Tumor necrosis factor receptors 1 and 2 are associated with early glomerular lesions in type 2 diabetes
Pavkov ME , Weil EJ , Fufaa GD , Nelson RG , Lemley KV , Knowler WC , Niewczas MA , Krolewski AS . Kidney Int 2015 89 (1) 226-34 Elevated serum tumor necrosis factor receptor 1 (TNFR1) and 2 (TNFR2) concentrations are strongly associated with increased risk of end-stage renal disease in type 2 diabetes. However, little is known about the early glomerular structural lesions that develop in patients when these markers are elevated. Here, we examined the relationships between TNFRs and glomerular structure in 83 American Indians with type 2 diabetes. Serum TNFRs and glomerular filtration rate (GFR, iothalamate) were measured during a research exam performed within a median of 0.9 months from a percutaneous kidney biopsy. Associations of TNFRs with glomerular structural variables were quantified by Spearman's correlations and by multivariable linear regression after adjustment for age, gender, diabetes duration, hemoglobin A1c, body mass index, and mean arterial pressure. The baseline mean age was 46 years, median GFR 130 ml/min, median albumin/creatinine ratio 26 mg/g, median TNFR1 1500 pg/ml, and median TNFR2 3284 pg/ml. After multivariable adjustment, TNFR1 and TNFR2 significantly correlated inversely with the percentage of endothelial cell fenestration and the total filtration surface per glomerulus. There were significant positive correlations with mesangial fractional volume, glomerular basement membrane width, podocyte foot process width, and percentage of global glomerular sclerosis. Thus, TNFRs may be involved in the pathogenesis of early glomerular lesions in diabetic nephropathy. |
Adults eligible for cardiovascular disease prevention counseling and participation in aerobic physical activity - United States, 2013
Omura JD , Carlson SA , Paul P , Watson KB , Loustalot F , Foltz JL , Fulton JE . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1047-1051 Cardiovascular disease (CVD) is the leading cause of death in the United States, and physical inactivity is a major risk factor (1). Health care professionals have a role in counseling patients about physical activity for CVD prevention. In August 2014, the U.S. Preventive Services Task Force (USPSTF) recommended that adults who are overweight or obese and have additional CVD risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Although the USPSTF recommendation does not specify an amount of physical activity, the 2008 Physical Activity Guidelines for Americans state that for substantial health benefits adults should achieve >/=150 minutes per week of moderate-intensity aerobic physical activity or >/=75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. To assess the proportion of adults eligible for intensive behavioral counseling and not meeting the aerobic physical activity guideline, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). This analysis indicated that 36.8% of adults were eligible for intensive behavioral counseling for CVD prevention. Among U.S. states and the District of Columbia (DC), the prevalence of eligible adults ranged from 29.0% to 44.6%. Nationwide, 19.9% of all adults were eligible and did not meet the aerobic physical activity guideline. These data can inform the planning and implementation of health care interventions for CVD prevention that are based on physical activity. |
The association between cardiovascular health and health-related quality of life and health status measures among U.S. adults: a cross-sectional study of the National Health and Nutrition Examination Surveys, 2001-2010
Allen NB , Badon S , Greenlund KJ , Huffman M , Hong Y , Lloyd-Jones DM . Health Qual Life Outcomes 2015 13 (1) 152 BACKGROUND: This study was conducted to examine the association between ideal cardiovascular health (CVH) and health-related quality of life and health status indicators. METHODS: This cross-sectional study included adult NHANES participants from 2001 to 2010 without CVD (N = 7115). CVH was defined according to AHA definitions with poor, intermediate and ideal levels of the seven factors (diet, BMI, physical activity, smoking, blood pressure, glucose, and cholesterol) assigned scores of 0, 1, and 2, respectively. A CVH score (CVHS) was calculated as the sum of the scores from each individual health factor (range 0-14; higher score indicating greater CVH). CVHS was categorized as poor (0-7), intermediate (8-10), and ideal (11-14). Linear regression models examined the association between CVHS category with health status and number of unhealthy days per month, adjusted for socio-demographic characteristics and disability. RESULTS: Among US adults 20-79 years, 14, 46 and 40 % had ideal, intermediate and poor CVHS, respectively. Compared to those with poor CVH, individuals in intermediate and ideal CVH were 44 and 71 % less likely to report being in fair/poor health. Participants with ideal CVH scores reported a mean of 2.4 fewer unhealthy days over the past month, including one less day in which their physical health was not good and two fewer days in which their mental health was not good. CONCLUSIONS: Ideal CVH is associated with greater overall health status and fewer physically and mentally unhealthy days. |
Tuberculosis case notification by private practitioners in Pune, India: how well are we doing?
Yeole RD , Khillare K , Chadha VK , Lo T , Kumar AM . Public Health Action 2015 5 (3) 173-9 SETTING: Pimpri Chinchwad Municipal Corporation area, Pune, India. OBJECTIVE: To assess the proportion of private practitioners (PPs) who notified tuberculosis (TB) patients during February-April 2013 and their contribution to the overall number notified, and to determine their perceived challenges in reporting TB cases. DESIGN: Mixed-method study including an analysis of notification data, followed by in-depth interviews with PPs. Interviews were transcribed and inductive content analysis was performed to derive themes. RESULTS: Of 831 PPs, 533 (64%) participated in case notification; of these 87 (16%) notified at least one TB case during the study period. In all, 138 TB cases were notified by PPs, accounting for 20% of the total TB cases notified. Emerging themes among perceived challenges and barriers were lack of complete knowledge about TB notification, fear of a breach of patient confidentiality, lack of a simplified operational mechanism of notification, and lack of trust and coordination with the government health system. CONCLUSION: About two thirds of PPs participated in case notification and contributed significantly to the overall TB cases notified. India's national TB programme should focus on training PPs and targeted media communication campaigns, and establish alternative mechanisms for notification, such as the internet and mobile telephones, to overcome perceived barriers. |
Unreported male sex partners among men with newly diagnosed HIV infection - North Carolina, 2011-2013
Wu H , Hightow-Weidman LB , Gay CL , Zhang X , Beagle S , Hall L , Jackson T , Marmorino J , Do AN , Peters PJ . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1037-1041 Human immunodeficiency virus (HIV) prevention interventions, such as preexposure prophylaxis (PrEP), are often targeted to men who have sex with men (MSM) who self-report high-risk behaviors. Data from a prospective study evaluating methods to detect acute HIV infection among a primarily young (aged <25 years) and black or African American (African American) population from North Carolina were analyzed. In the study, participants were asked about risk behaviors during pretest counseling (at the time of testing) and then during a partner services interview (at HIV diagnosis). Participants whose disclosure of sexual risk behaviors during pretest counseling was different from their disclosure of sexual risk behaviors during their partner services interview were identified, and factors associated with these discordant responses were examined. Among 113 HIV-infected men, 26 (23.0%) did not disclose male sex partners at pretest counseling, but subsequently did disclose this information during their partner services interview. When compared with men who disclosed having male partners at pretest counseling, these 26 MSM who did not disclose male partners during pretest counseling were found to have a similar number of male partners during contact tracing, but were more likely to have a female partner (30.8% versus 6.9%). In addition, the proportions of MSM found to have at least one HIV-infected partner were similar for both groups (MSM who disclosed having male partners during pretest counseling and those who did not). To better customize HIV prevention interventions for MSM, HIV prevention programs might consider using novel strategies to accurately assess risk in this population. |
Update: influenza activity - United States and worldwide, May 24-September 5, 2015
Blanton L , Kniss K , Smith S , Mustaquim D , Steffens C , Flannery B , Fry AM , Bresee J , Wallis T , Garten R , Xu X , Elal AI , Gubareva L , Wentworth DE , Burns E , Katz J , Jernigan D , Brammer L . MMWR Morb Mortal Wkly Rep 2015 64 (36) 1011-6 During May 24-September 5, 2015, the United States experienced typical low levels of seasonal influenza activity. Influenza A (H1N1)pdm09 (pH1N1), influenza A (H3N2), and influenza B viruses were detected worldwide and were identified sporadically in the United States. All of the influenza viruses collected from U.S. states and other countries during that time have been characterized antigenically and/or genetically as being similar to the influenza vaccine viruses recommended for inclusion in the 2015-16 Northern Hemisphere vaccine. During May 24-September 5, 2015, three influenza variantdagger virus infections were reported; one influenza A (H3N2) variant virus (H3N2v) from Minnesota in July, one influenza A (H1N1) variant (H1N1v) from Iowa in August, and one H3N2v from Michigan in August. |
Vancomycin-resistant Staphylococcus aureus - Delaware, 2015
Walters MS , Eggers P , Albrecht V , Travis T , Lonsway D , Hovan G , Taylor D , Rasheed K , Limbago B , Kallen A . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1056 Vancomycin-resistant Staphylococcus aureus (VRSA) is a rare, multidrug-resistant bacterium of public health concern that emerged in the United States in 2002. VRSA (S. aureus with vancomycin minimum inhibitory concentration [MIC] ≥16 µg/mL) arises when vancomycin resistance genes (e.g., the vanA operon, which codes for enzymes that result in modification or elimination of the vancomycin binding site) from vancomycin-resistant enterococci (VRE) are transferred to S. aureus (1). To date, all VRSA strains have arisen from methicillin-resistant S. aureus (MRSA). The fourteenth VRSA isolate (VRSA 14) identified in the United States was reported to CDC in February 2015. | VRSA 14 was cultured from the chronic toe wound of a patient in Delaware with diabetes mellitus and end-stage renal disease requiring hemodialysis; vancomycin-resistant Enterococcus faecalis was also isolated from this culture. The wound was first noted during an inpatient admission in April 2014. MRSA was isolated in August and October 2014, and MRSA and VRE were isolated in January 2015; these isolates are not available for further characterization. No antibiotic use was reported in the 4 months before VRSA isolation. | The VRSA and VRE toe wound isolates (February 2015) and an MRSA isolate from a nasal swab from the patient (March 2015) were sent to CDC for further characterization. The VRSA and VRE were confirmed to be resistant to vancomycin (MICs = 512 µg/mL for both); polymerase chain reaction testing confirmed the presence of vanA in both isolates. Pulsed-field gel electrophoresis and S. aureus protein A (spa) typing identified both the VRSA and MRSA as types USA100 and t002, placing them in staphylococcal clonal complex 5. This indicates that VRSA 14 has a health care–associated strain background, as do VRSA 1–12. Among VRSA isolated in the United States, only VRSA 13 had a community-associated strain background (2). |
Negative life events and depression in adolescents with HIV: a stress and coping analysis
Lewis JV , Abramowitz S , Koenig LJ , Chandwani S , Orban L . AIDS Care 2015 27 (10) 1-10 The prevalence of negative life events (NLE) and daily hassles, and their direct and moderated associations with depression, were examined among HIV-infected adolescents. Specifically, we examined whether the negative association with depression of NLE, daily hassles, and/or passive coping were moderated by social support or active coping strategies. Demographic characteristics, depression, coping, social support, NLE, and daily hassles were collected at baseline as part of the Adolescent Impact intervention via face-to-face and computer-assisted interviews. Of 166 HIV-infected adolescents, 53% were female, 72.9% black, 59.6% with perinatally acquired HIV (PIY), the most commonly reported NLE were death in family (81%), violence exposure (68%), school relocation (67%), and hospitalization (61%); and for daily hassles "not having enough money (65%)". Behaviorally infected youth (BIY - acquired HIV later in life) were significantly more likely to experience extensive (14-21) lifetime NLE (38.8% vs. 16.3%, p < .012) than PIY. In multiple stepwise regression analysis, the model accounting for the greatest variability in depression scores (32%) included (in order of entry): daily hassles, low social support, behaviorally acquired HIV, minority sexual orientation, and passive coping. A significant passive coping-by-social support interaction revealed that the association between passive coping and depression was exacerbated when social support was low. Social support moderated the effect of NLE, such that NLE were associated with greater depression when social support was low, although the effect did not remain statistically significant when main effects of other variables were accounted for. Daily hassles, poor coping, and limited social support can adversely affect the psychological well-being of HIV-infected adolescents, particularly sexual minority youth with behaviorally acquired HIV. Multimodal interventions that enhance social support and teach adaptive coping skills may help youth cope with environmental stresses and improve mental health outcomes. |
Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance
Winthrop KL , Novosad SA , Baddley JW , Calabrese L , Chiller T , Polgreen P , Bartalesi F , Lipman M , Mariette X , Lortholary O , Weinblatt ME , Saag M , Smolen J . Ann Rheum Dis 2015 74 (12) 2107-16 No consensus has previously been formed regarding the types and presentations of infectious pathogens to be considered as 'opportunistic infections' (OIs) within the setting of biologic therapy. We systematically reviewed published literature reporting OIs in the setting of biologic therapy for inflammatory diseases. The review sought to describe the OI definitions used within these studies and the types of OIs reported. These findings informed a consensus committee (infectious diseases and rheumatology specialists) in deliberations regarding the development of a candidate list of infections that should be considered as OIs in the setting of biologic therapy. We reviewed 368 clinical trials (randomised controlled/long-term extension), 195 observational studies and numerous case reports/series. Only 11 observational studies defined OIs within their methods; no consistent OI definition was identified across studies. Across all study formats, the most numerous OIs reported were granulomatous infections. The consensus group developed a working definition for OIs as 'indicator' infections, defined as specific pathogens or presentations of pathogens that 'indicate' the likelihood of an alteration in host immunity in the setting of biologic therapy. Using this framework, consensus was reached upon a list of OIs and case-definitions for their reporting during clinical trials and other studies. Prior studies of OIs in the setting of biologic therapy have used inconsistent definitions. The consensus committee reached agreement upon an OI definition, developed case definitions for reporting of each pathogen, and recommended these be used in future studies to facilitate comparison of infection risk between biologic therapies. |
Prevalence of HIV and associated risk factors among long distance truck drivers in Inchope, Mozambique, 2012
Botao C , Horth RZ , Frank H , Cummings B , Inguane C , Sathane I , McFarland W , Fisher Raymond H , Young PW . AIDS Behav 2015 20 (4) 811-20 This is the first integrated biological and behavioral surveillance survey among long-distance truck drivers (LDTD) in Mozambique. Using modified time-location sampling in 2012 at a key transportation junction (Inchope), we enrolled 327 male LDTD. HIV prevalence was 15.4 % (95 % confidence interval : 11.4-19.4 %, n = 318 tested). Among HIV-positive LDTD, 83.7 % did not know their status. One-third of LDTD had never tested for HIV and three-quarters had not received free condoms, lubricants or HIV literature in the past 12 months. In that same period, 61.4 % of LDTD had at least four sexual partners and 27.1 % paid for sex. Among sexually-active LDTD, 76.5 % did not use a condom at last sex. HIV was associated (p < 0.05) with primary education or lower (AOR 2.1), residence in Mozambique (AOR 2.3) and never having tested for HIV (AOR 2.2). Our findings reveal that broader coverage of HIV prevention and comprehensive care services for LDTD are urgently needed. |
Providing logistics support to CDC-deployed staff for the Ebola response in Liberia, Guinea, and Sierra Leone
Dopson SA , Rodriguez R , Rouse EN . Health Promot Pract 2015 16 (6) 792-5 The first Ebola cases in West Africa were reported by the Guinea Ministry of Health on March 23, 2014, and by June it became the largest recorded Ebola outbreak. Centers for Disease Control and Prevention field teams were deployed to West Africa, including in-country logistics staff who were critical for ensuring the movement of staff, equipment, and supplies to locations where public health knowledge and experience were applied to meet mission-related requirements. The logistics role was critical to creating the support for epidemiologists, medical doctors, laboratory staff, and health communicators involved in health promotion activities to successfully respond to the epidemic, both in the capital cities and in remote villages. Logistics personnel worked to procure equipment, such as portable video projectors, and have health promotion materials printed. Logistics staff also coordinated delivery of communication and health promotion materials to the embassy and provided assistance with distribution to various partners. |
"If you are not circumcised, I cannot say yes": the role of women in promoting the uptake of voluntary medical male circumcision in Tanzania
Osaki H , Mshana G , Wambura M , Grund J , Neke N , Kuringe E , Plotkin M , Mahler H , Terris-Prestholt F , Weiss H , Changalucha J . PLoS One 2015 10 (9) e0139009 Voluntary Medical Male Circumcision (VMMC) for HIV prevention in Tanzania was introduced by the Ministry of Health and Social Welfare in 2010 as part of the national HIV prevention strategy. A qualitative study was conducted prior to a cluster randomized trial which tested effective strategies to increase VMMC up take among men aged ≥20 years. During the formative qualitative study, we conducted in-depth interviews with circumcised males (n = 14), uncircumcised males (n = 16), and participatory group discussions (n = 20) with men and women aged 20-49 years in Njombe and Tabora regions of Tanzania. Participants reported that mothers and female partners have an important influence on men's decisions to seek VMMC both directly by denying sex, and indirectly through discussion, advice and providing information on VMMC to uncircumcised partners and sons. Our findings suggest that in Tanzania and potentially other settings, an expanded role for women in VMMC communication strategies could increase adult male uptake of VMMC services. |
Implementation and evaluation of an isoniazid preventive therapy pilot program among HIV-infected patients in Vietnam, 2008-2010
Trinh TT , Han DT , Bloss E , Le TH , Vu TT , Mai AH , Nguyen NV , Nguyen LT , Dinh SN , Whitehead S . Trans R Soc Trop Med Hyg 2015 109 (10) 653-9 BACKGROUND: WHO recommends screening for TB and evaluation for isoniazid preventive therapy (IPT) based on evidence that they reduce TB-related morbidity and mortality among HIV-infected persons. In Vietnam, an IPT pilot was implemented in two provinces; TB screening, treatment and outcomes were evaluated to inform the adoption and scale-up of IPT. METHODS: During April 2008 to March 2010, eligible HIV-infected persons aged >15 years, with no previous or current TB treatment, alcohol abuse or liver disease were screened for TB. If TB disease was ruled out based on symptoms, chest x-rays and sputum smears, isoniazid was administered for 9 months. RESULTS: Among 1281 HIV-infected persons who received initial eligibility screening, 520 were referred to and evaluated at district TB clinics for TB disease or IPT eligibility. Active TB was diagnosed in 17 patients and all were started on treatment. Of 520 patients evaluated, 416 (80.0%) initiated IPT: 382 (91.8%) completed IPT, 17 (4.1%) stopped treatment, 8 (1.9%) died, 3 (0.7%) developed TB during IPT and 6 (1.4%) had unknown outcomes. No severe adverse events were reported. CONCLUSIONS: IPT treatment completion was high; no serious complications occurred. Improving and expanding intensified case-finding and IPT should be considered in Vietnam. |
Influenza-associated disease burden in Kenya: a systematic review of literature
Emukule GO , Paget J , Velden KV , Mott JA . PLoS One 2015 10 (9) e0138708 BACKGROUND: In Kenya data on the burden of influenza disease are needed to inform influenza control policies. METHODS: We conducted a systematic review of published data describing the influenza disease burden in Kenya using surveillance data collected until December 2013. We included studies with laboratory confirmation of influenza, well-defined catchment populations, case definitions used to sample patients for testing and a description of the laboratory methods used for influenza testing. Studies with or without any adjustments on the incidence rates were included. RESULTS: Ten studies reporting the incidence of medically-attended and non-medically attended influenza were reviewed. For all age groups, the influenza positive proportion ranged from 5-10% among hospitalized patients, and 5-27% among all medically-attended patients (a combination of in- and outpatients). The adjusted incidence rate of hospitalizations with influenza among children <5 years ranged from 2.7-4.7 per 1,000 [5.7 per 1,000 in children <6 months old], and were 7-10 times higher compared to persons aged ≥5 years. The adjusted incidence of all medically-attended influenza among children aged <5 years ranged from 13.0-58.0 per 1,000 compared to 4.3-26.0 per 1,000 among persons aged ≥5 years. CONCLUSIONS: Our review shows an expanding set of literature on disease burden associated with influenza in Kenya, with a substantial burden in children under five years of age. Hospitalizations with influenza in these children were 2-3 times higher than reported in the United States. These findings highlight the possible value of an influenza vaccination program in Kenya, with children <5 years and pregnant women being potentially important targets. |
Clinical inquiries received by CDC regarding suspected Ebola virus disease in children - United States, July 9, 2014-January 4, 2015
Goodman AB , Meites E , Anstey EH , Fullerton KE , Jayatilleke A , Ruben W , Koumans E , Oster AM , Karwowski MP , Dziuban E , Kirkcaldy RD , Glover M , Lowe L , Peacock G , Mahon B , Griese SE . MMWR Morb Mortal Wkly Rep 2015 64 (36) 1006-10 The 2014-2015 Ebola virus disease (Ebola) epidemic is the largest in history and represents the first time Ebola has been diagnosed in the United States. On July 9, 2014, CDC activated its Emergency Operations Center and established an Ebola clinical consultation service to assist U.S. state and local public health officials and health care providers with the evaluation of suspected cases. CDC reviewed all 89 inquiries received by the consultation service during July 9, 2014- January 4, 2015, about children (persons aged </=18 years). Most (56 [63%]) children had no identifiable epidemiologic risk factors for Ebola; among the 33 (37%) who did have an epidemiologic risk factor, in every case this was travel from an Ebola-affected country. Thirty-two of these children met criteria for a person under investigation (PUI) because of clinical signs or symptoms. Fifteen PUIs had blood samples tested for Ebola virus RNA by reverse transcription-polymerase chain reaction; all tested negative. Febrile children who have recently traveled from an Ebola-affected country can be expected to have other common diagnoses, such as malaria and influenza, and in the absence of epidemiologic risk factors for Ebola, the likelihood of Ebola is extremely low. Delaying evaluation and treatment for these other more common illnesses might lead to poorer clinical outcomes. Additionally, many health care providers expressed concerns about whether and how parents should be allowed in the isolation room. While maintaining an appropriate level of vigilance for Ebola, public health officials and health care providers should ensure that pediatric PUIs receive timely triage, diagnosis, and treatment of other more common illnesses, and care reflecting best practices in supporting children's psychosocial needs. |
Detection of Measles Virus RNA in Air and Surface Specimens in a Hospital Setting
Bischoff WE , McNall RJ , Blevins MW , Turner J , Lopareva EN , Rota PA , Stehle JR Jr . J Infect Dis 2015 213 (4) 600-3 Measles virus (MeV) is known to be highly contagious with an infectious period lasting from the four days preceding to the four days following rash onset. An unvaccinated, young, female patient with measles confirmed by direct epidemiologic link was hospitalized on day five after rash onset. Environmental samples were collected over the four day hospitalization period in a single room. MeV RNA was detectable in air, on surfaces, and respirators on days 5-8 after rash onset. This is the first report of environmental surveillance for MeV and the results suggest that measles infected fomites may be present in healthcare settings. |
Measles in the 21st century, a continuing preventable risk to travelers: data from the GeoSentinel Global Network
Sotir MJ , Esposito DH , Barnett ED , Leder K , Kozarsky PE , Lim PL , Gkrania-Klotsas E , Hamer DH , Kuhn S , Connor BA , Pradhan R , Caumes E . Clin Infect Dis 2015 62 (2) 210-2 Measles remains a risk for travelers. Ninety-four measles diagnoses were reported to the GeoSentinel network from 2000-2014; two-thirds since 2010. Asia was the most common exposure region, followed by Africa and Europe. Efforts to reduce travel-associated measles should target vaccine-eligible travelers of all ages, including catch-up vaccination of susceptible adults. |
Eco-epidemiological study of an endemic Chagas disease region in northern Colombia reveals the importance of Triatoma maculata (Hemiptera: Reduviidae), dogs and Didelphis marsupialis in Trypanosoma cruzi maintenance.
Cantillo-Barraza O , Garces E , Gomez-Palacio A , Cortes LA , Pereira A , Marcet PL , Jansen AM , Triana-Chavez O . Parasit Vectors 2015 8 (1) 482 BACKGROUND: In Colombia, Rhodnius prolixus and Triatoma dimidiata are the main domestic triatomine species known to transmit T. cruzi. However, there are multiple reports of T. cruzi transmission involving secondary vectors. In this work, we carried out an eco-epidemiological study on Margarita Island, located in the Caribbean region of Colombia, where Chagas disease is associated with non-domiciliated vectors. METHODS: To understand the transmission dynamics of Trypanosoma cruzi in this area, we designed a comprehensive, multi-faceted study including the following: (i) entomological evaluation through a community-based insect-surveillance campaign, blood meal source determination and T. cruzi infection rate estimation in triatomine insects; (ii) serological determination of T. cruzi prevalence in children under 15 years old, as well as in domestic dogs and synanthropic mammals; (iii) evaluation of T. cruzi transmission capacity in dogs and Didelphis marsupialis, and (iv) genetic characterization of T. cruzi isolates targeting spliced-leader intergene region (SL-IR) genotypes. RESULTS: Out of the 124 triatomines collected, 94 % were Triatoma maculata, and 71.6 % of them were infected with T. cruzi. Blood-meal source analysis showed that T. maculata feeds on multiple hosts, including humans and domestic dogs. Serological analysis indicated 2 of 803 children were infected, representing a prevalence of 0.25 %. The prevalence in domestic dogs was 71.6 % (171/224). Domestic dogs might not be competent reservoir hosts, as inferred from negative T. cruzi xenodiagnosis and haemoculture tests. However, 61.5 % (8/13) of D. marsupialis, the most abundant synanthropic mammal captured, were T. cruzi-positive on xenodiagnosis and haemocultures. CONCLUSIONS: This study reveals the role of peridomestic T. maculata and dogs in T. cruzi persistence in this region and presents evidence that D. marsupialis are a reservoir mediating peridomestic-zoonotic cycles. This picture reflects the complexity of the transmission dynamics of T. cruzi in an endemic area with non-domiciliated vectors where active human infection exists. There is an ongoing need to control peridomestic T. maculata populations and to implement continuous reservoir surveillance strategies with community participation. |
Minimizing antibiotic misuse through evidence-based management of outpatient acute respiratory infections
Sanchez GV , Fleming-Dutra KE , Hicks LA . Antimicrob Agents Chemother 2015 59 (10) 6673 It was with considerable interest that we read the study by Schroeck et al. (1), which assessed the appropriateness of treatment for acute respiratory infections (ARIs) in the Veterans Affairs Western New York Healthcare System. These infections represent a large portion of injudicious antibiotic use among outpatients, and we applaud the authors for focusing on these conditions in the veteran population. However, we would like to clarify that clinical practice guidelines regarding the management of ARIs are published by professional societies such as the Infectious Diseases Society of America (IDSA) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and not by the Centers for Disease Control and Prevention (CDC). The CDC's Get Smart: Know When Antibiotics Work Program consolidates recommendations from the different guidelines into easy-to-use resources to help clinicians optimize outpatient antibiotic therapy (2). Although the authors cite the Get Smart Program as providing the criteria to diagnose and manage ARIs, the definitions of the clinical conditions presented do not accurately reflect current clinical practice guidelines or current Get Smart recommendations. |
The Navajo Birth Cohort Study
Hunter CM , Lewis J , Peter D , Begay MG , Ragin-Wilson A . J Environ Health 2015 78 (2) 42-45 The Navajo Nation encompasses more | than 24,000 square miles across three | states—New Mexico, Utah, and Arizona— | and is the largest Alaska Native/American | Indian Reservation in the U.S. From 1944 | to 1986, hundreds of uranium mining and | milling operations extracted an estimated | 400 million tons of uranium ore from Navajo | lands. These mining and processing operations have left a legacy of potential exposures | to uranium waste from abandoned mines/ | mills, drinking water and soil contamination, | and homes and structures built with mining waste (U.S. Environmental Protection | Agency [U.S. EPA], 2014). |
Evaluating evidence for association of human bladder cancer with drinking-water chlorination disinfection by-products
Hrudey SE , Backer LC , Humpage AR , Krasner SW , Michaud DS , Moore LE , Singer PC , Stanford BD . J Toxicol Environ Health B Crit Rev 2015 18 (5) 1-29 Exposure to chlorination disinfection by-products (CxDBPs) is prevalent in populations using chlorination-based methods to disinfect public water supplies. Multifaceted research has been directed for decades to identify, characterize, and understand the toxicology of these compounds, control and minimize their formation, and conduct epidemiologic studies related to exposure. Urinary bladder cancer has been the health risk most consistently associated with CxDBPs in epidemiologic studies. An international workshop was held to (1) discuss the qualitative strengths and limitations that inform the association between bladder cancer and CxDBPs in the context of possible causation, (2) identify knowledge gaps for this topic in relation to chlorine/chloramine-based disinfection practice(s) in the United States, and (3) assess the evidence for informing risk management. Epidemiological evidence linking exposures to CxDBPs in drinking water to human bladder cancer risk provides insight into causality. However, because of imprecise, inaccurate, or incomplete estimation of CxDBPs levels in epidemiologic studies, translation from hazard identification directly to risk management and regulatory policy for CxDBPs can be challenging. Quantitative risk estimates derived from toxicological risk assessment for CxDBPs currently cannot be reconciled with those from epidemiologic studies, notwithstanding the complexities involved, making regulatory interpretation difficult. Evidence presented here has both strengths and limitations that require additional studies to resolve and improve the understanding of exposure response relationships. Replication of epidemiologic findings in independent populations with further elaboration of exposure assessment is needed to strengthen the knowledge base needed to better inform effective regulatory approaches. |
Indoor dampness and mould health effects - ongoing questions on microbial exposures and allergic versus nonallergic mechanisms
Cox-Ganser JM . Clin Exp Allergy 2015 45 (10) 1478-82 For some time now, it has been apparent that living, working, or going to school in damp buildings is associated with adverse health effects. In 2004 and 2009, two major reviews were published relating to health effects and damp indoor environments. These were the Institute of Medicine (IOM) report [1] and the World Health Organization (WHO) guidelines for dampness and mould [2]. In 2011, a follow-up review to the WHO guidelines was published [3]. These three publications documented that occupants of damp indoor environments are at risk for upper and lower respiratory symptoms, onset and exacerbation of asthma, respiratory infections, hypersensitivity pneumonitis, allergic rhinitis, eczema, and bronchitis. | The IOM report covered pertinent literature published up to late 2003 on a wide range of health effects including asthma. The findings regarding asthma were that sufficient evidence existed for associating the presence of mould or other agents in damp buildings with asthma exacerbations and that limited or suggestive evidence existed for associating exposure to damp indoor environments with asthma development. The committee concluded that excessive indoor dampness is a public health problem and that prevention or reduction of this condition should be a public health goal. |
State and metropolitan area-based amyotrophic lateral sclerosis (ALS) surveillance
Wagner L , Rechtman L , Jordan H , Ritsick M , Sanchez M , Sorenson E , Kaye W . Amyotroph Lateral Scler Frontotemporal Degener 2015 17 1-7 Our objective was to develop state and metropolitan area-based surveillance projects to describe the characteristics of those with ALS and to assist with evaluating the completeness of the National ALS Registry. Because the literature suggested that ethnic/racial minorities have lower incidence of ALS, three state and eight metropolitan areas were selected to over-represent ethnic/racial minorities to have a sufficient number of minority patients. Project activities relied on reports from medical providers and medical records abstraction. The project areas represented approximately 27% of the U.S. POPULATION: The combined racial and ethnic distribution of these areas is 64.4% white, 16.0% African-American, 6.7% Asian, and 28.3% Hispanic. Most neurologists did not diagnose or provide care for ALS patients. The number of unique patients reported was close to expected (5883 vs. 6673). Age and gender distribution of patients was similar to the literature. The crude average annual incidence rate was 1.52 per 100,000 person-years, CI 1.44-1.61, and the 2009 prevalence rate was 3.84 per 100,000 population, CI 3.70-3.97. In conclusion, this study represents the largest number of clinically diagnosed ALS patients reported by neurologists in the U.S. Comparison of these data with those in the National ALS Registry will help evaluate the completeness of administrative databases. |
Laboratory, environmental, and epidemiologic investigation and regulatory enforcement actions in response to an outbreak of Salmonella bredeney infections linked to peanut butter
Viazis S , Beal JK , Monahan C , Lanier WA , Kreil KR , Melka DC , Boden WD , Dion JL , Miller ZA , Nguyen TA , Gieraltowski LB , Zink DL . Open Forum Infect Dis 2015 2 (3) ofv114 BACKGROUND: In September 2012, the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and state and local partners investigated an outbreak of Salmonella enterica serovar Bredeney linked to peanut butter (PB). METHODS: A case was defined as infection with the outbreak strain of Salmonella Bredeney between June 1, 2012 and October 31, 2012. Food exposure questionnaires were analyzed by the CDC to determine the food vehicle. The FDA reviewed production information from Retail Chain A's sole supplier of PB, Company A. The PB samples collected from case-patients and Company A were tested for Salmonella. Results. Forty-two case-patients from 20 states were identified. Of 33 case-patients from whom food exposure information was obtained, 25 (76%) shopped at Retail Chain A and 25 (100%) purchased Company A PB. Three state health departments isolated the outbreak strain from opened jars of PB collected from case-patients. The FDA investigators identified multiple deficiencies in current Good Manufacturing Practices (cGMPs) in Company A's manufacturing facility and determined that internal controls were insufficient to prevent shipment of contaminated product. The FDA isolated the outbreak strain of Salmonella Bredeney from implicated product collected at the firm and the environment of the firm's food production facility. CONCLUSIONS: Timely laboratory, investigational, and epidemiologic data led to the voluntary recall of PB by Company A. The FDA suspended Company A's food facility registration, prohibiting the firm from introducing food into interstate commerce. This outbreak underscores the need for effective preventive controls, including robust internal environmental monitoring programs, appropriate action in response to contamination findings, and an improved understanding of food safety at the managerial and corporate levels. |
Epidemiologic Association Between FUT2 Secretor Status and Severe Rotavirus Gastroenteritis in Children in the United States.
Payne DC , Currier RL , Staat MA , Sahni LC , Selvarangan R , Halasa NB , Englund JA , Weinberg GA , Boom JA , Szilagyi PG , Klein EJ , Chappell J , Harrison CJ , Davidson BS , Mijatovic-Rustempasic S , Moffatt MD , McNeal M , Wikswo M , Bowen MD , Morrow AL , Parashar UD . JAMA Pediatr 2015 169 (11) 1-6 IMPORTANCE: A genetic polymorphism affecting FUT2 secretor status in approximately one-quarter of humans of European descent affects the expression of histo-blood group antigens on the mucosal epithelia of human respiratory, genitourinary, and digestive tracts. These histo-blood group antigens serve as host receptor sites necessary for attachment and infection of some pathogens, including norovirus. OBJECTIVE: We investigated whether an association exists between FUT2 secretor status and laboratory-confirmed rotavirus infections in US children. DESIGN, SETTING, AND PARTICIPANTS: Multicenter case-control observational study involving active surveillance at 6 US pediatric medical institutions in the inpatient and emergency department clinical settings. We enrolled 1564 children younger than 5 years with acute gastroenteritis (diarrhea and/or vomiting) and 818 healthy controls frequency matched by age and month, from December 1, 2011, through March 31, 2013. MAIN OUTCOMES AND MEASURES: Paired fecal-saliva specimens were tested for rotavirus and for secretor status. Comparisons were made between rotavirus test-positive cases and healthy controls stratified by ethnicity and vaccination status. Adjusted multivariable analyses assessed the preventive association of secretor status against severe rotavirus gastroenteritis. RESULTS: One (0.5%) of 189 rotavirus test-positive cases was a nonsecretor, compared with 188 (23%) of 818 healthy control participants (P < .001). Healthy control participants of Hispanic ethnicity were significantly less likely to be nonsecretors (13%) compared with healthy children who were not of Hispanic ethnicity (25%) (P < .001). After controlling for vaccination and other factors, children with the nonsecretor FUT2 polymorphism appeared statistically protected (98% [95% CI, 84%-100%]) against severe rotavirus gastroenteritis. CONCLUSIONS AND RELEVANCE: Severe rotavirus gastroenteritis was virtually absent among US children who had a genetic polymorphism that inactivates FUT2 expression on the intestinal epithelium. We observed a strong epidemiologic association among children with rotavirus gastroenteritis compared with healthy control participants. The exact cellular mechanism behind this epidemiologic association remains unclear, but evidence suggests that it may be rotavirus genotype specific. The lower prevalence of nonsecretors among Hispanic children may translate to an enhanced burden of rotavirus gastroenteritis among this group. Our findings may have bearing on our full understanding of rotavirus infections and the effects of vaccination in diverse populations. |
Genomic Epidemiology of Hypervirulent Serogroup W, ST-11 Neisseria meningitidis.
Mustapha MM , Marsh JW , Krauland MG , Fernandez JO , de Lemos APS , Dunning Hotopp JC , Wang X , Mayer LW , Lawrence JG , Hiller NL , Harrison LH . EBioMedicine 2015 2 (10) 1447-55 Neisseria meningitidis is a leading bacterial cause of sepsis and meningitis globally with dynamic strain distribution over time. Beginning with an epidemic among Hajj pilgrims in 2000, serogroup W (W) sequence type (ST) 11 emerged as a leading cause of epidemic meningitis in the African 'meningitis belt' and endemic cases in South America, Europe, Middle East and China. Previous genotyping studies were unable to reliably discriminate sporadic W ST-11 strains in circulation since 1970 from the Hajj outbreak strain (Hajj clone). It is also unclear what proportion of more recent W ST-11 disease clusters are caused by direct descendants of the Hajj clone. Whole genome sequences of 270 meningococcal strains isolated from patients with invasive meningococcal disease globally from 1970 to 2013 were compared using whole genome phylogenetic and major antigen-encoding gene sequence analyses. We found that all W ST-11 strains were descendants of an ancestral strain that had undergone unique capsular switching events. The Hajj clone and its descendants were distinct from other W ST-11 strains in that they shared a common antigen gene profile and had undergone recombination involving virulence genes encoding factor H binding protein, nitric oxide reductase, and nitrite reductase. These data demonstrate that recent acquisition of a distinct antigen-encoding gene profile and variations in meningococcal virulence genes was associated with the emergence of the Hajj clone. Importantly, W ST-11 strains unrelated to the Hajj outbreak contribute a significant proportion of W ST-11 cases globally. This study helps illuminate genomic factors associated with meningococcal strain emergence and evolution. |
SLUG is required for SOX9 stabilization and functions to promote cancer stem cells and metastasis in human lung carcinoma.
Luanpitpong S , Li J , Manke A , Brundage K , Ellis E , McLaughlin SL , Angsutararux P , Chanthra N , Voronkova M , Chen YC , Wang L , Chanvorachote P , Pei M , Issaragrisil S , Rojanasakul Y . Oncogene 2015 35 (22) 2824-33 Cancer stem cells (CSCs) are a promising target for cancer therapy, particularly for metastatic lung cancers, but how CSCs are regulated is largely unknown. We identify two proteins, SLUG (encoded by SNAI2 gene) and SOX9, which are associated with advanced stage lung cancers and are implicated in the regulation of CSCs. Inhibition of either SLUG or SOX9 sufficiently inhibits CSCs in human lung cancer cells and attenuates experimental lung metastasis in a xenograft mouse model. Correlation between SLUG and SOX9 levels was observed remarkably, we therefore sought to explore their mechanistic relationship and regulation. SLUG, beyond its known function as an epithelial-mesenchymal transition transcription factor, was found to regulate SOX9 by controlling its stability via a post-translational modification process. SLUG interacts directly with SOX9 and prevents it from ubiquitin-mediated proteasomal degradation. SLUG expression and binding are necessary for SOX9 promotion of lung CSCs and metastasis in a mouse model. Together, our findings provide a novel mechanistic insight into the regulation of CSCs via SLUG-SOX9 regulatory axis, which represents a potential novel target for CSC therapy that may overcome cancer chemoresistance and relapse. |
Modeling the prevalence of immunodeficiency-associated long-term vaccine-derived poliovirus excretors and the potential benefits of antiviral drugs
Duintjer Tebbens RJ , Pallansch MA , Thompson KM . BMC Infect Dis 2015 15 (1) 379 BACKGROUND: A small number of individuals with B-cell-related primary immunodeficiency diseases (PIDs) may exhibit long-term (prolonged or chronic) excretion of immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) following infection with oral poliovirus vaccine (OPV). These individuals pose a risk of live poliovirus reintroduction into the population after global wild poliovirus eradication and subsequent OPV cessation. Treatment with polio antiviral drugs may potentially stop excretion in some of these individuals and thus may reduce the future population risk. METHODS: We developed a discrete event simulation model to characterize the global prevalence of long-term iVDPV excretors based on the best available evidence. We explored the impact of different assumptions about the effectiveness of polio antiviral drugs and the fraction of long-term excretors identified and treated. RESULTS: Due to the rarity of long-term iVDPV excretion and limited data on the survival of PID patients in developing countries, uncertainty remains about the current and future prevalence of long-term iVDPV excretors. While the model suggests only approximately 30 current excretors globally and a rapid decrease after OPV cessation, most of these excrete asymptomatically and remain undetected. The possibility that one or more PID patients may continue to excrete iVDPVs for several years after OPV cessation represents a risk for reintroduction of live polioviruses after OPV cessation, particularly for middle-income countries. With the effectiveness of a single polio antiviral drug possibly as low as 40 % and no system in place to identify and treat asymptomatic excretors, the impact of passive use of a single polio antiviral drug to treat identified excretors appears limited. Higher drug effectiveness and active efforts to identify long-term excretors will dramatically increase the benefits of polio antiviral drugs. CONCLUSIONS: Efforts to develop a second polio antiviral compound to increase polio antiviral effectiveness and/or to maximize the identification and treatment of affected individuals represent important risk management opportunities for the polio endgame. Better data on the survival of PID patients in developing countries and more longitudinal data on their exposure to and recovery from OPV infections would improve our understanding of the risks associated with iVDPV excretors and the benefits of further investments in polio antiviral drugs. |
Prevaccination Rotavirus Serum IgG and IgA Are Associated With Lower Immunogenicity of Live, Oral Human Rotavirus Vaccine in South African Infants
Moon SS , Groome MJ , Velasquez DE , Parashar UD , Jones S , Koen A , van Niekerk N , Jiang B , Madhi SA . Clin Infect Dis 2015 62 (2) 157-65 BACKGROUND: Live oral rotavirus (RV) vaccines have shown modest efficacy among children in African countries for reasons that are not completely understood. We examined the possible inhibitory effect of pre-existing anti-rotavirus antibodies on immunogenicity of monovalent rotavirus vaccine (RV1). METHODS: Mother-infant pairs were enrolled at presentation for their routine immunization visit in Soweto, South Africa at 5-8 weeks age. Infant serum samples were obtained before each of the first and second doses of RV1, and one month after the second dose. Maternal serum and breast milk samples were obtained prior to administration of each dose of RV1 to infants. RV-specific IgG, IgA and neutralizing activity in sera of infants and serum or breast milk samples of mothers were measured by enzyme-linked immunosorbent assays or a microneutralization test. RESULTS: Of the 107 serum pairs from infants who were seronegative for RV IgA at enrollment, we observed a strong positive association between IgG titers in pre-dose 1 sera of infants and mothers and significant negative associations between IgG titers in pre dose 1 sera of infants and seroconversion to RV1 post dose 1. Similarly, mothers whose infants IgA seroconverted after RV1 had significantly lower pre-dose 1 IgG titers in sera than those whose infants did not seroconvert. CONCLUSIONS: High levels of pre-existing serum IgG, including transplacentally acquired maternal IgG, appeared to have an inhibitory effect on the immunogenicity of RV1 among infants and may, in part, contribute to lower efficacy of RV vaccines in this and other low income settings. |
Prevalence and persistence of varicella antibodies in reviously immunized children and youth with perinatal HIV-1 infection
Purswani MU , Karalius B , Yao TJ , Schmid DS , Burchett SK , Siberry GK , Patel K , Van Dyke RB , Yogev R . Clin Infect Dis 2015 62 (1) 106-114 BACKGROUND: Two doses of live-attenuated varicella-zoster vaccine are recommended for human immunodeficiency virus 1 (HIV-1)-infected children with CD4% ≥15%. We determined the prevalence and persistence of antibody in immunized children with perinatal HIV (PHIV) and their association with number of vaccinations, combination antiretroviral therapy (cART), and HIV status. METHODS: The Adolescent Master Protocol is an observational study of children with PHIV and perinatally HIV-exposed but uninfected (PHEU) children conducted at 15 US sites. In a cross-sectional analysis, we tested participants' most recent stored sera for varicella antibody using whole-cell and glycoprotein enzyme-linked immunosorbent assay. Seropositivity predictors were identified using multivariable logistic regression models and C statistics. RESULTS: Samples were available for 432 children with PHIV and 221 PHEU children; 82% of children with PHIV and 97% of PHEU children were seropositive (P < .001). Seropositivity after 1 vaccine dose among children with PHIV and PHEU children was 100% at <3 years (both), 73% and 100% at 3-<7 years (P < .05), and 77% and 97% at ≥7 years (P < .01), respectively. Seropositivity among recipients of 2 vaccine doses was >94% at all intervals. Independent predictors of seropositivity among children with PHIV were receipt of 2 vaccine doses, receipt of 1 dose while on ≥3 months of cART, compared with none (adjusted odds ratio [aOR]: 14.0 and 2.8, respectively; P < .001 for overall dose effect), and in those vaccinated ≥3 years previously, duration of cART (aOR: 1.29 per year increase, P = .02). CONCLUSIONS: Humoral immune responses to varicella vaccine are best achieved when children with PHIV receive their first dose ≥3 months after cART initiation and maintained by completion of the 2-dose series and long-term cART use. |
Global progress toward rubella and congenital rubella syndrome control and elimination - 2000-2014
Grant GB , Reef SE , Dabbagh A , Gacic-Dobo M , Strebel PM . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1052-1055 Rubella virus usually causes a mild fever and rash in children and adults. However, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national routine immunization schedules, including an initial vaccination campaign usually targeting children aged 9 months-15 years . The Global Vaccine Action Plan endorsed by the World Health Assembly in 2012 and the Global Measles and Rubella Strategic Plan (2012-2020) published by Measles and Rubella Initiative partners in 2012 both include goals to eliminate rubella and CRS in at least two WHO regions by 2015, and at least five WHO regions by 2020 (2,3). This report updates a previous report and summarizes global progress toward rubella and CRS control and elimination during 2000-2014. As of December 2014, RCV had been introduced in 140 (72%) countries, an increase from 99 (51%) countries in 2000 (for this report, WHO member states are referred to as countries). Reported rubella cases declined 95%, from 670,894 cases in 102 countries in 2000 to 33,068 cases in 162 countries in 2014, although reporting is inconsistent. To achieve the 2020 Global Vaccine Action Plan rubella and CRS elimination goals, RCV introduction needs to continue as country criteria indicating readiness are met, and rubella and CRS surveillance need to be strengthened to ensure that progress toward elimination can be measured. |
Influenza vaccination coverage among health care personnel - United States, 2014-15 influenza season
Black CL , Yue X , Ball SW , Donahue SM , Izrael D , de Perio MA , Laney AS , Williams WW , Lindley MC , Graitcer SB , Lu PJ , Bridges CB , DiSogra C , Sokolowski J , Walker DK , Greby SM . MMWR Morb Mortal Wkly Rep 2015 64 (36) 993-9 The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel (HCP) to reduce influenza-related morbidity and mortality among both HCP and their patients and to decrease absenteeism among HCP. To estimate influenza vaccination coverage among U.S. HCP for the 2014-15 influenza season, CDC conducted an opt-in Internet panel survey of 1,914 HCP during March 31-April 15, 2015. Overall, 77.3% of HCP survey participants reported receiving an influenza vaccination during the 2014-15 season, similar to the 75.2% coverage among HCP reported for the 2013-14 season. Vaccination coverage was highest among HCP working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%). By occupation, coverage was highest among pharmacists (95.3%) and lowest among assistants and aides (64.4%). Influenza vaccination coverage was highest among HCP who were required by their employer to be vaccinated (96.0%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (73.6%) or multiple days (83.9%) and lowest among HCP working in settings where vaccine was neither required, promoted, nor offered on-site (44.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might help increase vaccination coverage among HCP and reduce the risk for influenza to HCP and their patients. |
Influenza vaccination coverage among pregnant women - United States, 2014-15 influenza season
Ding H , Black CL , Ball S , Donahue S , Fink RV , Williams WW , Kennedy ED , Bridges CB , Lu PJ , Kahn KE , Dean AK , Grohskopf LA , Ahluwalia IB , Devlin R , DiSogra C , Walker DK , Greby SM . MMWR Morb Mortal Wkly Rep 2015 64 (36) 1000-5 Pregnant women and infants are at increased risk for influenza-related complications and hospitalization. Influenza vaccination can reduce the risk for influenza-related illness among pregnant women and their infants. Since 2004, the Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester of pregnancy. To assess influenza vaccination coverage among pregnant women during the 2014-15 influenza season, CDC analyzed data from an Internet panel survey conducted during March 31-April 6, 2015. Among 1,702 survey respondents who were pregnant at any time during October 2014-January 2015, 50.3% reported receiving influenza vaccination before or during pregnancy, similar to the reported coverage in the preceding season. Overall, 64.9% of respondents reported receiving a provider offer of influenza vaccination, 14.8% received a recommendation but no offer, and 20.3% received no recommendation. Vaccination coverage among these groups of women was 67.9%, 33.5%, and 8.5%, respectively. Reminder systems and standing orders that allow health care personnel other than the attending provider to assess vaccination status and administer vaccination, can help to ensure that influenza vaccination is recommended and offered to a pregnant woman at each provider visit to increase pregnant women's vaccination coverage. |
What's past is prologue: a scoping review of recent public health and global health informatics literature
Dixon BE , Pina J , Kharrazi H , Gharghabi F , Richards J . Online J Public Health Inform 2015 7 (2) e216 OBJECTIVE: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. METHODS: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. RESULTS: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we identified a small but growing set of articles that measure the impact of ICT on clinical outcomes. DISCUSSION: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. CONCLUSION: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in ICT by governmental health agencies. |
Circumstances preceding homicide-suicides involving child victims: A qualitative analysis
Holland KM , Brown SV , Hall JE , Logan JE . J Interpers Violence 2015 33 (3) 379-401 Homicide-suicide incidents involving child victims can have a detrimental impact on survivors of the violence, family members and friends of the decedents, and other community members, but the rare occurrence of these acts makes using quantitative data to examine their associated antecedents challenging. Therefore, using qualitative data from the 2003-2011 National Violent Death Reporting System, we examined 175 cases of homicide-suicide involving child victims in an effort to better understand the complex situational factors of these events. Our findings indicate that 98% of homicide-suicides with child victims are perpetrated by adults (mostly parents) and propelled by the perpetrators' intimate partner problems, mental health problems, and criminal/legal problems. These events are often premeditated, and plans for the violence are sometimes disclosed prior to its occurrence. Findings provide support for several theoretical perspectives, and implications for prevention are discussed. |
Adverse childhood experiences and sexual victimization in adulthood
Ports KA , Ford DC , Merrick MT . Child Abuse Negl 2015 51 313-22 Understanding the link between adverse childhood experiences (ACEs) and sexual victimization (SV) in adulthood may provide important information about the level of risk for adult SV and sexual re-victimization among childhood sexual abuse (CSA) survivors. In the present paper, we explore the relationship between ACEs, including CSA, and SV in adulthood. Data from the CDC-Kaiser ACE Study were used to examine the effect of experiences of early adversity on adult SV. Adult HMO members (n=7,272) undergoing a routine health exam provided detailed information about ACEs that occurred at age 18 or younger and their experiences of SV in adulthood. Analyses revealed that as ACE score increased, so did risk of experiencing SV in adulthood. Each of the ACE variables was significantly associated with adult SV, with CSA being the strongest predictor of adult SV. In addition, for those who reported CSA, there was a cumulative increase in adult SV risk with each additional ACE experienced. As such, early adversity is a risk factor for adult SV. In particular, CSA is a significant risk factor for sexual re-victimization in adulthood, and additional early adversities experienced by CSA survivors may heighten adult SV risk above and beyond the risk associated with CSA alone. Given the interconnectedness among various experiences of early adversity, adult SV prevention actions must consider how other violence-related and non-violence-related traumatic experiences may exacerbate the risk conferred by CSA on subsequent victimization. |
A Multiplex PCR/LDR Assay for the Simultaneous Identification of Category A Infectious Pathogens: Agents of Viral Hemorrhagic Fever and Variola Virus.
Das S , Rundell MS , Mirza AH , Pingle MR , Shigyo K , Garrison AR , Paragas J , Smith SK , Olson VA , Larone DH , Spitzer ED , Barany F , Golightly LM . PLoS One 2015 10 (9) e0138484 CDC designated category A infectious agents pose a major risk to national security and require special action for public health preparedness. They include viruses that cause viral hemorrhagic fever (VHF) syndrome as well as variola virus, the agent of smallpox. VHF is characterized by hemorrhage and fever with multi-organ failure leading to high morbidity and mortality. Smallpox, a prior scourge, has been eradicated for decades, making it a particularly serious threat if released nefariously in the essentially non-immune world population. Early detection of the causative agents, and the ability to distinguish them from other pathogens, is essential to contain outbreaks, implement proper control measures, and prevent morbidity and mortality. We have developed a multiplex detection assay that uses several species-specific PCR primers to generate amplicons from multiple pathogens; these are then targeted in a ligase detection reaction (LDR). The resultant fluorescently-labeled ligation products are detected on a universal array enabling simultaneous identification of the pathogens. The assay was evaluated on 32 different isolates associated with VHF (ebolavirus, marburgvirus, Crimean Congo hemorrhagic fever virus, Lassa fever virus, Rift Valley fever virus, Dengue virus, and Yellow fever virus) as well as variola virus and vaccinia virus (the agent of smallpox and its vaccine strain, respectively). The assay was able to detect all viruses tested, including 8 sequences representative of different variola virus strains from the CDC repository. It does not cross react with other emerging zoonoses such as monkeypox virus or cowpox virus, or six flaviviruses tested (St. Louis encephalitis virus, Murray Valley encephalitis virus, Powassan virus, Tick-borne encephalitis virus, West Nile virus and Japanese encephalitis virus). |
Toxoplasmosis in sentinel chickens (Gallus domesticus) in New England farms: seroconversion, distribution of tissue cysts in brain, heart, and skeletal muscle by bioassay in mice and cats
Dubey JP , Lehmann T , Lautner F , Kwok OC , Gamble HR . Vet Parasitol 2015 214 55-8 Free-range chickens are a good indicator of soil contamination with oocysts because they feed from the ground and they are also an important source of infection for cats that in turn shed oocysts after eating tissues of intermediate hosts. Little is known of the epidemiology of toxoplasmosis in chickens. In the present study 90 Toxoplasma gondii seronegative, sentinel chickens were placed on three (30 each) swine farms in New England in November, 2003. Chickens were bled monthly and their sera were tested for T. gondii antibodies by the modified agglutination test (MAT, cut-off 1:25). Chickens that seroconverted were euthanized and their tissues were bioassayed in mice, cats, or both. Over the course of the experiment (7 months), 31 of 71 chickens seroconverted (MAT 1:100 or higher). Tissues of 26 seropositive chickens were bioassayed in both cats and mice; viable T. gondii was isolated, by bioassay in mice, from hearts (whole) of all 26 chickens, brains (whole) of 3 chickens and leg muscles (25g) of 11 chickens; 21 of 26 cats fed 250g of muscle from seropositive chickens excreted T. gondii oocysts. Results indicated that the density of T. gondii in poultry muscle is low but heart is the tissue of choice for isolation of viable parasites. |
Identification of newly synthesized proteins by Echinococcus granulosus protoscoleces upon induction of strobilation
Debarba JA , Monteiro KM , Moura H , Barr JR , Ferreira HB , Zaha A . PLoS Negl Trop Dis 2015 9 (9) e0004085 BACKGROUND: The proteins responsible for the key molecular events leading to the structural changes between the developmental stages of Echinococcus granulosus remain unknown. In this work, azidohomoalanine (AHA)-specific labeling was used to identify proteins expressed by E. granulosus protoscoleces (PSCs) upon the induction of strobilar development. METHODOLOGY/PRINCIPAL FINDINGS: The in vitro incorporation of AHA with different tags into newly synthesized proteins (NSPs) by PSCs was analyzed using SDS-PAGE and confocal microscopy. The LC-MS/MS analysis of AHA-labeled NSPs by PSCs undergoing strobilation allowed for the identification of 365 proteins, of which 75 were differentially expressed in comparison between the presence or absence of strobilation stimuli and 51 were expressed exclusively in either condition. These proteins were mainly involved in metabolic, regulatory and signaling processes. CONCLUSIONS/SIGNIFICANCE: After the controlled-labeling of proteins during the induction of strobilar development, we identified modifications in protein expression. The changes in the metabolism and the activation of control and signaling pathways may be important for the correct parasite development and be target for further studies. |
Survival of children with hypoplastic left heart syndrome
Siffel C , Riehle-Colarusso T , Oster ME , Correa A . Pediatrics 2015 136 (4) e864-70 OBJECTIVE: To examine the survival of infants with hypoplastic left heart syndrome (HLHS) and potential influence of demographic and clinical characteristics on survival using population-based data. METHODS: Infants with nonsyndromic HLHS (n = 212) born between 1979 and 2005 were identified through the Metropolitan Atlanta Congenital Defects Program. Vital status was ascertained through 2009 based on linkage with vital records. We estimated Kaplan-Meier survival probabilities stratified by select demographic and clinical characteristics. RESULTS: The overall survival probability to 2009 was 24% and significantly improved over time: from 0% in 1979-1984 to 32% in 1999-2005. Survival probability was 66% during the first week, 27% during the first year of life, and 24% during the first 10 years. Survival of very low and low birth weight or preterm infants and those born in high-poverty neighborhoods was significantly poorer. For children with information on surgical intervention (n = 88), the overall survival was 52%, and preterm infants had significantly poorer survival (31%) compared with term infants (56%). For children who survived to 1 year of age, long-term survival was approximately 90%. CONCLUSIONS: Survival to adolescence of children with nonsyndromic HLHS born in metropolitan Atlanta has significantly improved in recent years, with those born full term, with normal birth weight, or in a low-poverty neighborhood having a higher survival probability. Survival beyond infancy to adolescence is high. A better understanding of the growing population of survivors with HLHS is needed to inform resource planning. |
Development and implementation of the first national data quality standards for population-based birth defects surveillance programs in the United States
Anderka M , Mai CT , Romitti PA , Copeland G , Isenburg J , Feldkamp ML , Krikov S , Rickard R , Olney RS , Canfield MA , Stanton C , Mosley B , Kirby RS . BMC Public Health 2015 15 (1) 925 BACKGROUND: Population-based birth defects surveillance is a core public health activity in the United States (U.S.); however, the lack of national data quality standards has limited the use of birth defects surveillance data across state programs. Development of national standards will facilitate data aggregation and utilization across birth defects surveillance programs in the U.S. METHODS: Based on national standards for other U.S. public health surveillance programs, existing National Birth Defects Prevention Network (NBDPN) guidelines for conducting birth defects surveillance, and information from birth defects surveillance programs regarding their current data quality practices, we developed 11 data quality measures that focused on data completeness (n = 5 measures), timeliness (n = 2), and accuracy (n = 4). For each measure, we established tri-level performance criteria (1 = rudimentary, 2 = essential, 3 = optimal). In January 2014, we sent birth defects surveillance programs in each state, District of Columbia, Puerto Rico, Centers for Disease Control and Prevention (CDC), and the U.S. Department of Defense Birth and Infant Health Registry an invitation to complete a self-administered NBDPN Standards Data Quality Assessment Tool. The completed forms were electronically submitted to the CDC for analyses. RESULTS: Of 47 eligible population-based surveillance programs, 45 submitted a completed assessment tool. Two of the 45 programs did not meet minimum inclusion criteria and were excluded; thus, the final analysis included information from 43 programs. Average scores for four of the five completeness performance measures were above level 2. Conversely, the average scores for both timeliness measures and three of the four accuracy measures were below level 2. Surveillance programs using an active case-finding approach scored higher than programs using passive case-finding approaches for the completeness and accuracy measures, whereas their average scores were lower for timeliness measures. CONCLUSIONS: This initial, nation-wide assessment of data quality across U.S. population-based birth defects surveillance programs highlights areas for improvement. Using this information to identify strengths and weaknesses, the birth defects surveillance community, working through the NBDPN, can enhance and implement a consistent set of standards that can promote uniformity and enable surveillance programs to work towards improving the potential of these programs. |
Fruit consumption by youth in the United States
Herrick KA , Rossen LM , Nielsen SJ , Branum AM , Ogden CL . Pediatrics 2015 136 (4) 664-71 OBJECTIVES: To describe the contribution of whole fruit, including discrete types of fruit, to total fruit consumption and to investigate differences in consumption by sociodemographic characteristics. METHODS: We analyzed data from 3129 youth aged 2 to 19 years from the National Health and Nutrition Examination Survey, 2011 to 2012. Using the Food Patterns Equivalents Database and the What We Eat in America 150 food groups, we calculated the contribution of whole fruit, 100% fruit juices, mixed fruit dishes, and 12 discrete fruit and fruit juices to total fruit consumption. We examined differences by age, gender, race and Hispanic origin, and poverty status. RESULTS: Nearly 90% of total fruit intake came from whole fruits (53%) and 100% fruit juices (34%) among youth aged 2 to 19 years. Apples, apple juice, citrus juice, and bananas were responsible for almost half of total fruit consumption. Apples accounted for 18.9% of fruit intake. Differences by age were predominately between youth aged 2 to 5 years and 6 to 11 years. For example, apples contributed a larger percentage of total fruit intake among youth 6 to 11 years old (22.4%) than among youth 2 to 5 years old (14.6%), but apple juice contributed a smaller percentage (8.8% vs 16.8%), P < .05. There were differences by race and Hispanic origin in intake of citrus fruits, berries, melons, dried fruit, and citrus juices and other fruit juices. CONCLUSIONS: These findings provide insight into what fruits US youth are consuming and sociodemographic factors that may influence consumption. |
NIOSH national survey of long-haul truck drivers: injury and safety
Chen GX , Sieber WK , Lincoln JE , Birdsey J , Hitchcock EM , Nakata A , Robinson CF , Collins JW , Sweeney MH . Accid Anal Prev 2015 85 66-72 Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training. |
On the characterization of the generation rate and size-dependent crystalline silica content of the dust from cutting fiber cement siding
Qi C , Echt A , Gressel MG . Ann Occup Hyg 2015 60 (2) 220-30 A laboratory testing system was developed to systematically characterize the dust generation rate and size-dependent crystalline silica content when cutting or shaping silica containing materials. The tests of cutting fiber cement siding in this system verify that it provides high test repeatability, making it suitable for the targeted characterizations. The mass-based size distributions obtained from a gravimetric-based instrument and a direct reading instrument both show bimodal lognormal distributions with a larger mode ~13 microm and another mode <5 microm for the dusts from cutting four different brands of fiber cement siding. The generation rates of respirable dust obtained from the two instruments are comparable, and the results from each instrument are similar for the four brands. The silica content in the airborne dusts, however, strongly depends on the amount of silica used in the respective product. It is also observed that the silica content in the airborne dust from cutting the four brands of fiber cement siding showed the same trend of an increase with the aerodynamic diameter of the dust, approaching the silica content levels found in their respective bulk samples. Combining the results for both the dust size distribution and size-dependent silica content, it is found that most of the respirable crystalline silica (RCS) resides in the dust ~2.5 microm in aerodynamic diameter. These results would help guide the development of specific engineering control measures targeted at lowering workers' exposure to RCS while cutting fiber cement siding. With the high repeatability using the laboratory testing system, the dust generation rate could then be characterized under different operating conditions, and with the deployment of various engineering control measures. This would greatly facilitate the systematic evaluation of the control effectiveness and the selection of the optimal control solutions for field trials. |
Isolation gowns in health care settings: laboratory studies, regulations and standards, and potential barriers of gown selection and use
Kilinc Balci FS . Am J Infect Control 2015 44 (1) 104-11 Although they play an important role in infection prevention and control, textile materials and personal protective equipment (PPE) used in health care settings are known to be one of the sources of cross-infection. Gowns are recommended to prevent transmission of infectious diseases in certain settings; however, laboratory and field studies have produced mixed results of their efficacy. PPE used in health care is regulated as either class I (low risk) or class II (intermediate risk) devices in the United States. Many organizations have published guidelines for the use of PPE, including isolation gowns, in health care settings. In addition, the Association for the Advancement of Medical Instrumentation published a guidance document on the selection of gowns and a classification standard on liquid barrier performance for both surgical and isolation gowns. However, there is currently no existing standard specific to isolation gowns that considers not only the barrier resistance but also a wide array of end user desired attributes. As a result, infection preventionists and purchasing agents face several difficulties in the selection process, and end users have limited or no information on the levels of protection provided by isolation gowns. Lack of knowledge about the performance of protective clothing used in health care became more apparent during the 2014 Ebola epidemic. This article reviews laboratory studies, regulations, guidelines and standards pertaining to isolation gowns, characterization problems, and other potential barriers of isolation gown selection and use. |
In vitro and molecular surveillance for antimalarial drug resistance in Plasmodium falciparum parasites in western Kenya reveals sustained artemisinin sensitivity and increased chloroquine sensitivity.
Lucchi NW , Komino F , Okoth SA , Goldman I , Onyona P , Wiegand RE , Juma E , Shi YP , Barnwell JW , Udhayakumar V , Kariuki S . Antimicrob Agents Chemother 2015 59 (12) 7540-7 Malaria control is hindered by the evolution and spread of resistance to antimalarials, necessitating multiple changes to drug policies over time. A comprehensive antimalarial drug resistance surveillance program is vital for detecting the potential emergence of resistance to antimalarials including current artemisinin-based combination therapies.An antimalarial drug resistance surveillance study involving 203 P. falciparum malaria-positive children was conducted in western Kenya between 2010 and 2013. Specimens from enrolled children were analyzed in vitro for sensitivity to chloroquine (CQ), amodiaquine (AQ), mefloquine (MQ), lumefantrine and artemisinin derivatives (artesunate and dihydroartemisinin), and for drug resistance allele polymorphisms in Pfcrt, Pfmdr-1 and the K13 propeller domain (K13).We observed a significant increase in the proportion of samples with the Pfcrt wild type (CVMNK) genotype, from 61.2% in 2010 to 93.0% in 2013 (p < 0.0001) and higher proportions of parasites with elevated sensitivity to CQ in vitro. The majority of isolates harbored the wild type N allele in Pfmdr-1 codon 86 (93.5 %), with only 7 (3.50%) samples with the mutant N86Y allele. Likewise, most isolates harbored the wild-type Pfmdr-1 D1246 allele (79.8%) with only 12 (6.38%) specimens with the mutant D1246Y allele and 26 (13.8%) with mixed alleles. All the samples had a single copy of the Pfmdr-1 gene (mean= 0.907+/-0.141). None of the sequenced parasites had mutations in the K13.Our results suggest that artemisinin is likely to remain highly efficacious and that CQ sensitivity appears to be on the rise in western Kenya. |
Working with state health departments on emerging issues in maternal and child health: immediate postpartum long-acting reversible contraceptives
Kroelinger CD , Waddell LF , Goodman DA , Pliska E , Rudolph C , Ahmed E , Addison D . J Womens Health (Larchmt) 2015 24 (9) 693-701 BACKGROUND: Immediate postpartum long-acting reversible contraceptives (LARC) are highly effective in preventing unintended pregnancy. State health departments are in the process of implementing a systems change approach to better apply policies supporting the use of immediate postpartum LARC. METHODS: Beginning in 2014, a group of national organizations, federal agencies, and six states have convened a LARC Learning Community to share strategies and best practices in immediate postpartum LARC policy development and implementation. Community activities consist of in-person meetings and a webinar series as forums to discuss systems change. RESULTS: The Learning Community identified eight domains for discussion and development of resources: training, pay streams, stocking and supply, consent, outreach, stakeholder partnerships, service location, and data and surveillance. The community is currently developing resource materials and guidance for use by other state health departments. CONCLUSIONS: To effectively implement policies on immediate postpartum LARC, states must engage a number of stakeholders in the process, raise awareness of the challenges to implementation, and communicate strategies across agencies during policy development. |
Improving the implementation of evidence-based clinical practices in adolescent reproductive health care services
Romero LM , Middleton D , Mueller T , Avellino L , Hallum-Montes R . J Adolesc Health 2015 57 (5) 488-95 PURPOSE: The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. METHODS: Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. RESULTS: Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were "always" available to adolescents. CONCLUSIONS: The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities. |
A simulation study of nonparametric total deviation index as a measure of agreement based on quantile regression
Lin L , Pan Y , Hedayat AS , Barnhart HX , Haber M . J Biopharm Stat 2015 26 (5) 937-50 Total deviation index (TDI) captures a pre-specified quantile of the absolute deviation of paired observations from raters, observers, methods, assays, instruments, etc. We compare the performance of total deviation index (TDI) using nonparametric quantile regression to the TDI assuming normality (Lin 2000). This simulation study considers 3 distributions: normal, Poisson, and uniform at quantile levels of 0.8 and 0.9 for cases with and without contamination. Study endpoints include the bias of TDI estimates (compared to their respective theoretical values), standard error of TDI estimates (compared to their true simulated standard errors), and test size (compared to 0.05) and power. Nonparametric TDI using quantile regression, although it slightly underestimates and delivers slightly less power for data without contamination, works satisfactorily under all simulated cases even for moderate (say, ≥40) sample sizes. The performance of the TDI based on a quantile of 0.8 is in general superior to that of 0.9. The performances of nonparametric and parametric TDI methods are compared with a real data example. Nonparametric TDI can be very useful when the underlying distribution on the difference is not normal, especially when it has a heavy tail. |
Tobacco and marijuana initiation among African American and white young adults
Kennedy SM , Patel RP , Cheh P , Hsia J , Rolle IV . Nicotine Tob Res 2015 18 Suppl 1 S57-64 INTRODUCTION: African American youth use marijuana at similar rates and tobacco at lower rates compared with white youth; however, in adulthood, tobacco use is similar. Tobacco and marijuana use are closely associated; differing initiation patterns may contribute to observed racial differences in tobacco prevalence by age. Therefore, it is important to assess tobacco and marijuana initiation patterns by race. METHODS: Data were obtained from 56 555 adults aged 18-25 who completed the 2005-2012 National Survey on Drug Use and Health. The analysis was restricted to those who reported ever use of marijuana and combustible tobacco (cigarettes and/or cigars). Three mutually exclusive categories of initiation patterns were evaluated: use of marijuana before tobacco; marijuana and tobacco at the same age; and tobacco before marijuana. Multivariable regression models were used to assess changes over time and compare these outcomes by race while controlling for sociodemographics, risk perceptions, and current substance use. RESULTS: In 2005, 26.6% of African American and 14.3% of white young adults used marijuana before tobacco, compared with 41.5% of African American and 24.0% of white young adults in 2012 (P < .001). Overall, African American young adults had greater odds of using marijuana before tobacco (AOR = 1.79; 95% CI: 1.67, 1.91) compared with whites. CONCLUSION: African American young adults were more likely than whites to use marijuana before tobacco and both groups were increasingly likely to use marijuana before tobacco over time. A greater understanding of how marijuana initiation interacts with tobacco initiation could inform more effective tobacco and marijuana use prevention efforts. IMPLICATIONS: Among ever users of combustible tobacco and marijuana, greater proportions of African American young adults used marijuana before tobacco or at the same age than their white counterparts. Moreover, both African Americans and whites were more likely to use marijuana before tobacco in 2012 compared with 2005. Tobacco control policy may benefit from a broader understanding of the patterns of initiation to tobacco and marijuana use. Some public health interventions aimed at preventing and reducing combustible tobacco use among African American young adults may be strengthened by considering marijuana use. |
Alcohol use and binge drinking among women of childbearing age - United States, 2011-2013
Tan CH , Denny CH , Cheal NE , Sniezek JE , Kanny D . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1042-1046 Excessive alcohol use is risk factor for a wide range of health and social problems including liver cirrhosis, certain cancers, depression, motor vehicle crashes, and violence. Alcohol use during pregnancy can lead to fetal alcohol spectrum disorders (FASDs) and other adverse birth outcomes . Community studies estimate that as many as 2% to 5% of first grade students in the United States might have an FASD, which include physical, behavioral, or learning impairments. In 2005, the Surgeon General reissued an advisory urging women who are or might be pregnant to abstain from alcohol consumption to eliminate the risk for FASDs or other negative birth outcomes. To estimate current prevalences of any alcohol use and binge drinking (consuming four or more drinks on an occasion) among pregnant and nonpregnant women aged 18-44 years in the United States, CDC analyzed 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS) data. Among pregnant women, the prevalences of any alcohol use and binge drinking in the past 30 days were 10.2% and 3.1%, respectively. Among nonpregnant women, the prevalences of any alcohol use and binge drinking in the past 30 days were 53.6% and 18.2%, respectively. Among binge drinkers, pregnant women reported a significantly higher frequency of binge drinking than nonpregnant women (4.6 and 3.1 episodes, respectively); the largest amount consumed during binge drinking was also higher among pregnant women than nonpregnant women (7.5 versus 6.0 drinks), although this difference was not statistically significant. Implementation of evidence-based clinical and community-level strategies would be expected to reduce binge drinking among pregnant women and women of childbearing age, and any alcohol consumption among women who are or might be pregnant. Healthcare professionals can support these efforts by implementing alcohol screening and brief interventions in their primary care practices, and informing women that there is no known safe level of alcohol consumption when they are pregnant or might be pregnant. |
Rapid assessment of Malawi's civil registration and vital statistics system
Nichols EK , Giles D , Kang'oma S , Mwalwanda L , Onaka A , Notzon F . Public Health Action 2015 5 (3) 162-4 In 2010, Malawi adopted a National Registration Act, making the registration of births and deaths compulsory, and efforts to improve Malawi's civil registration and vital statistics (CRVS) system are underway. During a participatory-style workshop, stakeholders completed a rapid assessment of the national civil registration and vital statistics systems. While participants discussed and scored each item in a standard tool, the workshop focused on sharing of partners' roles and challenges. The workshop has enhanced receptiveness in collaboration, and an inter-ministerial technical working group has now been formed to develop a strategic plan and conduct a comprehensive assessment to guide future improvements. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Reproductive Health
- Statistics as Topic
- Substance Use and Abuse
- Vital Statistics
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