Progression of carotid intima-media thickness in a contemporary human immunodeficiency virus cohort
Baker JV , Henry WK , Patel P , Bush TJ , Conley LJ , Mack WJ , Overton ET , Budoff M , Hammer J , Carpenter CC , Hodis HN , Brooks JT . Clin Infect Dis 2011 53 (8) 826-835 BACKGROUND: Persons with human immunodeficiency virus (HIV) infection are at risk for premature cardiovascular disease (CVD). Predictors of atherosclerotic disease progression in contemporary patients have not been well described. METHODS: Using data from a prospective observational cohort of adults infected with HIV (Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy), we assessed common carotid artery intima-media thickness (CIMT) at baseline and year 2 by ultrasound. We examined HIV-associated predictors of CIMT progression after adjusting for age, sex, race/ethnicity, body mass index, smoking, hypertension, diabetes, low-density lipoprotein cholesterol level, and baseline CIMT using linear regression. RESULTS: Among 389 participants (median age at baseline, 42 years; male sex, 77%; median CD4+ cell count at baseline, 485 cells/mm(3); 78% receiving antiretroviral therapy), the median 2-year CIMT change was 0.016 mm (interquartile range, -0.003 to 0.033 mm; P < .001). Lesser CIMT progression was associated with a suppressed viral load at baseline (-0.009 mm change; P = .015) and remaining virologically suppressed throughout follow-up (-0.011 mm change; P < .001). After adjusting for additional risk factors and a suppressed viral load during follow-up, nonnucleoside reverse transcriptase inhibitor versus protease inhibitor exposure was associated with lesser CIMT progression (-0.011 mm change; P = .02). CONCLUSIONS: Suppressing HIV replication below clinical thresholds was associated with less progression of atherosclerosis. The proatherogenic mechanisms of HIV replication and the net CVD benefit of different antiretroviral drugs should be a focus of future research. |
Evidence that the prevalence of childhood overweight is plateauing: data from nine countries
Olds T , Maher C , Zumin S , Peneau S , Lioret S , Castetbon K , Bellisle , de Wilde J , Hohepa M , Maddison R , Lissner L , Sjoberg A , Zimmermann M , Aeberli I , Ogden C , Flegal K , Summerbell C . Int J Pediatr Obes 2011 6 342-60 Until quite recently, there has been a widespread belief in the popular media and scientific literature that the prevalence of childhood obesity is rapidly increasing. However, high quality evidence has emerged from several countries suggesting that the rise in the prevalence has slowed appreciably, or even plateaued. This review brings together such data from nine countries (Australia, China, England, France, Netherlands, New Zealand, Sweden, Switzerland and USA), with data from 467,294 children aged 2-19 years. The mean unweighted rate of change in prevalence of overweight and obesity was +0.00 (0.49)% per year across all age x sex groups and all countries between 1995 and 2008. For overweight alone, the figure was +0.01 (0.56)%, and for obesity alone -0.01 (0.24)%. Rates of change differed by sex, age, socioeconomic status and ethnicity. While the prevalence of overweight and obesity appears to be stabilizing at different levels in different countries, it remains high, and a significant public health issue. Possible reasons for the apparent flattening are hypothesised. |
Associations between sleep disorders, sleep duration, quality of sleep, and hypertension: results from the National Health and Nutrition Examination Survey, 2005 to 2008
Bansil P , Kuklina EV , Merritt RK , Yoon PW . J Clin Hypertens (Greenwich) 2011 13 (10) 739-43 Sleep is a contributing factor to optimal health and vitality. However, to date, no national study has evaluated the simultaneous relationship between sleep disorders, quality, and duration with hypertension. Using data from National Health and Nutrition Examination Survey (NHANES) (2005 to 2008), hypertension was defined by current use of antihypertensive medication or systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Self-reported sleep disorders and duration were categorized from a single household interview question, and sleep quality was determined from several questions on sleeping habits. The prevalence of hypertension was 30.2% and 7.5%, and 33.0% and 52.1% reported having sleep disorders, short sleep, and poor sleep, respectively. After adjustment for demographic characteristics and comorbidities, having sleep disorders only was not significantly associated with hypertension (odds ratio [OR], 1.65; 95% confidence interval [CI], 0.73-3.77). However, this association was modified by sleep duration: significant associations were observed among adults with concurrent sleep disorders and short sleep (OR, 2.30; 95% CI, 1.49-3.56) and with sleep disorders, short sleep, and poor sleep (OR, 1.84; 95% CI, 1.13-2.98). These findings indicate an association between a combination of sleep problems and hypertension, but prospective studies are needed to understand the complex interplay between them. J Clin Hypertens (Greenwich). 2011;13:739-743. (c)2011 Wiley Periodicals, Inc. |
The spectrum of engagement in HIV care: do more than 19% of HIV-infected persons in the US have undetectable viral load?
Marks G , Gardner LI , Craw J , Giordano TP , Mugavero MJ , Keruly JC , Wilson TE , Metsch LR , Drainoni ML , Malitz F . Clin Infect Dis 2011 53 (11) 1168-9; author's reply 1169-70 The paper by Gardner et al [1] on the spectrum of engagement in human immunodeficiency virus (HIV) care provides an important heuristic for understanding the parameters and outcomes for a successful test-and-treat strategy to reduce HIV transmission. The spectrum begins with persons infected with HIV (unaware and aware) and progresses through diagnosed, linked to care, retained in care, needing antiretroviral therapy (ART), receiving ART, and having undetectable viral load. Gardner et al estimated that 19% of HIV-infected persons in the United States have undetectable HIV RNA. | We have data that we believe help refine this estimate. First, a recently published meta-analysis found that 59% of HIV-diagnosed persons are retained in care (multiple medical visits during specified time intervals) [2], which is somewhat higher than the estimate of Gardner et al [1] of 50% retained in care. Second, we are currently conducting a study at 6 HIV outpatient clinics in the United States (Baltimore, MD; Birmingham, AL; Boston, MA; Brooklyn, NY; Houston, TX; and Miami, FL). A total of 11468 HIV-infected patients had 1 or more primary care visits from 1 October 2009 through 30 September 2010 and had a viral load laboratory result within 90 days of their most recent visit in that interval. We calculated the percentage of these patients who had suppressed viral load, using 2 thresholds that were available at all 6 clinics (<400 copies/mL and <75 copies/mL). We found that 73% of the patients had viral load of <400 copies/mL, which is consistent with data from 13 clinical cohorts participating in the North American AIDS Cohort Collaboration on Research and Design [3]. If a cut-point of <75 copies/mL was used, then 62% of the patients had viral suppression. |
Performance of premarket rapid hepatitis C virus antibody assays in 4 National Human Immunodeficiency Virus Behavioral Surveillance System sites
Smith BD , Teshale E , Jewett A , Weinbaum CM , Neaigus A , Hagan H , Jenness SM , Melville SK , Burt R , Thiede H , Al-Tayyib A , Pannala PR , Miles IW , Oster AM , Smith A , Finlayson T , Bowles KE , Dinenno EA . Clin Infect Dis 2011 53 (8) 780-6 SUMMARY: Performance characteristics of rapid assays for hepatitis C virus antibody were evaluated in 4 National HIV Behavioral Surveillance System injection drug use sites. The highest assay-specific sensitivities achieved for the Chembio, MedMira and OraSure tests were 94.0%, 78.9%, and 97.4%, respectively; the highest specificities were 97.7%, 83.3%, and 100%, respectively. BACKGROUND: The Centers for Disease Control and Prevention (CDC) estimates that 4.1 million Americans have been infected with hepatitis C virus (HCV) and 75%-80% of them are living with chronic HCV infection, many unaware of their infection. Persons who inject drugs (PWID) account for 57.5% of all persons with HCV antibody (anti-HCV) in the United States. Currently no point-of-care tests for HCV infection are approved for use in the United States. METHODS: Surveys and testing for human immunodeficiency virus (HIV) and anti-HCV were conducted among persons who reported injection drug use in the past 12 months as part of the National HIV Behavioral Surveillance System in 2009. The sensitivity and specificity of point-of-care tests (finger-stick and 2 oral fluid rapid assays) from 3 manufacturers (Chembio, MedMira, and OraSure) were evaluated in field settings in 4 US cities. Results. Sensitivity (78.9%-97.4%) and specificity (80.0%-100.0%) were variable across assays and sites. The highest assay-specific sensitivities achieved for the Chembio, MedMira, and OraSure tests were 94.0%, 78.9% and 97.4%, respectively; the highest specificities were 97.7%, 83.3%, and 100%, respectively. In multivariate analysis, false-negative anti-HCV results were associated with HIV positivity for the Chembio oral assay (adjusted odds ratio, 8.4-9.1; P < .01) in 1 site (New York City). CONCLUSIONS: Sensitive rapid anti-HCV assays are appropriate and feasible for high-prevalence, high-risk populations such as PWID, who can be reached through social service settings such as syringe exchange programs and methadone maintenance treatment programs. |
A pre-pandemic outbreak of triple-reassortant swine influenza virus infection among university students, South Dakota, 2008
Dawood FS , Dong L , Liu F , Blau DM , Peebles PJ , Lu X , Wagers L , Oakland B , Zielenski M , Daly R , Horan V , Swenson SL , Schmitt BJ , Hancock K , Katz JM , Bridges C , Kightlinger L , Finelli L . J Infect Dis 2011 204 (8) 1165-71 BACKGROUND: After identifying a student with triple-reassortant swine influenza virus (SIV) infection and pig exposure at a livestock event, we investigated whether others were infected and if human-to-human transmission occurred. METHODS: We conducted a cohort study and serosurvey among persons exposed to (1) event pigs, (2) other pigs, (3) the index case, and (4) persons without pig or index case exposure. Confirmed cases had respiratory specimens positive for SIV within 2 weeks of the index case's illness. Probable and suspected cases had illness and (1) exposure to any pig or (2) contact with a confirmed case preceding illness. Probable cases were seropositive. Suspected cases did not give serum samples. RESULTS: Of 99 event pig-exposed students, 72 (73%) participated in the investigation, and 42 (42%) provided serum samples, of whom 17 (40%) were seropositive and 5 (12%) met case criteria. Of 9 students exposed to other pigs, 2 (22%) were seropositive. Of 8 index case-exposed persons and 10 without exposures, none were seropositive. Pig-exposed persons were more likely to be seropositive than persons without pig exposure (37% vs 0%, P < .01). CONCLUSIONS: We identified an outbreak of human SIV infection likely associated with a livestock event; there was no evidence of human-to-human transmission. |
Enrollment characteristics and risk behaviors of injection drug users participating in the Bangkok Tenofovir Study, Thailand
Martin M , Vanichseni S , Suntharasamai P , Sangkum U , Chuachoowong R , Mock PA , Leethochawalit M , Chiamwongpaet S , Kittimunkong S , van Griensven F , McNicholl JM , Paxton L , Choopanya K . PLoS One 2011 6 (9) e25127 BACKGROUND: The Bangkok Tenofovir Study was launched in 2005 to determine if pre-exposure prophylaxis with tenofovir will reduce the risk of HIV infection among injecting drug users (IDUs). We describe recruitment, screening, enrollment, and baseline characteristics of study participants and contrast risk behavior of Tenofovir Study participants with participants in the 1999-2003 AIDSVAX B/E Vaccine Trial. METHODS: The Bangkok Tenofovir Study is an ongoing, phase-3, randomized, double-blind, placebo-controlled, HIV pre-exposure prophylaxis trial of daily oral tenofovir. The Tenofovir Study and the Vaccine Trial were conducted among IDUs at 17 drug-treatment clinics in Bangkok. Tenofovir Study sample size was based on HIV incidence in the Vaccine Trial. Standardized questionnaires were used to collect demographic, risk behavior, and incarceration data. The Tenofovir Study is registered with ClinicalTrials.gov, number-NCT00119106. RESULTS: From June 2005 through July 2010, 4094 IDUs were screened and 2413 enrolled in the Bangkok Tenofovir Study. The median age of enrolled participants was 31 years (range, 20-59), 80% were male, and 63% reported they injected drugs during the 3 months before enrollment. Among those who injected, 53% injected methamphetamine, 37% midazolam, and 35% heroin. Tenofovir Study participants were less likely to inject drugs, inject daily, or share needles (all, p<0.001) than Vaccine Trial participants. DISCUSSION: The Bangkok Tenofovir Study has been successfully launched and is fully enrolled. Study participants are significantly less likely to report injecting drugs and sharing needles than participants in the 1999-2003 AIDSVAX B/E Vaccine Trial suggesting HIV incidence will be lower than expected. In response, the Bangkok Tenofovir Study enrollment was increased from 1600 to 2400 and the study design was changed from a defined 1-year follow-up period to an endpoint-driven design. Trial results demonstrating whether or not daily oral tenofovir reduces the risk of HIV infection among IDUs are expected in 2012. |
Biological feasibility of measles eradication
Bellini WJ , Rota PA . Virus Res 2011 162 72-9 Because of the success of global measles control programs, the World Health Organization (WHO), along with its partner agencies, is once again considering the possibility of setting a target date for measles eradication. Measles would be the fourth viral agent to be eradicated joining the successful programs to eradicate smallpox and rinderpest virus, and the continuing effort to eradicate polio virus. A description of the recent progress toward measles eradication was recently published as a supplement in the Journal of Infectious Diseases (15 July, 2011, 204 (Suppl 1)) and the reader is referred to this document for a detailed summary of the global status of measles control. This review will focus on the biologic and virologic aspects of measles eradication. |
Competency of reptiles and amphibians for eastern equine encephalitis virus
White G , Ottendorfer C , Graham S , Unnasch TR . Am J Trop Med Hyg 2011 85 (3) 421-5 Eastern equine encephalitis virus (EEEV) is endemic throughout most of the eastern United States. Although it is transmitted year round in Florida, transmission elsewhere is seasonal. The mechanism that enables EEEV to overwinter in seasonal foci remains obscure. In previous field studies, early season EEEV activity was detected in mosquito species that feed primarily upon ectothermic hosts, suggesting that reptiles and amphibians might represent overwintering reservoir hosts for EEEV. To determine if this might be possible, two commonly fed upon amphibian and reptile species were evaluated as hosts for the North American subtype I strain of EEEV. Neither amphibian species was a competent host. However, circulating viremias were detected in both reptile species examined. Hibernating infected garter snakes remained viremic after exiting hibernation. These data suggest that snakes may represent an overwintering host for North American EEEV. |
Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma
Sauni R , Uitti J , Jauhiainen M , Kreiss K , Sigsgaard T , Verbeek JH . Cochrane Database Syst Rev 2011 9 (9) CD007897 BACKGROUND: Dampness and mould in buildings have been associated with adverse respiratory symptoms, asthma and respiratory infections of inhabitants. Moisture damage is a very common problem in private houses, workplaces and public buildings such as schools. OBJECTIVES: To determine the effectiveness of remediating buildings damaged by dampness and mould in order to reduce or prevent respiratory tract symptoms, infections and symptoms of asthma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1951 to June week 1, 2011), EMBASE (1974 to June 2011), CINAHL (1982 to June 2011), Science Citation Index (1973 to June 2011), Biosis Previews (1989 to June 2011), NIOSHTIC (1930 to November 2010) and CISDOC (1974 to November 2010). SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster-RCTs (cRCTs), interrupted time series studies and controlled before-after (CBA) studies of the effects of remediating dampness and mould in a building on respiratory symptoms, infections and asthma. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed the risk of bias in the included studies. MAIN RESULTS: We included eight studies (6538 participants); two RCTs (294 participants), one cRCT (4407 participants) and five CBA studies (1837 participants). The interventions varied from thorough renovation to cleaning only. We found moderate-quality evidence in adults that repairing houses decreased asthma-related symptoms (among others, wheezing (odds ratio (OR) 0.64; 95% confidence interval (CI) 0.55 to 0.75) and respiratory infections (among others, rhinitis (OR 0.57; 95% CI 0.49 to 0.66)). For children, we found moderate-quality evidence that the number of acute care visits (among others mean difference (MD) -0.45; 95% CI -0.76 to -0.14)) decreased in the group receiving thorough remediation.One CBA study showed very low-quality evidence that after repairing a mould-damaged office building, asthma-related and other respiratory symptoms decreased. For children and staff in schools, there was very low-quality evidence that asthma-related and other respiratory symptoms in mould-damaged schools were similar to those of children and staff in non-damaged schools, both before and after intervention. For children, respiratory infections might have decreased after the intervention. AUTHORS' CONCLUSIONS: We found moderate to very low-quality evidence that repairing mould-damaged houses and offices decreases asthma-related symptoms and respiratory infections compared to no intervention in adults. There is very low-quality evidence that although repairing schools did not significantly change respiratory symptoms in staff or children, pupils' visits to physicians due to a common cold were less frequent after remediation of the school. Better research, preferably with a cRCT design and with more validated outcome measures, is needed. |
Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia
Sodha SV , Menon M , Trivedi K , Ati A , Figueroa ME , Ainslie R , Wannemuehler K , Quick R . J Water Health 2011 9 (3) 577-85 In Indonesia, where diarrhea remains a major cause of mortality among children <5 years, the government promotes boiling of drinking water. We assessed the impact of boiling on water quality in South Sulawesi. We surveyed randomly selected households with at least one child <5 years old in two rural districts and tested source and stored water samples for Escherichia coli contamination. Among 242 households, 96% of source and 51% of stored water samples yielded E. coli. Unboiled water samples, obtained from 15% of households, were more likely to yield E. coli than boiled samples [prevalence ratios (PR) = 2.0, 95% confidence interval (CI) 1.7-2.5]. Water stored in wide-mouthed (PR = 1.4, 95% CI = 1.1-1.8) or uncovered (PR = 1.8, 95% CI = 1.3-2.4) containers, or observed to be touched by the respondent's hands (PR = 1.6, 95% CI = 1.3-2.1) was more likely to yield E. coli. A multivariable model showed that households that did not boil water were more likely to have contaminated stored water than households that did boil water (PR = 1.9, 95% CI = 1.5-2.3). Although this study demonstrated the effectiveness of boiling in reducing contamination, overall impact on water quality was suboptimal. Future studies are needed to identify factors behind the success of boiling water in Indonesia to inform efforts to scale up other effective water treatment practices. |
Multisite virological influenza surveillance in India: 2004-2008
Chadha MS , Broor S , Gunasekaran P , Potdar VA , Krishnan A , Chawla-Sarkar M , Biswas D , Abraham AM , Jalgaonkar SV , Kaur H , Klimov A , Lal RB , Moen A , Kant L , Mishra AC . Influenza Other Respir Viruses 2011 6 (3) 196-203 BACKGROUND: Influenza surveillance is important to identify circulating, emerging/reemerging strains and unusual epidemiological trends. With these objectives, a multisite human influenza surveillance network was initiated in India in 2004. METHODS: Epidemiologic data and throat swabs for laboratory testing were collected from patients with influenza-like illness (ILI) and severe acute respiratory infections (SARI). Virus isolation was carried out in Madin-Darby canine kidney cells and strains identified by hemagglutination inhibition assay. Meteorological data were collected. RESULTS: From September 2004 to December 2008, 617 (4.43%) of 13928 cases yielded isolates: 27.8% were influenza A(H1N1), 29.8% were type A(H3N2), and 42.3% were type B. The yearly type and subtype distribution varied significantly from site to site. Peak influenza activity was observed from June to August in Delhi, Pune, and Kolkata and October to December in Chennai. Maximum influenza activity was seen during the rains in Delhi, Pune, Chennai, and Kolkata in correlation with virus isolations. Multivariate analysis of ILI cases showed chill/rigors, cough, fatigue, and ILI in family, correlated positively with isolation. Genetic analysis of Indian isolates revealed that viruses matched with vaccine strains by and large. Overlapping between circulating and vaccine component strains of consecutive years was also observed. CONCLUSIONS: Seasonal influenza A(H1N1), H3N2, and type B co-circulated in all regions without any particular pattern of movement of any subtype. Year-round limited influenza activity with peaks during rains was observed. Genetic drifts and varying seasonality in different parts of the country suggest that a staggered timing of vaccination may be appropriate for India. (Please cite this paper as: Chadha et al. (2011) Multi site Virological Influenza Surveillance in India: 2004-2008. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2011.00293.x.) |
Needle in a haystack: the yield of syphilis outreach screening at 5 US sites-2000 to 2007
Lewis FM , Schillinger JA , Taylor M , Brewer TH , Blank S , Mickey T , Furness BW , Anschuetz GL , Salmon ME , Peterman TA . J Public Health Manag Pract 2011 17 (6) 513-521 BACKGROUND: Screening for syphilis has been performed for decades, but it is unclear if the practice yields many cases at acceptable cost, and if so, at which venues. We attempted a retrospective study to determine the costs, yield, and feasibility of analyzing health department-funded syphilis outreach screening in 5 diverse US sites with significant disease burdens. METHODS: Data (venue, costs, number of tests, reactive tests, new diagnoses) from 2000 to 2007 were collected for screening efforts funded by public health departments from Philadelphia; New York City; Washington, District of Columbia; Maricopa County, Arizona (Phoenix); and the state of Florida. Crude cost per new case was calculated. RESULTS: Screening was conducted in multiple venues including jails, shelters, clubs, bars, and mobile vans. Over the study period, approximately 926,258 tests were performed and 4,671 new syphilis cases were confirmed, of which 225 were primary and secondary, and 688 were early latent or high-titer late latent. Jail intake screening consistently identified the largest numbers of new cases (including 67.6% of early and high-titer late-latent cases) at a cost per case ranging from $144 to $3,454. Data quality from other venues varied greatly between sites and was often poor. CONCLUSIONS: Though the yield of jail intake screening was good, poor data quality, particularly cost data, precluded accurate cost/yield comparisons at other venues. Few cases of infectious syphilis were identified through outreach screening at any venue. Health departments should routinely collect all cost and testing data for screening efforts so that their yield can be evaluated. |
Eosinophilic meningitis attributable to Angiostrongylus cantonensis infection in Hawaii: clinical characteristics and potential exposures
Hochberg NS , Blackburn BG , Park SY , Sejvar JJ , Effler PV , Herwaldt BL . Am J Trop Med Hyg 2011 85 (4) 685-690 The most common infectious cause of eosinophilic meningitis is Angiostrongylus cantonensis, which is transmitted largely by consumption of snails/slugs. We previously identified cases of angiostrongyliasis that occurred in Hawaii from 2001 to 2005; the highest incidence was on the island of Hawaii. We now report symptoms, laboratory parameters, and exposures. Eighteen patients were evaluated; 94% had headache, and 65% had sensory symptoms (paresthesia, hyperesthesia, and/or numbness). These symptoms lasted a median of 17 and 55 days, respectively. Three persons recalled finding a slug in their food/drink. Case-patients on the island of Hawaii were more likely than case-patients on other islands to consume raw homegrown produce in a typical week (89% versus 0%, P < 0.001) and to see snails/slugs on produce (56% versus 0%, P = 0.03). Residents and travelers should be aware of the potential risks of eating uncooked produce in Hawaii, especially if it is from the island of Hawaii and locally grown. |
Qualitative assessment of study materials and communication strategies used in studies that include DNA collection.
Jenkins MM , Reed-Gross E , Barfield WD , Prue CE , Gallagher ML , Rasmussen SA , Honein MA . Am J Med Genet A 2011 155A (11) 2721-31 To understand motivations and barriers to participation in studies that include DNA collection, focus group discussions were held with mothers who had participated in a case-control study of birth defects. Recruited mothers had completed an interview and had received a mailed kit containing cytobrushes to collect buccal cells for DNA from herself, her infant, and her infant's father. Six moderator-led focus groups were attended by a total of 38 women residing in Atlanta, Georgia. Focus groups were segmented by DNA collection status (biologics participants or nonparticipants), infant case-control status, infant birthweight, and maternal race and ethnicity. This report assesses maternal attitudes toward study materials and communication strategies. Across groups, respondents expressed concern about how their contact information was obtained. Study materials were described as clear and professional by most women, although some respondents reported confusion about disclosure of individual genetic results. Respondents generally reported that monetary incentives were not a motivation to participate, but increased perceived study legitimacy. Biologics nonparticipants expressed concerns about kit component sterility; government involvement; and DNA sample use, storage, and disposal. Respondents suggested that investigators provide feedback on whether sample collection was performed correctly and provide materials targeted to fathers to help alleviate paternal skepticism. Participation in DNA collection might be improved by strengthening study materials and communication strategies. Published 2011. This article is a U.S. Government work and is in the public domain in the USA. |
Diverse mutational mechanisms cause pathogenic subtelomeric rearrangements.
Luo Y , Hermetz KE , Jackson JM , Mulle JG , Dodd A , Tsuchiya KD , Ballif BC , Shaffer LG , Cody JD , Ledbetter DH , Martin CL , Rudd MK . Hum Mol Genet 2011 20 (19) 3769-78 Chromosome rearrangements are a significant cause of intellectual disability and birth defects. Subtelomeric rearrangements, including deletions, duplications and translocations of chromosome ends, were first discovered over 40 years ago and are now recognized as being responsible for several genetic syndromes. Unlike the deletions and duplications that cause some genomic disorders, subtelomeric rearrangements do not typically have recurrent breakpoints and involve many different chromosome ends. To capture the molecular mechanisms responsible for this heterogeneous class of chromosome abnormality, we coupled high-resolution array CGH with breakpoint junction sequencing of a diverse collection of subtelomeric rearrangements. We analyzed 102 breakpoints corresponding to 78 rearrangements involving 28 chromosome ends. Sequencing 21 breakpoint junctions revealed signatures of non-homologous end-joining, non-allelic homologous recombination between interspersed repeats and DNA replication processes. Thus, subtelomeric rearrangements arise from diverse mutational mechanisms. In addition, we find hotspots of subtelomeric breakage at the end of chromosomes 9q and 22q; these sites may correspond to genomic regions that are particularly susceptible to double-strand breaks. Finally, fine-mapping the smallest subtelomeric rearrangements has narrowed the critical regions for some chromosomal disorders. |
Associations of medically documented psychiatric diagnoses and risky health behaviors in highly active antiretroviral therapy-experienced perinatally HIV-infected youth
Kapetanovic S , Wiegand RE , Dominguez K , Blumberg D , Bohannon B , Wheeling J , Rutstein R . AIDS Patient Care STDS 2011 25 (8) 493-501 The Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY) study is a prospective, multisite, longitudinal cohort of U.S. HIV-infected youth. This analysis was limited to perinatally HIV-infected youth (n=197), 13 years and older, with selected variables completely abstracted from HIV diagnosis through 2006. We evaluated relationships between ever having one or more nonsubstance related medically documented psychiatric diagnoses and three risky health behaviors (substance abuse, preadult sexual activity, and treatment adherence problems) recorded between 2001 and 2006. Logistic regression was used for all binary outcomes and participant age was included as a covariate when possible. All 197 participants included in the analysis were prescribed antiretroviral therapy during the study period; 110 (56%) were female, 100 (51%) were black non-Hispanic, and 86 (44%) were Hispanic; mean age at the last visit was 16.8 years, ranging from 13 to 24 years. One hundred forty-six (74%) participants had a history of at least one risky health behavior. There were 108 (55%) participants with at least one medically documented psychiatric diagnosis, 17 (9%) with at least one record of substance abuse, 12 (6%) with documented preadult sexual activity, and 142 (72%) participants with reported adherence problems. In the final model, a history of at least one psychiatric diagnosis was associated with having at least one of the three risky behaviors (odds ratio [OR]=2.33, p=0.015). There is a need for a continued close partnership between HIV specialty care providers and mental health services treating perinatally HIV-infected youth with an added focus on improving treatment adherence. |
Why take an HIV test? Concerns, benefits, and strategies to promote HIV testing among low-income heterosexual African American young adults
Wallace SA , McLellan-Lemal E , Harris MJ , Townsend TG , Miller KS . Health Educ Behav 2011 38 (5) 462-70 A qualitative study examined perceptions of HIV testing and strategies to enhance HIV testing among HIV-negative African American heterosexual young adults (ages 18-25 years). Twenty-six focus groups (13 male groups, 13 female groups) were conducted in two low-income communities (urban and rural). All sessions were audio-recorded and transcribed. Data analysis was completed using AnSWR software. Many participants expressed that learning one's HIV status, regardless of the result, was a benefit of taking an HIV test because this was perceived to produce emotional relief. Additional benefits included the avoidance of unknowingly spreading the virus, being offered treatment access if HIV-positive, and taking time to assess and modify risky sexual behaviors if HIV-negative. If diagnosed HIV-positive, HIV testing concerns included the recognition of one's mortality, the experience of social stigma, and concerns about accessing affordable treatment. Recommended promotion strategies included the use of HIV-positive individuals, pop culture icons, and the media to promote HIV testing messages. |
Analysis of participatory photojournalism in a widely disseminated skin cancer prevention program
Hall D , Kline M , Glanz K . Health Promot Pract 2011 12 (5) 666-72 This article describes the content of pictures submitted to a photo contest as part of a nationally disseminated skin cancer prevention program called Pool Cool. The aims of this analysis are to describe sun-safety behaviors and environmental supports depicted in the photos and to gain insight into pool staff perceptions of the program. A directed approach was used to assess the content of 1,886 photos submitted in 2005 and 2006. Staying in the shade and applying sunscreen were the most common sun-safety behaviors shown among children. Among adults and lifeguards, wearing sunglasses and a shirt with sleeves were most common. Most photos contained at least one sun-safety support, and half showed use of Pool Cool program materials. Most photos promoted the use of Pool Cool materials, sun-safety behaviors, or sun-safe pool environments. Participatory photojournalism is a low-cost and effective way to generate widespread interest and support for community health promotion programs. |
Measles elimination in the Americas: a comparison between countries with a one-dose and two-dose routine vaccination schedule
Sever AE , Rainey JJ , Zell ER , Hennessey K , Uzicanin A , Castillo-Solorzano C , Dietz V . J Infect Dis 2011 204 Suppl 2 S748-55 BACKGROUND: The Region of the Americas eliminated measles in 2002 through high first-dose routine measles vaccine coverage and vaccination campaigns every 4-6 years; a second routine dose at school entry was added in some countries. The impact of this second routine dose on measles elimination was evaluated. METHODS: Data on socioeconomic factors, demographic characteristics, vaccination coverage, and the estimated proportion of children (<15 years of age) susceptible to measles were compiled. Countries were grouped using propensity score methods, and Kaplan-Meier curves were used to compare time to measles elimination between countries with a 1-dose schedule and those with a 2-dose schedule. RESULTS: One-dose (n = 14) and 2-dose (n = 7) countries did not differ with respect to median routine first-dose measles vaccine coverage, median coverage for 3 measles campaigns, or estimated percentage of susceptible children after routine first vaccination dose and campaigns. Compared with 1-dose countries, 2-dose countries had higher median gross national income per capita (P =.002), percentage of population living in urban areas (P =.04), and female literacy (P =.01), as well as lower infant mortality (P = .007); however, no differences in time to elimination were found. CONCLUSIONS: One-dose and 2-dose countries had similar times to measles elimination despite socioeconomic differences between their populations. A second routine dose might not have hastened measles elimination, because threshold immunity needed to eliminate measles was achieved with high first routine dose coverage and vaccination campaigns. Further research will be needed to determine the applicability of these findings to other regions. |
Haiti 2007-2008 national measles-rubella vaccination campaign: implications for rubella elimination
Rainey JJ , Danovaro-Holliday MC , Magloire R , Kananda G , Lee CE , Chamouillet H , Lacapere F , Mung K , Luman ET . J Infect Dis 2011 204 Suppl 2 S616-21 BACKGROUND: A national campaign was conducted in Haiti in 2007-2008 to vaccinate all children and adolescents aged 1-19 years with measles-rubella vaccine in support of achieving the Region of the Americas' 2010 goal of eliminating rubella and congenital rubella syndrome (CRS). Measles-rubella vaccine was introduced into the country's routine childhood immunization schedule after the campaign. METHODS: A nationwide, stratified, multistage cluster sample survey of 20859 children was conducted to assess coverage using house-to-house interviews. RESULTS: Estimated national coverage with measles-rubella vaccine was 79.2% (95% confidence interval, 77.6%-80.7%), ranging from 90.2% in Nord-Ouest Department to 70.0% in Cite Soleil Metropolitan Area. National coverage was lower for children aged 1-5 years (76.7%) than for those aged 6-19 years (80.3%) (P< .001) but similar in rural departments (79.4%) and metropolitan areas (78.6%; P = .61). The reasons most frequently cited for nonparticipation in the campaign were that the child was ill or unavailable (18.6%), did not know vaccinations were important (13.8%), did not know when to go or forgot to go (13.3%), and did not have enough time (12.3%). CONCLUSIONS: The measles-rubella vaccination campaign was critical for raising rubella immunity levels in children and adolescents in Haiti. To remain free of rubella transmission and CRS, Haiti must also achieve and sustain high routine measles-rubella vaccination coverage and maintain high-quality integrated measles-rubella and CRS surveillance, including laboratory-based confirmation for reported rash illnesses. If routine measles-rubella vaccination coverage is suboptimal or if gaps in coverage are identified, additional mass campaigns with measles-rubella vaccine will be necessary. |
The impact of missed opportunities on seasonal influenza vaccination coverage for healthy young children
Allred NJ , Poehling KA , Szilagyi PG , Zhang F , Edwards KM , Staat MA , Donauer S , Prill MM , Fairbrother G . J Public Health Manag Pract 2011 17 (6) 560-564 OBJECTIVE: To estimate the impact of missed opportunities on influenza vaccination coverage among 6- through 23-month-old children who sought medical care during the 2004-2005 influenza season. DESIGN: Retrospective cohort study. SETTING: Fifty-two primary care practice sites located in Rochester, New York, Nashville, Tennessee, and Cincinnati, Ohio. PARTICIPANTS: Children 6 through 23 months of age. METHODS/OUTCOME MEASURE: Charts were reviewed and data collected on influenza vaccinations, type of health care visit (well child or other), and presence of illness symptoms. Missed opportunity was defined as a practice visit by an eligible child during influenza season, when vaccine was available, but during which the child did not receive an influenza vaccination. Vaccine was assumed to be available between the first and last dates influenza vaccination was recorded at that practice. Each child was classified as fully vaccinated, partially vaccinated, or unvaccinated. RESULTS: Data were analyzed for 1724 children, 6 through 23 months of age. Most children (62.0%) had at least 1 missed opportunity during this period. Among children with any missed opportunities, 12.8% were fully and 29.8% were partially vaccinated. Overall, 33.6% of the missed opportunities occurred during well child visits and 66.4% during other types of visits; 75% occurred when no other vaccines were given. Eliminating all missed opportunities would have increased full vaccination coverage from 30.3% to 49.9%. CONCLUSIONS: Missed opportunities for influenza vaccination are frequent. Reducing missed opportunities could significantly increase influenza vaccination rates and should be a goal in each practice. |
Comparative immunogenicity and cross-clade protective efficacy of mammalian cell-grown inactivated and live attenuated H5N1 reassortant vaccines in ferrets
Gustin KM , Maines TR , Belser JA , van Hoeven N , Lu X , Dong L , Isakova-Sivak I , Chen LM , Voeten JT , Heldens JG , van den Bosch H , Cox NJ , Tumpey TM , Klimov AI , Rudenko L , Donis RO , Katz JM . J Infect Dis 2011 204 (10) 1491-9 Continued H5N1 virus infection in humans highlights the need for vaccine strategies that provide cross-clade protection against this rapidly evolving virus. We report a comparative evaluation in ferrets of the immunogenicity and cross-protective efficacy of isogenic mammalian cell-grown, live attenuated influenza vaccine (LAIV) and adjuvanted, whole-virus, inactivated influenza vaccine (IIV), produced from a clade 1 H5N1 6:2 reassortant vaccine candidate (caVN1203-Len17rg) based on the cold-adapted A/Leningrad/134/17/57 (H2N2) master donor virus. Two doses of LAIV or IIV provided complete protection against lethal homologous H5N1 virus challenge and a reduction in virus shedding and disease severity after heterologous clade 2.2.1 H5N1 virus challenge and increased virus-specific serum and nasal wash antibody levels. Although both vaccines demonstrated cross-protective efficacy, LAIV induced higher levels of nasal wash IgA and reduction of heterologous virus shedding, compared with IIV. Thus, enhanced respiratory tract antibody responses elicited by LAIV were associated with improved cross-clade protection. |
Utilization of two web-based continuing education courses evaluated by Markov chain model
Tian H , Lin JM , Reeves WC . J Am Med Inform Assoc 2011 19 (3) 489-94 OBJECTIVES: To evaluate the web structure of two web-based continuing education courses, identify problems and assess the effects of web site modifications. DESIGN: Markov chain models were built from 2008 web usage data to evaluate the courses' web structure and navigation patterns. The web site was then modified to resolve identified design issues and the improvement in user activity over the subsequent 12 months was quantitatively evaluated.MeasurementsWeb navigation paths were collected between 2008 and 2010. The probability of navigating from one web page to another was analyzed. RESULTS: The continuing education courses' sequential structure design was clearly reflected in the resulting actual web usage models, and none of the skip transitions provided was heavily used. The web navigation patterns of the two different continuing education courses were similar. Two possible design flaws were identified and fixed in only one of the two courses. Over the following 12 months, the drop-out rate in the modified course significantly decreased from 41% to 35%, but remained unchanged in the unmodified course. The web improvement effects were further verified via a second-order Markov chain model. CONCLUSIONS: The results imply that differences in web content have less impact than web structure design on how learners navigate through continuing education courses. Evaluation of user navigation can help identify web design flaws and guide modifications. This study showed that Markov chain models provide a valuable tool to evaluate web-based education courses. Both the results and techniques in this study would be very useful for public health education and research specialists. |
Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka
Husain F , Anderson M , Lopes Cardozo B , Becknell K , Blanton C , Araki D , Vithana EK . JAMA 2011 306 (5) 522-31 CONTEXT: Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons. OBJECTIVES: To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka. DESIGN, SETTING, AND PARTICIPANTS: Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health. MAIN OUTCOME MEASURES: Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS: The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure. CONCLUSION: Among residents of Jaffna District in Sri Lanka, prevalence of symptoms of war-related mental health conditions was substantial and significantly associated with displacement status and underlying trauma exposure. |
Public health efforts to build a surveillance system for child maltreatment mortality: lessons learned for stakeholder engagement
Smith LR , Gibbs D , Wetterhall S , Schnitzer PG , Farris T , Crosby AE , Leeb RT . J Public Health Manag Pract 2011 17 (6) 542-9 CONTEXT: Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts. OBJECTIVE: We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance. DESIGN: Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance. PARTICIPANTS: Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states. RESULTS: Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non-public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement. CONCLUSIONS: The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders. |
Israeli adolescents exposed to community and terror violence: the protective role of social support
Brookmeyer KA , Henrich CC , Cohen G , Shahar G . J Early Adolesc 2011 31 (4) 577-603 This study investigates how social support may protect Israeli early adolescents who have witnessed community violence from engaging in violent behavior when they have also witnessed terror violence. The study examines how support from parents, school, and friends could serve as protective, despite the interactive risk effects of witnessing community and terror violence. In general, results indicate that support from parents operated as a protective factor, whereas support from friends acted as a risk by increasing the likelihood of violent behavior. Support from school has both a protective and risk effect, depending on the type of violence exposure witnessed. The extent to which these facets of social support operated as risk or protective factors is conditional on whether youth had also witnessed terror violence, and terror violence appear to moderate each of the three facets of support differently. The implications of these findings and intervention initiatives for Israeli youth are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved) (journal abstract). |
Effect of D222G mutation in the hemagglutinin protein on receptor binding, pathogenesis and transmissibility of the 2009 pandemic H1N1 influenza virus.
Belser JA , Jayaraman A , Raman R , Pappas C , Zeng H , Cox NJ , Katz JM , Sasisekharan R , Tumpey TM . PLoS One 2011 6 (9) e25091 Influenza viruses isolated during the 2009 H1N1 pandemic generally lack known molecular determinants of virulence associated with previous pandemic and highly pathogenic avian influenza viruses. The frequency of the amino acid substitution D222G in the hemagglutinin (HA) of 2009 H1N1 viruses isolated from severe but not mild human cases represents the first molecular marker associated with enhanced disease. To assess the relative contribution of this substitution in virus pathogenesis, transmission, and tropism, we introduced D222G by reverse genetics in the wild-type HA of the 2009 H1N1 virus, A/California/04/09 (CA/04). A dose-dependent glycan array analysis with the D222G virus showed a modest reduction in the binding avidity to human-like (alpha2-6 sialylated glycan) receptors and an increase in the binding to avian-like (alpha2-3 sialylated glycan) receptors in comparison with wild-type virus. In the ferret pathogenesis model, the D222G mutant virus was found to be similar to wild-type CA/04 virus with respect to lethargy, weight loss and replication efficiency in the upper and lower respiratory tract. Moreover, based on viral detection, the respiratory droplet transmission properties of these two viruses were found to be similar. The D222G virus failed to productively infect mice inoculated by the ocular route, but exhibited greater viral replication and weight loss than wild-type CA/04 virus in mice inoculated by the intranasal route. In a more relevant human cell model, D222G virus replicated with delayed kinetics compared with wild-type virus but to higher titer in human bronchial epithelial cells. These findings suggest that although the D222G mutation does not influence virus transmission, it may be considered a molecular marker for enhanced replication in certain cell types. |
Using next generation sequencing to identify yellow fever virus in Uganda.
McMullan LK , Frace M , Sammons SA , Shoemaker T , Balinandi S , Wamala JF , Lutwama JJ , Downing RG , Stroeher U , Macneil A , Nichol ST . Virology 2011 422 (1) 1-5 In October and November 2010, hospitals in northern Uganda reported patients with suspected hemorrhagic fevers. Initial tests for Ebola viruses, Marburg virus, Rift Valley fever virus, and Crimean Congo hemorrhagic fever virus were negative. Unbiased PCR amplification of total RNA extracted directly from patient sera and next generation sequencing resulted in detection of yellow fever virus and generation of 98% of the virus genome sequence. This finding demonstrated the utility of next generation sequencing and a metagenomic approach to identify an etiological agent and direct the response to a disease outbreak. |
Particle collection efficiency for nylon mesh screens
Cena LG , Ku BK , Peters TM . Aerosol Sci Technol 2012 46 (2) 214-221 Nylon mesh screens, unlike metal screens, are attractive as a collection substrate for nanoparticles because they can be digested or ashed prior to chemical analysis. A theoretical single-fiber efficiency expression developed for wire-mesh screens was evaluated for estimating the collection efficiency of 11-300 nm particles for nylon mesh screens. Pressure drop across the screens, the effect of particle morphology (spherical and highly fractal-like) on collection efficiency, and single-fiber efficiency were evaluated experimentally for three pore sizes (60, 100, and 180 mcm) at three flow rates (2.5, 4, and 6 Lpm). The pressure drop across the screens was found to increase linearly with superficial velocity. The collection efficiency of the screens was found to vary by less than 4% regardless of particle morphology. Single-fiber efficiency calculated from experimental data was in good agreement with that estimated from theory for particles between 40 and 150 nm but deviated from theory for particles outside this size range. New coefficients for the single-fiber efficiency model were identified that minimized the sum of square error (SSE) between the values estimated with the model and those determined experimentally. Compared to the original theory, the SSE calculated using the modified theory was at least one order of magnitude lower for all screens and flow rates with the exception of the 60-mcm pore screens at 2.5 Lpm, where the decrease was threefold. |
Reduced avian virulence and viremia of West Nile virus isolates from Mexico and Texas
Brault AC , Langevin SA , Ramey WN , Fang Y , Beasley DW , Barker CM , Sanders TA , Reisen WK , Barrett AD , Bowen RA . Am J Trop Med Hyg 2011 85 (4) 758-767 A West Nile virus (WNV) isolate from Mexico (TM171-03) and BIRD1153, a unique genotype from Texas, have exhibited reduced murine neuroinvasive phenotypes. To determine if murine neuroinvasive capacity equates to avian virulence potential, American crow (Corvus brachyrhynchos) and house sparrows (Passer domesticus) were experimentally inoculated with representative murine neuroinvasive/non-neuroinvasive strains. In both avian species, a plaque variant from Mexico that was E-glycosylation competent produced higher viremias than an E-glycosylation-incompetent variant, indicating the potential importance of E-glycosylation for avian replication. The murine non-neuroinvasive BIRD1153 strain was significantly attenuated in American crows but not house sparrows when compared with the murine neuroinvasive Texas strain. Despite the loss of murine neuroinvasive properties of nonglycosylated variants from Mexico, our data indicate avian replication potential of these strains and that unique WNV virulence characteristics exist between murine and avian models. The implications of reduced avian replication of variants from Mexico for restricted WNV transmission in Latin America is discussed. |
The stability of markers in dried-blood spots for recommended newborn screening disorders in the United States
Adam BW , Hall EM , Sternberg M , Lim TH , Flores SR , O'Brien S , Simms D , Li LX , De Jesus VR , Hannon WH . Clin Biochem 2011 44 1445-50 OBJECTIVE: We aimed to measure separately the contributions of heat and humidity to changes in levels of 34 markers of inborn disorders in dried-blood-spot (DBS) samples. DESIGN AND METHODS: We stored paired sets of DBSs at 37 degrees C for predetermined intervals in low-humidity and high-humidity environments. Marker levels of all samples in each complete sample set were measured in a single analytic run. RESULTS: During the 30+/-5day studies, galactose-1-phosphate uridyltransferase and biotinidase lost almost 65% of initial activities in low-humidity storage; most of the degradation in 27 other markers was attributable to adverse effects of high-humidity storage; seven markers in DBSs stored at high humidity lost more than 90% of initial levels by the end of the study and 4 of the 7 lost more than 50% of initial levels within the first week of storage. CONCLUSIONS: Minimizing both humidity and temperature in DBS transportation and storage environments is essential to maintaining sample integrity. |
Viable Staphylococcus aureus quantitation using 15N metabolically-labeled bacteriophage amplification coupled with a multiple reaction monitoring proteomic workflow
Pierce CL , Rees JC , Fernandez FM , Barr JR . Mol Cell Proteomics 2011 11 (1) M111 012849 A multiple reaction monitoring liquid chromatography (LC) method with tandem mass spectrometric detection (MS/MS) for quantitation of Staphylococcus aureus via phage amplification detection (PAD) is described. This PAD method enables rapid and accurate quantitation of viable S. aureus by detecting an amplified capsid protein from a specific phage. A known amount of metabolically-labeled (15)N reference bacteriophage, utilized as the input phage and as the internal standard for quantitation, was spiked into S. aureus samples. Following a 2-h incubation, the sample was subjected to a 3-min rapid trypsin digest and analyzed by high-throughput LC-MS/MS targeting peptides unique to both the (15)N (input phage) and (14)N (progeny phage) capsid proteins. Quantitation was achieved by comparing peak areas of target peptides from the metabolically labeled (15)N bacteriophage peptide internal standard with that of the wild-type (14)N peptides that were produced by phage amplification and subsequent digestion when the host bacteria was present. This approach is based on the fact that a labeled species differs from the unlabeled one in terms of its mass but exhibits almost identical chemical properties such as ion yields and retention times. A 6-point calibration curve for S. aureus concentration was constructed with standards ranging from 5.0x10(4) CFU mL(-1) to 2.0x10(6) CFU mL(-1), with the (15)N reference phage spiked at a concentration of 1.0x10(9) PFU mL(-1). Amplification with (15)N bacteriophage coupled with LC-MS/MS detection offers speed (3 h total analysis time), sensitivity (LOD: < 5.0 x 10(4) CFU mL(-1)), accuracy, and precision for quantitation of S. aureus. |
Measuring, rating, and comparing the real ear attenuation at threshold of four earplugs
Murphy WJ , Stephenson MR , Byrne DC . J Acoust Soc Am 2011 130 (4) 2435 The effect of training instruction, whether presented as the manufacturer's printed instructions, a short video training session, specific to the product, or as a one-on-one training session, was evaluated using four hearing protection devices with eight groups of subjects. The Howard Leight Fusion and Airsoft premolded earplugs and the Moldex PuraFit and EAR Classic foam earplugs were tested. Naive subjects were recruited and tested using three different forms of training: written, video, and individual training. The differences between group averages for A-weighted attenuation were not statistically significant when compared between the video or the written instruction conditions, regardless of presentation order. The experimenter- trained A-weighted attenuations were significantly greater than the written and video instruction for most of the protectors and groups. For each earplug, the noise reduction statistic for A-weighting (NRSA) and the associated confidence intervals were calculated for the 90th and 10th percentiles of protection. Across subject groups for each protector, the differences between NRSA ratings were found to be not statistically significant. Several comparisons evaluating the order of testing, the type of testing, and statistical tests of the performance across the groups are presented. [Portions of this work were supported by the U.S. EPA Interagency Agreement DW75921973-01-0.]. |
National validation study of a cellulose sponge-wipe processing method for use after sampling Bacillus anthracis spores from surfaces
Rose LJ , Hodges L , O'Connell H , Noble-Wang J . Appl Environ Microbiol 2011 77 (23) 8355-9 This work was initiated to address the gaps identified by Congress regarding validated biothreat environmental sampling and processing methods. Nine Laboratory Response Network (LRN) affiliated laboratories participated in a validation study of a cellulose sponge-wipe processing protocol for the recovery, detection, and quantification of viable Bacillus anthracis Sterne spores from steel surfaces. Steel coupons (645.16 cm(2)) were inoculated with 1-to 4-log(10) spores and then sampled with cellulose sponges (3M Sponge-Stick, St Paul, MN). Surrogate dust and background organisms were added to the sponges to mimic environmental conditions. Labs processed the sponges according to the provided protocol. Sensitivity, specificity, and mean percent recovery (%R), between-lab, within-lab and total %CV were calculated. The mean %R (SE) of spores from the surface was 32.4 (4.4), 24.4 (2.8) and 30.1 (2.3) for 1-, 2- and 4-log(10) inoculum levels, respectively. Sensitivities for colony counts were 84.1%, 100% and 100% for 1-, 2- and 4-log(10)inocula, respectively. These data help to characterize the variability of the processing method and thereby enhance confidence in the interpretation of the results of environmental sampling conducted during a B. anthracis contamination investigation. |
Increased MDSC accumulation and Th2 biased response to influenza A virus infection in the absence of TLR7 in mice
Jeisy-Scott V , Davis WG , Patel JR , Bowzard JB , Shieh WJ , Zaki SR , Katz JM , Sambhara S . PLoS One 2011 6 (9) e25242 Toll-like receptors (TLRs) play an important role in the induction of innate and adaptive immune response against influenza A virus (IAV) infection; however, the role of Toll-like receptor 7 (TLR7) during the innate immune response to IAV infection and the cell types affected by the absence of TLR7 are not clearly understood. In this study, we show that myeloid derived suppressor cells (MDSC) accumulate in the lungs of TLR7 deficient mice more so than in wild-type C57Bl/6 mice, and display increased cytokine expression. Furthermore, there is an increase in production of Th2 cytokines by TLR7(-/-) compared with wildtype CD4+ T-cells in vivo, leading to a Th2 polarized humoral response. Our findings indicate that TLR7 modulates the accumulation of MDSCs during an IAV infection in mice, and that lack of TLR7 signaling leads to a Th2-biased response. |
Alaska sentinel surveillance study of Helicobacter pylori isolates from Alaska Native persons from 2000 to 2008
Tveit AH , Bruce MG , Bruden DL , Morris J , Reasonover A , Hurlburt DA , Hennessy TW , McMahon B . J Clin Microbiol 2011 49 (10) 3638-43 Helicobacter pylori infection is more common in Alaska Native persons than in the general U.S. population, with seroprevalence to H. pylori approaching 75%. Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among H. pylori isolates. We analyzed H. pylori data from the Centers for Disease Control and Prevention's sentinel surveillance in Alaska from January 2000 to December 2008 to determine the proportion of culture-positive biopsy specimens with antimicrobial resistance from Alaska Native persons undergoing endoscopy. The aim of the present study was to monitor antimicrobial resistance of H. pylori isolates over time and by region in Alaska Native persons. Susceptibility testing of H. pylori isolates to metronidazole, clarithromycin, amoxicillin, and tetracycline was performed using agar dilution. Susceptibility testing for levofloxacin was performed by Etest. Overall, 45% (532/1,181) of persons undergoing upper endoscopy were culture positive for H. pylori. Metronidazole resistance was demonstrated in isolates from 222/531 (42%) persons, clarithromycin resistance in 159/531 (30%) persons, amoxicillin resistance in 10/531 (2%) persons, and levofloxacin resistance in 30/155 (19%) persons; no tetracycline resistance was documented. The prevalence of metronidazole, clarithromycin, and levofloxacin resistance varied by region. Female patients were more likely than male patients to demonstrate metronidazole (P < 0.05) and clarithromycin (P < 0.05) resistance. No substantial change in the proportion of persons with resistant isolates was observed over time. Resistance to metronidazole, clarithromycin, and levofloxacin is more common among H. pylori isolates from Alaska Native persons than those from elsewhere in the United States. |
Antioxidant c-FLIP inhibits Fas ligand-induced NF-kappaB activation in a phosphatidylinositol 3-kinase/Akt-dependent manner
Iyer AK , Azad N , Talbot S , Stehlik C , Lu B , Wang L , Rojanasakul Y . J Immunol 2011 187 (6) 3256-66 Fas ligand (FasL) belongs to the TNF family of death ligands, and its binding to the FasR leads to activation of several downstream signaling pathways and proteins, including NF-kappaB and PI3K/Akt. However, it is not known whether cross-talk exists between NF-kappaB and PI3K/Akt in the context of FasL signaling. We demonstrate using both human renal epithelial 293T cells and Jurkat T-lymphocyte cells that although FasL activates both Akt and NF-kappaB, Akt inhibits FasL-dependent NF-kappaB activity in a reactive oxygen species-dependent manner. Cellular FLICE-inhibitory protein (c-FLIP), an antioxidant and an important component of the death-inducing signaling complex, also represses NF-kappaB upstream of the regulatory IkappaB kinase-gamma protein subunit in the NF-kappaB signaling pathway, and positive cross-talk exists between Akt and c-FLIP in the context of inhibition of FasL-induced NF-kappaB activity. The presence of two death effector domains of c-FLIP and S-nitrosylation of its caspase-like domain were found to be important for mediating c-FLIP-dependent downregulation of NF-kappaB activity. Taken together, our study reveals a novel link between NF-kappaB and PI3K/Akt and establishes c-FLIP as an important regulator of FasL-mediated cell death. |
Calibration details for the impulse peak insertion loss measurement
Murphy WJ , Vernon JA . J Acoust Soc Am 2011 130 (4) 2434 The American National Standard ANSI S12.42-2010 specifies the measurement of hearing protector performance in the presence of impulse noise. A series of calibration impulses are recorded from an acoustic test fixture (ATF) and a field microphone for peak sound pressure levels of 130, 150, and 170 dB. The averaged acoustic transfer function between the ATF and field microphone is calculated as follows: H(ATF-FF)(f)=FFT(P(ATF,i)(t))/FFT(P(FF,i)(t)). The transfer function is computed for each of the ranges of impulse levels and is applied to the field microphone measurements to estimate the unoccluded fixture levels of the ATF when hearing protection is being tested. This method allows a comparison between occluded and unoccluded waveforms. The calibration transfer function is affected by the time-alignment of the field impulse peaks, time-windowing of the impulses, and compensation for any dc bias. Time-alignment significantly affected the accuracy of predicting individual calibration levels with H(ATF-FF). The prediction error variance was less at 170 dB than at 130 dB impulses. The time-window was varied from 2.5 to 100 ms preceding the peak of the field impulse. [Portions of this work were supported by the U.S. EPA Interagency Agreement DW75921973-01-0.]. |
Comparison of the HPDLab and REATMaster software/hardware systems for ANSI S12.6 testing
Byrne DC , Perry CC , Murphy WJ . J Acoust Soc Am 2011 130 (4) 2434 The American National Standard Methods for Measuring the Real-Ear Attenuation of Hearing Protectors (ANSI S12.6-2008) requires a Bekesy procedure for testing occluded and unoccluded thresholds. Since 2002, the National Institute for Occupational Safety and Health (NIOSH) has used the custom-designed HPDLab software operating Tucker-Davis Technologies System 3 hardware. ViAcoustics, Nelson Acoustics, NASA, and NIOSH researchers recently developed REATMaster which runs on National Instruments hardware in the LabVIEW environment. Ten subjects were trained by the experimenter on how to fit a passive earmuff and were qualified according to the requirements of ANSI S12.6-2008. The laboratory was configured such that diffuse sound field thresholds were tested with either the HPDLab or REATmaster hardware by flipping a toggle switch. The earmuff was not touched or re-positioned between test trials with the two different hardware/software systems. The test sequence for the order of open and occluded measurements was counterbalanced across occluded conditions and hardware system. Results from this testing were used to validate the REATMaster system for its ability to produce accurate threshold data. Preliminary results indicate no significant differences between the two systems. |
Comparison of three acoustics test fixtures for impulse peak insertion loss
Murphy WJ , Flamme GA , Meinke DK , Finan DS , Lankford J , Khan A , Sondergaard J , Stewart M . J Acoust Soc Am 2011 130 (4) 2433 Acoustic test fixtures (ATF) for testing the impulse peak insertion loss (IPIL) of a hearing protector are described by American National Standard ANSI S12.42-2010. The self-insertion loss, ear simulator design (canals, microphone, and temperature), hardness of the area surrounding the pinna, and the anthropometric shape of the head has been specified in the standard. The IPILs of four protector conditions were evaluated with three ATFs during an outdoor field study using firearm noise. The Etymotic Research ER20 musicians' earplug and electronic (EB1 earplugs), the Peltor Tactical Pro earmuffs, and a combination of the TacticalPro and ER20 protectors were tested at 130, 150, and 170 dB peak sound pressure level with the Institute de Saint Louis heated and unheated fixture and the GRAS 45CB heated ATF. IPILs exhibited good agreement across all three fixtures for earplugs. Significant differences were observed between the fixtures for the earmuff-only condition. These differences were more evident for the double-protection condition. [Portions of this work were supported by the U.S. EPA Interagency Agreement DW75921973-01-0.]. |
Development of a human-murine chimeric immunoglobulin M for use in the serological detection of human alphavirus antibodies
Thibodeaux BA , Liss NM , Panella AN , Roehrig JT . Clin Vaccine Immunol 2011 18 (12) 2181-2 Diagnosis of human alphaviral infections relies on serological techniques such as the immunoglobulin M antibody capture enzyme-linked immunosorbent assay (MAC-ELISA). We have humanized the broadly alphavirus cross-reactive murine monoclonal antibody 1A4B-6 to create a reagent capable of replacing human positive sera in the MAC-ELISA for diagnosis of human alphaviral infections. |
Development of an improved methodology to detect infectious airborne influenza virus using the NIOSH bioaerosol sampler
Cao G , Noti JD , Blachere FM , Lindsley WG , Beezhold DH . J Environ Monit 2011 13 (12) 3321-8 A unique two-stage cyclone bioaerosol sampler has been developed at NIOSH that can separate aerosols into three size fractions. The ability of this sampler to collect infectious airborne viruses from a calm-air chamber loaded with influenza A virus was tested. The sampler's efficiency at collecting aerosolized viral particles from a calm-air chamber is essentially the same as that from the high performance SKC BioSampler that collects un-fractionated particles directly into a liquid media (2.4 x 10(4) total viral particles per liter of sampled air (TVP/L) versus 2.6 x 10(4) TVP/L, respectively, after 15 min) and the efficiency is relatively constant over collection times of 15, 30 and 60 min. Approximately 34% of the aerosolized infectious virus collected after 15 min with the NIOSH bioaerosol sampler remained infectious, and infectious virus was found in all three size fractions. After 60 min of sampling, the infectious virus/liter air found in the NIOSH bioaerosol sampler was 15% of that found in the SKC BioSampler. This preservation of infectivity by the NIOSH bioaerosol sampler was maintained even when the initial infectivity prior to aerosolization was as low as 0.06%. The utility of the NIOSH bioaerosol sampler was further extended by incorporating an enhanced infectivity detection methodology developed in our laboratory, the viral replication assay, which amplified the infectious virus making it more readily detectable. |
Birth prevalence rates of newborn screening disorders in relation to screening practices in the United States.
Hertzberg VS , Hinton CF , Therrell BL , Shapira SK . J Pediatr 2011 159 (4) 555-60 OBJECTIVE: To examine the associations between the first-tier-screening laboratory methods and criteria and the birth prevalence of congenital adrenal hyperplasia (CAH), phenylketonuria (PKU), and the sickle hemoglobinopathies occurring in the United States between 1991 and 2000. STUDY DESIGN: By using validated data from the National Newborn Screening and Genetics Resource Center, we fit Poisson regression models with laboratory methods and criteria used in every year for each state for each disorder. We also examined whether there was an overall change in birth prevalence over the decade and whether there was an effect resulting from obligatory second screenings. RESULTS: There were no associations among any of the factors and the birth prevalence of PKU in this decade. Use of the enzyme-linked immunosorbent assay was more likely than any other laboratory method to identify cases of CAH (OR 1.16; 95% CI 1.04-1.30), but no other factors were associated with this disorder. None of the factors examined were associated with the birth prevalence rates of any of the sickle hemoglobinopathies. CONCLUSION: There were no substantial changes in the birth prevalence rates of PKU, CAH, or the sickle hemoglobinopathies over the study period despite rapid changes in technology. |
A reversal in reductions of child mortality in western Kenya, 2003-2009
Hamel MJ , Adazu K , Obor D , Sewe M , Vulule J , Williamson JM , Slutsker L , Feikin DR , Laserson KF . Am J Trop Med Hyg 2011 85 (4) 597-605 We report and explore changes in child mortality in a rural area of Kenya during 2003-2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008-2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs. |
Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring: a systematic review
Kim SY , England JL , Sharma JA , Njoroge T . Exp Diabetes Res 2011 2011 541308 We systematically reviewed research examining the association between gestational diabetes (GDM) and childhood overweight and obesity. We identified studies from three sources: (1) a PubMed search of articles published between January 1990-January 2011, (2) reference lists of publications from the PubMed search, and (3) reference lists of review articles. We included studies that examined GDM separately from pregestational diabetes and childhood overweight or obesity defined as BMI > 85th or 95th percentile. A total of 12 studies were included in the systematic review. Crude odds ratios for the relationship between GDM and childhood overweight or obesity ranged from 0.7 to 6.3; in 8 studies, the associations were not statistically significant. In only 3 studies were results adjusted for any confounders; in the 2 that adjusted for prepregnancy obesity, the GDM and childhood overweight or obesity associations were attenuated and not statistically significant after adjustment. This paper demonstrates inconsistent evidence of an association between GDM and offspring overweight and obesity due to the methodological limitations of existing studies. Recommendations for future research are presented, which address methodological challenges. |
Nutritional status of under-five children living in an informal urban settlement in Nairobi, Kenya
Olack B , Burke H , Cosmas L , Bamrah S , Dooling K , Feikin DR , Talley LE , Breiman RF . J Health Popul Nutr 2011 29 (4) 357-63 Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. However, little information on the nutritional status of children is available from informal settlements. During the period of post-election violence in Kenya during December 2007-March 2008, food shortages were widespread within informal settlements in Nairobi. To investigate whether food insecurity due to post-election violence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional survey was undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya Medical Research Institute/Centers for Disease Control and Prevention conducts population-based surveillance for infectious disease syndromes. During 25 March-4 April 2008, a structured questionnaire was administered to caregivers of 1,310 children identified through surveillance system databases to obtain information on household demographics, food availability, and child-feeding practices. Anthropometric measurements were recorded on all participating children. Indices were reported in z-scores and compared with the World Health Organization (WHO) 2005 reference population to determine the nutritional status of children. Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of the children; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of the children; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had the highest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged 6-11 months. Boys were more stunted than girls (p < 0.01), and older children were significantly (p < 0.0001) stunted compared to younger children. In the third year of life, girls were more likely than boys to be wasted (p < 0.01). The high prevalence of chronic malnutrition suggests that stunting is a sustained problem within this urban informal settlement, not specifically resulting from the relatively brief political crisis. The predominance of stunting in older children indicates failure in growth and development during the first two years of life. Food programmes in Kenya have traditionally focused on rural areas and refugee camps. The findings of the study suggest that tackling childhood stunting is a high priority, and there should be fostered efforts to ensure that malnutrition-prevention strategies include the urban poor. |
Formative research for the development of a market-based home fortification programme for young children in Niger
Tripp K , Perrine CG , de Campos P , Knieriemen M , Hartz R , Ali F , Jefferds ME , Kupka R . Matern Child Nutr 2011 7 Suppl 3 82-95 The objective of this formative research was to assess the acceptability of a micronutrient powder (Sprinkles((R)) ) and a lipid-based nutrient supplement (Nutributter((R)) ), and to explore people's willingness to pay for these products in a resource-poor context like Niger. In four sites, 84 focus group discussions among mothers, fathers and grandmothers of children 6-23 months were conducted, as well as 80 key informant interviews of mothers who participated in a home study where their children 6-23 months were given either Sprinkles((R)) or Nutributter((R)) to use either for a period of 4 weeks, or they were given both products over the 4-week period, i.e. Sprinkles((R)) for 2 weeks and Nutributter((R)) for an additional 2 weeks. The mothers understood how to use the products and generally used the products correctly. Both products were highly acceptable to adults and most children. In Niamey, where the 4-week home study used both products for 2 weeks each, the mothers tended to prefer Nutributter((R)) . The mothers who used either product were pleased with the improvements they saw in their children's health, including increased appetite, weight gain and increased energy and activity. A few mothers were concerned with how they would be able to provide for their child's increased appetite. Most participants across all four sites reported that they would be willing and able to afford to buy a single sachet of either Sprinkles((R)) at a cost of US$0.03 or Nutributter((R)) at a cost of US$0.08 several times a week. This study provides evidence that both of these products were are highly acceptable in different settings in Niger and suggests that delivery of Nutributter((R)) or Sprinkles((R)) at a low or subsidized cost through a market-based system may be possible in Niger, if an appropriate distribution system can be identified. |
Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age
De-Regil LM , Suchdev PS , Vist GE , Walleser S , Pena-Rosas JP . Cochrane Database Syst Rev 2011 9 (9) CD008959 BACKGROUND: Vitamin and mineral deficiencies, particularly those of iron, vitamin A and zinc, affect more than two billion people worldwide. Young children are highly vulnerable because of rapid growth and inadequate dietary practices. Micronutrient powders (MNP) are single-dose packets containing multiple vitamins and minerals in powder form that can be sprinkled onto any semi-solid food. The use of MNP for home or point-of-use fortification of complementary foods has been proposed as an intervention for improving micronutrient intake in children under two years of age. OBJECTIVES: To assess the effects and safety of home (point-of-use) fortification of foods with multiple micronutrient powders on nutritional, health and developmental outcomes in children under two years of age. SEARCH STRATEGY: We searched the following databases in February 2011: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (1948 to week 2 February 2011), EMBASE (1980 to Week 6 2011), CINAHL (1937 to current), CPCI-S (1990 to 19 February 2011), Science Citation Index (1970 to 19 February 2011), African Index Medicus (searched 23 February 2011), POPLINE (searched 21 February 2011), ClinicalTrials.gov (searched 23 February 2011), mRCT (searched 23 February 2011), and World Health Organization International Clinical Trials Registry Platform (ICTRP) (searched 23 February 2011). We also contacted relevant organisations (25 January 2011) for the identification of ongoing and unpublished studies. SELECTION CRITERIA: We included randomised and quasi-randomised trials with either individual or cluster randomisation. Participants were children under the age of two years at the time of intervention, with no specific health problems. The intervention was consumption of food fortified at the point of use with multiple micronutrient powders formulated with at least iron, zinc and vitamin A compared with placebo, no intervention or the use of iron containing supplements, which is the standard practice. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies and assessed the risk of bias of the included studies. MAIN RESULTS: We included eight trials (3748 participants) conducted in low income countries in Asia, Africa and the Caribbean, where anaemia is a public health problem. The interventions lasted between two and 12 months and the powder formulations contained between five and 15 nutrients. Six trials compared the use of MNP versus no intervention or a placebo and the other two compared the use of MNP versus daily iron drops. Most of the included trials were assessed as at low risk of bias.Home fortification with MNP reduced anaemia by 31% (six trials, RR 0.69; 95% CI 0.60 to 0.78) and iron deficiency by 51% (four trials, RR 0.49; 95% CI 0.35 to 0.67) in infants and young children when compared with no intervention or placebo, but we did not find an effect on growth.In comparison with daily iron supplementation, the use of MNP produced similar results on anaemia (one trial, RR 0.89; 95% CI 0.58 to 1.39) and haemoglobin concentrations (two trials, MD -2.36 g/L; 95% CI -10.30 to 5.58); however, given the limited amount of data these results should be interpreted cautiously. No deaths were reported in the trials and information on side effects and morbidity, including malaria, was scarce. It seems that the use of MNP is efficacious among infants and young children six to 23 months of age living in settings with different prevalences of anaemia and malaria endemicity, regardless of whether the intervention lasts two, six or 12 months or whether recipients are male or female. AUTHORS' CONCLUSIONS: Home fortification of foods with multiple micronutrient powders is an effective intervention to reduce anaemia and iron deficiency in children six months to 23 months of age. The provision of MNP is better than no intervention or placebo and possibly comparable to commonly used daily iron supplementation. The benefits of this intervention as a child survival strategy or on developmental outcomes are unclear. Data on effects on malaria outcomes are lacking and further investigation of morbidity outcomes is needed. The micronutrient powders containing multiple nutrients are well accepted but adherence is variable and in some cases comparable to that achieved in infants and young children receiving standard iron supplements as drops or syrups. |
A pilot study of workplace dermal exposures to cypermethrin at a chemical manufacturing plant
Buckley TJ , Geer LA , Connor TH , Robertson S , Sammons D , Smith J , Snawder J , Boeniger M . J Occup Environ Hyg 2011 8 (10) 600-8 Exposure during the manufacture of pesticides is of particular concern due to their toxicity and because little is known about worker exposure, since most studies have focused on end-use application within agriculture or buildings. Even though dermal exposure can be expected to dominate for pesticides, little is known about workplace dermal exposures or even appropriate methods for their assessment. The current study begins to address this gap by evaluating alternative methods for assessing dermal exposure at a chemical manufacturing plant. For this pilot study, eight workers were recruited from a U.S. plant that produced the pesticide cypermethrin. Exposure was evaluated using three approaches: (1) survey assessment (questionnaire), (2) biological monitoring, and (3) workplace environmental sampling including ancillary measurements of glove contamination (interior and exterior). In each case, cypermethrin was quantified by enzyme-linked immunosorbent assay (ELISA). Environmental measurements identified two potential pathways of cypermethrin exposure: glove and surface contamination. Workplace exposure was also indicated by urine levels (specific gravity adjusted) of the parent compound, which ranged from 35 to 253 mug/L (median of 121 mcg/L) with no clear trend in levels from pre- to post-shift. An exploratory analysis intended to guide future studies revealed a positive predictive association (Spearman correlation, p ≤ 0.10) between post-shift urine concentrations and a subset of survey questions evaluating worker knowledge, attitudes, and perceptions (KAP) of workplace dermal hazards, i.e., personal protective equipment self-efficacy, and inverse associations with behavior belief and information belief scales. These findings are valuable in demonstrating a variety of dermal exposure methods (i.e., behavioral attributes, external contamination, and biomarker) showing feasibility and providing measurement ranges and preliminary associations to support future and more complete assessments. Although these pilot data are useful for supporting design and sample size considerations for larger exposure and health studies, there is a need for validation studies of the ELISA assay for quantification of cypermethrin and its metabolites in urine. |
The effectiveness of using interferon-gamma release assays in screening immigration employees for latent tuberculosis infection
de Perio MA , Niemeier RT , Groenewold MR . Int J Occup Environ Health 2011 17 (4) 322-327 We assessed the prevalence of latent tuberculosis infection in immigration employees and compared two of the screening methods. Using a cross-sectional study design, we administered questionnaires regarding demographics, work, medical history, and tuberculosis risk factors to employees at two immigration facilities. Participants underwent tuberculin skin test (TST) placement and blood collection for the QuantiFERONTB Gold in-Tube (QFT-GIT) assay. Fifty-four employees underwent QFT-GIT and TST placement. All QFT-GIT results were negative, and three employees tested TST positive. Twenty-three (49%) of 47 employees requiring two-step TST testing underwent second TST placement. Return rates for first and second TST reading were 76% and 74%, respectively. The QFT-GIT completion rate was higher than that for TST (100% vs. 39%, P < 0.001). Agreement between TST and QFTGIT was 94%. Immigration employees had low return rates for their TST reading and second TST placement. Performing the one-visit QFT-GIT has administrative and logistical advantages in this occupational group. |
Exposure and emissions monitoring during carbon nanofiber production--part I: elemental carbon and iron-soot aerosols
Birch ME , Ku BK , Evans DE , Ruda-Eberenz TA . Ann Occup Hyg 2011 55 (9) 1016-36 Production of carbon nanofibers and nanotubes (CNFs/CNTs) and their composite products is increasing globally. High volume production may increase the exposure risks for workers who handle these materials. Though health effects data for CNFs/CNTs are limited, some studies raise serious health concerns. Given the uncertainty about their potential hazards, there is an immediate need for toxicity data and field studies to assess exposure to CNFs/CNTs. An extensive study was conducted at a facility that manufactures and processes CNFs. Filter, sorbent, cascade impactor, bulk, and microscopy samples, combined with direct-reading instruments, provided complementary information on air contaminants. Samples were analyzed for organic carbon (OC) and elemental carbon (EC), metals, and polycyclic aromatic hydrocarbons (PAHs), with EC as a measure of CNFs. Transmission electron microscopy with energy-dispersive X-ray spectroscopy also was applied. Fine/ultrafine iron-rich soot, PAHs, and carbon monoxide were production byproducts. Direct-reading instrument results were reported previously [Evans DE et al. (Aerosol monitoring during carbon nanofiber production: mobile direct-reading sampling. Ann Occup Hyg 2010;54:514-31.)]. Results for time-integrated samples are reported as companion papers in this Issue. OC and EC, metals, and microscopy results are reported here, in Part I, while results for PAHs are reported in Part II (Birch, this Issue). Respirable EC area concentrations inside the facility were about 6-68 times higher than outdoors, while personal breathing zone samples were up to 170 times higher. |
Exposure and emissions monitoring during carbon nanofiber production--part II: polycyclic aromatic hydrocarbons
Birch ME . Ann Occup Hyg 2011 55 (9) 1037-47 Production of carbon nanofibers and nanotubes (CNFs/CNTs) and their composite products is increasing globally. High-volume production may increase the exposure risks for workers who handle these materials. Though health effects data for CNFs/CNTs are limited, some studies raise serious health concerns. Given the uncertainty about their potential hazards, there is an immediate need for toxicity data and field studies to assess exposure to CNFs/CNTs. An extensive study was conducted at a facility that manufactures and processes CNFs. Filter, sorbent, cascade impactor, bulk, and microscopy samples, combined with direct-reading instruments, provided complementary information on air contaminants. Samples were analyzed for organic and elemental carbon (OC and EC), metals, and polycyclic aromatic hydrocarbons (PAHs), with EC as a measure of CNFs. Transmission electron microscopy with energy-dispersive X-ray spectroscopy also was applied. Fine/ultrafine iron-rich soot, PAHs, and carbon monoxide were production byproducts. Direct-reading instrument results were reported previously [Evans DE et al. (Aerosol monitoring during carbon nanofiber production: mobile direct-reading sampling. Ann Occup Hyg 2010; 54:514-31)]. Results for time-integrated samples are reported as companion papers in this issue. OC and EC, metals, and microscopy results are reported in Part I (Birch et al., 2011), whereas results for PAHs are reported here. Naphthalene and acenaphthylene were the dominant PAHs with average concentrations ranging from 115 to 336 mcg m(-3) and 35 to 84 mcg m(-3), respectively. Concentrations of other PAHs ranged from approximately 1 to 10 mcg m(-3). |
Detonability of natural gas-air mixtures
Gamezo VN , Zipf Jr RK , Sapko MJ , Marchewka WP , Mohamed KM , Oran ES , Kessler DA , Weiss ES , Addis JD , Karnack FA , Sellers DD . Combust Flame 2011 159 (2) 870-881 Direct initiation experiments were carried out in a 105 cm diameter tube to study detonation properties and evaluate the detonability limits for mixtures of natural gas (NG) with air. The natural gas was primarily methane with 1.5–1.7% of ethane. A stoichiometric methane–oxygen mixture contained in a large plastic bag was used as a detonation initiator. Self-supporting detonations with velocities and pressures close to theoretical CJ values were observed in NG–air mixtures containing from 5.3% to 15.6% of NG at atmospheric pressure. These detonability limits are wider than previously measured in smaller channels, and close to the flammability limits. Detonation cell patterns recorded near the limits vary from large cells of the size of the tube to spiral traces of spin detonations. Away from the limits, detonation cell sizes decrease to about 20 cm for 10% NG, and are consistent with existing data for methane–air mixtures obtained in smaller channels. Observed cell patterns are very irregular, and contain secondary cell structures inside primary cells and fine structures inside spin traces. |
Schistosoma mansoni enhances host susceptibility to mucosal but not intravenous challenge by R5 clade C SHIV
Siddappa NB , Hemashettar G , Shanmuganathan V , Semenya AA , Sweeney ED , Paul KS , Lee SJ , Secor WE , Ruprecht RM . PLoS Negl Trop Dis 2011 5 (8) e1270 BACKGROUND: The high prevalence of HIV-1/AIDS in areas endemic for schistosomiasis and other helminthic infections has led to the hypothesis that parasites increase host susceptibility to immunodeficiency virus infection. We previously showed that rhesus macaques (RM) with active schistosomiasis were significantly more likely to become systemically infected after intrarectal (i.r.) exposure to an R5-tropic clade C simian-human immunodeficiency virus (SHIV-C) than were parasite-free controls. However, we could not address whether this was due to systemic or mucosal effects. If systemic immunoactivation resulted in increased susceptibility to SHIV-C acquisition, a similarly large difference in host susceptibility would be seen after intravenous (i.v.) SHIV-C challenge. Conversely, if increased host susceptibility was due to parasite-induced immunoactivation at the mucosal level, i.v. SHIV-C challenge would not result in significant differences between parasitized and parasite-free monkeys. METHODS AND FINDINGS: We enrolled two groups of RM and infected one group with Schistosoma mansoni; the other group was left parasite-free. Both groups were challenged i.v. with decreasing doses of SHIV-C. No statistically significant differences in 50% animal infectious doses (AID(50)) or peak viremia were seen between the two groups. These data strongly contrast the earlier i.r. SHIV-C challenge (using the same virus stock) in the presence/absence of parasites, where we noted a 17-fold difference in AID(50) and one log higher peak viremia in parasitized monkeys (P<0.001 for both). The lack of significant differences after the i.v. challenge implies that the increased host susceptibility is predominantly due to parasite-mediated mucosal upregulation of virus replication and spread, rather than systemic effects. CONCLUSIONS: The major impact of schistosome-induced increased host susceptibility is at the mucosal level. Given that >90% of all new HIV-1 infections worldwide are acquired through mucosal contact, parasitic infections that inflame mucosae may play an important role in the spread of HIV-1. |
Soil-transmitted helminthiasis in the United States: a systematic review--1940-2010
Starr MC , Montgomery SP . Am J Trop Med Hyg 2011 85 (4) 680-4 The epidemiology of soil-transmitted helminth infections (hookworm, Trichuris trichiura, Ascaris lumbricoides, and Strongyloides stercoralis) in the United States is poorly understood. To gain understanding of the status of disease, a systematic review was performed to assess the prevalence of soil-transmitted helminth infections in the United States. Of all studies reviewed, 14 were designated as high-quality. High-quality studies were published from 1942 to 1982 and showed that infection was prevalent throughout the southern United States and Appalachia as recently as 1982, finding that hookworm (19.6%), T. trichiura (55.2%), A. lumbricoides (49.4%), and S. stercoralis (3.8%) affected significant percentages of the population. However, because the most recent high-quality studies were published over 25 years ago, the literature does not provide sufficient data to assess current endemic transmission. Because the status of disease remains unclear, there is a need for additional studies to determine if soil-transmitted helminths remain endemic in the United States. |
Trypanosoma cruzi and Chagas' disease in the United States
Bern C , Kjos S , Yabsley MJ , Montgomery SP . Clin Microbiol Rev 2011 24 (4) 655-81 SUMMARY: Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi and causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles of T. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected with T. cruzi. In the eastern United States, the prevalence of T. cruzi is highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, most T. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derived T. cruzi infections have been documented in the United States and Canada. As improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century. |
Presumptive treatment to reduce imported malaria among refugees from east Africa resettling in the United States
Phares CR , Kapella BK , Doney AC , Arguin PM , Green M , Mekonnen L , Galev A , Weinberg M , Stauffer WM . Am J Trop Med Hyg 2011 85 (4) 612-5 During May 4, 2007-February 29, 2008, the United States resettled 6,159 refugees from Tanzania. Refugees received pre-departure antimalarial treatment with sulfadoxine-pyrimethamine (SP), partially supervised (three/six doses) artemether-lumefantrine (AL), or fully supervised AL. Thirty-nine malaria cases were detected. Disease incidence was 15.5/1,000 in the SP group and 3.2/1,000 in the partially supervised AL group (relative change = -79%, 95% confidence interval = -56% to -90%). Incidence was 1.3/1,000 refugees in the fully supervised AL group (relative change = -92% compared with SP group; 95% confidence interval = -66% to -98%). Among 39 cases, 28 (72%) were in refugees < 15 years of age. Time between arrival and symptom onset (median = 14 days, range = 3-46 days) did not differ by group. Thirty-two (82%) persons were hospitalized, 4 (10%) had severe manifestations, and 9 (27%) had parasitemias > 5% (range = < 0.1-18%). Pre-departure presumptive treatment with an effective drug is associated with decreased disease among refugees. |
Cancer plan index: a measure for assessing the quality of cancer plans
Rochester P , Adams E , Porterfield DS , Holden D , McAleer K , Steele CB . J Public Health Manag Pract 2011 17 (6) E12-7 OBJECTIVE: To (1) conduct an in-depth assessment of the content of comprehensive cancer control plans and (2) obtain data that can be used to provide guidance to grantees supported by the Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) as they refine their plans, and to other health professionals as similar planning is done. DESIGN: Through an iterative development process, a workgroup of subject matter experts from NCCCP and Research Triangle Institute International (RTI International) identified 11 core or essential components that should be considered in cancer plans on the basis of their professional experience and expertise. They also developed a tool, the Cancer Plan Index (CPI), to assess the extent to which cancer plans addressed the 11 core components. SETTING: Sixty-five comprehensive cancer control programs in states, tribes, territories, and jurisdictions funded by the NCCCP. DATA SOURCE: Raters reviewed and abstracted all available cancer plans (n = 66), which included plans from 62 funded programs and 4 states of the Federated States of Micronesia funded by Centers for Disease Control and Prevention as a subcontractor of one funded program. Of the 66 plans, 3 plans were used to pilot test the CPI and the remaining 63 plans were subsequently reviewed and abstracted. MAIN OUTCOME MEASURE(S): The primary outcome measures are national-level component scores for 11 defined domains (global involvement of stakeholders, developing the plan, presentation of data on disease burden, goals, objectives, strategies, reduction of cancer disparities, implementation, funds for implementation of plan, evaluation, usability of plan), which represent an average of the component scores across all available cancer plans. RESULTS: To aid in the interpretation and usability of findings, the components were segmented into 3 tiers, representing a range high (average score = 2.01-4.00), moderate (average score = 1.01-2.00), and low (average score = 0-1.00) levels of description of the component. Programs overall provided relatively comprehensive descriptions of goals, objectives, and strategies; moderate description of the plan development process, presentation of data on disease burden, and plans on the reduction of cancer disparities; and little to no description of stakeholder involvement plans for implementation, funds for implementation, and evaluation of the plan. CONCLUSIONS: Areas of the CPI with low average component scores should stimulate technical assistance to the funded programs, either to increase program activities or to increase discussion of key activities in the plan. |
Postpartum intrauterine device insertion and postpartum tubal sterilization in the United States
Whiteman MK , Cox S , Tepper NK , Curtis KM , Jamieson DJ , Penman-Aguilar A , Marchbanks PA . Am J Obstet Gynecol 2011 206 (2) 127 e1-7 OBJECTIVE: The purpose of this study was to estimate US rates of postpartum intrauterine device (IUD) insertion and postpartum tubal sterilization. STUDY DESIGN: Data from the 2001-2008 Nationwide Inpatient Sample were used to identify delivery hospitalizations with IUD insertion or tubal sterilization procedure codes. RESULTS: Estimated rates of postpartum IUD insertion and postpartum tubal sterilization were 0.27 and 770.67 per 10,000 deliveries, respectively. Although the rate of IUD insertion was similar across age groups, the rate of tubal sterilization increased with age. Nonetheless, 15% of tubal sterilizations occurred among women who were ≤24 years old. IUD insertion was more likely among women who delivered at teaching hospitals (odds ratio, 3.02; 95% confidence interval, 1.43-6.37); tubal sterilization was more likely among women without private insurance (odds ratio, 2.04; 95% confidence interval, 1.97-2.11). CONCLUSION: Among US postpartum women, IUD insertion occurs considerably less frequently than tubal sterilization, even among younger women for whom poststerilization regret is a concern. |
Evaluation of variance estimators for the concentration and health achievement indices: a Monte Carlo simulation.
Chen Z , Roy K , Gotway Crawford CA . Health Econ 2011 21 (11) 1375-81 Although the concentration index (CI) and the health achievement index (HAI) have been extensively used, previous studies have relied on bootstrapping to compute the variance of the HAI, whereas competing variance estimators exist for the CI. This paper provides methods of statistical inference for the HAI and compares the available variance estimators for both the CI and the HAI using Monte Carlo simulation. Results for both the CI and the HAI suggest that analytical methods and bootstrapping are well behaved. The convenient regression method gives standard errors close to the other methods, provided the CI is not too large (< 0.2), but otherwise tends to understate the standard errors. In our simulation setting, the improvement from the Newey-West correction over the convenient regression method has mixed evidence when the CI ≤ 0.1 and is modest when the CI > 0.1. Published 2011. This article is a US Government work and is in the public domain in the USA. |
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