The National Spina Bifida Program transition initiative: the people, the plan, and the process
Thibadeau JK , Alriksson-Schmidt AI , Zabel TA . Pediatr Clin North Am 2010 57 (4) 903-10 This article outlines and summarizes the rationale and the working process that was undertaken by the National Spina Bifida Program to address the issues of transitioning throughout the life course for persons growing up with spina bifida. Their challenges include achieving independent living, vocational independence, community mobility, and participation in social activities, and health management. The creation, the underlying concepts, and the dissemination of the Life Course Model are described. |
Need for the life course model for spina bifida
Swanson ME . Pediatr Clin North Am 2010 57 (4) 893-901 Because children with chronic conditions, such as spina bifida, have grown up into adults in increasing numbers, they and their families have increasingly questioned whether they have reached their full potential and maximized their participation in adult activities. Lack of knowledgeable adult medical providers and longitudinal data about natural history places more responsibility on individuals and their family for self-care of the impairment. This article describes the need for the life course model, which merges several concepts and principles related to children with disabilities and provides a framework for services and research to achieve the desired adult outcomes. |
Preface. The natural history of spina bifida
Swanson ME , Sandler AD . Pediatr Clin North Am 2010 57 (4) xv-xvi Spina bifida is one of the most recognized impairments in pediatrics. Children with open lesions of the spine are identified increasingly in utero and always at birth, setting the stage for a lifelong journey to adulthood for the child and the family. Planning for services and supports requires input from an interdisciplinary team of professionals, working closely with the child, parents, and family members. With life expectancy stretching well into the fourth decade and beyond, the approach to childhood service delivery needs to be one that considers the entire life course. Principles of child development and the International Classification of Functioning, Disability and Health offer two complementary approaches to guide services and supports. | In this issue of Pediatric Clinic of North America, we discuss the natural history of spina bifida and the challenges and opportunities for improving health and development during childhood. There is a focus on the desired outcome of optimal function, independence, and full community participation for adults with spina bifida. The key role to be played by pediatricians and other health professionals is emphasized. |
Preventing perinatal transmission of HIV: the national perspective
Rogers MF , Taylor AW , Nesheim SR . J Public Health Manag Pract 2010 16 (6) 505-8 This article discusses the reduction in the rate of perinatal transmission of HIV because of the development of effective multidrug antiretroviral treatment of infected women and prophylaxis during pregnancy and the prenatal period. | The near elimination of human immunodeficiency virus (HIV) infection in children in developed countries such as the United States and those of western Europe is one of the great medical and public health accomplishments in the past 3 decades. The reports from the New York State Department of Health in this issue highlight this achievement.1,2 At the peak of the HIV epidemic in children in 1992, HIV was the seventh leading cause of death among children younger than 5 years of age nationwide and the second leading cause of death among black children aged 1 to 4 years in New York, New Jersey, Massachusetts, and Florida in that year.3 In 2008, the latest year that data are available, only 5 children were known to have died of AIDS in the United States,4 down from 560 deaths in 1994.5 |
Efficacy of structural-level condom distribution interventions: a meta-analysis of U.S. and international studies, 1998-2007
Charania MR , Crepaz N , Guenther-Gray C , Henny K , Liau A , Willis LA , Lyles CM . AIDS Behav 2010 15 (7) 1283-97 This systematic review examines the overall efficacy of U.S. and international-based structural-level condom distribution interventions (SLCDIs) on HIV risk behaviors and STIs and identifies factors associated with intervention efficacy. A comprehensive literature search of studies published from January 1988 through September 2007 yielded 21 relevant studies. Significant intervention effects were found for the following outcomes: condom use, condom acquisition/condom carrying, delayed sexual initiation among youth, and reduced incident STIs. The stratified analyses for condom use indicated that interventions were efficacious for various groups (e.g., youth, adults, males, commercial sex workers, clinic populations, and populations in areas with high STI incidence). Interventions increasing the availability of or accessibility to condoms or including additional individual, small-group or community-level components along with condom distribution were shown to be efficacious in increasing condom use behaviors. This review suggests that SLCDIs provide an efficacious means of HIV/STI prevention. |
[Hearing health, the human immunodeficiency virus and the acquired immunodeficiency syndrome: a review.]
Morata TC , Bevilaqua MC , Zeigelboim BS . Rev CEFAC 2010 12 (4) 678-684 BACKGROUND: Acquired Immunodeficiency Syndrome (or Acquired immune deficiency syndrome or AIDS) is caused by the Human Immunodeficiency Virus (HIV) and results in reduced immunity, leaving affected individuals more susceptible to illness and opportunistic infections. As the disease progresses, structures within the central auditory system can be affected either by the direct action of the virus or as a consequence of secondary infections. Other areas of the auditory system may also be more vulnerable to pathology in people living with HIV or AIDS. PURPOSE: The goal of this review was exploratory, to identify possible points of intersection between auditory disorders and Acquired Immune Deficiency Syndrome. This paper reports the results of a literature review on auditory disorders associated with HIV and AIDS and discusses the potential impact of ear pathologies among HIV/AIDS infected populations. CONCLUSION: Literature suggests several possible types of association between auditory disorders and the Acquired Immune Deficiency Syndrome and the Human Immunodeficiency Virus, and that people with HIV/AIDS may require hearing care interventions. Health professionals, including those from the Brazilian public health system, should examine the need for hearing-related services among HIV/AIDS patients in order to reduce the impact of the disease on daily life activities and prevent insofar, further auditory deterioration. |
Obstetrician-gynaecologist knowledge of and access to information about the risks of medication use during pregnancy
Morgan MA , Cragan JD , Goldenberg RL , Rasmussen SA , Schulkin J . J Matern Fetal Neonatal Med 2010 23 (10) 1143-50 OBJECTIVE: To assess opinions, knowledge, and informational resources of obstetrician-gynaecologists regarding the safety of medication use during pregnancy. METHODS: A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 58%. Of these, 305 respondents provide both routine gynecologic and obstetric care and are the focus of the study. There was wide variation in obstetrician-gynaecologists' assessments of the safety for the foetus of medications ranging from aspirin to valproic acid. The Physicians' Desk Reference was most frequently (75%) cited as a source of information about medication safety. Forty-two percent of obstetrician-gynaecologists selected lack of sufficient information on medications as the greatest barrier to counselling pregnant women about their use, while only 4% selected lack of access to information as the greatest barrier. Most (79%) obstetrician-gynaecologists indicated they would be willing to participate in pregnancy exposure registries, but far fewer (24%) reported having done so. CONCLUSION: These results emphasise the need for safety information about the effects of medication use during pregnancy and suggest that pregnancy exposure registries are underutilised. |
Low dose of some persistent organic pollutants predicts type 2 diabetes: a nested case-control study
Lee DH , Steffes MW , Sjodin A , Jones RS , Needham LL , Jacobs Jr DR . Environ Health Perspect 2010 118 (9) 1235-42 BACKGROUND: Low doses of some persistent organic pollutants (POPs) associate cross-sectionally with type 2 diabetes, whereas associations with high POP exposures are inconsistent. OBJECTIVES: We investigated whether several POPs prospectively predict type 2 diabetes within the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. METHODS: Participants in this nested case-control study were diabetes free in 1987-1988. By 2005-2006, the 90 controls remained free of diabetes, whereas the 90 cases developed diabetes. Using serum collected in 1987-1988, we measured 8 organochlorine pesticides, 22 polychlorinated biphenyl congeners (PCBs), and 1 polybrominated biphenyl (PBB). We compared POP concentrations from CARDIA and the National Health and Nutrition Examination Survey (NHANES) in 2003-2004. We computed odds ratios (ORs) for incident diabetes using logistic regression analysis. RESULTS: Chlorinated POPs in CARDIA in 1987-1988 were much higher than corresponding NHANES 2003-2004 concentrations. POPs showed nonlinear associations with diabetes risk. The highest risk was observed in the second quartiles of trans-nonachlor, oxychlordane, mirex, highly chlorinated PCBs, and PBB153-a finding that suggests low-dose effects. We concentrated risk by summing these POPs and isolated very low concentrations of multiple POPs in the lowest sextile of the sum. The adjusted OR in the second sextile vs. the lowest sextile was 5.3 overall and 20.1 for body mass index > or = 30 kg/m2. CONCLUSIONS: Several POPs at low doses similar to current exposure levels may increase diabetes risk, possibly through endocrine disruption. Certain POPs may a play a role in the current epidemic of diabetes, which has been attributed to obesity. |
Evaluating and regulating lead in synthetic turf
Van Ulirsch G , Gleason K , Gerstenberger S , Moffett DB , Pulliam G , Ahmed T , Fagliano J . Environ Health Perspect 2010 118 (10) 1345-9 BACKGROUND: In 2007, a synthetic turf recreational field in Newark, New Jersey, was closed because lead was found in synthetic turf fibers and in surface dust at concentrations exceeding hazard criteria. Consequently, public health professionals across the country began testing synthetic turf to determine whether it represented a lead hazard. Currently, no standardized methods exist to test for lead in synthetic turf or to assess lead hazards. OBJECTIVES: Our objectives were to increase awareness of potential lead exposure from synthetic turf by presenting data showing elevated lead in fibers and turf-derived dust; identify risk assessment uncertainties; recommend that federal and/or state agencies determine appropriate methodologies for assessing lead in synthetic turf; and recommend an interim standardized approach for sampling, interpreting results, and taking health-protective actions. DISCUSSION: Data collected from recreational fields and child care centers indicate lead in synthetic turf fibers and dust at concentrations exceeding the Consumer Product Safety Improvement Act of 2008 statutory lead limit of 300 mg/kg for consumer products intended for use by children, and the U.S. Environmental Protection Agency's lead-dust hazard standard of 40 microg/ft2 for floors. CONCLUSIONS: Synthetic turf can deteriorate to form dust containing lead at levels that may pose a risk to children. Given elevated lead levels in turf and dust on recreational fields and in child care settings, it is imperative that a consistent, nationwide approach for sampling, assessment, and action be developed. In the absence of a standardized approach, we offer an interim approach to assess potential lead hazards when evaluating synthetic turf. EDITOR'S SUMMARY: A recreational field in Newark, New Jersey, was closed in 2007 because lead concentrations found in synthetic turf fibers and in surface dust exceeded hazard criteria. Consequently, public health professionals across the country began testing synthetic turf to determine whether it represented a lead hazard. Data collected from recreational fields and child care centers indicated lead in synthetic turf fibers and dust at concentrations that exceed the Consumer Product Safety Improvement Act of 2008 statutory lead limit of 300 mg/kg for consumer products intended for use by children and the U.S. Environmental Protection Agency's lead-dust hazard standard of 40 microg/ft2 for floors. The authors conclude that synthetic turf can deteriorate to form dust containing lead at levels that may pose a risk to children. Currently, no standardized methods exist to test for lead in synthetic turf or to assess lead. Ulirsch et al. (p. 1345) summarize data on lead in fibers and turf-derived dust and discuss risk assessment uncertainties. They also note the need for regulatory agencies to develop standardized methods for assessing lead in synthetic turf and recommend an interim approach for sampling, interpreting results, and taking health-protective actions. |
Goitrogenic anions, thyroid-stimulating hormone, and thyroid hormone in infants
Cao Y , Blount BC , Valentin-Blasini L , Bernbaum JC , Phillips TM , Rogan WJ . Environ Health Perspect 2010 118 (9) 1332-7 BACKGROUND: Environmental exposure of infants to perchlorate, thiocyanate, nitrate, might interfere with thyroid function. U.S. women with higher background perchlorate exposure have higher thyroid-stimulating hormone (TSH) and lower thyroxine (T4). There are no studies with individual measures of thyroid function and these goitrogens available in infants. OBJECTIVE: We examined the association of urinary perchlorate, nitrate, iodide, and thiocyanate with urinary T4 and TSH in infants and whether that association differed by sex or iodide status. METHODS: We used data and samples from the Study of Estrogen Activity and Development, which assessed hormone levels of full-term infants over the first 12 months of life. The study included 92 full-term infants between birth and 1 year of age seen up to four times. Perchlorate, thiocyanate, nitrate, and iodide were measured in 206 urine samples; TSH and T4 and were measured in urines and in 50 blood samples. RESULTS: In separate mixed models, adjusting for creatinine, age, sex, and body mass index, infants with higher urinary perchlorate, nitrate or thiocyanate had higher urinary TSH. With all three modeled, children with higher nitrate and thiocyanate had higher TSH, but higher perchlorate was associated with TSH only in children with low iodide. Unexpectedly, exposure to the three chemicals was generally associated with higher T4. CONCLUSIONS: The association of perchlorate exposure with increased urinary TSH in infants with low urinary iodide is consistent with previous findings. Higher thiocyanate and nitrate exposure were also associated with higher TSH in infants. |
Differential West Nile fever ascertainment in the United States: a multilevel analysis
Silk BJ , Astles JR , Hidalgo J , Humes R , Waller LA , Buehler JW , Berkelman RL . Am J Trop Med Hyg 2010 83 (4) 795-802 We evaluated the completeness of West Nile fever (WNF) surveillance within the U.S. public health system. We surveyed laboratory and surveillance programs on policies, practices, and capacities for testing, confirmation, and reporting (collectively called ascertainment) from 2003 through 2005. We calculated syndrome ascertainment ratios by dividing WNF counts by neuroinvasive disease counts; separately, we performed multilevel modeling. Jurisdictions were more likely to ascertain at least one WNF cases per West Nile neuroinvasive disease case when ≤ 1 testing restrictions existed (odds ratio [OR] = 7.7, 95% confidence interval [CI] = 1.3-46.4), when conducting ≥ 4 activities to enhance reporting (OR = 9.3, 95% CI = 1.6-54.8), and when ≥ 5.0 staff per million residents were dedicated to arboviral surveillance (OR = 6.4, 95% CI = 1.0-40.3). Ascertainment of WNF was less likely among Blacks (OR = 0.56, 95% CI = 0.31-0.99) and Hispanics (OR = 0.69, 95% CI = 0.48-0.98) than among Whites. Ascertainment was more complete when testing and reporting were enhanced, but differentially incomplete for minorities. |
Disease reporting among Georgia physicians and laboratories
McClean CM , Silk BJ , Buehler JW , Berkelman RL . J Public Health Manag Pract 2010 16 (6) 535-43 Opportunities for improved disease reporting are identified by describing physicians' reporting knowledge and practices as well as reporting knowledge and specimen referral patterns among clinical laboratories in the state of Georgia. In 2005, a sample of physicians (n = 177) and all Georgia clinical laboratories (n = 139) were surveyed about reporting knowledge and practices. Knowledge was greater among physicians who received their medical degree before 1980 (P = .04), accessed e-mail (P< .01), used the Internet to obtain public health information (P < .01), and reported frequently (P= .06). Increased knowledge was not associated with training in reporting (P = .14). Physicians were often unaware of reporting procedures and mechanisms and often did not report because they believed others would report (52%). Laboratory representatives (56%) more often received training on disease reporting than physicians (32%). All laboratories sent some specimens for diagnostic testing at reference laboratories and 35% sent the specimens outside of Georgia. Physicians' characteristics may affect reporting knowledge independent of training on disease reporting, and increased knowledge is associated with increased reporting. Investigation of physician characteristics that contribute to improved reporting, such as an active engagement with public health, could help to guide changes to reporting-related training and technology. Reporting by other health care providers and physicians' perceptions that others will report both indicate that studies of all reporting stakeholders and clear delineation of reporting responsibilities are needed. Extensive specimen referral by laboratories suggests the need for coordination of reporting regulations and responsibilities beyond local boundaries. |
Implementation of exon arrays: alternative splicing during T-cell proliferation as determined by whole genome analysis
Whistler T , Chiang CF , Lonergan W , Hollier M , Unger ER . BMC Genomics 2010 11 496 BACKGROUND: The contribution of alternative splicing and isoform expression to cellular response is emerging as an area of considerable interest, and the newly developed exon arrays allow for systematic study of these processes. We use this pilot study to report on the feasibility of exon array implementation looking to replace the 3' in vitro transcription expression arrays in our laboratory. One of the most widely studied models of cellular response is T-cell activation from exogenous stimulation. Microarray studies have contributed to our understanding of key pathways activated during T-cell stimulation. We use this system to examine whole genome transcription and alternate exon usage events that are regulated during lymphocyte proliferation in an attempt to evaluate the exon arrays. RESULTS: Peripheral blood mononuclear cells form healthy donors were activated using phytohemagglutinin, IL2 and ionomycin and harvested at 5 points over a 7 day period. Flow cytometry measured cell cycle events and the Affymetrix exon array platform was used to identify the gene expression and alternate exon usage changes. Gene expression changes were noted in a total of 2105 transcripts, and alternate exon usage identified in 472 transcript clusters. There was an overlap of 263 transcripts which showed both differential expression and alternate exon usage over time. Gene ontology enrichment analysis showed a broader range of biological changes in biological processes for the differentially expressed genes, which include cell cycle, cell division, cell proliferation, chromosome segregation, cell death, component organization and biogenesis and metabolic process ontologies. The alternate exon usage ontological enrichments are in metabolism and component organization and biogenesis. We focus on alternate exon usage changes in the transcripts of the spliceosome complex. The real-time PCR validation rates were 86% for transcript expression and 71% for alternate exon usage. CONCLUSIONS: This study illustrates that the Exon array technology has the potential to provide information on both transcript expression and isoform usage, with very little increase in expense. |
Characterization of 107 genomic DNA reference materials for CYP2D6, CYP2C19, CYP2C9, VKORC1, and UGT1A1. A GeT-RM and Association for Molecular Pathology collaborative project
Pratt VM , Zehnbauer B , Wilson JA , Baak R , Babic N , Bettinotti M , Buller A , Butz K , Campbell M , Civalier C , El-Badry A , Farkas DH , Lyon E , Mandal S , McKinney J , Muralidharan K , Noll L , Sander T , Shabbeer J , Smith C , Telatar M , Toji L , Vairavan A , Vance C , Weck KE , Wu AH , Yeo KT , Zeller M , Kalman L . J Mol Diagn 2010 12 (6) 835-46 Pharmacogenetic testing is becoming more common; however, very few quality control and other reference materials that cover alleles commonly included in such assays are currently available. To address these needs, the Centers for Disease Control and Prevention's Genetic Testing Reference Material Coordination Program, in collaboration with members of the pharmacogenetic testing community and the Coriell Cell Repositories, have characterized a panel of 107 genomic DNA reference materials for five loci (CYP2D6, CYP2C19, CYP2C9, VKORC1, and UGT1A1) that are commonly included in pharmacogenetic testing panels and proficiency testing surveys. Genomic DNA from publicly available cell lines was sent to volunteer laboratories for genotyping. Each sample was tested in three to six laboratories using a variety of commercially available or laboratory-developed platforms. The results were consistent among laboratories, with differences in allele assignments largely related to the manufacturer's assay design and variable nomenclature, especially for CYP2D6. The alleles included in the assay platforms varied, but most were identified in the set of 107 DNA samples. Nine additional pharmacogenetic loci (CYP4F2, EPHX1, ABCB1, HLAB, KIF6, CYP3A4, CYP3A5, TPMT, and DPD) were also tested. These samples are publicly available from Coriell and will be useful for quality assurance, proficiency testing, test development, and research. |
Multiple healthy behaviors and optimal self-rated health: findings from the 2007 Behavioral Risk Factor Surveillance System Survey
Tsai J , Ford ES , Li C , Zhao G , Pearson WS , Balluz LS . Prev Med 2010 51 268-74 OBJECTIVE: The aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes. METHODS: We estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors. RESULTS: The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors. CONCLUSION: The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults. |
Non-monogamy: risk factor for STI transmission and acquisition and determinant of STI spread in populations
Aral SO , Leichliter JS . Sex Transm Infect 2010 86 Suppl 3 iii29-36 BACKGROUND: The concept of concurrent partnerships, while theoretically appealing, has been challenged at many levels. However, non-monogamy may be an important risk factor for the acquisition and transmission of sexually transmitted infections (STI). One's own non-monogamy is a risk factor for transmitting STI to others, partners' non-monogamy is a risk factor for acquiring STI and, most importantly, mutual non-monogamy is a population level determinant of increased STI spread. This study describes the levels, distribution and correlates of non-monogamy, partners' non-monogamy and mutual non-monogamy among adult men and women in the USA. METHODS: Data from the National Survey of Family Growth (NSFG) Cycle 6 were used. NSFG is a national household survey of subjects aged 15-44 years in the USA. Cochran-Mantel-Haenszel tests and chi(2) tests were used in the analysis. RESULTS: Among sexually active adults, 17.6% of women and 23.0% of men (an estimated 19 million) reported non-monogamy over the past 12 months in 2002. An estimated 11 million Americans (1 in 10) reported partners' non-monogamy and an estimated 8.4 million (7% of women and 10.5% of men) reported mutual non-monogamy. All three types of non-monogamy were reported more frequently by men than women. Younger age, lower education, formerly or never married status, living below the poverty level and having spent time in jail were associated with all three types of non-monogamy in general. CONCLUSIONS: The three types of non-monogamy may be helpful in tailoring prevention messages and targeting prevention efforts to subgroups most likely to spread infection. |
The concentration of sexual behaviours in the USA: a closer examination of subpopulations
Leichliter JS , Chesson HW , Sternberg M , Aral SO . Sex Transm Infect 2010 86 Suppl 3 iii45-51 OBJECTIVE: To examine the frequency of three sexual behaviours from the most active to the least active members of the population in various subpopulations using measures of inequality. METHODS: Data from a US national probability sample of the population aged 15-44 years (National Survey of Family Growth) were used. Gini coefficients and Lorenz curves were calculated in order to examine the concentration of three sexual behaviours: vaginal sex acts (past 4 weeks) and number of opposite-sex partners (past 12 months; lifetime). Analyses were conducted separately for men and women and subpopulations of interest (by age, race/ethnicity, educational level and poverty level). RESULTS: The sexual behaviours examined were concentrated within the most active members of the population. This concentration was most pronounced for vaginal sex acts in the past 4 weeks and lifetime opposite-sex partners, with the top 5% of each population accounting for more of the sexual behaviour than the bottom 50% of the population. Sexual behaviours were most concentrated among adolescents, the least educated and the most impoverished. Some subpopulations had similar mean or median numbers of sex acts (or sex partners), but had different degrees of concentration of these behaviours. Finally, the most impoverished men and women had the highest concentration levels for two of the three sexual behaviours (vaginal sex acts, opposite-sex partners in past 12 months). CONCLUSION: Given that sexual behaviours tended to be highly concentrated in subpopulations that are often at the highest risk of sexually transmitted infections, targeted interventions may be the most efficient method to reduce risk in these groups while minimising potential unintended consequences. |
An evaluation of health communication materials for individuals with disabilities developed by three state disability and health programs
Williams-Piehota P , Uhrig J , Doto JK , Anderson W , Williams P , Thierry JM . Disabil Health J 2010 3 (3) 146-154 BACKGROUND: Health communication increasingly has been recognized as an important part of public health practice that can help raise awareness of potential health risks, influence attitudes and beliefs, and motivate individuals to change unhealthy behaviors. Yet, few health communication messages exist that target people with disabilities. An evaluation was conducted to assess the relevance and usefulness of health communication materials developed by or disseminated in, or both, three state disability and health programs. METHODS: Health care providers and people with a variety of physical and sensory disabilities participated in the evaluation. Qualitative and quantitative data were collected in each of the three states using key informant interviews, focus groups, and a Web-based provider survey. RESULTS: State program staff reported that health communication strategies and messages should be developed to improve access and remove barriers to health care, provide access to facilities, empower consumers, and educate health care providers about the needs of people with disabilities. Several of these needs are consistent with the needs identified by consumers in the focus groups. Consumers indicated that improvements to the overall content and design of the state-developed health communication materials are needed, yet health care and human service providers who participated in the Web-based survey were generally satisfied with the materials. Nearly all providers reported being aware of the materials; however, consumers were not familiar with the state-developed materials reviewed by the focus groups. CONCLUSIONS: Improvements in the content and dissemination of health promotion materials designed by states are indicated. Implications for public health practice, including recommendations for improving future health communication materials, are addressed in this article. 2010 Elsevier Inc. All rights reserved. |
Diabetes update. Helping students cope with diabetes: the role of the school nurse
Owens-Gary MD , Shea L , Lewis S . School Nurse News 2010 27 (4) 29-30 The article reports on the difficulties faced by children and adolescents with diabetes and discusses ways a school nurse can help them. It states that the school nurse can help in removing the stressors being experienced by the diabetic students. The National Diabetes Education Program (NDEP) has developed tip sheets that offer suggestions on preventing and managing diabetes. NDEP also developed a guide that can help the nurse assist students with the ailment face their feelings in a positive manner and help them whenever they feel depressed. |
Primary immunodeficiency diseases: practice among primary care providers and awareness among the general public, United States, 2008.
Waltenburg R , Kobrynski L , Reyes M , Bowen S , Khoury MJ . Genet Med 2010 12 (12) 792-800 PURPOSE: Primary immunodeficiency disorders (PIDDs) represent a class of genetic diseases of the immune system. Delayed primary immunodeficiency disorder diagnosis leads to increased morbidity and mortality. This study assessed current primary immunodeficiency disorder practice among physicians and awareness among the public. METHODS: Primary immunodeficiency disorder practice and awareness data were collected using national surveys of physicians (DocStyles) and the public (HealthStyles). RESULTS: Physician respondents (n = 1250) were family practitioners (41%), internists (39%), and pediatricians (20%). Overall, 32% of physicians had diagnosed, treated, or referred a patient with primary immunodeficiency disorder in the last 5 years. Physician specialty was the only significant predictor of having a patient with primary immunodeficiency disorder in unconditional logistic modeling (pediatrician odds ratio = 4.4; internist odds ratio = 1.5; and family practitioner odds ratio = referent). When a possible primary immunodeficiency disorder case presented, 81% of physicians performed laboratory testing and 77% referred the patient to a specialist. Of the general population surveyed (n = 5399), 40% were aware of primary immunodeficiency disorder. Those respondents were more likely to be older, female, white, married (ever), more highly educated, with a higher income level. Most people learned about primary immunodeficiency disorder from media outlets (64% television/radio and 41% magazine/newspaper). CONCLUSION: Additional primary immunodeficiency disorder educational efforts, which target both physicians and the public, may be needed because increased primary immunodeficiency disorder awareness may lead to earlier diagnosis and less morbidity and mortality. |
Maternal influenza vaccination and effect on influenza virus infection in young infants
Eick AA , Uyeki TM , Klimov A , Hall H , Reid R , Santosham M , O'Brien KL . Arch Pediatr Adolesc Med 2010 165 (2) 104-11 OBJECTIVE: To assess the effect of seasonal influenza vaccination during pregnancy on laboratory-confirmed influenza in infants to 6 months of age. DESIGN: Nonrandomized, prospective, observational cohort study. SETTING: Navajo and White Mountain Apache Indian reservations, including 6 hospitals on the Navajo reservation and 1 on the White Mountain Apache reservation. PARTICIPANTS: A total of 1169 mother-infant pairs with mothers who delivered an infant during 1 of 3 influenza seasons. MAIN EXPOSURE: Maternal seasonal influenza vaccination. MAIN OUTCOME MEASURES: In infants, laboratory-confirmed influenza, influenzalike illness (ILI), ILI hospitalization, and influenza hemagglutinin inhibition antibody titers. RESULTS: A total of 160 mother-infant pairs had serum collected and were included in the analysis. Among infants, 193 (17%) had an ILI hospitalization, 412 (36%) had only an ILI outpatient visit, and 555 (48%) had no ILI episodes. The ILI incidence rate was 7.2 and 6.7 per 1000 person-days for infants born to unvaccinated and vaccinated women, respectively. There was a 41% reduction in the risk of laboratory-confirmed influenza virus infection (relative risk, 0.59; 95% confidence interval, 0.37-0.93) and a 39% reduction in the risk of ILI hospitalization (relative risk, 0.61; 95% confidence interval, 0.45-0.84) for infants born to influenza-vaccinated women compared with infants born to unvaccinated mothers. Infants born to influenza-vaccinated women had significantly higher hemagglutinin inhibition antibody titers at birth and at 2 to 3 months of age than infants of unvaccinated mothers for all 8 influenza virus strains investigated. CONCLUSIONS: Maternal influenza vaccination was significantly associated with reduced risk of influenza virus infection and hospitalization for an ILI up to 6 months of age and increased influenza antibody titers in infants through 2 to 3 months of age. |
Effects of adverse events on the projected population benefits and cost-effectiveness of using live attenuated influenza vaccine in children aged 6 months to 4 years
Prosser LA , Meltzer MI , Fiore A , Epperson S , Bridges CB , Hinrichsen V , Lieu TA . Arch Pediatr Adolesc Med 2010 165 (2) 112-8 OBJECTIVE: To evaluate the effect of adverse events associated with live attenuated influenza vaccine (LAIV) in children younger than 5 years on the cost-effectiveness of influenza vaccination. DESIGN: A decision analytic model was developed to predict costs and health effects of no vaccination, vaccination with LAIV, and vaccination with inactivated influenza vaccine (IIV). Probabilities, costs, and quality adjustments for uncomplicated influenza, outpatient visits, hospitalizations, deaths, vaccination, and vaccine adverse events were based on primary and published data. The analysis included the possible increased incidence of adverse events following vaccination with LAIV for children younger than 5 years, including fever, wheezing, and hospitalization. A societal perspective was used. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted. SETTING: Vaccination in the physician office setting in the United States. PARTICIPANTS: Hypothetical cohorts of healthy children aged 6 months to 4 years. INTERVENTION: Vaccination with LAIV or IIV. MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratio in dollars per quality-adjusted life-year (QALY). RESULTS: Cost-effectiveness ratios ranged from $20,000/QALY (age 6-23 months) to $33,000/QALY (age 3-4 years) for LAIV and from $21,000/QALY to $37,000/QALY for IIV for healthy children aged 6 months to 4 years. Inclusion of possible new adverse events for LAIV had varying effects on cost-effectiveness results. Results were not sensitive to the inclusion of wheezing as an adverse event but were sensitive to a possible increase in the probability of hospitalization. CONCLUSION: Live attenuated influenza vaccine had comparable cost-effectiveness compared with IIV for children younger than 5 years under a wide range of assumptions about the incidence of adverse events. |
Advancing research in youth violence prevention to inform evidence-based policy and practice
Haegerich TM , Gorman-Smith D , Wiebe DJ , Yonas M . Inj Prev 2010 16 (5) 358 President Obama's administration has shown a renewed emphasis on evidence-based policy. The President's FY11 budget includes over US$100 million for rigorous evaluations to grow the number of interventions backed by strong evidence of effectiveness. Other efforts focus on increased funding for top tier programmes and practices, evaluation of programmes with some supportive evidence of effects, and testing of innovative programmes that are supported by preliminary research findings. | Youth violence prevention is an area of social and health policy that is ripe for the application of scientific evidence. Youth violence is a significant public health problem: homicide is the second leading cause of death for youth ages 10–24.1 As a result of decades of investment in research by federal agencies, such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, as well as non-profit foundations, a substantial body of scientific evidence has uncovered factors that place youth at risk for experiencing violence, and strategies that may prevent violence from occurring. For example, with support from the Office of Juvenile Justice and Delinquency Prevention and the Division of Violence Prevention in the Injury Center at CDC, Blueprints for Violence Prevention has identified 11 Model programmes and 19 Promising programmes with significant positive effects on youth violence or risk factors for youth violence.2 | Recognising the extent of the evidence and the need for communities to incorporate primary prevention efforts, the Division of Violence Prevention is leading an evidence-based national initiative: Striving To Reduce Youth Violence Everywhere (STRYVE). Guided by a public health approach, STRYVE provides communities guidance based on the best available research to facilitate comprehensive, integrated, multisector activities to address youth violence (http://www.cdc.gov/violenceprevention/STRYVE/index.html). To support the utilisation of evidence-based approaches in communities, however, STRYVE and other programmatic efforts require better scientific information regarding how to best support the scale-up of evidence-based approaches, and build prevention infrastructure and capacity in communities to allow sustainability. |
Tandem mass spectrometric identification of dextrose markers in dried-blood spots from infants receiving total parenteral nutrition
Chace DH , De Jesus VR , Lim TH , Hannon WH , Spitzer AR . Clin Chim Acta 2010 411 1806-16 BACKGROUND: The false positive rate for the newborn screening of disorders of amino acid metabolism for premature infants is higher than full term infants. This may be due to very low birth weight infants receiving high concentrations of amino acids from total parenteral nutrition (TPN) administration and/or immature metabolism. An investigation of the possible influence of TPN on screening of premature infants resulted in the detection of three unusual peaks in the tandem mass spectrometry (MS/MS) acylcarnitine profile. These markers were closely correlated with the detection of very high multiple amino acid increases in the profiles of newborns administered with TPN and who were ultimately found to be normal and free of inherited metabolic disorders. METHODS: TPN solutions contain a concentrated mixture of amino acids and dextrose and other nutrients in saline. Due to its high concentration and suggestion of a carbohydrate, it was hypothesized that dextrose (D-glucose) was the contaminant and source of the markers detected. Dextrose, stable isotope-labeled 13C6-dextrose and various TPN solutions were analyzed directly or after enrichment in whole blood by multiple MS/MS acquisition modes including MS-only, product and precursor ion and neutral loss scans. RESULTS: Analysis of dried-blood spots (DBS) prepared from whole blood spiked with TPN solutions containing 12.5% dextrose and amino acid formulations designed to deliver 2.5 gm/kg/day of an amino acid mixture had moderate increases of all 3 dextrose markers detected at m/z 325, 399 and 473 as compared to controls. MS-only scans, product and precursor ion scans of dextrose and 13C6-dextrose in positive ion mode confirmed that these 3 peaks are derived from dextrose. Mass spectral analysis of labeled and unlabeled dextrose suggested that these peaks were dimers derived from dextrose. CONCLUSION: The identification of dextrose markers in DBS indicates that high concentrations of dextrose were present in blood and the likely source was contamination by TPN solutions most likely occurring during a sample collection process. |
Measured and estimated ground reaction forces for multi-segment foot models
Bruening DA , Cooney KM , Buczek FL , Richards JG . J Biomech 2010 43 (16) 3222-6 Accurate measurement of ground reaction forces under discrete areas of the foot is important in the development of more advanced foot models, which can improve our understanding of foot and ankle function. To overcome current equipment limitations, a few investigators have proposed combining a pressure mat with a single force platform and using a proportionality assumption to estimate subarea shear forces and free moments. In this study, two adjacent force platforms were used to evaluate the accuracy of the proportionality assumption on a three segment foot model during normal gait. Seventeen right feet were tested using a targeted walking approach, isolating two separate joints: transverse tarsal and metatarsophalangeal. Root mean square (RMS) errors in shear forces up to 6% body weight (BW) were found using the proportionality assumption, with the highest errors (peak absolute errors up to 12% BW) occurring between the forefoot and toes in terminal stance. The hallux exerted a small braking force in opposition to the propulsive force of the forefoot, which was unaccounted for by the proportionality assumption. While the assumption may be suitable for specific applications (e.g. gait analysis models), it is important to understand that some information on foot function can be lost. The results help highlight possible limitations of the assumption. Measured ensemble average subarea shear forces during normal gait are also presented for the first time. |
Neutralizing antibodies to human and simian adenoviruses in humans and New-World monkeys
Ersching J , Hernandez MI , Cezarotto FS , Ferreira JD , Martins AB , Switzer WM , Xiang Z , Ertl HC , Zanetti CR , Pinto AR . Virology 2010 407 (1) 1-6 Vaccines based on adenovirus (Ad) vectors are currently in development against several pathogens. However, neutralizing antibodies (NAb) to human adenovirus type 5 (AdHu5), the best-studied vector, are highly prevalent in humans worldwide. Less-prevalent adenoviruses, including human and simian serotypes, provide alternative vaccine platforms. In this study, sera from 200 Brazilian human subjects and New-World monkeys were tested for NAb titers to human serotypes AdHu5 and AdHu26 and chimpanzee-origin Ad viruses of serotype 6 (AdC6) and serotype 68 (AdC68). Seroprevalence rates of NAb in humans were 69.5% for AdHu5, 44% for AdHu26, 21% for AdC6 and 23.5% for AdC68. In addition, NAb titers to human Ad were consistently higher than those found to simian serotypes. Surprisingly, sera from some New-World monkey species were able to neutralize AdC6 and/or AdC68. A possible explanation for these findings and the implications for the development of Ad-vector vaccines are discussed in detail. |
Identification and characterization of clinical Bacillus spp. isolates phenotypically similar to Bacillus anthracis
Beesley CA , Vanner CL , Helsel LO , Gee JE , Hoffmaster AR . FEMS Microbiol Lett 2010 313 (1) 47-53 Bacillus anthracis, the etiological agent of anthrax, is a gram-positive, spore-forming rod, with colonies exhibiting a unique ground-glass appearance, and lacking hemolysis and motility. In addition to these phenotypes, several others traits are characteristic of B. anthracis such as susceptibility to gamma phage, the presence of two virulence plasmids (pX01 and pX02), and specific cell wall and capsular antigens that are commonly detected by direct fluorescent-antibody assays. We report on the identification and characterization of 14 Bacillus megaterium and four Bacillus sp. clinical isolates that are nonhemolytic, nonmotile, and produce a capsule antigenically similar to B. anthracis. This work furthers our understanding of Bacillus diversity and the limitations of the assays and phenotypes that are used to differentiate species in this genus. Further work is necessary to understand whether these strains are opportunistic pathogens or just contaminates. |
Domain-III FG loop of the dengue virus type 2 envelope protein is important for infection of mammalian cells and Aedes aegypti mosquitoes
Erb SM , Butrapet S , Moss KJ , Luy BE , Childers T , Calvert AE , Silengo SJ , Roehrig JT , Huang CY , Blair CD . Virology 2010 406 (2) 328-35 The FG extended loop in domain III of the dengue virus type 2 (DENV2) envelope protein is postulated to be a molecular determinant for host cell infectivity. To determine the contribution of the FG loop to virus infectivity, an infectious cDNA clone of DENV2 was manipulated by deleting amino acids in the loop (VEPGDelta) to mimic tick-borne flaviviruses or by substituting these AAs with RGD or RGDK/S to mimic motifs present in other mosquito-borne flaviviruses. We found the FG loop to be dispensable for infection of C6/36 cells but critical for infection of Aedes aegypti mosquito midguts and mammalian cells. All the FG loop mutants were able to bind to and enter mammalian cells but replication of VEPGDelta in Vero cells at 37 degrees C was delayed until acquisition of secondary mutations. Reduced binding of DENV2 type-specific monoclonal antibody 3H5 to mutant viruses confirmed the FG loop motif as its target epitope. |
Risk for cognitive deficit in a population-based sample of U.S. children with autism spectrum disorders: variation by perinatal health factors
Schieve LA , Baio J , Rice CE , Durkin M , Kirby RS , Drews-Botsch C , Miller LA , Nicholas JS , Cunniff CM . Disabil Health J 2010 3 (3) 202-212 BACKGROUND: From 30% to 60% of children with an autism spectrum disorder (ASD) have an IQ measure that falls in the intellectual disability (ID) range. It is not well studied whether, for children within this ASD subgroup, there is variation in the risk for low IQ based on a child's perinatal risk factors. OBJECTIVE/HYPOTHESES: We assessed whether preterm delivery and term small-for-gestational-age (tSGA) were associated with various measures of cognitive deficit among children with ASDs. METHODS: A sample of 1129 singleton children born in 1994 and identified through school and health record review as having an ASD by age 8 years were selected from a U.S. population-based surveillance network. Mean IQ and dichotomous IQ outcomes indicating various levels of ID were examined according to whether a child was preterm (<37 weeks' gestation) or tSGA (term delivery and birth weight <10th percentile for gestational age of a U.S. referent). Results for the total sample and within race-ethnicity/maternal education strata were adjusted for child sex and ASD subtype classification. RESULTS: Mean IQ was significantly (p < .05) lower in children delivered preterm (69.5) than term (74.5) and tSGA (69.3) than term appropriate-for gestational age (75.3). In stratified analyses, the preterm-IQ association was significant only among non-Hispanic white (NHW) children with maternal education at birth of high school or less; adjusted mean IQ was 8 points lower among those delivered preterm (65.4) than term (73.8). Term-SGA was associated with a significant 8-point deficit in adjusted mean IQ (75.5 vs. 83.8) in NHW children with maternal education greater than high school and a 6-point deficit that approached significance (68.4 vs. 74.5, p = 0.10) in NHW children with maternal education of high school or less. Non-Hispanic black children in both maternal education groups had significantly lower mean IQs than NHW children with little variation by preterm or tSGA. CONCLUSIONS: In children with ASDs, the risk for concurrent ID or IQ deficit is associated with both preterm delivery and tSGA; these associations may vary by race-ethnicity and SES. Further studies of ASD-ID co-occurrence and the effectiveness of intervention strategies should consider both perinatal and sociodemographic factors. 2010 Elsevier Inc. All rights reserved. |
Physiatrists and developmental pediatricians working together to improve outcomes in children with spina bifida
Swanson ME , Dicianno BE . Pediatr Clin North Am 2010 57 (4) 973-81 Based on the experience of 2 physicians from physiatry and developmental pediatrics, this article proposes a framework for improving care and outcomes for children with spina bifida. The combined skills of physiatrists and developmental pediatricians, along with other disciplines, can form the ideal team to manage the complex issues faced by this population. The developmental pediatrician is best suited for directing care for younger children through the elementary and middle school years, during which time behavioral and educational issues are prominent. As the child assumes more responsibility for self-management in adolescence, the physiatrist is ideally suited to provide major clinical input that improves functional outcomes. The addition of the discipline of physiatry to traditional, developmentally oriented pediatric interdisciplinary teams can add the much needed dimensions of activity and participation, and improve functional outcomes at the adult level by encouraging activities in adolescence that lead to full participation in adulthood. |
Antiretroviral therapy and preterm delivery-a pooled analysis of data from the United States and Europe
Townsend C , Schulte J , Thorne C , Dominguez KI , Tookey PA , Cortina-Borja M , Peckham CS , Bohannon B , Newell ML . BJOG 2010 117 (11) 1399-410 OBJECTIVE: To investigate reported differences in the association between highly active antiretroviral therapy (HAART) in pregnancy and the risk of preterm delivery among HIV-infected women. DESIGN: Combined analysis of data from three observational studies. SETTING: USA and Europe. POPULATION: A total of 19, 585 singleton infants born to HIV-infected women, 1990-2006. METHODS: Data from the Pediatric Spectrum of HIV Disease project (PSD), a US monitoring study, the European Collaborative Study (ECS), a consented cohort study, and the National Study of HIV in Pregnancy and Childhood (NSHPC), the United Kingdom and Ireland surveillance study. MAIN OUTCOME MEASURE: Preterm delivery rate (<37 weeks of gestation). RESULTS: Compared with monotherapy, HAART was associated with increased preterm delivery risk in the ECS (adjusted odds ratio [AOR] 2.40, 95% CI 1.49-3.86) and NSHPC (AOR 1.43, 95% CI 1.10-1.86), but not in the PSD (AOR 0.92, 95% CI 0.67-1.26), after adjusting for relevant covariates. Because of heterogeneity, data were not pooled for this comparison, but heterogeneity disappeared when HAART was compared with dual therapy (P = 0.26). In a pooled analysis, HAART was associated with 1.5-fold increased odds of preterm delivery compared with dual therapy (95% CI 1.19-1.87, P=0.001), after adjusting for covariates. CONCLUSIONS: Heterogeneity in the association between HAART and preterm delivery was not explained by study design, adjustment for confounders or a standard analytical approach, but may have been the result of substantial differences in populations and data collected. The pooled analysis comparing HAART with dual therapy showed an increased risk of preterm delivery associated with HAART. |
Changes in autism spectrum disorder prevalence in 4 areas of the United States
Rice C , Nicholas J , Baio J , Pettygrove S , Lee LC , Van Naarden Braun K , Doernberg N , Cunniff C , Newschaffer C , Meaney FJ , Charles J , Washington A , King L , Kolotos M , Mancilla K , Mervis CA , Carpenter L , Yeargin-Allsopp M . Disabil Health J 2010 3 (3) 186-201 BACKGROUND: We sought to describe autism spectrum disorder (ASD) population characteristics and changes in identified prevalence across 3 time periods. METHODS: Children with a potential ASD were identified through records abstraction at multiple sources with clinician review based on Diagnostic and Statistical Manual (DSM-IV-TR) criteria. Multisite, population-based data from the Autism and Developmental Disabilities Monitoring (ADDM) Network were analyzed from areas of Arizona (AZ), Georgia (GA), Maryland (MD), and South Carolina (SC). Participants were 8-year-old children (born in 1992, 1994, or 1996) in 2000, 2002, or 2004 (and children born in 1988 residing in metropolitan Atlanta in 1996) who had been evaluated for a variety of developmental concerns at education and/or health sources. RESULTS: From 2000 to 2004, the identified prevalence of the ASDs per 1,000 8-year-old children showed significant increases of 38% in GA and 72% in MD and a nonsignificant increase of 26% in AZ. ASD prevalence was relatively stable in SC with a nonsignificant decrease of 17%. Males had a higher identified prevalence of ASD in all years. Increases among racial, ethnic, and cognitive functioning subgroups varied by site and surveillance year. More children were classified with an ASD by community professionals over time, except in AZ. CONCLUSIONS: There was a trend toward increase in identified ASD prevalence among 8-year-old children who met the surveillance case definition in 3 of the 4 study sites from 2000 to 2004. Some of the observed increases are due to improved ascertainment; however, a true increase in ASD symptoms cannot be ruled out. These data confirm that the prevalence of ASDs is undergoing significant change in some areas of the United States and that ASDs continue to be of urgent public health concern. 2010 Elsevier Inc. All rights reserved. |
The impact of the availability of school vending machines on eating behavior during lunch: the Youth Physical Activity and Nutrition Survey
Park S , Sappenfield WM , Huang Y , Sherry B , Bensyl DM . J Am Diet Assoc 2010 110 (10) 1532-6 Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included chi2 tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines. |
Statistical evaluation and analysis of safety intervention in the determination of an effective resource allocation strategy
Oyewole SA , Haight JM , Freivalds A , Cannon DJ , Rothrock L . J Loss Prev Process Ind 2010 23 (5) 585-593 This paper provides an analytical background for the development of an effective safety intervention program with the aim of minimizing incident rates. Safety intervention data were collected from the environmental health and safety department of an American-owned oil company in the Niger-Delta region of Nigeria. A safety model was developed to determine the safety intervention factors and interactions which minimize incident rates, with the aim of predicting a better resource allocation strategy. Five main safety intervention factors (factor A: leadership and accountability; factor B: qualification selection and pre-job; factor C: employee engagement and planning; factor D: work in progress; factor E: evaluation, measurement and verification) were highlighted and investigated to show their effects on incident rate performance. Analysis of variance test showed that four safety factors (A, C, D, and E) were significant. Statistical techniques such as response surface design plots were used to determine the resource allocation method. The developed safety model recommended the allocation of 16.66% of the available resources to the significant safety intervention activities in order to achieve the desirable incident rate. In order to reap the benefits of this research, it will be important to concentrate more efforts and resources on significant factors which have positive impacts in minimizing incident rates. 2010 Elsevier Ltd. |
Vibration-white foot: a case report
Thompson AM , House R , Krajnak K , Eger T . Occup Med (Lond) 2010 60 (7) 572-4 BACKGROUND: Hand-arm vibration syndrome (HAVS) refers to the neurological, vascular and musculoskeletal problems that may arise due to exposure to segmental vibration to the hands. An analogous syndrome may occur in the lower extremities of workers exposed to foot-transmitted vibration. AIMS: This report describes the case of a worker with a history of foot-transmitted vibration exposure presenting with cold intolerance in the feet and blanching in the toes. Case report A 54-year-old miner presented with a chief complaint of blanching and pain in his toes. The worker had a history of foot-transmitted vibration exposure over his 18 year career as a miner, primarily from the operation of vehicle-mounted bolting machines. Cold provocation digital plethysmography showed cold-induced vasospastic disease in the feet, but not in the hands. CONCLUSIONS: This case illustrates a condition descriptively termed 'vibration-white foot': a disease analogous to HAVS arising after segmental vibration exposure to the feet. Further research is required to increase awareness of, and direct preventive efforts for, this potentially debilitating condition. |
Persistence of deposited metals in the lungs after stainless steel and mild steel welding fume inhalation in rats
Antonini JM , Roberts JR , Stone S , Chen BT , Schwegler-Berry D , Chapman R , Zeidler-Erdely PC , Andrews RN , Frazer DG . Arch Toxicol 2010 85 (5) 487-98 Welding generates complex metal fumes that vary in composition. The objectives of this study were to compare the persistence of deposited metals and the inflammatory potential of stainless and mild steel welding fumes, the two most common fumes used in US industry. Sprague-Dawley rats were exposed to 40 mg/m(3) of stainless or mild steel welding fumes for 3 h/day for 3 days. Controls were exposed to filtered air. Generated fume was collected, and particle size and elemental composition were determined. Bronchoalveolar lavage was done on days 0, 8, 21, and 42 after the last exposure to assess lung injury/inflammation and to recover lung phagocytes. Non-lavaged lung samples were analyzed for total and specific metal content as a measure of metal persistence. Both welding fumes were similar in particle morphology and size. Following was the chemical composition of the fumes-stainless steel: 57% Fe, 20% Cr, 14% Mn, and 9% Ni; mild steel: 83% Fe and 15% Mn. There was no effect of the mild steel fume on lung injury/inflammation at any time point compared to air control. Lung injury and inflammation were significantly elevated at 8 and 21 days after exposure to the stainless steel fume compared to control. Stainless steel fume exposure was associated with greater recovery of welding fume-laden macrophages from the lungs at all time points compared with the mild steel fume. A higher concentration of total metal was observed in the lungs of the stainless steel welding fume at all time points compared with the mild steel fume. The specific metals present in the two fumes were cleared from the lungs at different rates. The potentially more toxic metals (e.g., Mn, Cr) present in the stainless steel fume were cleared from the lungs more quickly than Fe, likely increasing their translocation from the respiratory system to other organs. |
Addressing the need for research on bariatric patient handling
Galinsky T , Hudock S , Streit J . Rehabil Nurs 2010 35 (6) 242-247 During the past 3 decades numerous studies have documented the high prevalence of patient handling-related musculoskeletal injuries among healthcare workers and evaluated ergonomic interventions using mechanized equipment for lifting and moving patients. A great deal of research-based evidence now demonstrates the effectiveness of ergonomic interventions to reduce injury risk among healthcare workers who handle patients of average weights and sizes. In contrast, there is a lack of evidence-based research that evaluates ergonomic interventions for handling bariatric patients, whose extreme weights and sizes necessitate specialized handling equipment. The obesity epidemic, along with special medical and therapeutic concerns regarding bariatric patients, exacerbates healthcare workers' patient handling demands. The National Institute for Occupational Safety and Health is conducting a new study to evaluate bariatric patient handling hazards and interventions and identify evidence-based best practices for handling this population. |
Developing evidence-based interventions to address the leading cause of workers' compensation among healthcare workers
Collins JW , Bell JL , Gronqvist R . Rehabil Nurs 2010 35 (6) 225-35 Overexertion and slip, trip, and fall (STF) incidents are two of the leading sources of workers' compensation claims and costs in healthcare settings (Bell et al., 2008; Bureau of Labor Statistics BLS, 2008). Working in conjunction with a team of international researchers, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research to demonstrate the effectiveness of comprehensive safe patient handling and STF-prevention programs. The purpose of this article is to summarize the research and outreach efforts of NIOSH and their partners to address the leading occupational injury hazards facing healthcare workers. This article also provides an overview of the changes that are occurring in the healthcare industry as a result of the evidence-based research on safe patient handling and STF prevention that has been conducted in recent years. |
Mood disorders and physical functioning difficulties as predictors of complex activity limitations in young U.S. adults
Jonas BS , Loeb M . Disabil Health J 2010 3 (3) 171-178 BACKGROUND: There is established research that shows associations between basic physical functional difficulties and complex activity limitations. In addition, there is some research that shows associations between mood disorders and complex activity limitations. However, there is limited research looking at the joint association between mood disorders and physical functioning and complex activity limitations. Furthermore, because mood disorders and physical functioning limitations increase with age, there is a lack of information available on younger adults. OBJECTIVES: We assess the impact of mood disorders and physical function difficulties as predictors of complex activity limitations in young U.S. adults, using data from a national survey. METHODS: We use data from the Third National Health and Nutrition Examination Survey (NHANES III) among young U.S. adults 17 to 39 years of age. Selected basic actions difficulties include physical functioning difficulties (motor, visual, or hearing difficulties) and mood disorders (major depressive disorder, dysthymia, or bipolar disorder). Selected complex activity limitations include limitations in activities of daily living (ADLs) (walking inside the home, standing from a chair, getting into and out of bed, eating, and dressing), instrumental activities of daily living (IADLs) (doing chores around the house, preparing meals, and managing money), and/or specific major life activities (limitations in the kind or amount of work or housework they could perform, or being limited in any way because of an impairment or health problem). RESULTS: The prevalence of basic actions difficulty (physical functioning and/or mood disorder difficulties) among young adults is 34%. Among the young adults with basic actions difficulty, nearly 39% have mood disorders. The prevalence rates for ADL/IADL, major life activities, and any complex activity limitation are 8.6%, 8.1%, and 13.6%, respectively. Compared with young adults with no basic actions difficulties, the results showed that young adults with mood disorders alone had elevated adjusted odds ratios (2.5) for limitations in ADLs and/IADLs. For all the complex activity limitations analyzed, compared to those with no basic actions difficulties, young adults with physical functioning difficulties alone had substantially higher adjusted odds ratios (5.4-8.7) and young adults with comorbid mood disorder and physical functioning difficulties had the highest observed odds ratios (9.7-14.0). CONCLUSIONS: The data suggest a stronger risk of complex activity limitations when mood disorders coexist with physical functioning difficulties, leading to potential interference with a person's ability to accomplish the ADLs/IADLs or major life activities measured in this study. Given the magnitude of basic actions difficulty prevalence, and particularly the substantial contribution of mood disorders to this prevalence, further examination of the mental health component of basic actions difficulty is warranted. A possible area for future research could explore coordinated efforts to reduce physical and mental difficulties and facilitate the accomplishment of complex activities. 2010 Elsevier Inc. All rights reserved. |
Structural factors and best practices in implementing a linkage to HIV care program using the ARTAS model
Craw J , Gardner L , Rossman A , Gruber D , Noreen O , Jordan D , Rapp R , Simpson C , Phillips K . BMC Health Serv Res 2010 10 246 BACKGROUND: Implementation of linkage to HIV care programs in the U.S. is poorly described in the literature despite the central role of these programs in delivering clients from HIV testing facilities to clinical care sites. Models demonstrating success in linking clients to HIV care from testing locations that do not have co-located medical care are especially needed. METHODS: Data from the Antiretroviral Treatment Access Studies-II project ('ARTAS-II') as well as site visit and project director reports were used to describe structural factors and best practices found in successful linkage to care programs. Successful programs were able to identify recently diagnosed HIV-positive persons and ensure that a high percentage of persons attended an initial HIV primary care provider visit within six months of enrolling in the linkage program. RESULTS: Eight categories of best practices are described, supplemented by examples from 5 of 10 ARTAS-II sites. These five sites highlighted in the best practices enrolled a total of 352 HIV+ clients and averaged 85% linked to care after six months. The other five grantees enrolled 274 clients and averaged 72% linked to care after six months. Sites with co-located HIV primary medical care services had higher linkage to care rates than non-co-located sites (87% vs. 73%). Five grantees continued linkage to care activities in some capacity after project funding ended. CONCLUSIONS: With the push to expand HIV testing in all U.S. communities, implementation and evaluation of linkage to care programs is needed to maximize the benefits of expanded HIV testing efforts. |
The World Health Organization African region laboratory accreditation process: improving the quality of laboratory systems in the African region
Gershy-Damet GM , Rotz P , Cross D , Belabbes el H , Cham F , Ndihokubwayo JB , Fine G , Zeh C , Njukeng PA , Mboup S , Sesse DE , Messele T , Birx DL , Nkengasong JN . Am J Clin Pathol 2010 134 (3) 393-400 Few developing countries have established laboratory quality standards that are affordable and easy to implement and monitor. To address this challenge, the World Health Organization Regional Office for Africa (WHO AFRO) established a stepwise approach, using a 0- to 5-star scale, to the recognition of evolving fulfillment of the ISO 15189 standard rather than pass-fail grading. Laboratories that fail to achieve an assessment score of at least 55% will not be awarded a star ranking. Laboratories that achieve 95% or more will receive a 5-star rating. This stepwise approach acknowledges to laboratories where they stand, supports them with a series of evaluations to use to demonstrate improvement, and recognizes and rewards their progress. WHO AFRO's accreditation process is not intended to replace established ISO 15189 accreditation schemes, but rather to provide an interim pathway to the realization of international laboratory standards. Laboratories that demonstrate outstanding performance in the WHO-AFRO process will be strongly encouraged to enroll in an established ISO 15189 accreditation scheme. We believe that the WHO-AFRO approach for laboratory accreditation is affordable, sustainable, effective, and scalable. |
Country leadership and policy are critical factors for implementing laboratory accreditation in developing countries: a study on Uganda
Opio A , Wafula W , Amone J , Kajumbula H , Nkengasong JN . Am J Clin Pathol 2010 134 (3) 381-7 Accreditation of laboratories is one means to promote quality laboratory services, underscoring the need to document factors that facilitate laboratory accreditation. A desk review and key informant's interviews were conducted to determine the roles of country leadership and policies in laboratory accreditation. Overall, the review revealed that Uganda has enabling factors for laboratory accreditation, putting the country in a state of accreditation-readiness and including strong leadership that provides stewardship and availability of a national health laboratory policy with an explicit statement on laboratory accreditation. A National Laboratory Technical and Policy Committee coordinated the development of the policy. Laboratory training schools provide leadership in training laboratory professionals, while the Association of Medical Laboratory Technologists provides professional leadership. Although there is no national accreditation system, some laboratories are participating in international laboratory accreditation. Key informants expressed strong support for and observed that laboratory accreditation is beneficial and can be implemented in Uganda. Lessons from this study can benefit countries planning to implement laboratory accreditation. Countries that have not developed national laboratory policies and strategic plans should do so to guide the strengthening of laboratory systems and services as a part of health systems strengthening, which would be a springboard for laboratory accreditation. |
Non-dioxin-like polychlorinated biphenyls and risk of endometriosis
Trabert B , De Roos AJ , Schwartz SM , Peters U , Scholes D , Barr DB , Holt VL . Environ Health Perspect 2010 118 (9) 1280-5 BACKGROUND: Endometriosis, a gynecologic disorder affecting 8-10% of reproductive-age women in the United States, is defined as the presence of endometrial tissue outside the uterus and is linked to pelvic pain and infertility. Environmental contaminants, including polychlorinated biphenyls (PCBs), are hypothesized to contribute to endometriosis risk through effects on steroid hormones. OBJECTIVE: We evaluated serum concentrations of certain noncoplanar PCBs, which have no or only weak dioxin-like properties, as risk factors for endometriosis. METHODS: In a case-control study of Group Health enrollees in western Washington State, 20 PCB congeners were measured in serum from surgically confirmed endometriosis cases that were newly diagnosed between 1996 and 2001 (n = 251) and from female controls matched for age and reference year (n = 538). RESULTS: Summed and estrogenic PCB concentrations were not associated with endometriosis risk [summed: odds ratio (OR) = 1.3; 95% confidence interval (CI), 0.8-2.2; estrogenic: OR = 1.1; 95% CI, 0.8-1.4]. Although several congener-specific ORs were statistically above or below the null (PCB 170: third quartile vs. lowest: OR = 0.5; 95% CI, 0.3-0.9; PCB 196: third quartile vs. lowest: OR = 0.4; 95% CI, 0.2-0.7; PCB 201: second vs. lowest: OR = 0.5; 95% CI, 0.3-0.8; third quartile vs. lowest: OR = 0.4; 95% CI, 0.2-0.7), there were no overall consistent patterns of endometriosis risk. CONCLUSIONS: Taken in context with other North American studies, our findings suggest that noncoplanar PCB concentrations consistent within the range of exposure currently observed in western Washington State do not contribute meaningfully to endometriosis risk. |
Integrating HIV prevention in reproductive health settings
Zotti ME , Pringle J , Stuart G , Boyd WA , Brantley D , de Ravello L . J Public Health Manag Pract 2010 16 (6) 512-20 CONTEXT: This article describes results of a process evaluation of a cooperative agreement between the Centers for Disease Control and Prevention's Division of Reproductive Health and 10 regional training centers to increase the number of reproductive health (RH) settings that integrate human immunodeficiency virus (HIV) prevention services at an appropriate level into routine care. OBJECTIVE: Our goal was to learn about the process of integrating HIV prevention into RH settings. DESIGN: We conducted a retrospective evaluation, using qualitative methods. SETTING: The clinics were from 10 US Department of Health and Human Services regions. PARTICIPANTS: We interviewed 16 key informants from 10 selected model clinics. MAIN OUTCOME MEASURES: The main outcome was organization change. RESULTS: The most common obstacles to integration were staff issues, logistics barriers, inadequate clinic structure to support integration, and staff training barriers. Using the transtheoretical model (TTM) applied to organizations, we documented organizational change as informants described their clinics' progression to integration and overcoming obstacles. All model clinics began in the contemplation stage of transtheoretical model. Every clinic exhibited at least 1 process of change for every stage. In the contemplation stage, most informants discussed fears about not changing, stated that the integration was consistent with the agency's mission, and described thinking about commitment to the change. In the preparation stage, all informants described building teams that supported integration of HIV prevention. During the action stage, informants talked about assessments of facilities, staff and protocols, commitments through grants or agreements, and then using training to support new behaviors and adopting new cognitions. In the maintenance stage, all reported changing policies, procedures, or protocols, most promoted helping relationships among the staff, and nearly all reported rewards for the new ways of working. CONCLUSIONS: RH settings were able to integrate HIV prevention services by employing a systematic process. |
Are environmental levels of bisphenol A associated with reproductive function in fertile men?
Mendiola J , Jorgensen N , Andersson AM , Calafat AM , Ye X , Redmon JB , Drobnis EZ , Wang C , Sparks A , Thurston SW , Liu F , Swan SH . Environ Health Perspect 2010 118 (9) 1286-91 BACKGROUND: Rodent and in vitro studies have demonstrated the estrogenicity of bisphenol A (BPA). However, few studies have examined the relationship between human exposure to BPA and male reproductive function. OBJECTIVES: We investigated the relationships between environmental BPA exposure and reproductive parameters, including semen quality and male reproductive hormones, in prospectively recruited fertile men. METHODS: Participants (n = 375) were partners of pregnant women who participated in the Study for Future Families in four U.S. cities, and all of the men provided blood, semen, and urine samples. BPA was measured in urine. Serum samples were analyzed for reproductive hormones, including follicle-stimulating hormone, luteinizing hormone (LH), testosterone, inhibin B, estradiol, and sex hormone-binding globulin (SHBG), as well as the free androgen index (FAI). Semen analyses were performed according to World Health Organization criteria. Pearson correlations were used for unadjusted analyses, and multiple linear regression analyses were used to examine associations controlling for age, body mass index, smoking, ethnicity, urinary creatinine concentration, time of sample collection, and duration of abstinence. RESULTS: After multivariate adjustment, we observed no significant associations between any semen parameter and urinary BPA concentration. However, a significant inverse association was found between urinary BPA concentration and FAI levels and the FAI/LH ratio, as well as a significant positive association between BPA and SHBG. CONCLUSIONS: Our results suggest that, in fertile men, exposure to low environmental levels of BPA may be associated with a modest reduction in markers of free testosterone, but any effects on reproductive function are likely to be small, and of uncertain clinical significance. |
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