusion. A third author adjudicated disagreements. The risk of bias in each study was determined using the American Academy of Neurology Classification of Evidence Scheme. Conclusion statements were developed regarding the evidence within each clinical question, and a level of confidence in the evidence was assigned to each conclusion using a modified GRADE methodology. Data analysis was completed from October 2014 to May 2015 for the initial search and from November 2015 to April 2016 for the updated search. Findings: Validated tools are available to assist clinicians in the diagnosis and management of pediatric mTBI. A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury, delayed recovery from mTBI, and long-term sequelae. However, high-quality studies of treatments meant to improve mTBI outcomes are currently lacking. Conclusions and Relevance: This systematic review was used to develop an evidence-based clinical guideline for the diagnosis and management of pediatric mTBI. While an increasing amount of research provides clinically useful information, this systematic review identified key gaps in diagnosis, prognosis, and management. |
Economics and violence against children, findings from the Violence Against Children Survey in Nigeria
Miller GF , Chiang L , Hollis N . Child Abuse Negl 2018 85 9-16 This study seeks to assess the impact of economic factors on sexual, emotional, and physical violence on Nigerian children and adolescents aged 13-24 years. Data collected from the Nigerian Violence Against Children Survey (VACS), a national, cross-sectional household survey of females and males aged 13-24 years were used to examine sexual, emotional, and physical violence victimization. Data were collected on household economic status, e.g., flooring and roofing materials, transportation. A poverty index was developed using the Simple Poverty Scorecard() for Nigeria to determine the impact that economic factors have on these violence measures. Children aged 13-17 years in households with high economic status (ES) were 1.81, 1.78, and 4.91 times, more likely to experience sexual, emotional, and physical violence, respectively, within the last 12 months than those in the lowest ES. Individuals aged 18-24 years in households with high ES were 1.62 and 1.41 times more likely to experience emotional and physical violence, respectively, prior to age 18 than those in the lowest ES. Individuals aged 18-24 years in households with middle or high ES were 1.65 and 1.96, respectively, times more likely to experience physical violence prior to age 18 than those in the lowest ES. Highest tertile ES was significantly associated with sexual, emotional, and physical violence among Nigerians aged 13-24 years. Further research is needed to determine the cause of increased violence amongst high ES households. Targeted interventions towards this ES class are recommended to reduce violence against children in Nigeria. |
Efforts and opportunities to understand women's mortality due to suicide and homicide using the National Violent Death Reporting System
Ivey-Stephenson AZ , Blair JM , Crosby AE . J Womens Health (Larchmt) 2018 27 (9) 1073-1081 Women's mortality due to violent deaths is a public health issue that has received national attention. Many data systems only collect death certificate data, which provide very limited information about the circumstances surrounding a violent death. The Centers for Disease Control and Prevention's (CDC's) National Violent Death Reporting System (NVDRS) is the first and only surveillance system to capture data from death certificates, coroner/medical examiner reports, and law enforcement reports allowing for a more comprehensive picture and targeted prevention efforts. The system currently operates in 40 states, the District of Columbia, and Puerto Rico; however, with additional funding from the Consolidated Appropriations Act of 2018, this surveillance system will fully expand to cover all 50 states. A number of analyses have been conducted using NVDRS data to compare suicide and homicide among women with men; however, only a handful of studies have been conducted among subgroups of women. The present study provides an overview of NVDRS while highlighting a few key analytic studies with implications for suicide and homicide prevention/intervention among women. Data from the 2014 NVDRS Surveillance Summary are also presented to emphasize the unique opportunity to use NVDRS data to study the characteristics of suicide and homicide among women. The summary includes data from 18 states that were collected statewide. This information can provide state and local public health experts with essential data on female suicide and homicide, not provided in other surveillance systems, to help shape prevention and intervention efforts. |
Molecular Epidemiology, Ecology, and Evolution of Group A Streptococci.
Bessen DE , Smeesters PR , Beall BW . Microbiol Spectr 2018 6 (5) The clinico-epidemiological features of diseases caused by group A streptococci (GAS) is presented through the lens of the ecology, population genetics, and evolution of the organism. The serological targets of three typing schemes (M, T, SOF) are themselves GAS cell surface proteins that have a myriad of virulence functions and a diverse array of structural forms. Horizontal gene transfer expands the GAS antigenic cell surface repertoire by generating numerous combinations of M, T, and SOF antigens. However, horizontal gene transfer of the serotype determinant genes is not unconstrained, and therein lies a genetic organization that may signify adaptations to a narrow ecological niche, such as the primary tissue reservoirs of the human host. Adaptations may be further shaped by selection pressures such as herd immunity. Understanding the molecular evolution of GAS on multiple levels-short, intermediate, and long term-sheds insight on mechanisms of host-pathogen interactions, the emergence and spread of new clones, rational vaccine design, and public health interventions. |
Molecular strain typing of the yaws pathogen, Treponema pallidum subspecies pertenue.
Katz SS , Chi KH , Nachamkin E , Danavall D , Taleo F , Kool JL , Addo KK , Ampofo W , Simpson SV , Ye T , Asiedu KB , Ballard RC , Chen CY , Pillay A . PLoS One 2018 13 (9) e0203632 Yaws is a neglected tropical disease caused by the bacterium Treponema pallidum subspecies pertenue. The disease primarily affects children under 15 years of age living in low socioeconomic conditions in tropical areas. As a result of a renewed focus on the disease owing to a recent eradication effort initiated by the World Health Organization, we have evaluated a typing method, adapted from and based on the enhanced Centers for Disease Control and Prevention typing method for T. pallidum subsp. pallidum, for possible use in epidemiological studies. Thirty DNA samples from yaws cases in Vanuatu and Ghana, 11 DNA samples extracted from laboratory strains, and 3 published genomic sequences were fully typed by PCR/RFLP analysis of the tpr E, G, and J genes and by determining the number of 60-bp repeats within the arp gene. Subtyping was performed by sequencing a homonucleotide "G" tandem repeat immediately upstream of the rpsA gene and an 84-bp region of tp0548. A total of 22 complete strain types were identified; two strain types in clinical samples from Vanuatu (5q11/ak and 5q12/ak), nine strain types in clinical samples from Ghana (3q12/ah, 4r12/ah, 4q10/j, 4q11/ah, 4q12/ah, 4q12/v, 4q13/ah, 6q10/aj, and 9q10/ai), and twelve strain types in laboratory strains and published genomes (2q11/ae, 3r12/ad, 4q11/ad, 4q12/ad, 4q12/ag, 4q12/v, 5r12/ad, 6r12/x, 6q11/af, 10q9/r, 10q12/r, and 12r12/w). The tpr RFLP patterns and arp repeat sizes were subsequently verified by sequencing analysis of the respective PCR amplicons. This study demonstrates that the typing method for subsp. pallidum can be applied to subsp. pertenue strains and should prove useful for molecular epidemiological studies on yaws. |
Screening for Pfhrp2/3-Deleted Plasmodium falciparum, Non-falciparum, and Low-Density Malaria Infections by a Multiplex Antigen Assay.
Plucinski MM , Herman C , Jones S , Dimbu R , Fortes F , Ljolje D , Lucchi N , Murphy SC , Smith NT , Cruz KR , Seilie AM , Halsey ES , Udhayakumar V , Aidoo M , Rogier E . J Infect Dis 2018 219 (3) 437-447 Background: Detection of Plasmodium antigens provides evidence of malaria infection status and is the basis for most malaria diagnosis worldwide. Methods: We developed a sensitive bead-based multiplex assay for laboratory use which simultaneously detects the pan-Plasmodium pAldo, pan-Plasmodium pLDH, and P. falciparum PfHRP2 antigens. The assay was validated against purified recombinant antigens, mono-species malaria infections, and non-infected blood samples. To test against samples collected in an endemic setting, Angolan outpatient samples (n=1267) were assayed. Results: Of 466 Angolan samples positive for at least one antigen, the most common antigen profiles were PfHRP2+/pAldo+/pLDH+ (167, 36%), PfHRP2+/pAldo-/pLDH- (163, 35%), and PfHRP2+/pAldo+/pLDH- (129, 28%). Antigen profile was predictive of qRT-PCR positivity and parasite density. Eight Angolan samples (1.7%) had either no or very low levels of PfHRP2 but were positive for one or both of the other antigens. PCR analysis confirmed three (0.6%) were P. ovale infections, and two (0.4%) represented P. falciparum parasites lacking Pfhrp2 and/or Pfhrp3. Conclusions: These are the first reports of P. falciparum Pfhrp2/3 deletion mutants in Angola. High-throughput multiplex antigen detection can inexpensively screen for low density P. falciparum, non-falciparum, and Pfhrp2/3-deleted malaria parasites to provide population-level antigen estimates and identify specimens requiring further molecular characterization. |
Novel trimethoprim resistance gene dfrA34 identified in Salmonella Heidelberg in the USA.
Tagg KA , Francois Watkins L , Moore MD , Bennett C , Joung YJ , Chen JC , Folster JP . J Antimicrob Chemother 2018 74 (1) 38-41 Background: Trimethoprim/sulfamethoxazole is a synthetic antibiotic combination recommended for the treatment of complicated non-typhoidal Salmonella infections in humans. Resistance to trimethoprim/sulfamethoxazole is mediated by the acquisition of mobile genes, requiring both a dfr gene (trimethoprim resistance) and a sul gene (sulfamethoxazole resistance) for a clinical resistance phenotype (MIC >/=4/76 mg/L). In 2017, the CDC investigated a multistate outbreak caused by a Salmonella enterica serotype Heidelberg strain with trimethoprim/sulfamethoxazole resistance, in which sul genes but no known dfr genes were detected. Objectives: To characterize and describe the molecular mechanism of trimethoprim resistance in a Salmonella Heidelberg outbreak isolate. Methods: Illumina sequencing data for one outbreak isolate revealed a 588 bp ORF encoding a putative dfr gene. This gene was cloned into Escherichia coli and resistance to trimethoprim was measured by broth dilution and Etest. Phylogenetic analysis of previously reported dfrA genes was performed using MEGA. Long-read sequencing was conducted to determine the context of the novel dfr gene. Results and conclusions: The novel dfr gene, named dfrA34, conferred trimethoprim resistance (MIC >/=32 mg/L) when cloned into E. coli. Based on predicted amino acid sequences, dfrA34 shares less than 50% identity with other known dfrA genes. The dfrA34 gene is located in a class 1 integron in a multiresistance region of an IncC plasmid, adjacent to a sul gene, thus conferring clinical trimethoprim/sulfamethoxazole resistance. Additionally, dfrA34 is associated with ISCR1, enabling easy transmission between other plasmids and bacterial strains. |
Mycobacterium decipiens sp. nov., a new species closely related to the Mycobacterium tuberculosis complex.
Brown-Elliott BA , Simmer PJ , Trovato A , Hyle EP , Droz S , Buckwalter SP , Borroni E , Branda JA , Iana E , Mariottini A , Nelson J , Matteelli A , Toney NC , Scarparo C , de Man TJB , Vasireddy R , Gandhi RT , Wengenack NL , Cirillo DM , Wallace RJ , Tortoli E . Int J Syst Evol Microbiol 2018 68 (11) 3557-3562 Two mycobacterial strains with close similarity to the Mycobacterium tuberculosis complex (MTBC) were isolated from cutaneous lesions of patients in the USA and Italy. At the phenotypic level, similarities to the MTBC included slow growth rate, rough morphotype of the unpigmented colonies and nearly identical high-performance liquid chromatography profiles of mycolic acids. In contrast to the MTBC, the strains were niacin- and nitrate-negative, and catalase-positive both at 68 degrees C and in semi-quantitative tests. The clinical isolates were more closely related to M. tuberculosis than to any other known mycobacterium and scored positive with commercial DNA probes (Hologic AccuProbe M. tuberculosis). Both average nucleotide identity and genome-to-genome distance suggested the strains are different from the MTBC. Therefore, given the distinguishing phenotypic and genomic-scale differences, we submit that the strains belong to a new species we have named Mycobacteriumdecipiens with type strain TBL 1200985(T) (=ATCC TSD-117(T)=DSM 105360(T)). |
Influence of Molecular Testing on Influenza Diagnosis.
Yarbrough ML , Burnham CD , Anderson NW , Banerjee R , Ginocchio CC , Hanson KE , Uyeki TM . Clin Chem 2018 64 (11) 1560-1566 Influenza viruses infect millions of people each year, leading to several hundred thousand hospitalizations and thousands of deaths annually in the US. Early antiviral therapy reduces illness duration, complications, and mortality associated with influenza. Yet, antivirals are consistently used at a suboptimal rate. Patients with positive influenza diagnostic testing results are more likely to receive antiviral therapy and less likely to be prescribed unnecessary antibiotics. Thus, access to reliable influenza testing in both ambulatory and inpatient settings is critical to facilitate both optimal patient outcomes and antimicrobial stewardship. Recently, the first point-of-care (POC)7 molecular diagnostic test was cleared by the US Food and Drug Administration (FDA) for the detection of influenza. At the same time, concerns about the performance of commonly used rapid antigen tests, particularly the test sensitivity, led to modified regulatory requirements for these devices. The landscape of influenza diagnostics is rapidly evolving, and clinical laboratorians are certain to face pressure regarding new testing modalities. In this article, 5 experts that span the continuum of influenza diagnosis from the clinical laboratory to industry to public health and regulatory agencies discuss recent advances and ongoing challenges in influenza diagnostics. |
Triplex Real-Time PCR without DNA Extraction for the Monitoring of Meningococcal Disease.
Whaley MJ , Jenkins LT , Hu F , Chen A , Diarra S , Ouedraogo-Traore R , Sacchi CT , Wang X . Diagnostics (Basel) 2018 8 (3) Detection of Neisseria meningitidis has become less time- and resource-intensive with a monoplex direct real-time PCR (drt-PCR) to amplify genes from clinical specimens without DNA extraction. To further improve efficiency, we evaluated two triplex drt-PCR assays for the detection of meningococcal serogroups AWX and BCY. The sensitivity and specificity of the triplex assays were assessed using 228 cerebrospinal fluid (CSF) specimens from meningitis patients and compared to the monoplex for six serogroups. The lower limit of detection range for six serogroup-specific drt-PCR assays was 178(-)5264 CFU/mL by monoplex and 68(-)2221 CFU/mL by triplex. The triplex and monoplex showed 100% agreement for six serogroups and the triplex assays achieved similar sensitivity and specificity estimates as the monoplex drt-PCR assays. Our triplex method reduces the time and cost of processing CSF specimens by characterizing six serogroups with only two assays, which is particularly important for testing large numbers of specimens for N. meningitidis surveillance. |
Differences in antigenic sites and other functional regions between genotype A and G mumps virus surface proteins.
Gouma S , Vermeire T , Van Gucht S , Martens L , Hutse V , Cremer J , Rota PA , Leroux-Roels G , Koopmans M , Binnendijk RV , Vandermarliere E . Sci Rep 2018 8 (1) 13337 The surface proteins of the mumps virus, the fusion protein (F) and haemagglutinin-neuraminidase (HN), are key factors in mumps pathogenesis and are important targets for the immune response during mumps virus infection. We compared the predicted amino acid sequences of the F and HN genes from Dutch mumps virus samples from the pre-vaccine era (1957-1982) with mumps virus genotype G strains (from 2004 onwards). Genotype G is the most frequently detected mumps genotype in recent outbreaks in vaccinated communities, especially in Western Europe, the USA and Japan. Amino acid differences between the Jeryl Lynn vaccine strains (genotype A) and genotype G strains were predominantly located in known B-cell epitopes and in N-linked glycosylation sites on the HN protein. There were eight variable amino acid positions specific to genotype A or genotype G sequences in five known B-cell epitopes of the HN protein. These differences may account for the reported antigenic differences between Jeryl Lynn and genotype G strains. We also found amino acid differences in and near sites on the HN protein that have been reported to play a role in mumps virus pathogenesis. These differences may contribute to the occurrence of genotype G outbreaks in vaccinated communities. |
Survey of diagnostic testing for respiratory syncytial virus (RSV) in adults: Infectious disease physician practices and implications for burden estimates.
Allen KE , Beekmann SE , Polgreen P , Poser S , St Pierre J , Santibanez S , Gerber SI , Kim L . Diagn Microbiol Infect Dis 2017 92 (3) 206-209 Respiratory syncytial virus (RSV) often causes respiratory illness in adults. Over 40 RSV vaccine and monoclonal antibody products are currently in preclinical development or clinical trials. Because RSV diagnostic practices may impact disease burden estimates, we investigated infectious disease physicians' RSV diagnostic practices among their adult patients. |
Development and use of an endpoint titration assay to characterize mumps IgG avidity following measles, mumps, and rubella vaccination and wild-type mumps infection
Mercader S , McGrew M , Sowers SB , Williams NJ , Bellini WJ , Hickman CJ . mSphere 2018 3 (5) Waning mumps IgG antibody and incomplete IgG avidity maturation may increase susceptibility to mumps virus infection in some vaccinees. To measure mumps IgG avidity, serum specimens serially diluted to the endpoint were incubated on a commercial mumps-specific IgG enzyme immunoassay and treated with the protein denaturant diethylamine (60 mM, pH 10). End titer avidity indices (etAIs [percent ratio of detected diethylamine-resistant IgG at endpoint]) were calculated. Unpaired serum specimens (n = 108) from 15-month-old children living in a low-incidence setting were collected 1 month and 2 years after the first measles, mumps, and rubella vaccine dose (MMR1) and tested for mumps avidity. Per the receiver operating characteristic curve, the avidity assay is accurate (area under the curve, 0.994; 95% confidence interval [CI], 0.956 to 1.000), 96.5% sensitive (95% CI, 87.9 to 99.6%), and 92.2% specific (95% CI, 81.1 to 97.8%) at an etAI of 30%. When 9 sets of paired serum specimens collected 1 to 60 months post-MMR1 were tested for mumps and measles IgG avidity using comparable methods, the mumps etAI increased from 11% to 40 to 60% in 6 months. From 6 to 60 months, avidity was sustained at a mean etAI of 50% (95% CI, 46 to 54%), significantly lower (P < 0.0001) than the mean measles etAI of 80% (95% CI, 74 to 86%). Mean etAIs in children 2 years post-MMR1 (n = 51), unvaccinated adults with distant mumps disease (n = 29), and confirmed mumps cases (n = 23) were 54, 62, and 57%, respectively. A mumps-specific endpoint avidity assay was developed and validated, and mumps avidity was determined to be generally sustained at etAIs of 40 to 60%, reaching etAIs of >80% in some individuals.IMPORTANCE Numerous outbreaks of mumps have occurred in the United States among two-dose measles-mumps-rubella (MMR)-vaccinated populations since 2006. The avidity of mumps-specific IgG antibodies may affect susceptibility to mumps virus infection in some vaccinated individuals. To accurately measure mumps avidity, we developed and validated a mumps-specific IgG avidity assay that determines avidity at the endpoint titer of serially diluted serum specimens, providing results that are independent of IgG concentration. At low antibody titers, endpoint methods are considered more accurate than methods that determine avidity at a single dilution. We determined that 6 months after the first MMR dose, mumps IgG avidity is high and generally sustained at avidity indices of 40 to 60%, reaching values of >80% in some individuals. Additionally, 4% (4/103) of individuals had avidity indices of </=30% (low avidity) 2 years after vaccination. Inadequate mumps avidity maturation may be one factor influencing susceptibility to mumps virus infection among previously vaccinated or naturally infected individuals. |
Proficiency of WHO Global Foodborne Infections Network External Quality Assurance System participants in the identification and susceptibility testing of thermo-tolerant Campylobacter spp. from 2003-2012
Pedersen SK , Wagenaar JA , Vigre H , Roer L , Mikoleit M , Aidara-Kane A , Cawthorne AL , Aarestrup FM , Hendriksen RS . J Clin Microbiol 2018 56 (11) Campylobacter spp. are food- and water borne pathogens. While rather accurate estimates for these pathogens are available in industrialized countries, a lack of diagnostic capacity in developing countries limits accurate assessments of prevalence in many regions. Proficiency in the identification and susceptibility testing of these organisms is critical for surveillance and control efforts. The aim of the study was to assess performance for identification and susceptibility testing of thermo-tolerant Campylobacter among laboratories participating in the World Health Organization (WHO) Global Foodborne Infections Network (GFN) External Quality Assurance System (EQAS) over a nine year period.Participants (primarily national level laboratories) were encouraged to self-evaluate performance as part of continuous quality improvement.The ability to correctly identify Campylobacter spp. varied by year and ranged from 61.9 % (2008) to 90.7 % (2012), and the ability to correctly perform antimicrobial susceptibility testing (AST) for Campylobacter spp. appeared to steadily increase from 91.4 % to 93.6 % in the test period (2009-2012).Poorest performance (60.0 % correct identification and 86.8 % correct AST results) was observed in African laboratories.Overall, approximately 10 % of laboratories reported either an incorrect identification or antibiogramme. As most participants were (supra)-national reference laboratories, these data raise significant concerns regarding capacity and proficiency at the local, clinical level. Addressing these diagnostic challenges is critical for both patient level management and broader surveillance and control efforts. |
Reference antigen-free and antibody-free LTD-IDMS assay for influenza H7N9 vaccine in vitro potency determination
Morgenstern K , Xie Y , Palladino G , Barr JR , Settembre EC , Williams TL , Wen Y . Vaccine 2018 36 (41) 6144-6151 Influenza vaccines are the most effective intervention to prevent the substantial public health burden of seasonal and pandemic influenza. Hemagglutinin (HA), as the main antigen in inactivated influenza vaccines (IIVs), elicits functional neutralizing antibodies and largely determines IIV effectiveness. HA potency has been evaluated by single-radial immunodiffusion (SRID), the standard in vitro potency assay for IIVs, to predict vaccine immunogenicity with a correlation to protective efficacy. We previously reported that limited trypsin digestion (LTD) selectively degraded stressed HA, so that an otherwise conformationally insensitive biophysical quantification technique could specifically quantify trypsin-resistant, immunologically active HA. Here, we demonstrate that isotope dilution mass spectrometry (IDMS), a method capable of quantifying the absolute HA concentration without reference antigen use, can be further expanded by adding LTD followed with precipitation to selectively quantify the active HA. We test the LTD-IDMS assay on H7N9 vaccines stressed by low pH, raised temperature, or freeze/thaw cycles. This method, unlike SRID, has no requirement for strain-specific reference antigens or antibodies and can generate potency values that correlate with SRID. Thus, LTD-IDMS is a promising alternative in vitro potency assay for influenza vaccines to complement and potentially replace SRID in a pandemic when strain specific reagents may not be readily available. |
Utilization of dried blood spot specimens can expedite nationwide surveillance of HIV drug resistance in resource-limited settings
Zhang G , DeVos J , Medina-Moreno S , Wagar N , Diallo K , Beard RS , Zheng DP , Mwachari C , Riwa C , Jullu B , Wangari NE , Kibona MS , Ng'Ang'A LW , Raizes E , Yang C . PLoS One 2018 13 (9) e0203296 INTRODUCTION: Surveillance of HIV drug resistance (HIVDR) is crucial to ensuring the continued success of antiretroviral therapy (ART) programs. With the concern of reduced genotyping sensitivity of HIV on dried blood spots (DBS), DBS for HIVDR surveillance have been limited to ART-naive populations. To investigate if DBS under certain conditions may also be a feasible sample type for HIVDR testing in ART patients, we piloted nationwide surveys for HIVDR among ART patients using DBS in two African countries with rapid scale-up of ART. METHODS: EDTA-venous blood was collected to prepare DBS from adult and pediatric ART patients receiving treatment during the previous 12-36 months. DBS were stored at ambient temperature for two weeks and then at -80 degrees C until shipment at ambient temperature to the WHO-designated Specialized HIVDR Laboratory at CDC in Atlanta. Viral load (VL) was determined using NucliSENS EasyQ(R) HIV-1 v2.0 kits; HIVDR genotyping was performed using the ATCC HIV-1 Drug Resistance Genotyping kits. RESULTS: DBS were collected from 1,368 and 1,202 ART patients; 244 and 255 these specimens had VL >/=1,000 copies/mL in Kenya and Tanzania, respectively. The overall genotyping rate of those DBS with VL >/=1,000 copies/mL was 93.0% (95% CI: 89.1%-95.6%) in Kenya and 91.8% (87.7%-94.6%) in Tanzania. The turnaround times for the HIVDR surveys from the time of collecting DBS to completing laboratory testing were 6.5 months and 9.3 months for the Kenya and Tanzania surveys, respectively. CONCLUSIONS: The study demonstrates a favorable outcome of using DBS for nationwide surveillance of HIVDR in ART patients. Our results confirm that DBS collected and stored at ambient temperature for two weeks, and shipped with routine courier services are a reliable sample type for large-scale surveillance of acquired HIVDR. |
A collaborative, mixed-methods evaluation of a low-cost, handheld 3D imaging system for child anthropometry
Conkle J , Keirsey K , Hughes A , Breiman J , Ramakrishnan U , Suchdev PS , Martorell R . Matern Child Nutr 2018 15 (2) e12686 3D imaging for body measurements (e.g., anthropometry) is regularly used for design of garments and ergonomic products. The development of low-cost 3D scanners provided an opportunity to extend the use of 3D imaging to the health sector. We developed and tested the AutoAnthro System, the first mobile, low-cost, full-body, 3D imaging system designed specifically for child anthropometry. This study evaluated the efficiency, invasiveness, and user experience of the newly developed 3D imaging system. We used a mixed-methods, collaborative approach that included a quantitative time-motion study and qualitative interviews of anthropometrists. The time-motion study employed continuous observation of manual measurement and scanning based on milestone timing, and we designed and analyzed the qualitative component based on grounded theory from a constructivist point of view. For cooperative children, anthropometrists considered the use of 3D imaging an easy, 'streamlined experience,' but with uncooperative children anthropometrists reported that capturing a good quality scan was out of their control. The mean time to complete a full set of scans was 68 seconds (standard deviation (SD) 29), compared to 135 seconds (SD 22) for a set of manual measurements (stature, head circumference, and arm circumference). We observed that crying was more common during manual measurement, and anthropometrist interviews confirmed that 3D imaging was less stressful for children than manual measurement. Overall, the anthropometrists were not yet ready to completely abandon traditional, manual equipment for 3D scanners. Revising the AutoAnthro System to address anthropometrists' concerns on capturing good quality scans of uncooperative children should help to facilitate widespread use of 3D imaging for child anthropometry in the health sector. |
Effects of inflammation on biomarkers of vitamin A status among a cohort of Bolivian infants
Burke RM , Whitehead RDJr , Figueroa J , Whelan D , Aceituno AM , Rebolledo PA , Revollo R , Leon JS , Suchdev PS . Nutrients 2018 10 (9) Globally, vitamin A deficiency (VAD) affects nearly 200 million children with negative health consequences. VAD can be measured by a retinol-binding protein (RBP) and serum retinol concentrations. Their concentrations are not always present in a 1:1 molar ratio and are affected by inflammation. This study sought to quantify VAD and its impact on infant mortality and infectious morbidity during the first 18 months of life in a cohort of mother-infant dyads in El Alto, Bolivia, while accounting for the previously mentioned measurement issues. Healthy mother-infant dyads (n = 461) were enrolled from two hospitals and followed for 12 to 18 months. Three serum samples were collected (at one to two, six to eight, and 12 to 18 months of infant age) and analyzed for RBP, and a random 10% subsample was analyzed for retinol. Linear regression of RBP on retinol was used to generate RBP cut-offs equivalent to retinol <0.7 micromol/L. All measures of RBP and retinol were adjusted for inflammation, which was measured by a C-reactive protein and alpha (1)-acid glycoprotein serum concentrations using linear regression. Infant mortality and morbidity rates were calculated and compared by early VAD status at two months of age. Retinol and RBP were weakly affected by inflammation. This association varied with infant age. Estimated VAD (RBP < 0.7 micromol/L) decreased from 71.0% to 14.8% to 7.7% at two, six to eight, and 12 to 18 months of age. VAD was almost nonexistent in mothers. Early VAD was not significantly associated with infant mortality or morbidity rates. This study confirmed a relationship between inflammation and vitamin A biomarkers for some subsets of the population and suggested that the vitamin A status in early infancy improves with age and may not have significantly affected morbidity in this population of healthy infants. |
Components of an occupational safety and health communication research strategy for small- and medium-sized enterprises
Schulte PA , Cunningham TR , Guerin RJ , Hennigan B , Jacklitsch B . Ann Work Expo Health 2018 62 S12-s24 The majority of the global labor force works in firms with fewer than 50 employees; firms with fewer than 250 employees make up 99% of workplaces. Even so, the lack of extensive or comprehensive research has failed to focus on occupational safety and health communication to these small- and medium-sized enterprises (SMEs). Given that the magnitude of all occupational safety and health (OSH) morbidity, mortality, and injury disproportionately occurs in businesses with fewer than 250 employees, efforts to communicate with employers to engage in preventative occupational safety and health efforts merit attention. This article provides an overview of important components that should be considered in developing an occupational safety and health (OSH) communication research strategy targeting SMEs. Such a strategy should raise awareness about the diversity and complexity of SMEs and the challenges of targeting OSH communication toward this diverse group. Companies of differing sizes (e.g. 5, 50, 500 employees) likely require differing communication approaches. Communication strategies will benefit from deconstructing the term 'small business' into smaller, more homogenous categories that might require approaches. Theory-based research assessing barriers, message content, channels, reach, reception, motivation, and intention to act serve as the foundation for developing a comprehensive research framework. Attention to this type of research by investigators is warranted and should be encouraged and supported. There would also be value in developing national and international strategies for research on communication with small businesses. |
Conference summary Understanding Small Enterprises Conference, 25-27 October 2017
Brown CE , Cunningham TR , Newman LS , Schulte PA . Ann Work Expo Health 2018 62 S1-s11 Objectives: The specific objectives of the 2017 Understanding Small Enterprises Conference were to: (i) identify successful strategies for overcoming occupational safety and health (OS&H) barriers in small and medium-sized enterprises (SMEs); (ii) disseminate best practices to research and business communities; (iii) build collaborations between different stakeholders including researchers, insurers, small enterprises, government agencies; and (iv) better inform OS&H research relevant to SMEs. Methods: A two and a half day international conference was organized, building upon three previously successful iterations. This conference brought together researchers, practitioners, and other stakeholders from 16 countries to share best practices and emerging strategies for improving OS&H in SMEs. Findings: Cross-cutting themes that emerged at the conference centered around: 1) stakeholder and intermediary involvement; 2) what occupational health and safety looks like across different industries; 3) intervention programs (tools and resources); 4) precarious and vulnerable work and the informal sector; and 5) Total Worker Health(R) in SMEs. Conclusion: A number of innovative initiatives were shared at the conference. Researchers must build collaborations involving a variety of stakeholder groups to ensure that OS&H solutions are successful in SMEs. Future OS&H research should continue to build upon the successful work of the 2017 Understanding Small Enterprises Conference. |
Influence of work characteristics on the association between police stress and sleep quality
Ma CC , Hartley TA , Sarkisian K , Fekedulegn D , Mnatsakanova A , Owens S , Gu JK , Tinney-Zara C , Violanti JM , Andrew ME . Saf Health Work 2018 10 (1) 30-38 Background: Police officers’ stress perception, frequency of stressful events (stressors), and police work characteristics may contribute to poor sleep quality through different mechanisms. Methods: We investigated associations of stress severity (measured by stress rating score) and frequency of stressors with sleep quality and examined the influence of police work characteristics including workload, police rank, prior military experience, and shift work on the associations. Participants were 356 police officers (256 men and 100 women) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study from 2004 to 2009. A mean stress rating score and mean frequency of stressors occurring in the past month were computed for each participant from the Spielberger Police Stress Survey data. Sleep quality was assessed using the global score derived from the Pittsburgh Sleep Quality Index survey. Linear associations of the stress rating score and frequency of stressors with sleep quality (Pittsburgh Sleep Quality Index global score) were tested. Age, sex, race/ethnicity, and smoking status were selected as potential confounders. Results: The stress rating score was positively and independently associated with poor sleep quality (beta = 0.17, p = 0.002). Only workload significantly modified this association (beta = 0.23, p = 0.001 for high workload group; p-interaction = 0.109). The frequency of stressors was positively and independently associated with poor sleep quality (beta = 0.13, p = 0.025). Only police rank significantly modified the association (beta = 0.007, p = 0.004 for detectives/other executives; p-interaction = 0.076). Conclusion: Both police officers’ perception of stress severity and the frequency of stressors are associated with poor sleep quality. Stress coping or sleep promotion regimens may be more beneficial among police officers reporting high workloads. |
Safety talk and safety culture: Discursive repertoires as indicators of workplace safety and health practice and readiness to change
Cunningham TR , Jacobson CJ . Ann Work Expo Health 2018 62 S55-s64 Background: Small construction businesses (SCBs) account for a disproportionate share of occupational injuries, days lost, and fatalities in the US and other modern economies. Owner/managers of SCBs confront risks associated with their own and workers' safety and business survival, and their occupational safety and health (OSH) related values and practices are key drivers of safety and business outcomes. Given owner/mangers are the key to understanding and affecting change in smaller firms, as well as the pressing need for improved OSH in small firms particularly in construction, there is a critical need to better understand SCB owners' readiness to improve or adopt enhanced OSH activities in their business. Unfortunately, the social expectation to support safety can complicate efforts to evaluate owners' readiness. Objectives: To get a more accurate understanding of the OSH values and practices of SCBs and the factors shaping SCB owners' readiness and intent to implement or improve safety and health programming by comparing their discourse on safety with their self-rated level of stage of change. Methods: In-depth, semi-structured interviews were conducted with 30 SCB owner managers. Respondents were asked to self-rate their safety program activity on a 5-point scale from unaware or ignorant ('haven't thought about it at all') to actively vigilant ('well-functioning safety and health program for at least 6 months'). They were also asked to discuss the role and meaning of OSH within their trade and company, as well as attitudes and inclinations toward improving or enhancing business safety practices. Analysis and results: Respondents' self-rating of safety program activity was compared and contrasted with results from discourse analysis of their safety talk, or verbal descriptions of their safety values and activities. Borrowing from normative and stage theories of safety culture and behavioral change, these sometimes contradictory descriptions were taxonomized along a safety culture continuum and a range of safety cultures and stages of readiness for change were found. These included descriptions of strong safety cultures with intentions for improvement as well as descriptions of safety cultures with more reactive and pathological approaches to OSH, with indications of no intentions for improvement. Some owner/managers rated themselves as having an effective OSH program in place, yet described a dearth of OSH activity and/or value for OSH in their business. Conclusion: Assessing readiness to change is key to improving OSH performance, and more work is needed to effectively assess SCB OSH readiness and thus enable greater adoption of best practices. |
Work-related lung cancer: The practitioner's perspective
Weissman DN , Howard J . Am J Public Health 2018 108 (10) 1290-1292 Work exposures are well-known risk factors for lung cancer. A recent review noted that the International Agency for Research on Cancer (IARC) has found “sufficient evidence” that 19 occupational agents can cause lung cancer in humans (IARC Group 1; see the box on the next page).1 Two key factors affecting risk for work-related lung cancer are level of exposure to one or more occupational carcinogens2 and smoking history, with these two factors often having greater than additive effects.3 |
Numerical and experimental investigation of carbon monoxide spread in underground mine fires
Zhou L , Yuan L , Bahrami D , Thomas RA , Rowland JH . J Fire Sci 2018 36 (5) 406-418 The primary danger with underground mine fires is carbon monoxide poisoning. A good knowledge of smoke and carbon monoxide movement in an underground mine during a fire is of importance for the design of ventilation systems, emergency response, and miners escape and rescue. Mine fire simulation software packages have been widely used to predict carbon monoxide concentration and its spread in a mine for effective mine fire emergency planning. However, they are not highly recommended to be used to forecast the actual carbon monoxide concentration due to lack of validation studies. In this article, MFIRE, a mine fire simulation software based on ventilation networks, was evaluated for its carbon monoxide spread prediction capabilities using experimental results from large-scale diesel fuel and conveyor belt fire tests conducted in the Safety Research Coal Mine at The National Institute for Occupational Safety and Health. The comparison between the simulation and test results of carbon monoxide concentration shows good agreement and indicates that MFIRE is able to predict the carbon monoxide spread in underground mine fires with confidence. The Author(s) 2018. |
Work practices and respiratory health status of Appalachian coal miners with progressive massive fibrosis
Reynolds LE , Blackley DJ , Colinet JF , Potts JD , Storey E , Short C , Carson R , Clark KA , Laney AS , Halldin CN . J Occup Environ Med 2018 60 (11) e575-e581 OBJECTIVE: To characterize workplace practices and respiratory health among coal miners with large opacities consistent with progressive massive fibrosis (PMF) who received care at a federally-funded black lung clinic network in Virginia. METHODS: Participants were interviewed about their workplace practices and respiratory health. Medical records were reviewed. RESULTS: Nineteen former coal miners were included. Miners reported cutting rock, working downwind of dust-generating equipment, non-adherence to mine ventilation plans (including dust controls), improper sampling of respirable coal mine dust exposures, working after developing respiratory illness, and suffering from debilitating respiratory symptoms. CONCLUSIONS: Consistent themes of suboptimal workplace practices contributing to development of PMF emerged during the interviews. Some of the practices reported were unsafe and unacceptable. Further research is needed to determine the prevalence of these factors and how best to address them. |
Chloroquine as weekly chemoprophylaxis or intermittent treatment to prevent malaria in pregnancy in Malawi: a randomised controlled trial
Divala TH , Mungwira RG , Mawindo PM , Nyirenda OM , Kanjala M , Ndaferankhande M , Tsirizani LE , Masonga R , Muwalo F , Potter GE , Kennedy J , Goswami J , Wylie BJ , Muehlenbachs A , Ndovie L , Mvula P , Mbilizi Y , Tomoka T , Laufer MK . Lancet Infect Dis 2018 18 (10) 1097-1107 BACKGROUND: Sulfadoxine-pyrimethamine resistance threatens efficacy of intermittent preventive treatment of malaria during pregnancy, and alternative regimens need to be identified. With the return of chloroquine efficacy in southern Africa, we postulated that chloroquine either as an intermittent therapy or as weekly chemoprophylaxis would be more efficacious than intermittent sulfadoxine-pyrimethamine for prevention of malaria in pregnancy and associated maternal and newborn adverse outcomes. METHODS: We did an open-label, single-centre, randomised controlled trial at Ndirande Health Centre, Blantyre, in southern Malawi. We enrolled pregnant women (first or second pregnancy) at 20-28 weeks' gestation who were HIV negative. Participants were randomly assigned in a 1:1:1 ratio using a computer-generated list to either intermittent sulfadoxine-pyrimethamine (two doses of 1500 mg sulfadoxine and 75 mg pyrimethamine, 4 weeks apart), intermittent chloroquine (two doses of 600 mg on day 1, 600 mg on day 2, and 300 mg on day 3), or chloroquine prophylaxis (600 mg on day 1 then 300 mg every week). The primary endpoint was placental malaria in the modified intent-to-treat population, which consisted of participants who contributed placental histopathology data at birth. Secondary outcomes included clinical malaria, maternal anaemia, low birthweight, and safety. This trial is registered with ClinicalTrials.gov, number NCT01443130. FINDINGS: Between February, 2012, and May, 2014, we enrolled and randomly allocated 900 women, of whom 765 contributed histopathological data and were included in the primary analysis. 108 (14%) women had placental malaria, which was lower than the anticipated prevalence of placental malaria infection. Protection from placental malaria was not improved by chloroquine as either prophylaxis (30 [12%] of 259 had positive histopathology; relative risk [RR] 0.75, 95% CI 0.48-1.17) or intermittent therapy (39 [15%] of 253; RR 1.00, 0.67-1.50) compared with intermittent sulfadoxine-pyrimethamine (39 [15%] of 253). In protocol-specified analyses adjusted for maternal age, gestational age at enrolment, bednet use the night before enrolment, anaemia at enrolment, and malaria infection at enrolment, women taking chloroquine as prophylaxis had 34% lower placental infections than did those allocated intermittent sulfadoxine-pyrimethamine (RR 0.66, 95% CI 0.46-0.95). Clinical malaria was reported in nine women assigned intermittent sulfadoxine-pyrimethamine, four allocated intermittent chloroquine (p=0.26), and two allocated chloroquine prophylaxis (p=0.063). Maternal anaemia was noted in five women assigned intermittent sulfadoxine-pyrimethamine, 15 allocated intermittent chloroquine (p=0.038), and six assigned chloroquine prophylaxis (p>0.99). Low birthweight was recorded for 31 babies born to women allocated intermittent sulfadoxine-pyrimethamine, 29 assigned intermittent chloroquine (p=0.78), and 41 allocated chloroquine prophylaxis (p=0.28). Four women assigned intermittent sulfadoxine-pyrimethamine had adverse events possibly related to study product compared with 94 women allocated intermittent chloroquine (p<0.0001) and 26 allocated chloroquine prophylaxis (p<0.0001). Three women had severe or life-threatening adverse events related to study product, of whom all were assigned intermittent chloroquine (p=0.25). INTERPRETATION: Chloroquine administered as intermittent therapy did not provide better protection from malaria and related adverse effects compared with intermittent sulfadoxine-pyrimethamine in a setting of high resistance to sulfadoxine-pyrimethamine. Chloroquine chemoprophylaxis might provide benefit in protecting against malaria during pregnancy, but studies with larger sample sizes are needed to confirm these results. FUNDING: US National Institutes of Health. |
Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April-July 2016
Dynes MM , Bernstein E , Morof D , Kelly L , Ruiz A , Mongo W , Chaote P , Bujari RN , Serbanescu F . Reprod Health 2018 15 (1) 152 BACKGROUND: Integration of family planning (FP) services into non-FP care visits is an essential strategy for reducing maternal and neonatal mortality through reduction of short birth intervals and unplanned pregnancies. METHODS: Cross-sectional surveys were conducted across 61 facilities in Kigoma Region, Tanzania, April-July 2016. Multilevel, mixed effects logistic regression analyses were conducted on matched data from providers (n = 330) and clients seeking delivery (n = 935), well-baby (n = 272), pregnancy loss (PL; n = 229), and other routine (postnatal, HIV/STI, other; n = 69) services. Outcomes of interest included receipt of FP information and a modern FP method (significance level p < 0.05). RESULTS: Clients had significantly greater odds of receiving FP information if the primary reason for seeking care was for PL versus (vs) any other types of care (aOR 1.97), had four or more pregnancies vs fewer (aOR 1.78), and had had a FP discussion with their partner vs no FP discussion (aOR 1.73). Clients had lower odds of receiving FP information if they were aged 40-49 vs 15-19 (aOR 0.50) and reported attending religious services at least weekly vs less frequently (aOR 0.61). Clients of providers who perceived that in-service training had helped vs had not helped job performance (aOR 2.27), and clients of providers having high vs low recent FP training index scores (aOR 1.58) had greater odds of receiving FP information. Clients had greater odds of receiving a modern method when they received information on two or more vs fewer methods (aOR 7.13), had had a FP discussion with their partner vs no discussion (aOR 5.87), if the primary reason for seeking care was for PL vs any other types of care (aOR 4.08), had zero vs one or more live births (aOR 3.92), made their own FP decisions vs not made own FP decisions (aOR 3.17), received FP information from two or more vs fewer sources (aOR 3.12), and were in the middle or high vs the low wealth tercile (aOR 1.99 and 2.30, respectively). Well-baby care clients, Other routine services clients, and married clients had significantly lower odds of receiving a method (aOR 0.14; aOR 0.08; and aOR 0.41, respectively) compared to their counterparts. CONCLUSIONS: Strategies that better integrate FP into routine care visits, encourage women to have FP discussions with their partners and providers, increase FP training among providers, and expand FP options and sources of information may help reduce the unmet need for FP, and ultimately lower maternal and neonatal mortality. |
Contraceptive, condom and dual method use at last coitus among perinatally and horizontally HIV-infected young women in Atlanta, Georgia
Haddad LB , Brown JL , King C , Gause NK , Cordes S , Chakraborty R , Kourtis AP . PLoS One 2018 13 (9) e0202946 OBJECTIVE: To evaluate factors within the social-ecological framework associated with most or moderately effective contraception, condom and dual method use at last coitus among young, HIV-infected women in Atlanta. METHODS: This is a cross-sectional study conducted from November, 2013 until August, 2015 at the Grady Infectious Disease Clinic in Atlanta, Georgia. We recruited perinatally and horizontally HIV-infected women of ages 14-30 years to complete an audio computer-assisted self-interview. We evaluated factors within a social-ecological framework associated with most or moderately effective contraceptive use (hormonal contraception or an IUD), condom use, and dual method use (use of condom and most or moderately effective contraceptive) at last coitus. RESULTS: Of 103 women enrolled, 74 reported a history of sexual activity. The average age was 22.1; 89% were African American, 52% were perinatally infected, 89% received combination antiretroviral therapy, and 63% had undetectable viral loads. At last coitus, 46% reported most or moderately effective contraception, 62% reported condom use and 27% reporting dual-method use. The odds of most or moderately effective contraceptive use was significantly reduced among those with detectable viral loads (versus undetectable viral loads; aOR 0.13 [0.04, 0.38]). Older age (aOR 0.85 [0.74, 0.98] and more frequent coitus (>once/week versus < = once/week; aOR 0.24 [0.08, 0.72]) was significantly associated with reduced condom use. Having a detectable viral load (versus undetectable viral loads; aOR 0.13 [0.03, 0.69]) and more frequent coitus (>once/week versus < = once/week; aOR 0.14 [0.03,0.82]), was associated with reduced dual method use, while being enrolled in school (aOR 5.63 [1.53, 20.71]) was significantly associated with increased dual method use. CONCLUSIONS: Most or moderately effective contraception, condom and dual method use remained inadequate in this cohort of young HIV-infected women. Individual-level interventions are needed to increase the uptake of dual methods with user-independent contraceptives. |
Intrauterine device expulsion after postpartum placement: A systematic review and meta-analysis
Jatlaoui TC , Whiteman MK , Jeng G , Tepper NK , Berry-Bibee E , Jamieson DJ , Marchbanks PA , Curtis KM . Obstet Gynecol 2018 132 (4) 895-905 OBJECTIVE: To estimate expulsion rates among women with postpartum intrauterine device (IUD) placement by timing of insertion, IUD type, and delivery method. DATA SOURCES: We searched PubMed, Cochrane Library, and ClinicalTrials.gov from 1974 to May 2018. METHODS OF STUDY SELECTION: We searched databases for any published studies that examined postpartum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model. TABULATION, INTEGRATION, AND RESULTS: We identified 48 level I to II-3 studies of poor to good quality. Pooled rates of expulsion varied by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum). Immediate and early postpartum placements were associated with increased risk of expulsion compared with interval placement (adjusted RR 7.63, 95% CI 4.31-13.51; adjusted RR 6.17, 95% CI 3.19-11.93, respectively). Postpartum placement less than 4 weeks after vaginal delivery was associated with an increased risk of expulsion compared with cesarean delivery (adjusted RR 5.19, 95% CI 3.85-6.99). Analysis of expulsion rates at less than 4 weeks postpartum also indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50-2.43) compared with CuT380A. CONCLUSION: Postpartum IUD expulsion rates vary by timing of placement, delivery method, and IUD type. These results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs. |
Pregnancy Risk Assessment Monitoring System for dads: Public health surveillance of new fathers in the perinatal period
Garfield CF , Simon CD , Harrison L , Besera G , Kapaya M , Pazol K , Boulet S , Grigorescu V , Barfield W , Warner L . Am J Public Health 2018 108 (10) 1314-1315 As Father’s Day approaches each June, the nation pauses to reflect on the importance of fathers. In the United States, approximately 60% of American men are fathers, 82% of whom live with at least one of their children.1 Over the past few decades, we have learned that paternal involvement is strongly associated with better prenatal and postnatal maternal health and with improved developmental outcomes for children.2 A number of key indicators demonstrate the influence fathers have on perinatal maternal and child health,3 including improvements in first trimester prenatal care initiation, infant morbidity and mortality, and breastfeeding initiation and continuation. Although fathers’ involvement in families is increasing, there has been limited research on how fatherhood affects the health and well-being of fathers themselves, especially around the time of the transition into fatherhood. In particular, surveillance efforts examining new fathers’ behaviors and attitudes remain suboptimal. Expectant fathers’ preconception health is a newly emerging area of research focused on measuring the health of men during their reproductive years, a key tenet of men’s health.4 |
Factors associated with prescription opioid analgesic use in the US population, 2011-2014
Frenk SM , Lukacs SL , Gu Q . Pain Med 2018 20 (7) 1338-1346 Objective: This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined. Methods: Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011-2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days. Results: Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being "fair" or "poor" (40.4% [95% confidence interval {CI} = 34.9%-46.2%] compared with 15.6% [95% CI = 14.3%-17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9-15.8] days compared with 2.3 [95% CI = 2.0-2.7] days), and had depression (22.5% [95% CI = 17.3%-28.7%] compared with 7.1% [95% CI = 6.2%-8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%-24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%-7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20-39 and 40-59 years. Conclusions: Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose. |
Contraception as a medical countermeasure to reduce adverse outcomes associated with Zika virus infection in Puerto Rico: The Zika Contraception Access Network Program
Romero L , Koonin LM , Zapata LB , Hurst S , Mendoza Z , Lathrop E . Am J Public Health 2018 108 S227-s230 The Zika Contraception Access Network established a network of 153 physicians across Puerto Rico as a short-term emergency response during the 2016-2017 Zika virus outbreak to provide client-centered contraceptive counseling and same-day contraception services at no cost for women who chose to prevent pregnancy. Between May 2016 and August 2017, 21 124 women received services. Contraception was used as a medical countermeasure to reduce adverse Zika-related reproductive outcomes during the outbreak and may be considered a key strategy in other emergencies. |
Sampling considerations for a potential Zika virus urosurvey in New York City
Thompson CN , Lee CT , Immerwahr S , Resnick S , Culp G , Greene SK . Epidemiol Infect 2018 146 (13) 1628-1634 In 2016, imported Zika virus (ZIKV) infections and the presence of a potentially competent mosquito vector (Aedes albopictus) implied that ZIKV transmission in New York City (NYC) was possible. The NYC Department of Health and Mental Hygiene developed contingency plans for a urosurvey to rule out ongoing local transmission as quickly as possible if a locally acquired case of confirmed ZIKV infection was suspected. We identified tools to (1) rapidly estimate the population living in any given 150-m radius (i.e. within the typical flight distance of an Aedes mosquito) and (2) calculate the sample size needed to test and rule out the further local transmission. As we expected near-zero ZIKV prevalence, methods relying on the normal approximation to the binomial distribution were inappropriate. Instead, we assumed a hypergeometric distribution, 10 missed cases at maximum, a urine assay sensitivity of 92.6% and 100% specificity. Three suspected example risk areas were evaluated with estimated population sizes of 479-4,453, corresponding to a minimum of 133-1244 urine samples. This planning exercise improved our capacity for ruling out local transmission of an emerging infection in a dense, urban environment where all residents in a suspected risk area cannot be feasibly sampled. |
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