A randomized controlled trial of an emergency department intervention for patients with chronic noncancer pain
Ringwalt C , Shanahan M , Wodarski S , Jones J , Schaffer D , Fusaro A , Paulozzi L , Garrettson M , Ford M . J Emerg Med 2015 49 (6) 974-83 BACKGROUND: Emergency Departments (EDs) are beginning to notify their physicians of patients reporting chronic noncancer pain (CNCP) who frequent EDs, and are suggesting that the physicians not prescribe opioids to these patients. OBJECTIVES: We hypothesized that this intervention would reduce both the number of opioids prescribed to these patients by their ED physicians and the number of these patients' return visits to the ED. METHODS: We conducted a randomized controlled trial of this intervention in 13 electronically linked EDs. Patients eligible for the study were characterized by CNCP, lacked evidence of sickle cell anemia and suicide ideation, and made frequent (>10) visits to the EDs over a 12-month period. We randomly assigned 411 of these patients to either an intervention group or a control group. Our intervention comprised both an alert placed in eligible patients' medical files and letters sent to the patients and their community-based providers. The alert suggested that physicians decline requests for opioid analgesic prescriptions and instead refer these patients to community-based providers to manage their ongoing pain. RESULTS: During the 12 months after randomization, patients in the intervention and control groups averaged 11.9 and 16.6 return visits, and received prescriptions for opioids on 16% and 26% of those visits, respectively. Altogether, patients in the intervention group made 1033 fewer return visits to the EDs in the follow-up year than those in the control group. CONCLUSION: This intervention constitutes a promising practice that EDs should consider to reduce the number of visits made by frequent visitors with CNCP. |
Providers' knowledge, attitudes, and practices related to colorectal cancer control in Brazil
Puricelli Perin DM , Saraiya M , Thompson TD , de Moura L , Simoes EJ , Parra DC , Brownson RC . Prev Med 2015 In Brazil, colorectal cancer (CRC) is the fourth most common cause of cancer-related death among men, and the third most common among women. We aimed to examine CRC screening-related knowledge, attitudes, and practices among physicians and nurses working in Brazil's network of health units, and to describe the capacity of these units for CRC screening. In 2011, 1,600 health units were randomly selected from all 26 states and the Federal District. One coordinator and one health care provider were selected for the interview. Response rates were 78% for coordinators, 34% for physicians, and 65% for nurses. The Brazilian National Cancer Institute (INCA) recommendations for CRC screening were not often used in the health units, but screening outreach and use of CRC exams were more common in units that were using them. Physicians and nurses differed in most characteristics, and in their knowledge, attitudes, and practices of CRC screening. Forty-seven percent of physicians reported not conducting CRC screening compared to 65% of nurses. Fecal occult blood test was most often used by physicians and nurses, but fewer physicians than nurses perceived this exam as very effective in reducing CRC mortality. Physicians' gender, years since graduation, and geographical region of practice in Brazil were associated to CRC screening practice. The findings may reflect the low influence of INCA CRC screening recommendations, physicians receiving their medical education when CRC burden in Brazil was of low concern, and the lack of CRC screening capacity in some regions of Brazil. |
Healthier school environment leads to decreases in childhood obesity: the Kearney Nebraska Story
Heelan KA , Bartee RT , Nihiser A , Sherry B . Child Obes 2015 11 (5) 600-7 BACKGROUND: Schools play a role in addressing childhood obesity by implementing healthy eating and physical activity strategies. The primary aim of this case study was to describe prevalence of overweight and obesity among elementary school students in a rural Mid-western community between 2006 and 2012. The secondary aim was to use a novel approach called "population dose" to retrospectively evaluate the impact dose of each strategy implemented and its estimated potential population level impact on changes in overweight and obesity. METHODS: Weight and height were directly measured annually beginning in January 2006 to assess weight status, using BMI (kg/m(2)), for all kindergarten to fifth-grade students (N approximately 2400 per year). Multiple evidence-based strategies were implemented in nine schools to increase physical activity and healthy eating behaviors. BMI reporting and revised school meal programs were implemented districtwide. Comprehensive school physical activity programs, school food environment, and supportive/promotional strategies were implemented at individual schools. RESULTS: The absolute change in prevalence of obesity (BMI ≥95th percentile) decreased from 16.4% to 13.9%, indicating a 15.2% relative change in prevalence of obesity in 6 years. There was an inverse relationship between the number of strategies implemented and prevalence of overweight and obesity over time. CONCLUSIONS: District and school-level approaches have the potential to impact childhood obesity. Schools can successfully implement strategies to address overweight and obesity, but the extent of implementation between schools may vary. Population dose analysis can be used to estimate impact of clusters of strategies to address overweight/obesity. |
Acute cardiac injury events ≤30 days after laboratory-confirmed influenza virus infection among U.S. veterans, 2010-2012
Ludwig A , Lucero-Obusan C , Schirmer P , Winston C , Holodniy M . BMC Cardiovasc Disord 2015 15 (1) 109 BACKGROUND: Cardiac injury is a known potential complication of influenza infection. Because U.S. veterans cared for at the U.S. Department of Veterans Affairs are older and have more cardiovascular disease (CVD) risk factors than the general U.S. population, veterans are at risk for cardiac complications of influenza infection. We investigated biomarkers of cardiac injury characteristics and associated cardiac events among veterans who received cardiac biomarker testing ≤30 days after laboratory-confirmed influenza virus infection. METHODS: Laboratory-confirmed influenza cases among veterans cared for at U.S. Department of Veterans Affairs' facilities for October 2010-December 2012 were identified using electronic medical records (EMRs). Influenza confirmation was based on respiratory specimen viral culture or antigen or nucleic acid detection. Acute cardiac injury (ACI) was defined as an elevated cardiac biomarker (troponin I or creatinine kinase isoenzyme MB) >99 % of the upper reference limit occurring ≤30 days after influenza specimen collection. EMRs were reviewed for demographics, CVD history and risk factors, and ACI-associated cardiac events. RESULTS: Among 38,197 patients with influenza testing results, 4,469 (12 %) had a positive result; 600 of those patients had cardiac biomarker testing performed ≤30 days after influenza testing, and 143 (24 %) had one or more elevated cardiac biomarkers. Among these 143, median age was 73 years (range 44-98 years), and 98 (69 %) were non-Hispanic white. All patients had one or more CVD risk factors, and 98 (69 %) had a history of CVD. Eighty-six percent of ACI-associated events occurred within 3 days of influenza specimen collection date. Seventy patients (49 %) had documented or probable acute myocardial infarction, 8 (6 %) acute congestive heart failure, 6 (4 %) myocarditis, and 4 (3 %) atrial fibrillation. Eleven (8 %) had non-cardiac explanations for elevated cardiac biomarkers, and 44 (31 %) had no documented explanation. Sixty-eight (48 %) patients had received influenza vaccination during the related influenza season. CONCLUSION: Among veterans with laboratory-confirmed influenza infection and cardiac biomarker testing ≤30 days after influenza testing, approximately 25 % had evidence of ACI, the majority within 3 days. Approximately half were myocardial infarctions. Our findings emphasize the importance of considering ACI associated with influenza infection among patients at high risk, including this older population with prevalent CVD risk factors. |
Development of the National Healthy Sleep Awareness Project sleep health surveillance questions
Morgenthaler TI , Croft JB , Dort LC , Loeding LD , Mullington JM , Thomas SM . J Clin Sleep Med 2015 11 (9) 1057-62 OBJECTIVES: For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA). METHODS: An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward. RESULTS: The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA. CONCLUSIONS: Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation. |
Sexually transmitted infections associated with alcohol use and HIV infection among men who have sex with men in Kampala, Uganda
Kim EJ , Hladik W , Barker J , Lubwama G , Sendagala S , Ssenkusu JM , Opio A , Serwadda D . Sex Transm Infect 2015 92 (3) 240-5 OBJECTIVES: Few studies have been conducted in Africa to assess prevalence of sexually transmitted infections (STIs) and risk factors among men who have sex with men (MSM). We report findings from the first behavioural survey to include STI testing among MSM in Kampala, Uganda. METHODS: Respondent-driven sampling (RDS) was used to recruit MSM for a biobehavioural survey. Eligible participants were men who reported anal sex with another man in the previous 3 months, were 18 years or older, and resided in Kampala. Information was collected on demographics, sexual behaviour, alcohol and drug use, and STI symptoms. Blood, urine and rectal specimens were tested for syphilis, HIV, rectal and urethral gonorrhoea, and chlamydia. Analyses weighted for RDS were conducted to assess associations with STI diagnosis. RESULTS: A total of 295 MSM participated in the survey. Almost half (weighted percentage: 47.3%) reported STI symptoms in the last 6 months and 12.9% tested HIV-positive. Prevalence of non-HIV STI was 13.5%; syphilis prevalence was 9.0%. Adjusting for age and education, STI was associated with HIV (adjusted OR (AOR)=3.46, 95% CI 1.03 to 11.64), alcohol use before sex (AOR=4.99, 95% CI 1.86 to 13.38) and having sold sex in the last 3 months (AOR=3.17, 95% CI 1.25 to 8.07), and inversely associated with having anonymous sex partners (AOR=0.20, 95% CI 0.07 to 0.61). CONCLUSIONS: We observed high levels of self-reported STI symptoms and STI prevalence associated with alcohol use and HIV among MSM in Kampala. Public health interventions supporting MSM are needed to address STI risk and facilitate access to diagnosis and treatment services. |
Measles in a patient with presumed immunity - Los Angeles County, 2015
Kamali A , Bagchi CP , Mendoza E , Wilson D , Schwartz B , Mascola L . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1123 On February 14, 2015, patient A, aged 17 years, was seen in an emergency department for evaluation of reactive airway disease. In the waiting room at the same time were two siblings, aged 6 months, presenting with fever and rash; these two children (patients B and C) were later confirmed to have measles. Patient A began a 5-day course of oral prednisone (50 mg per day); however, symptoms continued, and patient A returned to the emergency department the next day and received 125 mg of intravenous (IV) methylprednisolone. Patient A had documentation of receipt of 2 doses of measles, mumps, and rubella (MMR) vaccine at ages 12 months and 4 years. |
Progress towards poliomyelitis eradication in Nigeria, January 2014- July 2015
Andrew E , Gunnala R , Shuaib F , Damisa E , Mkanda P , Ticha JM , Banda R , Korir C , Chevez AE , Enemaku O , Corkum M , Davis LB , Nganda GW , Burns CC , Wassilak S , Vertefeuille JF . Wkly Epidemiol Rec 2015 90 (34) 423-30 Since the launch of the Global Polio Eradication Initiative in 1988, 4 of the 6 WHO Regions have been certified | polio-free.1 | With Afghanistan and Pakistan, Nigeria is | one of only 3 countries where transmission of wild | poliovirus (WPV) has never been interrupted. During | 2003–2013, northern Nigeria represented a reservoir | from which WPV was reintroduced into 26 previously | polio-free countries.2 | In 2012, the Nigerian government | launched a national polio eradication emergency plan3 | in order to intensify efforts to interrupt WPV transmission. This report updates previous reports2, 4 and describes | polio eradication activities and progress in Nigeria | during January 2014–July 2015 |
Qualitative interviews with non-national tuberculosis patients in Cairo, Egypt: understanding the financial and social cost of treatment adherence
Lohiniva AL , Mokhtar A , Azer A , Elmoghazy E , Kamal E , Benkirane M , Dueger E . Health Soc Care Community 2015 24 (6) e164-e172 Limited data are available about the challenges of non-national TB patients undergoing long-term treatment courses in an urban setting. This study aimed to understand the financial and social cost of adherence of non-national TB patients in Cairo, Egypt as a means to inform the development of context-specific interventions to support treatment adherence. In 2011, 22 in-depth interviews were conducted with TB patients from Sudan, Ethiopia, Eritrea, Somalia and Djibouti to obtain qualitative data. Analysis was based on thematic analysis that aimed to identify recurrent themes and codes from the narratives. The study identified a number of factors that influence TB treatment adherence. Uncertain financial status due to limited or no employment was frequently discussed in interviews, which resulted in fear of not being able to support family, loss of pride, dependence on family and friends, fear of losing housing, food insecurity and limited food options. Respondents also feared infecting other household members and longed for opportunities to discuss their illness and treatment experiences with other individuals but their social networks were often limited. TB-related stigma was driven by shame and blame of infection. Respondents also believed stigma was based on their foreign origin. Stigma manifested in distancing and exclusion in various ways, resulting in isolation, psychological distress and reluctance to disclose TB status to others. Poverty-related factors and social context with a special focus on stigma should be considered when developing strategies for supporting long-term treatment courses for non-national patients in Cairo and other similar urban settings. |
Epidemiology of carbapenem-resistant Enterobacteriaceae in 7 US communities, 2012-2013
Guh AY , Bulens SN , Mu Y , Jacob JT , Reno J , Scott J , Wilson LE , Vaeth E , Lynfield R , Shaw KM , Vagnone PM , Bamberg WM , Janelle SJ , Dumyati G , Concannon C , Beldavs Z , Cunningham M , Cassidy PM , Phipps EC , Kenslow N , Travis T , Lonsway D , Rasheed JK , Limbago BM , Kallen AJ . JAMA 2015 314 (14) 1479-1487 IMPORTANCE: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly reported worldwide as a cause of infections with high-mortality rates. Assessment of the US epidemiology of CRE is needed to inform national prevention efforts. OBJECTIVE: To determine the population-based CRE incidence and describe the characteristics and resistance mechanism associated with isolates from 7 US geographical areas. DESIGN, SETTING, AND PARTICIPANTS: Population- and laboratory-based active surveillance of CRE conducted among individuals living in 1 of 7 US metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, and Oregon. Cases of CRE were defined as carbapenem-nonsusceptible (excluding ertapenem) and extended-spectrum cephalosporin-resistant Escherichia coli, Enterobacter aerogenes, Enterobacter cloacae complex, Klebsiella pneumoniae, or Klebsiella oxytoca that were recovered from sterile-site or urine cultures during 2012-2013. Case records were reviewed and molecular typing for common carbapenemases was performed. EXPOSURES: Demographics, comorbidities, health care exposures, and culture source and location. MAIN OUTCOMES AND MEASURES: Population-based CRE incidence, site-specific standardized incidence ratios (adjusted for age and race), and clinical and microbiological characteristics. Results: Among 599 CRE cases in 481 individuals, 520 (86.8%; 95% CI, 84.1%-89.5%) were isolated from urine and 68 (11.4%; 95% CI, 8.8%-13.9%) from blood. The median age was 66 years (95% CI, 62.1-65.4 years) and 284 (59.0%; 95% CI, 54.6%-63.5%) were female. The overall annual CRE incidence rate per 100000 population was 2.93 (95% CI, 2.65-3.23). The CRE standardized incidence ratio was significantly higher than predicted for the sites in Georgia (1.65 [95% CI, 1.20-2.25]; P < .001), Maryland (1.44 [95% CI, 1.06-1.96]; P = .001), and New York (1.42 [95% CI, 1.05-1.92]; P = .048), and significantly lower than predicted for the sites in Colorado (0.53 [95% CI, 0.39-0.71]; P < .001), New Mexico (0.41 [95% CI, 0.30-0.55]; P = .01), and Oregon (0.28 [95% CI, 0.21-0.38]; P < .001). Most cases occurred in individuals with prior hospitalizations (399/531 [75.1%; 95% CI, 71.4%-78.8%]) or indwelling devices (382/525 [72.8%; 95% CI, 68.9%-76.6%]); 180 of 322 (55.9%; 95% CI, 50.0%-60.8%) admitted cases resulted in a discharge to a long-term care setting. Death occurred in 51 (9.0%; 95% CI, 6.6%-11.4%) cases, including in 25 of 91 cases (27.5%; 95% CI, 18.1%-36.8%) with CRE isolated from normally sterile sites. Of 188 isolates tested, 90 (47.9%; 95% CI, 40.6%-55.1%) produced a carbapenemase. CONCLUSIONS AND RELEVANCE: In this population- and laboratory-based active surveillance system in 7 states, the incidence of CRE was 2.93 per 100000 population. Most CRE cases were isolated from a urine source, and were associated with high prevalence of prior hospitalizations or indwelling devices, and discharge to long-term care settings. |
Establishment of an Ebola treatment unit and laboratory - Bombali District, Sierra Leone, July 2014-January 2015
Gleason B , Redd J , Kilmarx P , Sesay T , Bayor F , Mozalevskis A , Connolly A , Akpablie J , Prybylski D , Moffett D , King M , Bass M , Joseph K , Jones J , Ocen F . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1108-1111 The first confirmed case of Ebola virus disease (Ebola) in Sierra Leone related to the ongoing epidemic in West Africa occurred in May 2014, and the outbreak quickly spread. To date, 8,704 Ebola cases and 3,955 Ebola deaths have been confirmed in Sierra Leone. The first Ebola treatment units (ETUs) in Sierra Leone were established in the eastern districts of Kenema and Kailahun, where the first Ebola cases were detected, and these districts were also the first to control the epidemic. By September and October 2014, districts in the western and northern provinces, including Bombali, had the highest case counts, but additional ETUs outside of the eastern province were not operational for weeks to months. Bombali became one of the most heavily affected districts in Sierra Leone, with 873 confirmed patients with Ebola during July-November 2014. The first ETU and laboratory in Bombali District were established in late November and early December 2014, respectively. T- evaluate the impact of the first ETU and laboratory becoming operational in Bombali on outbreak control, the Bombali Ebola surveillance team assessed epidemiologic indicators before and after the establishment of the first ETU and laboratory in Bombali. After the establishment of the ETU and laboratory, the interval from symptom onset to laboratory result and from specimen collection to laboratory result decreased. By providing treatment to Ebola patients and isolating contagious persons to halt ongoing community transmission, ETUs play a critical role in breaking chains of transmission and preventing uncontrolled spread of Ebola (4). Prioritizing and expediting the establishment of an ETU and laboratory by pre-positioning resources needed to provide capacity for isolation, testing, and treatment of Ebola are essential aspects of pre-outbreak planning. |
Characteristics of transgender women living with HIV receiving medical care in the United States
Mizuno Y , Frazier EL , Huang P , Skarbinski J . LGBT Health 2015 2 (3) 228-234 PURPOSE: Little has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs. METHODS: We used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests. RESULTS: An estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing. CONCLUSION: We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further. |
Co-trimoxazole prophylaxis in adults, including pregnant women, with HIV: a systematic review and meta-analysis
Suthar AB , Vitoria MA , Nagata JM , Anglaret X , Mbori-Ngacha D , Sued O , Kaplan JE , Doherty MC . Lancet HIV 2015 2 (4) e137-50 INTRODUCTION: Co-trimoxazole prophylaxis is used to reduce morbidity and mortality in people with HIV. We systematically reviewed three topics related to co-trimoxazole prophylaxis to update WHO guidelines: initiation, discontinuation, and dose. METHODS: We searched PubMed, Embase, WHO Global Index Medicus, and clinical trial registries in November, 2013, for randomised controlled trials and observational studies including co-trimoxazole prophylaxis and a comparator group. Studies were eligible if they reported death, WHO clinical stage 3 or 4 events, admittance to hospital, severe bacterial infections, tuberculosis, pneumonia, diarrhoea, malaria, or treatment-limiting adverse events. Infant mortality, low birthweight, and placental malaria were additional outcomes for the comparison of co-trimoxazole prophylaxis and intermittent preventive treatment for malaria in pregnant women (IPTp). We compared a dose of 480 mg co-trimoxazole once a day with one of 960 mg co-trimoxazole once a day. We used a 10% margin for non-inferiority and equivalence analyses. We used random-effects models for all meta-analyses. This study is registered with PROSPERO, number CRD42014007163. FINDINGS: 19 articles, published from 1995 to 2014 and including 35 328 participants, met the inclusion criteria. Co-trimoxazole prophylaxis reduced rates of death (hazard ratio [HR] 0.40, 95% CI 0.26-0.64) when started at CD4 counts of 350 cells per muL or lower with antiretroviral therapy (ART) worldwide. Co-trimoxazole prophylaxis started at higher than 350 cells per muL without ART reduced rates of death (0.50, 0.30-0.83) and malaria (0.25, 0.10-0.57) in Africa. Co-trimoxazole prophylaxis was non-inferior to IPTp with respect to infant mortality (risk difference [RD] -0.05, 95% CI -0.12 to 0.02), low birthweight (0.00, -0.07 to 0.07), and placental malaria (0.00, -0.10 to 0.10). Co-trimoxazole prophylaxis continuation after ART-induced recovery with CD4 counts higher than 350 cells per muL reduced admittances to hospital (HR 0.42, 95% CI 0.22-0.80), pneumonia (0.73, 0.61-0.88), malaria (0.03, 0.01-0.10), and diarrhoea (0.61, 0.48-0.78) in Africa. A dose of 480 mg co-trimoxazole prophylaxis once a day did not reduce treatment-limiting adverse events compared with 960 mg once a day (RD -0.07, 95% CI -0.52 to 0.39). INTERPRETATION: Co-trimoxazole prophylaxis should be given with ART in people with CD4 counts of 350 cells per muL or lower in low-income and middle-income countries. Co-trimoxazole prophylaxis should be provided irrespective of CD4 count in settings with a high burden of infectious diseases. Pregnant women with HIV in Africa should use co-trimoxazole rather than IPTp to prevent malaria complications in infants. Further research is needed to inform dose optimisation and co-trimoxazole use in the context of expanded ART in different epidemiological settings. FUNDING: None. |
A cross-sectional study of the magnitude, barriers, and outcomes of HIV status disclosure among women participating in a perinatal HIV transmission study, "the Nevirapine Repeat Pregnancy study"
Kiweewa FM , Bakaki PM , McConnell MS , Musisi M , Namirembe C , Nakayiwa F , Kusasira F , Nakintu D , Mubiru MC , Musoke P , Fowler MG . BMC Public Health 2015 15 (1) 988 BACKGROUND: HIV status disclosure is a difficult emotional task for HIV-infected persons and may create the opportunity for both social support and rejection. In this study, we evaluated the proportions, patterns, barriers and outcomes of HIV- 1 status disclosure among a group of women in Uganda. METHODS: An exit interview was conducted one year post-partum for 85 HIV-infected women who participated in a study of HIV-1 transmission rates among NVP-experienced compared with NVP-naive women in "The Nevirapine Repeat Pregnancy (NVP-RP) Study" at the Makerere University-Johns Hopkins University Research Collaboration, Kampala-Uganda, between June 2004 and June 2006. RESULTS: Of the 85 women interviewed, 99 % had disclosed their HIV status to at least one other person. Disclosure proportions ranged between 1 % to employer(s) and 69 % to a relative other than a parent. Only 38 % of the women had disclosed to their sex partners. Women with an HIV-infected baby were more likely than those with an uninfected baby to disclose to their sex partner, OR 4.9 (95 % CI, 2.0 -11.2), and women were less likely to disclose to a partner if they had previously disclosed to another relative than if they had not, OR 0.19 (95 % CI, 0.14-0.52). The most common reasons for non-disclosure included fear of separation from the partner and subsequent loss of financial support 34 %, and not living with the partner (not having opportunities to disclose) 26 %. While most women (67 %) reported getting social support following disclosure, 22 % reported negative outcomes (neglect, separation from their partners, and loss of financial support). Following disclosure of HIV status, 9 % of women reported that their partner (s) decided to have an HIV test. CONCLUSION: Results from this study show high overall HIV disclosure proportions and how this disclosure of HIV status can foster social support. However, proportions of disclosure specifically to male sex partners were low, which suggests the need for interventions aimed at increasing male involvement in perinatal care, along with supportive counseling. |
Cytomegalovirus IgG level and avidity in breastfeeding infants of HIV-infected mothers in Malawi
Kourtis AP , Wiener J , Chang TS , Dollard SC , Amin MM , Ellington S , Kayira D , van der Horst C , Jamieson DJ . Clin Vaccine Immunol 2015 22 (12) 1222-6 BACKGROUND: Cytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated results with presence of detectable CMV DNA in the blood. METHODS: The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither, for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth, 24 and 48 weeks of age. RESULTS: Ninety four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infection. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infection. Taken together, the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG, most of them (70.9%) of high avidity. CONCLUSIONS: CMV serology and avidity testing, combined with PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. CMV PCR in the blood detected most, but not all infant CMV infections. |
Diagnoses and prevalence of HIV infection among Hispanics or Latinos - United States, 2008-2013
Gray KM , Valverde EE , Tang T , Siddiqi AE , Hall HI . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1097-1103 Hispanics or Latinos represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States. In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6). To better characterize HIV infection among Hispanics or Latinos aged >/=13 years in the United States, CDC analyzed data from the National HIV Surveillance System (NHSS). During 2008-2013, the rate of diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (estimated annual percentage change [EAPC] = -3.6); however, the number of diagnoses among males with infection attributed to male-to-male sexual contact increased 16%, from 6,141 in 2008 to 7,098 in 2013 (EAPC = 3.0). In 2013, the rate of diagnosis of HIV infection among males (41.3) was six times the rate among females (6.8). During 2008-2013, behavioral risk factors for HIV infection among Hispanics or Latino differed among males and females and by place of birth. Among Hispanic or Latino males born in Puerto Rico, the proportion of HIV infections attributed to injection drug use (24.9%) was greater than among those born elsewhere. Among HIV-infected Hispanic or Latino females, those born in the United States (21.2%) and Puerto Rico (20.5%) had a greater proportion of HIV infections attributed to injection drug use than those born elsewhere. Additional interventions and public health strategies to further decrease the rates of HIV among the Hispanic or Latino population are needed. |
Supporting the whole child through coordinated policies, processes, and practices
Murray SD , Hurley J , Ahmed SR . J Sch Health 2015 85 (11) 795-801 BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model provides a framework for promoting greater alignment, integration, and collaboration between health and education across the school setting and improving students' cognitive, physical, social, and emotional development. By providing a learning environment that ensures each student is emotionally and physically healthy, safe, actively engaged, supported, and challenged, the WSCC model presents a framework for school systems to evaluate, streamline, implement, and sustain policies, processes, and practices. METHODS: This article examines the essential roles of the school district and of schools in aligning, developing, and implementing policy, processes, and practices to create optimal learning environments that support the whole child. RESULTS: Three key factors advance efforts to align policies, processes, and practices. These include hiring a coordinator at the district and school levels, having collaborative teams address health and learning at the district and school levels, and using data to make decisions and build health outcomes into school and district accountability systems. CONCLUSIONS: These key factors provide a road map for successfully implementing WSCC. More research is needed to determine the extent that coordinators, collaborative teams, and the inclusion of health indicators in accountability systems impact student health and learning. |
What have we learned from collaborative partnerships to concomitantly improve both education and health?
Kolbe LJ , Allensworth DD , Potts-Datema W , White DR . J Sch Health 2015 85 (11) 766-74 BACKGROUND: Collaborative partnerships are an essential means to concomitantly improve both education outcomes and health outcomes among K-12 students. METHODS: We describe examples of contemporaneous, interactive, and evolving partnerships that have been implemented, respectively, by a national governmental health organization, national nongovernmental education and health organizations, a state governmental education organization, and a local nongovernmental health organization that serves partner schools. RESULTS: Each of these partnerships strategically built operational infrastructures that enabled partners to efficiently combine their resources to improve student education and health. CONCLUSIONS: To implement a Whole School, Whole Community, Whole Child Framework, we need to purposefully strengthen, expand, and interconnect national, state, and local collaborative partnerships and supporting infrastructures that concomitantly can improve both education and health. |
A Whole School approach: collaborative development of school health policies, processes, and practices
Hunt P , Barrios L , Telljohann SK , Mazyck D . J Sch Health 2015 85 (11) 802-9 BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model shows the interrelationship between health and learning and the potential for improving educational outcomes by improving health outcomes. However, current descriptions do not explain how to implement the model. METHODS: The existing literature, including scientific articles, programmatic guidance, and publications by national agencies and organizations, was reviewed and synthesized to describe an overview of interrelatedness of learning and health and the 10 components of the WSCC model. RESULTS: The literature suggests potential benefits of applying the WSCC model at the district and school level. But, the model lacks specific guidance as to how this might be made actionable. A collaborative approach to health and learning is suggested, including a 10-step systematic process to help schools and districts develop an action plan for improving health and education outcomes. Essential preliminary actions are suggested to minimize the impact of the challenges that commonly derail systematic planning processes and program implementation, such as lack of readiness, personnel shortages, insufficient resources, and competing priorities. CONCLUSIONS: All new models require testing and evidence to confirm their value. District and schools will need to test this model and put plans into action to show that significant, substantial, and sustainable health and academic outcomes can be achieved. |
The Whole School, Whole Community, Whole Child model: a new approach for improving educational attainment and healthy development for students
Lewallen TC , Hunt H , Potts-Datema W , Zaza S , Giles W . J Sch Health 2015 85 (11) 729-39 BACKGROUND: The Whole Child approach and the coordinated school health (CSH) approach both address the physical and emotional needs of students. However, a unified approach acceptable to both the health and education communities is needed to assure that students are healthy and ready to learn. METHODS: During spring 2013, the ASCD (formerly known as the Association for Supervision and Curriculum Development) and the US Centers for Disease Control and Prevention (CDC) convened experts from the field of education and health to discuss lessons learned from implementation of the CSH and Whole Child approaches and to explore the development of a new model that would incorporate the knowledge gained through implementation to date. RESULTS: As a result of multiple discussions and review, the Whole School, Whole Community, Whole Child (WSCC) approach was developed. The WSCC approach builds upon the traditional CSH model and ASCD's Whole Child approach to learning and promotes greater alignment between health and educational outcomes. CONCLUSION: By focusing on children and youth as students, addressing critical education and health outcomes, organizing collaborative actions and initiatives that support students, and strongly engaging community resources, the WSCC approach offers important opportunities that will improve educational attainment and healthy development for students. |
Communicating with school staff about sexual identity, health and safety: an exploratory study of the experiences and preferences of black and Latino teen young men who have sex with men
Lesesne CA , Rasberry CN , Kroupa E , Topete P , Carver LH , Morris E , Robin L . LGBT Health 2015 2 (3) 258-264 PURPOSE: This exploratory study examined the experiences of black and Latino teen young men who have sex with men (YMSM) and their preferences for communication with school staff about matters related to sexual orientation. METHODS: Participants for this study were recruited in three urban centers in the United States and by multiple community-based organizations serving black and Latino YMSM. Eligible youth were male, black or Latino, ages 13-19, enrolled in 90 days of school in the previous 18 months, and reported attraction to or sexual behavior with other males, or identified as gay or bisexual. Participants completed Web-based questionnaires (n=415) and/or in-depth interviews (n=32). RESULTS: Questionnaire participants reported willingness to talk to at least one school staff member about: safety, dating and relationships, and feeling attracted to other guys (63.4%, 58.4%, and 55.9%, respectively). About one-third of the sample reported they would not talk with any school staff about these topics. Exploratory analyses revealed youth who experienced feeling unsafe at school and who had higher levels of trust in the information provided by school staff were more likely to be willing to talk with school staff about safety issues, dating, or same sex attraction (aOR=2.80 and aOR=4.85, respectively). Interview participants reported being most willing to talk to staff who (1) were able and willing to help them; (2) would keep discussions confidential, and (3) expressed genuine care. Preferences for confiding in school staff perceived to be LGBT and having similar racial/ethnic background were also noted. CONCLUSION: Findings suggest school staff can serve as points of contact for reaching YMSM and professional development and interventions can be tailored to reach YMSM and connect them to services they need. Additional research is needed to understand how to increase YMSM comfort talking with school staff about sexual health or sexual identity concerns. |
Critical connections: health and academics
Michael SL , Merlo CL , Basch CE , Wentzel KR , Wechsler H . J Sch Health 2015 85 (11) 740-58 BACKGROUND: While it is a national priority to support the health and education of students, these sectors must better align, integrate, and collaborate to achieve this priority. This article summarizes the literature on the connection between health and academic achievement using the Whole School, Whole Community, and Whole Child (WSCC) framework as a way to address health-related barriers to learning. METHODS: A literature review was conducted on the association between student health and academic achievement. RESULTS: Most of the evidence examined the association between student health behaviors and academic achievement, with physical activity having the most published studies and consistent findings. The evidence supports the need for school health services by demonstrating the association between chronic conditions and decreased achievement. Safe and positive school environments were associated with improved health behaviors and achievement. Engaging families and community members in schools also had a positive effect on students' health and achievement. CONCLUSIONS: Schools can improve the health and learning of students by supporting opportunities to learn about and practice healthy behaviors, providing school health services, creating safe and positive school environments, and engaging families and community. This evidence supports WSCC as a potential framework for achieving national educational and health goals. |
Environmental exposure to manganese in air: associations with tremor and motor function
Bowler RM , Beseler CL , Gocheva VV , Colledge M , Kornblith ES , Julian JR , Kim Y , Bollweg G , Lobdell DT . Sci Total Environ 2015 541 646-654 BACKGROUND: Manganese (Mn) inhalation has been associated with neuropsychological and neurological sequelae in exposed workers. Few environmental epidemiologic studies have examined the potentially neurotoxic effects of Mn exposure in ambient air on motor function and hand tremor in adult community residents. Mn exposed residents were recruited in two Ohio towns: Marietta, a town near a ferro-manganese smelter, and East Liverpool, a town adjacent to a facility processing, crushing, screening, and packaging Mn products. METHODS: Chronic (≥10years) exposure to ambient air Mn in adult residents and effects on neuropsychological and neurological outcomes were investigated. Participants from Marietta (n=100) and East Liverpool (n=86) were combined for analyses. AERMOD dispersion modeling of fixed-site outdoor air monitoring data estimated Mn inhalation over a ten year period. Adult Mn-exposed residents' psychomotor ability was assessed using Finger Tapping, Hand Dynamometer, Grooved Pegboard, and the Computerized Adaptive Testing System (CATSYS) Tremor system. Bayesian structural equation modeling was used to assess associations between air-Mn and motor function and tremor. RESULTS: Air-Mn exposure was significantly correlated in bivariate analyses with the tremor test (CATSYS) for intensity, center frequency and harmonic index. The Bayesian path analysis model showed associations of air-Mn with the CATSYS non-dominant center frequency and harmonic index; while the Bayesian structural equation model revealed associations between air-Mn and lower Finger Tapping scores. Household income was significantly associated with motor dysfunction but not with tremor. CONCLUSION: Tremor and motor function were associated with higher exposure to airborne Mn. |
Associations of birth outcomes with maternal polybrominated diphenyl ethers and thyroid hormones during pregnancy
Miranda ML , Anthopolos R , Wolkin A , Stapleton HM . Environ Int 2015 85 244-253 BACKGROUND: Previous research has linked polybrominated diphenyl ether (PBDE) exposure to poor birth outcomes and altered thyroid hormone levels. OBJECTIVES: We examined whether maternal PBDE serum levels were associated with infant birth weight (g), head circumference (cm), birth length (cm), and birth weight percentile for gestational age. We explored the potential for a mediating role of thyroid hormone levels. METHODS: During 2008-2010, we recruited 140 pregnant women in their third trimester as part of a larger clinical obstetrics study known as Healthy Pregnancy, Healthy Baby. Blood samples were collected during a routine prenatal clinic visit. Serum was analyzed for PBDEs, phenolic metabolites, and thyroid hormones. Birth outcome information was abstracted from medical records. RESULTS: In unadjusted models, a two-fold increase in maternal BDE 153 was associated with an average decrease in head circumference of 0.32cm (95% CI: -0.53, -0.12); however, this association was attenuated after control for maternal risk factors. BDE 47 and 99 were similarly negatively associated but with 95% confidence intervals crossing the null. Associations were unchanged in the presence of thyroid hormones. CONCLUSIONS: Our data suggest a potential deleterious association between maternal PBDE levels and infant head circumference; however, confirmatory studies are needed in larger sample sizes. A mediating role of thyroid hormones was not apparent. |
Biomonitoring of polycyclic aromatic hydrocarbons exposure in small groups of residents in Brisbane, Australia and Hanoi, Vietnam, and those travelling between the two cities
Thai PK , Li Z , Sjodin A , Fox A , Diep NB , Binh TT , Mueller JF . Chemosphere 2015 139 358-64 Exposure to polycyclic aromatic hydrocarbons (PAHs) has been associated with adverse health outcomes. Concentrations of urinary PAH metabolites (OH-PAHs) provide an integrated measure of human exposure to PAHs but measurement of urinary OH-PAHs has not been done in Australia and rarely in Vietnam, where air pollution is of concern. In this study, we assessed exposure to PAHs in 16 participants living in Brisbane, Australia and Hanoi, Vietnam, with 4 participants travelling between the two cities during the monitoring period. A total of 312 first morning urine samples were collected over 10weeks and were analysed for nine OH-PAHs. Concentrations of the urinary OH-PAHs were 2-10 times higher in participants from Hanoi than those from Brisbane. For example, the median concentrations of 1-hydroxypyrene were 292pg/mL in Hanoi, compared to 64pg/mL in Brisbane. For participants travelling from Brisbane to Hanoi and back, differences in exposure to PAHs in these two cities resulted in corresponding changes of urinary OH-PAH concentrations, demonstrating that the more polluted environment in Hanoi was likely the source for higher PAH exposure there. |
Nocardia arizonensis sp. nov., obtained from human respiratory specimens.
Lasker BA , Bell M , Klenk HP , Schumann P , Brown JM . Antonie Van Leeuwenhoek 2015 108 (5) 1129-37 In 2008, three clinical isolates (W9405T, W9409 and W9575) were obtained from bronchial wash or sputum specimens from patients from the state of Arizona and characterised by polyphasic analysis. All three clinical isolates 16S rRNA gene sequences were found to be 100 % identical to each other and showed the strains belong in the genus Nocardia. BLASTn searches in the GenBank database of near full-length 16S rRNA gene sequences showed the highest sequence similarities to the type strains of Nocardia takedensis (98.3 %, sequence similarity), Nocardia lijiangensis (97.4 %), Nocardia harenae (97.4 %), and Nocardia xishanensis (97.1 %). The DNA-DNA relatedness between isolate W9405T and the type strain of N. takedensis is 26.0 +/- 2.4 % when measured in silico using genomic DNA sequences. The G+C content of isolate W9405T is 68.6 mol%. Chemotaxonomic analyses of the clinical isolates were consistent with their assignment to the genus Nocardia: whole cell hydrolysates contain meso-diaminopimelic acid as the diagnostic diamino acid of peptidoglycan; the whole-cell sugars are arabinose and galactose; the predominant phospholipids include diphosphatidylglycerol, phosphatidylethanolamine and phosphatidylinositol; MK-8-(H4) omega-cyc as the major menaquinone; mycolic acids ranging from 38 to 62 carbon atoms; and palmitic acid, tuberculostearic acid, palmitelaidic acid and oleic acid are the major fatty acids. Genus and species specific profiles were obtained following analysis by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectra of the clinical isolates. All isolates were found to be intermediately resistant or resistant to minocycline and resistant to ciprofloxacin but were susceptible to amikacin, imipenem and linezolid. Our polyphasic analysis suggest the three clinical isolates obtained from patients in Arizona represent a novel species of Nocardia for which we propose the name Nocardia arizonensis, with strain W9405T (=DSM 45748T = CCUG 62754T = NBRC 108935T) as the type strain. |
Rabovirus: a proposed new picornavirus genus that is phylogenetically basal to enteroviruses and sapeloviruses.
Ng TF , Sachsenroder J , Reuter G , Knowles NJ , Delwart E , Johne R . Arch Virol 2015 160 (10) 2569-75 We have sequenced the genome of a novel picornavirus, rabovirus A (rat-borne virus, RaBoV-A, NC_026314), which was present in the feces of a Norway rat (Rattus norvegicus) from Berlin, Germany. This virus is related to members of the genera Enterovirus and Sapelovirus. RaboV-A contains a type II IRES that is unlike the type I IRES elements of enteroviruses and the type IV elements of sapeloviruses. Its genome is marked by an L protein and a chymotrypsin-like 2A protease. Our analysis of genome organization, pairwise identities, motif, phylogenic and UTR (GIMPU) indicates that RaBoV-A potentially represents a new picornavirus genus, for which we propose the name "Rabovirus". Spread by their rodent hosts and detected in New York and Berlin rats, these viruses may have a wide geographic distribution. |
Health and economic impact of switching from a 4-valent to a 9-valent HPV vaccination program in the United States
Brisson M , Laprise JF , Chesson HW , Drolet M , Malagon T , Boily MC , Markowitz LE . J Natl Cancer Inst 2016 108 (1) BACKGROUND: Randomized clinical trials have shown the 9-valent human papillomavirus (HPV) vaccine to be highly effective against types 31/33/45/52/58 compared with the 4-valent. Evidence on the added health and economic benefit of the 9-valent is required for policy decisions. We compare population-level effectiveness and cost-effectiveness of 9- and 4-valent HPV vaccination in the United States. METHODS: We used a multitype individual-based transmission-dynamic model of HPV infection and disease (anogenital warts and cervical, anogenital, and oropharyngeal cancers), 3% discount rate, and societal perspective. The model was calibrated to sexual behavior and epidemiologic data from the United States. In our base-case, we assumed 95% vaccine-type efficacy, lifelong protection, and a cost/dose of $145 and $158 for the 4- and 9-valent vaccine, respectively. Predictions are presented using the mean (80% uncertainty interval [UI] = 10(th)-90(th) percentiles) of simulations. RESULTS: Under base-case assumptions, the 4-valent gender-neutral vaccination program is estimated to cost $5500 (80% UI = 2400-9400) and $7300 (80% UI = 4300-11 000)/quality-adjusted life-year (QALY) gained with and without cross-protection, respectively. Switching to a 9-valent gender-neutral program is estimated to be cost-saving irrespective of cross-protection assumptions. Finally, the incremental cost/QALY gained of switching to a 9-valent gender-neutral program (vs 9-valent girls/4-valent boys) is estimated to be $140 200 (80% UI = 4200->1 million) and $31 100 (80% UI = 2100->1 million) with and without cross-protection, respectively. Results are robust to assumptions about HPV natural history, screening methods, duration of protection, and healthcare costs. CONCLUSIONS: Switching to a 9-valent gender-neutral HPV vaccination program is likely to be cost-saving if the additional cost/dose of the 9-valent is less than $13. Giving females the 9-valent vaccine provides the majority of benefits of a gender-neutral strategy. |
Nearly half of US adults living with HIV received federal disability benefits in 2009
Huang YL , Frazier EL , Sansom SL , Farnham PG , Shrestha RK , Hutchinson AB , Fagan JL , Viall AH , Skarbinski J . Health Aff (Millwood) 2015 34 (10) 1657-65 The effects of HIV infection on national labor-force participation have not been rigorously evaluated. Using data from the Medical Monitoring Project and the National Health Interview Survey, we present nationally representative estimates of the receipt of disability benefits by adults living with HIV receiving care compared with the general US adult population. We found that in 2009, adults living with HIV were nine times more likely than adults in the general population to receive disability benefits. The risk of being on disability is also greater for younger and more educated adults living with HIV compared to the general population, which suggests that productivity losses can result from HIV infection. To prevent disability, early diagnosis and treatment of HIV are essential. This study offers a baseline against which to measure the impacts of recently proposed or enacted changes to Medicaid and private insurance markets, including the Affordable Care Act and proposed revisions to the Social Security Administration's HIV Infection Listings. |
Estimated lifetime medical and work-loss costs of emergency department-treated nonfatal injuries - United States, 2013
Florence C , Haegerich T , Simon T , Zhou C , Luo F . MMWR Morb Mortal Wkly Rep 2015 64 (38) 1078-82 A large number of nonfatal injuries are treated in U.S. emergency departments (EDs) every year. CDC's National Center for Health Statistics estimates that approximately 29% of all ED visits in 2010 were for injuries. To assess the economic impact of ED-treated injuries, CDC examined injury data from the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP) for 2013, as well as injury-related lifetime medical and work-loss costs from the Web-Based Injury Statistics Query and Reporting System (WISQARS). NEISS-AIP collects data from a nationally representative sample of EDs, using specific guidelines for recording the primary diagnosis and mechanism of injury. Number of injuries, crude- and age-specific injury rates, and total lifetime work-loss costs and medical costs were calculated for ED-treated injuries, stratified by sex, age groups, and intent and mechanism of injury. ED-treated injuries were further classified as those that were subsequently hospitalized or treated and released. The rate of hospitalized injuries was 950.8 per 100,000, and the rate of treated and released injuries was 8,549.8 per 100,000. Combined medical and work-loss costs for all ED-treated injuries (both hospitalized and treated and released) were $456.9 billion, or approximately 68% of the total costs of $671 billion associated with all fatal and ED-treated injuries. The substantial economic burden associated with nonfatal injuries underscores the need for effective prevention strategies. |
Estimated lifetime medical and work-loss costs of fatal injuries - United States, 2013
Florence C , Simon T , Haegerich T , Luo F , Zhou C . MMWR Morb Mortal Wkly Rep 2015 64 (38) 1074-7 Injury-associated deaths have substantial economic consequences. In 2013, unintentional injury was the fourth leading cause of death, suicide was the tenth, and homicide was the sixteenth; these three causes accounted for approximately 187,000 deaths in the United States. To assess the economic impact of fatal injuries, CDC analyzed death data from the National Vital Statistics System for 2013, along with cost of injury data using the Web-Based Injury Statistics Query and Reporting System. This report updates a previous study that analyzed death data from the year 2000, and employs recently revised methodology for determining the costs of injury outcomes, which uses the most current economic data and incorporates improvements for estimating medical costs associated with injury. Number of deaths, crude and age-specific death rates, and total lifetime work-loss costs and medical costs were calculated for fatal injuries by sex, age group, intent (intentional versus unintentional), and mechanism of injury. During 2013, the rate of fatal injury was 61.0 per 100,000 population, with combined medical and work-loss costs exceeding $214 billion. Costs from fatal injuries represent approximately one third of the total $671 billion medical and work-loss costs associated with all injuries in 2013. The magnitude of the economic burden associated with injury-associated deaths underscores the need for effective prevention. |
Text message reminders for timely routine MMR vaccination: a randomized controlled trial
Hofstetter AM , DuRivage N , Vargas CY , Camargo S , Vawdrey DK , Fisher A , Stockwell MS . Vaccine 2015 33 (43) 5741-5746 OBJECTIVE: Measles-mumps-rubella (MMR) vaccination is important for preventing disease outbreaks, yet pockets of under-vaccination persist. Text message reminders have been employed successfully for other pediatric vaccines, but studies examining their use for MMR vaccination are limited. This study assessed the impact of text message reminders on timely MMR vaccination. STUDY DESIGN: Parents (n=2054) of 9.5-10.5-month-old children from four urban academically-affiliated pediatric clinics were randomized to scheduling plus appointment text message reminders, appointment text message reminder-only, or usual care. The former included up to three text reminders to schedule the one-year preventive care visit. Both text messaging arms included a text reminder sent 2 days before that visit. Outcomes included appointment scheduling, appointment attendance, and MMR vaccination by age 13 months, the standard of care at study sites. RESULTS: Children of parents in the scheduling plus appointment text message reminders arm were more likely to have a scheduled one-year visit than those in the other arms (71.9% vs. 67.4%, relative risk ratio (RRR) 1.07 [95% CI 1.005-1.13]), particularly if no appointment was scheduled before randomization (i.e., no baseline appointment) (62.1% vs. 54.7%, RRR 1.14 [95% CI 1.04-1.24]). One-year visit attendance and timely MMR vaccination were similar between arms. However, among children without a baseline appointment, those with parents in the scheduling plus appointment text message reminders arm were more likely to undergo timely MMR vaccination (61.1% vs. 55.1%, RRR 1.11 [95% CI 1.01-1.21]). CONCLUSION: Text message reminders improved timely MMR vaccination of high-risk children without a baseline one-year visit. |
Measles outbreak associated with vaccine failure in adults - Federated States of Micronesia, February-August 2014
Breakwell L , Moturi E , Helgenberger L , Gopalani SV , Hales C , Lam E , Sharapov U , Larzelere M , Johnson E , Masao C , Setik E , Barrow L , Dolan S , Chen TH , Patel M , Rota P , Hickman C , Bellini W , Seward J , Wallace G , Papania M . MMWR Morb Mortal Wkly Rep 2015 64 (38) 1088-92 On May 15, 2014, CDC was notified of two laboratory-confirmed measles cases in the Federated States of Micronesia (FSM), after 20 years with no reported measles. FSM was assisted by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and CDC in investigating suspected cases, identify contacts, conduct analyses to guide outbreak vaccination response, and review vaccine cold chain practices. During February-August, three of FSM's four states reported measles cases: Kosrae (139 cases), Pohnpei (251), and Chuuk (3). Two thirds of cases occurred among adults aged >/=20 years; of these, 49% had received >/=2 doses of measles-containing vaccine (MCV). Apart from infants aged <12 months who were too young for routine vaccination, measles incidence was lower among children than adults. A review of current cold chain practices in Kosrae revealed minor weaknesses; however, an absence of historical cold chain maintenance records precluded an evaluation of earlier problems. Each state implemented vaccination campaigns targeting children as young as age 6 months through adults up to age 57 years. The preponderance of cases in this outbreak associated with vaccine failure in adults highlights the need for both thorough case investigation and epidemiologic analysis to guide outbreak response vaccination. Routine childhood vaccination coverage achieved in recent years limited the transmission of measles among children. Even in areas where transmission has not occurred for years, maintaining high 2-dose MCV coverage through routine and supplemental immunization is needed to prevent outbreaks resulting from increased measles susceptibility in the population. |
Effectiveness and cost of bidirectional text messaging for adolescent vaccines and well care
O'Leary ST , Lee M , Lockhart S , Eisert S , Furniss A , Barnard J , Shmueli D , Stokley S , Dickinson LM , Kempe A . Pediatrics 2015 136 (5) e1220-7 OBJECTIVE: To evaluate the effectiveness and cost of bidirectional short messaging service in increasing rates of vaccination and well child care (WCC) among adolescents. METHODS: We included all adolescents needing a recommended adolescent vaccine (n = 4587) whose parents had a cell-phone number in 5 private and 2 safety-net pediatric practices. Adolescents were randomized to intervention (n = 2228) or control (n = 2359). Parents in the intervention group received up to 3 personalized short messaging services with response options 1 (clinic will call to schedule), 2 (parent will call clinic), or STOP (no further short messaging service). Primary outcomes included completion of all needed services, WCC only, all needed vaccinations, any vaccination, and missed opportunity for vaccination. RESULTS: Intervention patients were more likely to complete all needed services (risk ratio [RR] 1.31, 95% confidence interval [CI] 1.12-1.53), all needed vaccinations (RR 1.29, 95% CI 1.12-1.50), and any vaccination (RR 1.36, 95% CI 1.20-1.54). Seventy-five percent of control patients had a missed opportunity versus 69% of intervention (P = .002). There was not a significant difference for WCC visits. Responding that the clinic should call to schedule ("1") was associated with the highest effect size for completion of all needed services (RR 1.89, 95% CI 1.41-2.54). Net cost ranged from $855 to $3394 per practice. CONCLUSIONS: Bidirectional short messaging service to parents was effective at improving rates for all adolescent vaccinations and for all needed services, especially among parents who responded they desired a call from the practice. |
Enhancing vaccine safety capacity globally: a lifecycle perspective
Chen RT , Shimabukuro TT , Martin DB , Zuber PL , Weibel DM , Sturkenboom M . Vaccine 2015 33 Suppl 4 D46-54 Major vaccine safety controversies have arisen in several countries beginning in the last decades of 20th century. Such periodic vaccine safety controversies are unlikely to go away in the near future as more national immunization programs mature with near elimination of target vaccine-preventable diseases that result in relative greater prominence of adverse events following immunizations, both true reactions and temporally coincidental events. There are several ways in which vaccine safety capacity can be improved to potentially mitigate the impact of future vaccine safety controversies. This paper aims to take a "lifecycle" approach, examining some potential pre- and post-licensure opportunities to improve vaccine safety, in both developed (specifically U.S. and Europe) and low- and middle-income countries. |
Influenza vaccine effectiveness in a low-income, urban community cohort
Smithgall M , Vargas CY , Reed C , Finelli L , LaRussa P , Larson E , Saiman L , Stockwell MS . Clin Infect Dis 2015 62 (3) 358-360 In this community-based cohort study of 275 primarily low-income, urban households in New York City, overall 2013-14 influenza vaccine effectiveness (VE) was 62.5% (95% CI 21.7 to 82.0). VE point estimates were highest against 2009 H1N1 and for those vaccinated in 2013-14 but not also vaccinated in 2012-13. |
Association between hospitalization with community-acquired laboratory-confirmed influenza pneumonia and prior receipt of influenza vaccination
Grijalva CG , Zhu Y , Williams DJ , Self WH , Ampofo K , Pavia AT , Stockmann CR , McCullers J , Arnold SR , Wunderink RG , Anderson EJ , Lindstrom S , Fry AM , Foppa IM , Finelli L , Bramley AM , Jain S , Griffin MR , Edwards KM . JAMA 2015 314 (14) 1488-1497 IMPORTANCE: Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection. OBJECTIVE: To assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia. DESIGN, SETTING, AND PARTICIPANTS: The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 at 4 US sites. In this case-control study, we used EPIC data from patients 6 months or older with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (case) and influenza-negative (control) patients with pneumonia, controlling for demographics, comorbidities, season, study site, and timing of disease onset. Vaccine effectiveness was estimated as (1 - adjusted odds ratio) x 100%. EXPOSURE: Influenza vaccination, verified through record review. MAIN OUTCOMES AND MEASURES: Influenza pneumonia, confirmed by real-time reverse-transcription polymerase chain reaction performed on nasal/oropharyngeal swabs. RESULTS: Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) had laboratory-confirmed influenza. Twenty-eight of 162 cases (17%) with influenza-associated pneumonia and 766 of 2605 controls (29%) with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI, 0.28-0.68; estimated vaccine effectiveness, 56.7%; 95% CI, 31.9%-72.5%). CONCLUSIONS AND RELEVANCE: Among children and adults hospitalized with community-acquired pneumonia, those with laboratory-confirmed influenza-associated pneumonia, compared with those with pneumonia not associated with influenza, had lower odds of having received influenza vaccination. |
Characteristics of travelers to Asia requiring multidose vaccine schedules: Japanese encephalitis and rabies prevention
Walker XJ , Barnett ED , Wilson ME , Macleod WB , Jentes ES , Karchmer AW , Hamer DH , Chen LH . J Travel Med 2015 22 (6) 403-9 BACKGROUND: Japanese encephalitis (JE) and rabies are serious vaccine preventable diseases which are an important consideration for travelers to Asia. METHODS: Five Boston-area travel clinics collected demographic data, trip information, and interventions for travelers to Asia seen at pre-travel consultations from March 1, 2008, through July 31, 2010. We evaluated travelers for proportion vaccinated for JE and rabies, those traveling for >1 month, and whether travelers had adequate time to complete the JE series (clinic visit ≥28 days before departure) and rabies pre-exposure prophylaxis (clinic visit ≥21 days before departure). RESULTS: Among 15,440 travelers from five Boston Area Travel Medicine Network travel clinics, Asia was the most common destination region, visited by 5,582 (36%) of travelers. Among these travelers, 4,810 (86%) planned to travel to only one Asian subregion. Median trip duration was 17 days, with more than 20% traveling for >1 month. The most common destinations were South (41%), Southeast (26%), and East (23%) Asia. Of those traveling to South, Southeast, or East Asia, over one-third with trips >1 month had insufficient time to complete a series for either JE or rabies vaccine. Overall, only 10% of travelers were vaccinated (past and pre-travel visit) for either JE or rabies, with lowest percentages among travelers visiting friends and relatives. Most travelers received advice on vector precautions (96%) and rabies prevention, which included avoiding animal contact, washing wounds, and obtaining appropriate post-exposure prophylaxis (88%). CONCLUSION: Given the insufficient time for completion and relatively low vaccination rates, greater awareness of earlier pre-travel consultations, at least 4-6 weeks before travel, and accurate risk assessment for travelers are important. Effective counseling about vector avoidance, rabies, and animal bite prevention and management remains critical. |
The Nanomaterial Data Curation Initiative: a collaborative approach to assessing, evaluating, and advancing the state of the field
Hendren CO , Powers CM , Hoover MD , Harper SL . Beilstein J Nanotechnol 2015 6 1752-62 The Nanomaterial Data Curation Initiative (NDCI), a project of the National Cancer Informatics Program Nanotechnology Working Group (NCIP NanoWG), explores the critical aspect of data curation within the development of informatics approaches to understanding nanomaterial behavior. Data repositories and tools for integrating and interrogating complex nanomaterial datasets are gaining widespread interest, with multiple projects now appearing in the US and the EU. Even in these early stages of development, a single common aspect shared across all nanoinformatics resources is that data must be curated into them. Through exploration of sub-topics related to all activities necessary to enable, execute, and improve the curation process, the NDCI will provide a substantive analysis of nanomaterial data curation itself, as well as a platform for multiple other important discussions to advance the field of nanoinformatics. This article outlines the NDCI project and lays the foundation for a series of papers on nanomaterial data curation. The NDCI purpose is to: 1) present and evaluate the current state of nanomaterial data curation across the field on multiple specific data curation topics, 2) propose ways to leverage and advance progress for both individual efforts and the nanomaterial data community as a whole, and 3) provide opportunities for similar publication series on the details of the interactive needs and workflows of data customers, data creators, and data analysts. Initial responses from stakeholder liaisons throughout the nanoinformatics community reveal a shared view that it will be critical to focus on integration of datasets with specific orientation toward the purposes for which the individual resources were created, as well as the purpose for integrating multiple resources. Early acknowledgement and undertaking of complex topics such as uncertainty, reproducibility, and interoperability is proposed as an important path to addressing key challenges within the nanomaterial community, such as reducing collateral negative impacts and decreasing the time from development to market for this new class of technologies. |
Motor vehicle crashes, medical outcomes, and hospital charges among children aged 1-12 years - Crash Outcome Data Evaluation System, 11 states, 2005-2008
Sauber-Schatz EK , Thomas AM , Cook LJ . MMWR Surveill Summ 2015 64 (8) 1-32 PROBLEM: Motor vehicle crashes are a leading cause of death among children. Age- and size-appropriate restraint use is an effective way to prevent motor vehicle-related injuries and deaths. However, children are not always properly restrained while riding in a motor vehicle, and some are not restrained at all, which increases their risk for injury and death in a crash. REPORTING PERIOD: 2005-2008. DESCRIPTION OF THE SYSTEM: The Crash Outcome Data Evaluation System (CODES) is a multistate program facilitated by the National Highway Traffic Safety Administration to probabilistically link police crash reports and hospital databases for traffic safety analyses. Eleven participating states (Connecticut, Georgia, Kentucky, Maryland, Minnesota, Missouri, Nebraska, New York, Ohio, South Carolina, and Utah) submitted data to CODES during the reporting period. Descriptive analysis was used to describe drivers and child passengers involved in motor vehicle crashes and to summarize crash and medical outcomes. Odds ratios and 95% confidence intervals were used to compare a child passenger's likelihood of sustaining specific types of injuries by restraint status (optimal, suboptimal, or unrestrained) and seating location (front or back seat). Because of data constraints, optimal restraint use was defined as a car seat or booster seat use for children aged 1-7 years and seat belt use for children aged 8-12 years. Suboptimal restraint use was defined as seat belt use for children aged 1-7 years. Unrestrained was defined as no use of car seat, booster seat, or seat belt for children aged 1-12 years. RESULTS: Optimal restraint use in the back seat declined with child's age (1 year: 95.9%, 5 years: 95.4%, 7 years: 94.7%, 8 years: 77.4%, 10 years: 67.5%, 12 years: 54.7%). Child restraint use was associated with driver restraint use; 41.3% of children riding with unrestrained drivers also were unrestrained compared with 2.2% of children riding with restrained drivers. Child restraint use also was associated with impaired driving due to alcohol or drug use; 16.4% children riding with drivers suspected of alcohol or drug use were unrestrained compared with 2.9% of children riding with drivers not suspected of such use. Optimally restrained and suboptimally restrained children were less likely to sustain a traumatic brain injury than unrestrained children. The 90th percentile hospital charges for children aged 4-7 years who were in motor vehicle crashes were $1,630.00 and $1,958.00 for those optimally restrained in a back seat and front seat, respectively; $2,035.91 and $3,696.00 for those suboptimally restrained in a back seat and front seat, respectively; and $9,956.60 and $11,143.85 for those unrestrained in a back seat and front seat, respectively. INTERPRETATION: Proper car seat, booster seat, and seat belt use among children in the back seat prevents injuries and deaths, as well as averts hospital charges. However, the number, severity, and cost of injuries among children in crashes who were not optimally restrained or who were seated in a front seat indicates the need for improvements in proper use of age- and size-appropriate car seats, booster seats, and seat belts in the back seat. PUBLIC HEALTH ACTIONS: Effective interventions for increasing proper child restraint use could be universally implemented by states and communities to prevent motor vehicle-related injuries among children and their resulting costs. |
Positively biased self-perceptions of peer acceptance and subtypes of aggression in children
Lynch RJ , Kistner JA , Stephens HF , David-Ferdon C . Aggress Behav 2015 42 (1) 82-96 There is a growing body of research linking children's positively biased self-perceptions with higher levels of aggression. This study extended this area of research by examining prospective associations of positively biased self-perceptions of peer acceptance with overt and relational aggression. In addition, moderating effects of peer rejection were examined to test the "disputed overestimation hypothesis," which posits that the link between bias and aggression is limited to children who are rejected by their peers. Using a two-wave longitudinal design, measures of peer-rated and self-perceived peer acceptance and peer-rated overt and relational aggression were obtained for 712 children in 3rd through 5th grades (386 girls and 326 boys). Positively biased perceptions led to increases in relational, but not overt, aggression. This pattern was observed even when the effects of gender, race, peer rejection, and overt aggression on relational aggression were controlled. Contrary to the disputed overestimation hypothesis, the prospective associations between bias and aggression did not vary as a function of children's peer rejection status, thus supporting the view that positive bias predicts future aggressive behavior, regardless of social status. The results are discussed in terms of the comparability with previous findings and practical implications. |
Associations between antibullying policies and bullying in 25 states
Hatzenbuehler ML , Schwab-Reese L , Ranapurwala SI , Hertz MF , Ramirez MR . JAMA Pediatr 2015 169 (10) e152411 IMPORTANCE: Bullying is the most widespread form of peer aggression in schools. In an effort to address school bullying, 49 states have passed antibullying statutes. Despite the ubiquity of these policies, there has been limited empirical examination of their effectiveness in reducing students' risk of being bullied. OBJECTIVE: To evaluate the effectiveness of antibullying legislation in reducing students' risk of being bullied and cyberbullied, using data from 25 states in the United States. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional observational study was conducted using a population-based survey of 63635 adolescents in grades 9 to 12 from 25 states participating in the 2011 Youth Risk Behavior Surveillance System study (September 2010-December 2011). Data on antibullying legislation were obtained from the US Department of Education (DOE), which commissioned a systematic review of state laws in 2011. The report identified 16 key components that were divided into the following 4 broad categories: purpose and definition of the law, district policy development and review, school district policy components (eg, responsibilities for reporting bullying incidents), and additional components (eg, how policies are communicated). Policy variables from 25 states were linked to individual-level data from the Youth Risk Behavior Surveillance System on experiencing bullying and cyberbullying. Analyses were conducted between March 1, 2014, and December 1, 2014. EXPOSURE: State antibullying legislation. MAIN OUTCOMES AND MEASURES: Exposure to bullying and cyberbullying in the past 12 months. RESULTS: There was substantial variation in the rates of bullying and cyberbullying across states. After controlling for relevant state-level confounders, students in states with at least 1 DOE legislative component in the antibullying law had a 24% (95% CI, 15%-32%) reduced odds of reporting bullying and 20% (95% CI, 9%-29%) reduced odds of reporting cyberbullying compared with students in states whose laws had no DOE legislative components. Three individual components of antibullying legislation were consistently associated with decreased odds of exposure to both bullying and cyberbullying: statement of scope, description of prohibited behaviors, and requirements for school districts to develop and implement local policies. CONCLUSIONS AND RELEVANCE: Antibullying policies may represent effective intervention strategies for reducing students' risk of being bullied and cyberbullied in schools. |
Simultaneous quantitation of hexacosanoyl lysophosphatidylcholine, amino acids, acylcarnitines, and succinylacetone during FIA-ESI-MS/MS analysis of dried blood spot extracts for newborn screening
Haynes CA , De Jesus VR . Clin Biochem 2015 49 161-5 OBJECTIVES: The goal of this study was to include the quantitation of hexacosanoyl lysophosphatidylcholine, a biomarker for X-linked adrenoleukodystrophy and other peroxisomal disorders, in the routine extraction and analysis procedure used to quantitate amino acids, acylcarnitines, and succinylacetone during newborn screening. Criteria for the method included use of a single punch from a dried blood spot, one simple extraction of the punch, no high-performance liquid chromatography, and utilizing tandem mass spectrometry to quantitate the analytes. DESIGN AND METHODS: Dried blood spot punches were extracted with a methanolic solution of stable-isotope labeled internal standards, formic acid, and hydrazine, followed by flow injection analysis-electrospray ionization-tandem mass spectrometry. RESULTS: Quantitation of amino acids, acylcarnitines, and hexacosanoyl lysophosphatidylcholine using this combined method was similar to results obtained using two separate methods. CONCLUSIONS: A single dried blood spot punch extracted by a rapid (45min), simple procedure can be analyzed with high throughput (2min per sample) to quantitate amino acids, acylcarnitines, succinylacetone, and hexacosanoyl lysophosphatidylcholine. |
Emissions from a diesel engine using Fe-based fuel additives and a sintered metal filtration system
Bugarski AD , Hummer JA , Stachulak JS , Miller A , Patts LD , Cauda EG . Ann Occup Hyg 2015 60 (2) 252-62 A series of laboratory tests were conducted to assess the effects of Fe-containing fuel additives on aerosols emitted by a diesel engine retrofitted with a sintered metal filter (SMF) system. Emission measurements performed upstream and downstream of the SMF system were compared, for cases when the engine was fueled with neat ultralow sulfur diesel (ULSD) and with ULSD treated with two formulations of additives containing Fe-based catalysts. The effects were assessed for four steady-state engine operating conditions and one transient cycle. The results showed that the SMF system reduced the average total number and surface area concentrations of aerosols by more than 100-fold. The total mass and elemental carbon results confirmed that the SMF system was indeed very effective in the removal of diesel aerosols. When added at the recommended concentrations (30 p.p.m. of iron), the tested additives had minor adverse impacts on the number, surface area, and mass concentrations of filter-out (FOut) aerosols. For one of the test cases, the additives may have contributed to measurable concentrations of engine-out (EOut) nucleation mode aerosols. The additives had only a minor impact on the concentration and size distribution of volatile and semi-volatile FOut aerosols. Metal analysis showed that the introduction of Fe with the additives substantially increased Fe concentration in the EOut, but the SMF system was effective in removal of Fe-containing aerosols. The FOut Fe concentrations for all three tested fuels were found to be much lower than the corresponding EOut Fe concentrations for the case of untreated ULSD fuel. The results support recommendations that these additives should not be used in diesel engines unless they are equipped with exhaust filtration systems. Since the tested SMF system was found to be very efficient in removing Fe introduced by the additives, the use of these additives should not result in a measurable increase in emissions of de novo generated Fe-containing aerosols. The findings from this study should promote a better understanding of the benefits and challenges of using sintered metal systems and fuel additives to control the exposure of underground miners and other workers to diesel aerosols and gases. |
Exposure to nicotine increases nicotinic acetylcholine receptor density in the reward pathway and binge ethanol consumption in C57BL/6J adolescent female mice
Locker AR , Marks MJ , Kamens HM , Klein LC . Brain Res Bull 2015 123 13-22 Nearly 80% of adult smokers begin smoking during adolescence. Binge alcohol consumption is also common during adolescence. Past studies report that nicotine and ethanol activate dopamine neurons in the reward pathway and may increase synaptic levels of dopamine in the nucleus accumbens through nicotinic acetylcholine receptor (nAChR) stimulation. Activation of the reward pathway during adolescence through drug use may produce neural alterations affecting subsequent drug consumption. Consequently, the effect of nicotine exposure on binge alcohol consumption was examined along with an assessment of the neurobiological underpinnings that drive adolescent use of these drugs. Adolescent C57BL/6J mice (postnatal days 35-44) were exposed to either water or nicotine (200mug/ml) for ten days. On the final four days, ethanol intake was examined using the drinking-in-the-dark paradigm. Nicotine-exposed mice consumed significantly more ethanol and displayed higher blood ethanol concentrations than control mice. Autoradiographic analysis of nAChR density revealed higher epibatidine binding in frontal cortical regions in mice exposed to nicotine and ethanol compared to mice exposed to ethanol only. These data show that nicotine exposure during adolescence increases subsequent binge ethanol consumption, and may affect the number of nAChRs in regions of the brain reward pathway, specifically the frontal cortex. |
Identification of immunodominant antigens for the laboratory diagnosis of toxocariasis
Zhan B , Ajmera R , Geiger S , Goncalves MT , Liu Z , Wei J , Wilkins PP , Fujiwara R , Gazzinelli-Guimaraes PH , Bottazzi ME , Hotez P . Trop Med Int Health 2015 20 (12) 1787-96 OBJECTIVES: To identify immunodominant antigens of Toxocara canis recognized by Toxocara-infected sera as recombinant reagents for immunodiagnosis of toxocariasis.. METHODS: Pooled sera from human cases of toxocariasis were used to identify immunodominant antigens by immunoscreening a T. canis larval expression cDNA library. The positive clones were sequenced to reveal the identity of the antigens. The recombinant proteins were expressed in E. coli and then used to confirm their immunoreaction with sera of humans with toxocariasis. Two chosen antigens were also used to differentiate Toxocara infection from other helminth infections in mice. RESULTS: 11 antigens with immunodiagnostic potential were identified, including two C-type lectins (CTLs) that reacted strongly with the Toxocara-positive serum pool. The first CTL (Tc-CTL-1) is the same as TES-32, previously identified as a major immunodominant component of TES; the second CTL (Tc-CTL-2) is a novel C-type lectin sharing 83% amino acid sequence identity within the functional domain of Tc-CTL-1. The E. coli expressed recombinant Tc-CTL-1 was strongly recognized by the Toxocara-positive serum pool or sera from animals experimentally infected with T. canis. Reactivity with recombinant Tc-CTL-1 was higher when the unreduced protein was used in an ELISA, Dot blot assay or Western blot test compared to the protein under reduced condition. Both recombinant Tc-CTL-1 and Tc-CTL-2 based ELISAs were able to differentiate T. canis infection from other helminth infections in experimentally infected mice. CONCLUSIONS: Both Tc-CTL-1 and Tc-CTL-2 were able to differentiate Toxocara infection from other helminth infections and could potentially be used as sensitive and specific immunodiagnostic antigens. |
Improving the performance of factor VIII inhibitor tests in hemophilia A
Miller CH . Thromb Res 2015 136 (6) 1047-8 In this issue, Montalvão and colleagues [1] present important information on the value of heat treatment of specimens for inhibitor measurement in hemophilia A patients undergoing immune tolerance induction therapy (ITI). Inhibitors, antibodies directed against infused treatment products, are the most significant complication of hemophilia therapy today, occurring in up to 30% of severe patients during their initial exposures to factor VIII (FVIII) replacement. Risk of inhibitor development persists through the lifespan, with a second peak of inhibitors occurring later in life [2], and patients with all severities of hemophilia A develop inhibitors [3]. Annual testing is recommended for all patients, with more frequent monitoring for those at highest risk [4]. In addition to clinical use of the inhibitor test in detection of new inhibitors, selection of therapy, and monitoring for successful inhibitor eradication, this test is also the key endpoint measurement for evaluation of product safety, assessment of population trends, and studies of inhibitor risk factors. We have previously introduced modifications to traditional inhibitor tests to improve their usefulness for these purposes by minimizing false negative and false positive results [5,6]. | The first standardized method for measuring hemophilic inhibitors, the Bethesda assay, was described in 1975 [7], with reagent modifications to improve its performance added in 1995 [8], producing what has come to be called the Nijmegen–Bethesda assay. In the past 20 years, however, the usefulness of these assays has been compromised by changes in hemophilia treatment. Patients receiving prophylactic therapy, by design, have factor present at all times and must refrain from treating to “wash out” their factor prior to undergoing traditional inhibitor tests. Presence of factor in the test specimen may result in failure to detect low titer inhibitors and produce a false negative result [5]. Patients undergoing ITI present similar problems due to frequent FVIII infusions. |
The 2012/2013 ABRF Proteomic Research Group Study: Assessing Longitudinal Intralaboratory Variability in Routine Peptide Liquid Chromatography Tandem Mass Spectrometry Analyses
Bennett KL , Wang X , Bystrom CE , Chambers MC , Andacht TM , Dangott LJ , Elortza F , Leszyk J , Molina H , Moritz RL , Phinney BS , Thompson JW , Bunger MK , Tabb DL . Mol Cell Proteomics 2015 14 (12) 3299-309 Questions concerning longitudinal data quality and reproducibility of proteomic laboratories spurred the Protein Research Group of the Association of Biomolecular Resource Facilities (ABRF-PRG) to design a study to systematically assess the reproducibility of proteomic laboratories over an extended period of time. Developed as an open study, initially 64 participants were recruited from the broader mass spectrometry community to analyse provided aliquots of a 6 bovine protein tryptic digest mixture every month for a period of nine months. Data were uploaded to a central repository, and the operators answered an accompanying survey. Ultimately, 45 laboratories submitted a minimum of 8 LC-MSMS raw data files collected in data-dependent acquisition (DDA) mode. No standard operating procedures were enforced; rather the participants were encouraged to analyse the samples according to usual practices in the laboratory. Unlike previous studies, this investigation was not designed to compare laboratories or instrument configuration, but rather to assess the temporal intra-laboratory reproducibility. The outcome of the study was reassuring with 80% of the participating laboratories performing analyses at a medium to high level of reproducibility and quality over the 9 month period. For the groups that had one or more outlying experiments, the major contributing factor that correlated to the survey data was the performance of preventative maintenance prior to the LC-MSMS analyses. Thus, the ABRF-PRG recommends that laboratories closely scrutinise the quality control data following such events. Additionally, improved quality control recording is imperative. This longitudinal study provides evidence that mass spectrometry-based proteomics is reproducible. When quality control measures are strictly adhered to, such reproducibility is comparable amongst many disparate groups. Data from the study are available via ProteomeXchange under the accession code PXD002114. |
Access and quality of HIV-related point of care diagnostic testing in global health programs
Fonjungo PN , Boeras DI , Zeh C , Alexander H , Parekh BS , Nkengasong JN . Clin Infect Dis 2015 62 (3) 369-374 Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of HIV-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS in partnership with other organizations recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets will require increased access to reliable and accurate POC test results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. |
Candida lusitaniae MICs to the echinocandins are elevated but FKS-mediated resistance is rare
Lockhart SR , Pham CD , Kuykendall RJ , Bolden CB , Cleveland AA . Diagn Microbiol Infect Dis 2015 84 (1) 52-54 MIC values were generated for caspofungin, micafungin, and anidulafungin against 106 isolates of C. lusitaniae, and these values were compared to established epidemiologic cutoff values. The majority of isolates were wild type both by MIC value as well as by FKS1 hotspot sequencing. Although C. lusitaniae isolates have MIC values to the echinocandins that are elevated compared to other common species, with regard to known mechanisms of resistance to the echinocandins, isolates with MIC values at or below the epidemiological cutoff values of 0.5 and 1mug/mL for micafungin and anidulafungin, respectively, should be considered wild type. |
Development of a high-content orthopoxvirus infectivity and neutralization assays
Gates I , Olson V , Smith S , Patel N , Damon I , Karem K . PLoS One 2015 10 (10) e0138836 Currently, a number of assays measure Orthopoxvirus neutralization with serum from individuals, vaccinated against smallpox. In addition to the traditional plaque reduction neutralization test (PRNT), newer higher throughput assays are based on neutralization of recombinant vaccinia virus, expressing reporter genes such as beta-galactosidase or green fluorescent protein. These methods could not be used to evaluate neutralization of variola virus, since genetic manipulations of this virus are prohibited by international agreements. Currently, PRNT is the assay of choice to measure neutralization of variola virus. However, PRNT assays are time consuming, labor intensive, and require considerable volume of serum sample for testing. Here, we describe the development of a high-throughput, cell-based imaging assay that can be used to measure neutralization, and characterize replication kinetics of various Orthopoxviruses, including variola, vaccinia, monkeypox, and cowpox. |
Update: shortened interval for postvaccination serologic testing of infants born to hepatitis B-infected mothers
Schillie S , Murphy TV , Fenlon N , Ko S , Ward JW . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1118-1120 Infants born to hepatitis B-infected mothers receive postexposure prophylaxis to reduce their risk for perinatal hepatitis B virus (HBV) infection. Postexposure prophylaxis consists of hepatitis B (HepB) vaccine and hepatitis B immune globulin administered within 12 hours of birth, followed by completion of the 3-dose or 4-dose HepB vaccine series. Postvaccination serologic testing (PVST) assesses an infant's response to HepB vaccination and has typically occurred at age 9-18 months. This report provides a CDC update recommending shortening the interval for PVST from age 9-18 months to age 9-12 months. Providers should order PVST (consisting of hepatitis B surface antigen [HBsAg] and antibody to HBsAg [anti-HBs]) for infants born to HBsAg-positive mothers at age 9-12 months (or 1-2 months after the final dose of the vaccine series, if the series is delayed). This recommendation was prompted by the discontinuation of production of Hib/HepB vaccine (Comvax) and new data from the Enhanced Perinatal Hepatitis B Prevention Program supporting PVST 1・2 months after receipt of the last HepB vaccine dose, and at age >/=9 months. |
Vital Signs: improvements in maternity care policies and practices that support breastfeeding - United States, 2007-2013
Perrine CG , Galuska DA , Dohack JL , Shealy KR , Murphy PE , Grummer-Strawn LM , Scanlon KS . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1112-1117 BACKGROUND: Although 80% of U.S. mothers begin breastfeeding their infants, many do not continue breastfeeding as long as they would like to. Experiences during the birth hospitalization affect a mother's ability to establish and maintain breastfeeding. The Baby-Friendly Hospital Initiative is a global program launched by the World Health Organization and the United Nations Children's Fund, and has at its core the Ten Steps to Successful Breastfeeding (Ten Steps), which describe evidence-based hospital policies and practices that have been shown to improve breastfeeding outcomes. METHODS: Since 2007, CDC has conducted the biennial Maternity Practices in Infant Nutrition and Care (mPINC) survey among all birth facilities in all states, the District of Columbia, and territories. CDC analyzed data from 2007 (baseline), 2009, 2011, and 2013 to describe trends in the prevalence of facilities using maternity care policies and practices that are consistent with the Ten Steps to Successful Breastfeeding. RESULTS: The percentage of hospitals that reported providing prenatal breastfeeding education (range = 91.1%-92.8%) and teaching mothers breastfeeding techniques (range = 87.8%-92.2%) was high at baseline and across all survey years. Implementation of the other eight steps was lower at baseline. From 2007 to 2013, six of these steps increased by 10-21 percentage points, although limiting non-breast milk feeding of breastfed infants and fostering post-discharge support only increased by 5-6 percentage points. Nationally, hospitals implementing more than half of the Ten Steps increased from 28.7% in 2007 to 53.9% in 2013. CONCLUSIONS: Maternity care policies and practices supportive of breastfeeding are improving nationally; however, more work is needed to ensure all women receive optimal breastfeeding support during the birth hospitalization. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Because of the documented benefits of breastfeeding to both mothers and children, and because experiences in the first hours and days after birth help determine later breastfeeding outcomes, improved hospital policies and practices could increase rates of breastfeeding nationwide, contributing to improved child health. |
Lessons learned from the whole child and coordinated school health approaches
Rasberry CN , Slade S , Lohrmann DK , Valois RF . J Sch Health 2015 85 (11) 759-65 BACKGROUND: The new Whole School, Whole Community, Whole Child (WSCC) model, designed to depict links between health and learning, is founded on concepts of coordinated school health (CSH) and a whole child approach to education. METHODS: The existing literature, including scientific articles and key publications from national agencies and organizations, was reviewed and synthesized to describe (1) the historical context for CSH and a whole child approach, and (2) lessons learned from the implementation and evaluation of these approaches. RESULTS: The literature revealed that interventions conducted in the context of CSH can improve health-related and academic outcomes, as well as policies, programs, or partnerships. Several structural elements and processes have proved useful for implementing CSH and a whole child approach in schools, including use of school health coordinators, school-level and district-level councils or teams; systematic assessment and planning; strong leadership and administrative support, particularly from school principals; integration of health-related goals into school improvement plans; and strong community collaborations. CONCLUSIONS: Lessons learned from years of experience with CSH and the whole child approaches have applicability for developing a better understanding of the WSCC model as well as maximizing and documenting its potential for impacting both health and education outcomes. |
Hepatitis B virus infection in northern Uganda: Impact of pentavalent hepatitis B vaccination
Teshale EH , Kamili S , Drobeniuc J , Denniston M , Bakamutamaho B , Downing R . Vaccine 2015 33 (46) 6161-3 Chronic hepatitis B virus infection (CHBI) is effectively prevented by vaccination starting at birth. Beginning in 2002 Uganda adopted a policy of providing the pentavalent hepatitis B vaccine starting at 6 weeks of age. However, there is concern that this delay may leave the infant vulnerable to infection during the first 6 weeks of life. We assessed whether vaccination at 6 weeks was an effective strategy by HBV serologic study. Of 656 persons tested for HBV, 9.4% were chronically infected; among children aged 5-9 years the prevalence was 7.6%. Of all tested, 73 were born (i.e., aged ≤4 years) after the introduction of the pentavalent vaccine; none were infected with HBV (p=0.003). In this study, vaccination with the pentavalent vaccine at 6 weeks did not result in CHBI, but rather provides an opportunity to prevent mother-to-infant transmission of HBV infection where there is no access to birth-dose vaccine. |
CDC Grand Rounds: understanding the causes of major birth defects - steps to prevention
Simeone RM , Feldkamp ML , Reefhuis J , Mitchell AA , Gilboa SM , Honein MA , Iskander J . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1104-1107 Major birth defects (birth defects) are defined as structural abnormalities, present at birth, with surgical, medical, or cosmetic importance. Each year in the United States, 3% of live births (approximately 120,000 infants) have an identifiable structural birth defect. Examples of birth defects include neural tube defects, such as spina bifida; orofacial clefts; abdominal wall defects, such as gastroschisis; and congenital heart defects, such as hypoplastic left heart syndrome. Collectively, congenital heart defects are the most common birth defects (27%), followed by musculoskeletal defects (18%), genitourinary defects (15%), orofacial defects (5%), and neural tube defects (2%). |
Evidence of the effectiveness of flour fortification programs on iron status and anemia: a systematic review
Pachon H , Spohrer R , Mei Z , Serdula MK . Nutr Rev 2015 73 (11) 780-95 CONTEXT: More than 80 countries fortify flour, yet the public health impact of this intervention on iron and anemia outcomes has not been reviewed. OBJECTIVE: The objective of this systematic review was to review published and gray literature pertaining to the impact of flour fortification on iron and anemia. DATA SOURCES: A systematic review was conducted by searching 17 databases and appealing for unpublished reports, yielding 1881 documents. STUDY SELECTION: Only studies of government-supported, widely implemented fortification programs in which anemia or iron status was measured prior to and ≥12 months after initiation of fortification were included. DATA EXTRACTION: Details about the design, coverage, compliance with national standards, and evaluation (e.g., anemia prevalence before and after fortification) of flour fortification programs were extracted from the reports. DATA SYNTHESIS: Thirteen studies describing 26 subgroups (n = 14 for children ≤15 y, n = 12 for women of reproductive age) were included. During the period from pre- to postfortification (and as difference-in-difference for those studies that included a control group), there were statistically significant decreases in the prevalence of anemia in 4 of 13 subgroups of children and in 4 of 12 subgroups of women of reproductive age as well as significant decreases in the prevalence of low ferritin in 1 of 6 subgroups of children and in 3 of 3 subgroups of women of reproductive age. CONCLUSIONS: . Evidence of the effectiveness of flour fortification for reducing the prevalence of anemia is limited; however, evidence of effectiveness for reducing the prevalence of low ferritin in women is more consistent. |
The effects of repetitive vibration on sensorineural function: biomarkers of sensorineural injury in an animal model of metabolic syndrome
Kiedrowski M , Waugh S , Miller R , Johnson C , Krajnak K . Brain Res 2015 1627 216-24 Exposure to hand-transmitted vibration in the work-place can result in the loss of sensation and pain in workers. These effects may be exacerbated by pre-existing conditions such as diabetes or the presence of primary Raynaud's phenomena. The goal of these studies was to use an established model of vibration-induced injury in Zucker rats. Lean Zucker rats have a normal metabolic profile, while obese Zucker rats display symptoms of metabolic disorder or Type II diabetes. This study examined the effects of vibration in obese and lean rats. Zucker rats were exposed to 4h of vibration for 10 consecutive days at a frequency of 125Hz and acceleration of 49m/sec2 for 10 consecutive days. Sensory function was checked using transcutaneous electrical stimulation on days 1, 5 and 9 of the exposure. Once the study was complete the ventral tail nerves, dorsal root ganglia and spinal cord were dissected, and levels of various transcripts involved in sensorineural dysfunction were measured. Sensorineural dysfunction was assessed using transcutaneous electrical stimulation. Obese Zucker rats displayed very few changes in sensorineural function. However they did display significant changes in transcript levels for factors involved in synapse formation, peripheral nerve remodeling, and inflammation. The changes in transcript levels suggested that obese Zucker rats had some level of sensory nerve injury prior to exposure, and that exposure to vibration activated pathways involved in injury and re-innervation. |
Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin-piperaquine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial
Desai M , Gutman J , L'Lanziva A , Otieno K , Juma E , Kariuki S , Ouma P , Were V , Laserson K , Katana A , Williamson J , Ter Kuile FO . Lancet 2015 386 (10012) 2507-19 BACKGROUND: Every year, more than 32 million pregnancies in sub-Saharan Africa are at risk of malaria infection and its adverse consequences. The effectiveness of the intermittent preventive treatment with sulfadoxine-pyrimethamine strategy recommended by WHO is threatened by high levels of parasite resistance. We aimed to assess the efficacy and safety of two alternative strategies: intermittent screening with malaria rapid diagnostic tests and treatment of women who test positive with dihydroartemisinin-piperaquine, and intermittent preventive treatment with dihydroartemisinin-piperaquine. METHODS: We did this open-label, three-group, randomised controlled superiority trial at four sites in western Kenya with high malaria transmission and sulfadoxine-pyrimethamine resistance. HIV-negative pregnant women between 16 and 32 weeks' gestation were randomly assigned (1:1:1), via computer-generated permuted-block randomisation (block sizes of three, six, and nine), to receive intermittent screening and treatment with dihydroartemisinin-piperaquine, intermittent preventive treatment with dihydroartemisinin-piperaquine, or intermittent preventive treatment with sulfadoxine-pyrimethamine. Study participants, study clinic nurses, and the study coordinator were aware of treatment allocation, but allocation was concealed from study investigators, delivery unit nurses, and laboratory staff. The primary outcome was malaria infection at delivery, defined as a composite of peripheral or placental parasitaemia detected by placental histology, microscopy, or rapid diagnostic test. The primary analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01669941. FINDINGS: Between Aug 21, 2012, and June 19, 2014, we randomly assigned 1546 women to receive intermittent screening and treatment with dihydroartemisinin-piperaquine (n=515), intermittent preventive treatment with dihydroartemisinin-piperaquine (n=516), or intermittent preventive treatment with sulfadoxine-pyrimethamine (n=515); 1368 (88%) women comprised the intention-to-treat population for the primary endpoint. Prevalence of malaria infection at delivery was lower in the intermittent preventive treatment with dihydroartemisinin-piperaquine group than in the intermittent preventive treatment with sulfadoxine-pyrimethamine group (15 [3%] of 457 women vs 47 [10%] of 459 women; relative risk 0.32, 95% CI 0.18-0.56; p<0.0001), but not in the intermittent screening and treatment with dihydroartemisinin-piperaquine group (57 [13%] of 452 women; 1.23, 0.86-1.77; p=0.26). Compared with intermittent preventive treatment with sulfadoxine-pyrimethamine, intermittent preventive treatment with dihydroartemisinin-piperaquine was associated with a lower incidence of malaria infection during pregnancy (192.0 vs 54.4 events per 100 person-years; incidence rate ratio [IRR] 0.28, 95% CI 0.22-0.36; p<0.0001) and clinical malaria during pregnancy (37.9 vs 6.1 events; 0.16, 0.08-0.33; p<0.0001), whereas intermittent screening and treatment with dihydroartemisinin-piperaquine was associated with a higher incidence of malaria infection (232.0 events; 1.21, 1.03-1.41; p=0.0177) and clinical malaria (53.4 events; 1.41, 1.00-1.98; p=0.0475). We recorded 303 maternal and infant serious adverse events, which were least frequent in the intermittent preventive treatment with dihydroartemisinin-piperaquine group. INTERPRETATION: At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine-pyrimethamine in the context of high sulfadoxine-pyrimethamine resistance and malaria transmission. However, dihydroartemisinin-piperaquine is a promising alternative drug to replace sulfadoxine-pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine. FUNDING: The Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine. |
Data, workforce, action!
Monroe JA , Moore GA . J Public Health Manag Pract 2015 21 Suppl 6 S7-8 This commentary describes data for action, including trend data about workforce demographics, needs, gaps, impact, and programs and tools, which are essential for planning, implementing, and evaluating workforce development programs and activities across all levels and jurisdictions. | One infectious disease can change everything, at any time: Ebola. One storm can change anything, at any time: Hurricane Katrina. One technological innovation can change how people relate to one another, learn, and connect: smartphones. One tipping point in social vigilance can result in the resurgence of a disease once controlled: measles. One policy can catalyze transformation: the Affordable Care Act. | How do we recruit, train, support, and retain a public health workforce capable of working in this highly connected, fast-changing environment? This is an important question for governmental public health across all levels and jurisdictions. | It is imperative to have data for action, including trend data about workforce demographics, needs, gaps, impact, and programs and tools. This information is essential to planning, implementing, and evaluating workforce development programs and activities and for ensuring that workforce investments are well spent |
Severe illness associated with reported use of synthetic cannabinoids - Mississippi, April 2015
Kasper AM , Ridpath AD , Arnold JK , Chatham-Stephens K , Morrison M , Olayinka O , Parker C , Galli R , Cox R , Preacely N , Anderson J , Kyle PB , Gerona R , Martin C , Schier J , Wolkin A , Dobbs T . MMWR Morb Mortal Wkly Rep 2015 64 (39) 1121-1122 On April 2, 2015, four patients were evaluated at the University of Mississippi Medical Center (UMMC) in Jackson, Mississippi, for agitated delirium after using synthetic cannabinoids. Over the next 3 days, 24 additional persons went to UMMC with illnesses suspected to be related to synthetic cannabinoid use; one patient died. UMMC notified the Mississippi State Department of Health, which issued a statewide alert via the Health Alert Network on April 5, requesting that health care providers report suspected cases of synthetic cannabinoid intoxication to the Mississippi Poison Control Center (MPCC). A suspected case was defined as the occurrence of at least two of the following symptoms: sweating, severe agitation, or psychosis in a person with known or suspected synthetic cannabinoid use. A second statewide alert was issued on April 13, instructing all Mississippi emergency departments to submit line lists of suspected patients to MPCC each day. By April 21, 16 days after the first alert was issued, MPCC had received reports of approximately 400 cases, including eight deaths possibly linked to synthetic cannabinoid use; in contrast, during April 2012-March 2015, the median number of telephone calls to MPCC regarding synthetic cannabinoid use was one per month (range = 0-11). The Mississippi State Department of Health, with the assistance of CDC, initiated an investigation to better characterize the outbreak, identify risk factors associated with severe illness, and prevent additional illnesses and deaths. |
Strategies to support tobacco cessation and tobacco-free environments in mental health and substance abuse facilities
Marshall LL , Kuiper NM , Lavinghouze SR . Prev Chronic Dis 2015 12 E167 We identified and described strategies for promoting smoking cessation and smoke-free environments that were implemented in Oregon and Utah in treatment centers for mental illness and substance abuse. We reviewed final evaluation reports submitted by state tobacco control programs (TCPs) to the Centers for Disease Control and Prevention and transcripts from a call study evaluation. The TCPs described factors that assisted in implementing strategies: being ready for opportunity, having a sound infrastructure, and having a branded initiative. These strategies could be used by other programs serving high-need populations for whom evidence-based interventions are still being developed. |
Factors influencing quit attempts among male daily smokers in China
Zhao L , Song Y , Xiao L , Palipudi K , Asma S . Prev Med 2015 81 361-6 BACKGROUND: China has the largest population of smokers in the world, yet the quit rate is low. We used data from the 2010 Global Adult Tobacco Survey China to identify factors influencing quit attempts among male Chinese daily smokers. METHODS: The study sample included 3303 male daily smokers. To determine the factors that were significantly associated with making a quit attempt, we conducted logistic regression analyses. In addition, mediation analyses were carried out to investigate how the intermediate association among demographics (age, education, urbanicity) and smoking related variables affected making a quit attempt. RESULTS: An estimated 11.0% of male daily smokers tried to quit smoking in the 12 months prior to the survey. Logistic regression analysis indicated that younger age (15-24 years), being advised to quit by a health care provider (HCP) in the past 12 months, lower cigarette cost per pack, monthly or less frequent exposure to smoking at home, and awareness of the harms of tobacco use were significantly associated with making a quit attempt. Additional mediation analyses showed that having knowledge of the harm of tobacco, exposure to smoking at home, and having been advised to quit by an HCP were mediators of making a quit attempt for other independent variables. CONCLUSION: Evidence-based tobacco control measures such as conducting educational campaigns on the harms of tobacco use, establishing smoke-free policies at home, and integrating tobacco cessation advice into primary health care services can increase quit attempts and reduce smoking among male Chinese daily smokers. |
Flavored tobacco product use among middle and high school students - United States, 2014
Corey CG , Ambrose BK , Apelberg BJ , King BA . MMWR Morb Mortal Wkly Rep 2015 64 (38) 1066-70 The 2009 Family Smoking Prevention and Tobacco Control Act prohibits "characterizing flavors" (e.g., candy, fruit, and chocolate) other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products. Analyses of retail sales data suggest that U.S. consumption of flavored noncigarette tobacco products, including flavored cigars and flavored e-cigarettes, has increased in recent years. There is growing concern that widely marketed varieties of new and existing flavored tobacco products might appeal to youths (2) and could be contributing to recent increases in the use of tobacco products, including e-cigarettes and hookah, among youths. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine the prevalence of past 30 day use (current use) of flavored e-cigarette, hookah tobacco, cigar, pipe tobacco or smokeless tobacco products, and menthol cigarettes among middle and high school students, and the proportion of current tobacco product users who have used flavored products. An estimated 70.0% (3.26 million) of all current youth tobacco users had used at least one flavored tobacco product in the past 30 days. Among current users, 63.3%, (1.58 million) had used a flavored e-cigarette, 60.6%, (1.02 million) had used flavored hookah tobacco, and 63.5% (910,000) had used a flavored cigar in the past 30 days. Given the millions of current youth tobacco users, it is important for comprehensive tobacco prevention and control strategies to address all forms of tobacco use, including flavored tobacco products, among U.S. youths. |
Frequency of tobacco use among middle and high school students - United States, 2014
Neff LJ , Arrazola RA , Caraballo RS , Corey CG , Cox S , King BA , Choiniere CJ , Husten CG . MMWR Morb Mortal Wkly Rep 2015 64 (38) 1061-5 The use of tobacco products during adolescence increases the risk for adverse health effects and lifelong nicotine addiction. In 2014, an estimated 4.6 million middle and high school students were current users of any tobacco product, of whom an estimated 2.2 million were current users of two or more types of tobacco products. Symptoms of nicotine dependence are increased for multiple tobacco product users compared with single-product users. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine how frequently (the number of days in the preceding 30 days) U.S. middle school (grades 6-8) and high school (grades 9-12) students used cigarettes, e-cigarettes, cigars, and smokeless tobacco products. Among current users (>/=1 day during the preceding 30 days) in high school, frequent use (>/=20 days during the preceding 30 days) was most prevalent among smokeless tobacco users (42.0%), followed by cigarette smokers (31.6%), e-cigarette users (15.5%), and cigar smokers (13.1%); a similar pattern was observed for those who used during all 30 days. Among current users in middle school, frequent use was greatest among smokeless tobacco users (29.2%), followed by cigarette smokers (20.0%), cigar smokers (13.2%) and e-cigarette users (11.8%). Current use of two or more types of tobacco products was common, even among students who used tobacco products 1-5 days during the preceding 30 days: 77.3% for cigar smokers, 76.9% for cigarette smokers, 63.4% for smokeless tobacco users, and 54.8% for e-cigarettes users. Preventing youths from initiating the use of any tobacco product is important to tobacco use prevention and control strategies in the United States. Monitoring the frequency and patterns of tobacco use among youths, including the use of two or more tobacco products, is important to inform evidence-based interventions to prevent and reduce all forms of tobacco use among youths. |
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