Trends in lipids and lipoproteins in US adults, 1988-2010
Carroll MD , Kit BK , Lacher DA , Shero ST , Mussolino ME . JAMA 2012 308 (15) 1545-54 CONTEXT: Serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) contribute to atherosclerosis and its clinical consequences. Between the periods 1988-1994 and 1999-2002, mean TC and mean LDL-C declined in adults. During this time, there was an increase in the percentage of adults receiving lipid-lowering medications. Geometric mean triglyceride levels increased but mean high-density lipoprotein cholesterol (HDL-C) remained unchanged. OBJECTIVE: To examine trends in serum lipids in adults between 1988 and 2010. DESIGN, SETTING, AND PARTICIPANTS: Three distinct US cross-sectional National Health and Nutrition Examination Surveys, 1988-1994 (n = 16,573), 1999-2002 (n = 9471), and 2007-2010 (n = 11,766). MAIN OUTCOME MEASURES: Mean TC, LDL-C, HDL-C, non-HDL-C, and geometric mean triglyceride levels and the prevalence of lipid-lowering medication use. RESULTS: Mean TC declined from 206 (95% CI, 205-207) mg/dL in 1988-1994 to 196 (95% CI, 195-198) mg/dL in 2007-2010 (P <.001 for linear trend); mean LDL-C declined from 129 (95% CI, 127-130) mg/dL to 116 (95% CI, 114-117) mg/dL (P <.001 for linear trend). Mean non-HDL-C declined from 155 (95% CI, 153-157) mg/dL in 1988-1994 to 144 (95% CI, 143-145) mg/dL in 2007-2010 (P <.001 for linear trend). Mean HDL-C increased from 50.7 (95% CI, 50.0-51.0) mg/dL during 1988-1994 to 52.5 (95% CI, 51.8-53.2) mg/dL in 2007-2010 (P =.001 for linear trend). Geometric mean serum triglyceride levels increased from 118 (95% CI, 114-121) mg/dL in 1988-1994 to 123 (95% CI, 119-127) mg/dL in 1999-2002 and decreased to 110 (95% CI, 107-113) mg/dL in 2007-2010 (P <.001 for quadratic trend). The prevalence of lipid-lowering medication use increased from 3.4% (95% CI, 2.9%-3.9%) in 1988-1994 to 15.5% (95% CI, 14.7%-16.3%) in 2007-2010 (P <.001 for linear trend). Among adults not receiving lipid-lowering medications, trends in lipids were similar to those reported for adults overall. Among obese adults, mean TC, non-HDL-C, LDL-C, and geometric mean triglycerides declined between 1988 and 2010. CONCLUSION: Between 1988 and 2010, favorable trends in lipid levels have occurred among adults in the United States. |
Medical care and payment for diabetes in China: enormous threat and great opportunity
Yang W , Zhao W , Xiao J , Li R , Zhang P , Kissimova-Skarbek K , Schneider E , Jia W , Ji L , Guo X , Shan Z , Liu J , Tian H , Chen L , Zhou Z , Ji Q , Ge J , Chen G , Brown J . PLoS One 2012 7 (9) e39513 BACKGROUND: The Diabetes Impact Study followed up a large national population-based screening study to estimate the use of and expenditures for medical care caused by diabetes in China and to ascertain the use and cost of essential basic medicines and care. METHODS: In 2009-10, the study team interviewed 1482 adults with diabetes and 1553 adults with glucose tolerance in the normal range from population-based random samples at 12 sites in China. The response rate was 67%. FINDINGS: After adjusting for age, sex, and urban/rural location, people with diabetes received 1.93 times more days of inpatient treatment, 2.40 times more outpatient visits, and 3.35 times more medications than people with normal glucose tolerance (all p<0.05). Adjusted expenditures for medical care were 3.38 times higher among people with diabetes than among people with normal glucose tolerance (p<0.01, unadjusted 3.97). Persons who were diagnosed with ≥10 years prior to the survey paid 3.75 times as much for medical care as those with ≤5 years of diagnosed diabetes. Among persons with diabetes, 45.2% took medication to control blood sugar, 21.1% took an antihypertensive medicine, 22.4% took daily aspirin, and 1.8% took a statin. Over the three months before the interview, 46.1% of persons with diabetes recalled seeing a doctor, 48.9% recalled a blood pressure measurement, and 54.5% recalled a blood sugar test. Over the year preceding the interview, 32.1% recalled a retinal screening and 17.9% recalled a foot examination. CONCLUSIONS: In China, health care use and costs were dramatically higher for people with diabetes than for people with normal glucose tolerance and, in relative terms, much higher than in industrialized countries. Low-cost generic medicines that would reduce diabetes expenditures were not fully used. |
Cervical cancer screening measures need to evolve to continue to tell the story
Saraiya M , Watson M , Benard VB . J Womens Health (Larchmt) 2012 21 (11) 1128-9 According to Chen et al.,1 6% of U.S. adult women reported never having been screened for cervical cancer. These women were young (< 21 years) or old (≥ 70 years), less educated, uninsured, Hispanic, widowed, and never married. Besides the focus on the never screened women, this study offers many insights into the successes, failures, and gaps of cervical cancer screening over the past two decades. Additionally, it gives public health professionals who develop and use survey measures issues to consider in finding the right balance between keeping the survey consistent to allow for interpretation of trends and flexibility to allow measurement of emerging technologies and new practices. | One important success not fully appreciated in the article by Chen et al. is that for the first time, in 2012, cervical cancer screening guidelines are consistent among the three national organizations2–4 (www.cdc.gov/cancer/cervical/pdf/guidelines.pdf for table), including consensus that women <age 21 years no longer need to be screened. Chen’s Behavioral Risk Factor Surveillance System (BRFSS) analysis foreshadows this sentinel event by documenting that the percentage of young women <21 years who report never being screened increased from 35% in 1993 to 54.3% in 2010. This could be a result of concern over the increased adverse pregnancy outcomes associated with screening before the recommended age or the aggressive treatment of preclinical lesions that have a long latency period and a strong likelihood of regression.5,6 We expect that the decline that we are seeing now will continue to be observed in future surveys. A lower proportion of women reported screening in the past year (from 64.5% in 1993 to 54.1% in 2010); this finding may signal the wave of the future because of the call by all three organizations for an end to annual cervical cancer screening. Additionally, the Chen et al. article highlights that screening continues among women with a hysterectomy when recommendations for this have been consistent for 10 years.7–9 Why do half of women who have had a hysterectomy report having had a Pap test within the past 3 years? Surely, we cannot expect that all these women have had a supracervical hysterectomy or a history of treatment for cervical intraepithelial neoplasia (CIN2) and still require a Pap test. The aim of measuring screening failure is to avoid harm for women at lowest risk and target resources for women at highest risk of getting cervical cancer. |
Dietary patterns, inflammation and the metabolic syndrome
Ahluwalia N , Andreeva VA , Kesse-Guyot E , Hercberg S . Diabetes Metab 2012 39 (2) 99-110 AIM: The study of dietary patterns offers a comprehensive, real-life approach towards examining the complex diet and disease relationship. The simultaneous association of dietary patterns with inflammation and the metabolic syndrome (MetS) has not been extensively reviewed. This report reviews the association of dietary patterns with inflammation in the context of the MetS. METHODS: Original English-language research studies with humans were identified via MEDLINE, using inflammation, MetS, whole diets and dietary patterns as keywords. The findings were carefully examined and synthesized along consistent axes. RESULTS: Many observational and a few prospective studies, as well as some randomized controlled trials (RCTs), support an inverse association between a Mediterranean dietary pattern and markers of inflammation. The link is generally independent of traditional cardiovascular disease (CVD) risk factors and weight loss. The few studies that have examined the association between following a healthy dietary pattern, evaluated using various diet quality scores, and inflammation report an inverse association; however, this association was attenuated upon adjusting for CVD risk factors. A Mediterranean dietary pattern has also been associated with a reduced risk of the MetS in several cross-sectional studies and a few prospective studies conducted with healthy people. Few RCTs (lasting 1-2years) have confirmed the benefits of following a Mediterranean diet on MetS risk in obese individuals, in those with the MetS or in those at CVD risk. The evidence, albeit limited, for a link between healthy diets based on other diet quality scores and the MetS supports a similar inverse association for the primary and secondary prevention of the MetS. CONCLUSION: Adhering to healthy diets such as the Mediterranean diet and/or national dietary guidelines can reduce inflammation and the MetS. |
Prevalence of the 23S rRNA A2058G point mutation and molecular subtypes in Treponema pallidum in the United States, 2007 to 2009.
Su JR , Pillay A , Hook EW , Ghanem KG , Wong W , Jackson D , Smith LD , Pierce E , Philip SS , Wilson S , Golden MR , Workowski KA , Chi KH , Parrish DD , Chen CY , Weinstock HS . Sex Transm Dis 2012 39 (10) 794-798 BACKGROUND: The 23S rRNA A2058G point mutation in Treponema pallidum is associated with macrolide antibiotic treatment failure. Its prevalence and potential association with a molecular subtype within the United States are unknown. METHODS: During 2007 to 2009, 11 clinics across the United States sent samples from genital ulcers to the Centers for Disease Control and Prevention. Molecular techniques were used to identify T. pallidum DNA sequences, the A2058G mutation, and subtype of T. pallidum. Accompanying epidemiologic information was abstracted from medical records. RESULTS: A total of 141 samples with T. pallidum were collected from individuals whose median age was 33 years (range, 13-68 years): 118 were male (69% reported as men having sex with men [MSM]). The A2058G mutation was carried in 75 samples (53%) with T. pallidum, with samples from MSM (versus women and other men) more likely carrying the A2058G mutation (65/82 samples versus 8/57 samples; prevalence ratio, 5.7; 95% confidence interval, 2.9-10.8). Of 98 strain-typed samples, 61 (62%) were the 14d9 subtype of T. pallidum, which was also associated with samples with T. pallidum from MSM (prevalence ratio, 3.5; 95% confidence interval, 1.9-6.5). However, among T. pallidum from MSM, the A2058G mutation was not associated with the 14d9 subtype. CONCLUSIONS: The A2058G mutation and 14d9 subtype of T. pallidum were present throughout the United States. Both were more commonly found in T. pallidum from MSM compared with women or other men but were not associated with each other. Treating syphilis with azithromycin should be done cautiously and only when treatment with penicillin or doxycycline is not feasible. (Copyright 2012 American Sexually Transmitted Diseases Association All rights reserved.) |
Suboptimal adherence to repeat testing recommendations for men and women with positive chlamydia tests in the United States, 2008-2010
Hoover KW , Tao G , Nye MB , Body BA . Clin Infect Dis 2012 56 (1) 51-7 BACKGROUND: Chlamydia is prevalent among young persons in the United States. Infected persons have a high prevalence of infection several months later, most likely from reinfection. Retesting of all men and women with a positive test is recommended 3 months after treatment. A test-of-cure is recommended for pregnant women 3-4 weeks after treatment. METHODS: We analyzed 2008-2010 chlamydia testing data from a large US laboratory to estimate test positivity by patient demographic characteristics and diagnoses, and patterns of repeat testing of men and nonpregnant women with a positive test and tests-of-cures of pregnant women with a positive test. RESULTS: During the study period, 7.0% of 0.40 million tests performed in men and 4.0% of 2.92 million tests performed in women were positive. Among young women, positivity rates were highest among those aged 15-19 years, ranging from 8.5% to 10.0%. Retesting rates of persons with a positive test were suboptimal, with 22.3% of men and 38.0% of nonpregnant women retested. Although 60.1% of pregnant women with a positive test were retested, only 22.0% received a test-of-cure within the 4-week recommended time frame. Repeat tests were positive in 15.9% of men, 14.2% of nonpregnant women, and 15.4% of pregnant women. CONCLUSIONS: Analyses of laboratory testing data provided important insights into chlamydia testing, retesting, and positivity among a diverse US population of men and women. Too few persons were retested as recommended, and interventions are needed to increase both healthcare provider and patient adherence to recommendations for retesting men and women with positive tests. |
Tuberculosis caused by RDRio Mycobacterium tuberculosis is not associated with differential clinical features
De Barbosa CB , Lazzarini LCO , Elias AR , Leung JAM , Ribeiro SB , Da Silva MG , Duarte RS , Suffys P , Gomes HM , Kritski AL , Lapa ESilva JR , Ho JL , Boechat N . Int J Tuberc Lung Dis 2012 16 (10) 1377-1382 BACKGROUND: We recently described the Mycobacterium tuberculosis RD(Rio) genotype, a clonally derived sublineage within the Latin American-Mediterranean (LAM) family. Genetic diversity of M. tuberculosis likely affects the clinical aspects of tuberculosis (TB). Prospective studies that address this issue are scarce and remain controversial. OBJECTIVE: To determine the association of differential clinical features of pulmonary TB with the RD(Rio) M. tuberculosis etiology. METHODS: Culture-proven pulmonary TB patients (n = 272) were clinically evaluated, including history, physical examination, chest X-ray and anti-human immunodeficiency virus serology. Isolates were classified as RD(Rio) or non-RD(Rio) M. tuberculosis by multiplex polymerase chain reaction and further spoligotyped. Clinical and M. tuberculosis genotype data were analyzed. RESULTS: RD(Rio) M. tuberculosis caused disease in 26.5% (72/270) of all TB cases. The LAM genotype, of which RD(Rio) strains are members, was responsible for 46.0% of the TB cases. Demographic data, major signs and symptoms, radiographic presentation, microbiological features and clinical outcomes were not significantly different among patients with TB caused by RD(Rio) and non-RD(Rio) strains. CONCLUSIONS: Disease caused by M. tuberculosis RD(Rio) strains was not clinically distinctive or more severe than disease caused by non-RD(Rio) strains in this series of TB patients. Larger prospective studies specifically designed to disclose differential clinical characteristics of TB caused by specific M. tuberculosis lineages are needed. (2012 The Union.) |
Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis
Kurbatova E , Gammino VM , Bayona J , Becerra MC , Danilovitz M , Falzon D , Gelmanova I , Keshavjee S , Leimane V , Mitnick CD , Quelapio MI , Riekstina V , Taylor A , Viiklepp P , Zignol M , Cegielski JP . Int J Tuberc Lung Dis 2012 16 (10) 1335-1343 OBJECTIVE: To identify predictors of initial sputum culture conversion, estimate the usefulness of persistent positive cultures at different time points in predicting treatment failure, and evaluate different definitions of culture conversion for predicting failure among patients with multidrug-resistant tuberculosis (MDR-TB) in five countries, 2000-2004. METHODS: Predictors of time to conversion were identified using multivariate Cox proportional hazards regression modeling. Receiver operating characteristic curves were plotted to visualize the effect of using different definitions of 'culture conversion' on the balance between sensitivity and specificity. RESULTS: Overall, 1209/1416 (85%) of patients with baseline positive cultures converted in a median of 3.0 months (interquartile range 2.0-5.0). Independent predictors of less likely conversion included baseline positive smear (hazard ratio [HR] 0.60, 95%CI 0.53-0.68), resistance to pyrazinamide (HR 0.82, 95%CI 0.70-0.96), fluoroquinolones (FQs; HR 0.65, 95%CI 0.51-0.83) or thioamide (HR 0.83, 95%CI 0.71-0.96), previous use of FQs (HR 0.71, 95%CI 0.60-0.83), poor outcome of previous anti-tuberculosis treatment (HR 0.69, 95%CI 0.54-0.88) and alcoholism (HR 0.74, 95%CI 0.63-0.87). The maximum combined sensitivity (84%) and specificity (94%) in predicting treatment failure was based on lack of culture conversion at month 9 of treatment, assuming conversion is defined as five consecutive negative cultures. CONCLUSION: Patients with identified risk factors were less likely to achieve sputum culture conversion during MDR-TB treatment. (2012 The Union.) |
Prevalence and associations of genital ulcer and urethral pathogens in men presenting with genital ulcer syndrome to primary health care clinics in South Africa
Lewis DA , Muller E , Steele L , Sternberg M , Radebe F , Lyall M , Ballard RC , Paz-Bailey G . Sex Transm Dis 2012 39 (11) 880-885 BACKGROUND: This study aimed to determine the prevalence of genital ulcer and urethral pathogens, as well as their association with clinical features, in men with genital ulcer disease (GUD) enrolled in a clinical trial. METHODS: Clinical data were collected by questionnaire. Ulcer swabs were tested for herpes simplex viruses (HSV-1/2), Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis L1-L3. First-pass urine was tested for urethral pathogens, namely Neisseria gonorrhoeae, C. trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Pathogens were detected by real-time molecular assays. Blood was tested for HIV, HSV-2, and syphilis-associated antibodies. Pathogens and clinical associations were investigated using the chi test. RESULTS: A total of 615 men with GUD were recruited. Herpes simplex virus (HSV-1, 4.2%; HSV-2, 98.2%) and bacterial pathogens were detected in 451 (73.6%) and 48 (7.8%) of genital ulcers, respectively. Human immunodeficiency virus, HSV-2, and treponemal antibodies were detected in 387 (62.9%), 434 (70.6%), and 141 (23.0%) men, respectively, whereas 54 men (8.8%) were rapid plasmin reagin (RPR) seropositive. A total of 223 urethral infections were diagnosed in 188 men (30.6%), including 69 (11.2%) M. genitalium, 64 (10.4%) T. vaginalis, 60 (9.8%) C. trachomatis, and 30 (4.9%) N. gonorrhoeae infections. Dysuria was reported by 170 men (27.6%), and 69 men (11.5%) had urethral discharge on examination. Urethral pathogens were detected in 102/409 (24.9%) men without these clinical features. CONCLUSIONS: Herpes accounted for most GUD cases and urethral pathogen coinfections were common. Erythromycin, dispensed to treat infrequent chancroid and lymphogranuloma venereum cases, provided additional treatment of some asymptomatic urethral pathogens. Additional antibiotics would be required to treat asymptomatic trichomoniasis and gonorrhea. |
Early uptake of HIV clinical care after testing HIV-positive during home-based testing and counseling in western Kenya
Medley A , Ackers M , Amolloh M , Owuor P , Muttai H , Audi B , Sewe M , Laserson K . AIDS Behav 2012 17 (1) 224-34 Home-based HIV testing and counseling (HBTC) has the potential to increase access to HIV testing. However, the extent to which HBTC programs successfully link HIV-positive individuals into clinical care remains unclear. To determine factors associated with early enrollment in HIV clinical care, adult residents (aged ≥13 years) in the Health and Demographic Surveillance System in Kisumu, Kenya were offered HBTC. All HIV-positive residents were referred to nearby HIV clinical care centers. Two to four months after HBTC, peer educators conducted home visits to consenting HIV-positive residents. Overall, 9,895 (82 %) of 12,035 residents accepted HBTC; 1,087 (11 %) were HIV-positive; and 737 (68 %) received home visits. Of those receiving home visits, 42 % reported HIV care attendance. Factors associated with care attendance included: having disclosed, living with someone attending HIV care, and wanting to seek care after diagnosis. Residents who reported their current health as excellent or who doubted their HBTC result were less likely to report care attendance. While findings indicate that HBTC was well-received in this setting, less than half of HIV-positive individuals reported current care attendance. Identification of effective strategies to increase early enrollment and retention in HIV clinical care is critical and will require coordination between testing and treatment program staff and systems. |
Emergence of increased azithromycin resistance during unsuccessful treatment of Neisseria gonorrhoeae infection with azithromycin (Portland, OR, 2011)
Soge OO , Harger D , Schafer S , Toevs K , Raisler KA , Venator K , Holmes KK , Kirkcaldy RD . Sex Transm Dis 2012 39 (11) 877-9 We describe the emergence of an azithromycin-resistant Neisseria gonorrhoeae variant in a man from Portland, Oregon, during sole treatment with 2 g azithromycin. This report highlights the ease with which gonococcal macrolide resistance can emerge, the threat of multidrug resistant N. gonorrhoeae, and the need for adherence to Centers for Disease Control and Prevention treatment guidelines. |
Home-based HIV testing and counseling in rural and urban Kenyan communities
Dalal W , Feikin DR , Amolloh M , Ransom R , Burke H , Lugalia F , Ouma A , Laserson KF , Mermin J , Breiman RF , Bunnell R . J Acquir Immune Defic Syndr 2012 62 (2) e47-54 BACKGROUND: In sub-Saharan Africa, the majority of people with HIV do not know they are infected. METHODS: We conducted door-to-door home-based testing and counseling (HBTC) in rural western Kenya (Lwak) and an informal urban settlement in Nairobi (Kibera) in 2008. Following consent, eligible persons (adults and adolescents ≥ 13 years and children ≤ 12 years whose biologic mother was HIV-infected or deceased) received parallel fingerstick HIV rapid testing and counseling. Persons newly HIV-diagnosed were referred to care services, fingerstick blood for CD4 testing was collected, and a one-month follow-up home visit was conducted. FINDINGS: Among 24,450 people offered HBTC, 19,966 (81.7%) accepted; 65.4% of whom were HIV-tested for the first time. Prevalence in adults ≥18 years old being HIV-tested for the first time was 13.5% (12.6% Kibera, 14.2% Lwak). Among adults who reported a previously negative test, HIV prevalence was 7.4% (7.2% Kibera, 7.7% Lwak). Among all persons with HIV in these communities, two-thirds were newly diagnosed through HBTC. Median CD4 count among newly diagnosed adults was 403 (interquartile range (IQR) =252-594). Among couples, 38.0% in Kibera and 51.7% in Lwak were counseled together. Among HIV-infected people in a couple, 34.6% had an HIV-uninfected partner. Among newly diagnosed HIV-infected persons, at the one-month follow-up visit, 53.6% in Kibera and 43.6% in Lwak reported having visited an HIV patient support center. INTERPRETATION: HBTC acceptance was high and most HIV-infected persons did not previously know they had HIV. HBTC can be an effective strategy for early HIV diagnosis and treatment referral. |
2011: the year in review. Part II: tuberculosis and lung disease
Iademarco MF , Koh WJ . Int J Tuberc Lung Dis 2012 16 (10) 1291-1299 IN THIS YEAR-IN-REVIEW ARTICLE, we review | 52 of 55 articles published on tuberculosis (TB) in the | International Journal of Tuberculosis and Lung Disease from August through December 2011, complementing the 104 summarized by Chang and Nuermberger,1 and using the same categories (Table 1). We | also summarize 33 of 36 non-TB articles for the entire year (Table 2). | ACTIVE TB | Epidemiology | There was diversity in six epidemiological publications. | Over 8 years, one Madrid hospital showed an overall | incidence of disease of 1.9 cases per 100 person-years | in a retrospective cohort of 1824 human immunodefi ciency virus (HIV) infected patients receiving ART; | 19% had TST-positive results, with an increased risk | of progression to disease (odds ratio [OR] 4.4). Baseline CD4 count was a factor only in patients with tuberculin skin test (TST) negative results, elevating the | risk 16-fold.2 A 2-year Polish hospital-based survey | affi rmed that the current genotyping triage methodology, the combination of 15-loci MIRU-VNTR (mycobacterial interspersed repetitive units-variable number of tandem repeats) typing with spoligotyping for | primary analysis, with insertion sequence 6110-RFLP | (restriction fragment length polymorphism) typing | reserved as a fi nal step, is suffi cient for disaggregating epidemiologically linked clusters.3 A 5-month | nationwide Mongolian survey among new and previously treated sputum smear-positive TB patients demonstrated striking emergence of multidrug-resistant | (MDR) disease among those previously treated: 28% | vs. 1.4% among new cases. MDR-TB among new | cases had risen slightly from 1.0% in 1999, in a survey excluding retreatment cases.4 |
Eastern equine encephalitis in moose (Alces americanus) in northeastern Vermont
Mutebi JP , Swope BN , Saxton-Shaw KD , Graham AC , Turmel JP , Berl E . J Wildl Dis 2012 48 (4) 1109-12 During fall 2010, 21 moose (Alces americanus) sera collected in northeastern Vermont were screened for eastern equine encephalitis virus (EEEV) antibodies using plaque reduction neutralization tests. Six (29%) were antibody positive. This is the first evidence of EEEV activity in Vermont, and the second report of EEEV antibodies in moose. |
Obstructive lung disease and exposure to burning biomass fuel in the indoor environment
Diette GB , Accinelli RA , Balmes JR , Buist AS , Checkley W , Garbe P , Hansel NN , Kapil V , Gordon S , Lagat DK , Yip F , Mortimer K , Perez-Padilla R , Roth C , Schwaninger JM , Punturieri A , Kiley JP . Glob Heart 2012 7 (3) 265-270 It is estimated that up to half of the world’s population burns biomass fuel (wood, crop residues, animal dung and coal) for indoor uses such as cooking, lighting and heating. As a result, a large proportion of women and children are exposed to high levels of household air pollution (HAP). The short and long term effects of these exposures on the respiratory health of this population are not clearly understood. On May 9–11, 2011 NIH held an international workshop on the "Health Burden of Indoor Air Pollution on Women and Children," in Arlington, VA. To gather information on the knowledge base on this topic and identify research gaps, ahead of the meeting we conducted a literature search using PubMed to identify publications that related to HAP, asthma, and chronic obstructive pulmonary disease (COPD). Abstracts were all analyzed and we report on those considered by the respiratory sub study group at the meeting to be most relevant to the field. Many of the studies published are symptom-based studies (as opposed to objective measures of lung function or clinical examination etc.) and measurement of HAP was not done. Many found some association between indoor exposures to biomass smoke as assessed by stove type (e.g., open fire vs. liquid propane gas) and respiratory symptoms such as wheeze and cough. Among the studies that examined objective measures (e.g. spirometry) as a health outcome, the data supporting an association between biomass smoke exposure and COPD in adult women are fairly robust, but the findings for asthma are mixed. If an association was observed between the exposures and lung function, most data seemed to demonstrate mild to moderate reductions in lung function, the pathophysiological mechanisms of which need to be investigated. In the end, the group identified a series of scientific gaps and opportunities for research that need to be addressed to better understand the respiratory effects of exposure to indoor burning of the different forms of biomass fuels. |
Secondary mapping of lymphatic filariasis in Haiti-definition of transmission foci in low-prevalence settings
Drexler N , Washington CH , Lovegrove M , Grady C , Milord MD , Streit T , Lammie P . PLoS Negl Trop Dis 2012 6 (10) e1807 To eliminate Lymphatic filariasis (LF) as a public health problem, the World Health Organization (WHO) recommends that any area with infection prevalence greater than or equal to 1% (denoted by presence of microfilaremia or antigenemia) should receive mass drug administration (MDA) of antifilarial drugs for at least five consecutive rounds. Areas of low-antigen prevalence (<1%) are thought to pose little risk for continued transmission of LF. Five low-antigen prevalence communes in Haiti, characterized as part of a national survey, were further assessed for transmission in this study. An initial evaluation of schoolchildren was performed in each commune to identify antigen-positive children who served as index cases for subsequent community surveys conducted among households neighboring the index cases. Global positioning system (GPS) coordinates and immunochromatographic tests (ICT) for filarial antigenemia were collected on approximately 1,600 persons of all ages in the five communes. The relationship between antigen-positive cases in the community and distance from index cases was evaluated using multivariate regression techniques and analyses of spatial clustering. Community surveys demonstrated higher antigen prevalence in three of the five communes than was observed in the original mapping survey; autochthonous cases were found in the same three communes. Regression techniques identified a significantly increased likelihood of being antigen-positive when living within 20 meters of index cases when controlling for age, gender, and commune. Spatial clustering of antigen-positive cases was observed in some, but not all communes. Our results suggest that localized transmission was present even in low-prevalence settings and suggest that better surveillance methods may be needed to detect microfoci of LF transmission. |
A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes
Vesco KK , Dietz PM , Bulkley J , Bruce FC , Callaghan WM , England L , Kimes T , Bachman DJ , Hartinger KJ , Hornbrook MC . Am J Obstet Gynecol 2012 207 (4) 283 e1-6 OBJECTIVE: We sought to determine whether our process improvement program led to increased postpartum diabetes screening rates among women with gestational diabetes mellitus (GDM). STUDY DESIGN: In early 2009, we conducted obstetrics department staff education sessions, revised GDM patient care protocols, and developed an electronic system to trigger reminder calls to patients who had not completed diabetes mellitus screening by 3 months postpartum. We then evaluated the rates of postpartum glucose test order entry and completion for women with GDM delivering from July 2009 through June 2010 (n = 179) and July 2007 through June 2008 (n = 200). RESULTS: After the program's implementation, the proportion of women receiving an order for a postpartum glucose test within 3 months of delivery increased from 77.5-88.8% (P = .004), and test completion increased from 59.5-71.5% (hazard ratio, 1.37; 95% confidence interval, 1.07-1.75). CONCLUSION: Rates of postpartum diabetes testing can be improved with system changes and reminders. |
Diversity and relationships of cocirculating modern human rotaviruses revealed using large-scale comparative genomics.
McDonald SM , McKell AO , Rippinger CM , McAllen JK , Akopov A , Kirkness EF , Payne DC , Edwards KM , Chappell JD , Patton JT . J Virol 2012 86 (17) 9148-62 Group A rotaviruses (RVs) are 11-segmented, double-stranded RNA viruses and are primary causes of gastroenteritis in young children. Despite their medical relevance, the genetic diversity of modern human RVs is poorly understood, and the impact of vaccine use on circulating strains remains unknown. In this study, we report the complete genome sequence analysis of 58 RVs isolated from children with severe diarrhea and/or vomiting at Vanderbilt University Medical Center (VUMC) in Nashville, TN, during the years spanning community vaccine implementation (2005 to 2009). The RVs analyzed include 36 G1P[8], 18 G3P[8], and 4 G12P[8] Wa-like genogroup 1 strains with VP6-VP1-VP2-VP3-NSP1-NSP2-NSP3-NSP4-NSP5/6 genotype constellations of I1-R1-C1-M1-A1-N1-T1-E1-H1. By constructing phylogenetic trees, we identified 2 to 5 subgenotype alleles for each gene. The results show evidence of intragenogroup gene reassortment among the cocirculating strains. However, several isolates from different seasons maintained identical allele constellations, consistent with the notion that certain RV clades persisted in the community. By comparing the genes of VUMC RVs to those of other archival and contemporary RV strains for which sequences are available, we defined phylogenetic lineages and verified that the diversity of the strains analyzed in this study reflects that seen in other regions of the world. Importantly, the VP4 and VP7 proteins encoded by VUMC RVs and other contemporary strains show amino acid changes in or near neutralization domains, which might reflect antigenic drift of the virus. Thus, this large-scale, comparative genomic study of modern human RVs provides significant insight into how this pathogen evolves during its spread in the community. |
Has the use of complementary and alternative medicine therapies by U.S. adults with chronic disease-related functional limitations changed from 2002 to 2007?
Okoro CA , Zhao G , Li C , Balluz LS . J Altern Complement Med 2012 19 (3) 217-23 OBJECTIVES: This study examined changes in the use of complementary and alternative medicine (CAM) therapies by U.S. adults aged 18 years or older with chronic disease-related functional limitations between 2002 and 2007. DESIGN: The study was a cross-sectional survey. SETTING/LOCATION: The study was conducted in the United States. SUBJECTS:The study comprised adults aged 18 years or older with chronic disease-related functional limitations. METHODS: Data were obtained from the 2002 and 2007 U.S. National Health Interview Survey to compare the use of 22 CAM therapies (n=9313 and n=7014, respectively). Estimates were age adjusted to the year 2000 U.S. standard population. RESULTS: The unadjusted and age-standardized prevalence of overall CAM use (22 therapies comparable between both survey years) was higher in 2007 than in 2002 (30.6% versus 26.9%, p<0.001 and 34.4% versus 30.6%, p<0.001, respectively). Adults with functional limitations that included changing and maintaining body position experienced a significant increase in CAM use between 2002 and 2007 (31.1%-35.0%, p<0.01). The use of deep breathing exercises was the most prevalent CAM therapy in both 2002 and 2007 and increased significantly during this period (from 17.9% to 19.9%, p<0.05). The use of meditation, massage, and yoga also increased significantly from 2002 and 2007 (11.0%-13.5%, p<0.01; 7.0%-10.9%, p<0.0001; and 5.1% to 6.6%, p<0.05, respectively), while the use of the Atkins diet decreased (2.2%- 1.4%, p<0.01). CONCLUSIONS: Among U.S. adults with chronic disease-related functional limitations, the overall increase in CAM use from 2002 to 2007 was significant, particularly among those with changing and maintaining body position limitations. |
The African American Women and Mass Media campaign: a CDC breast cancer screening project
Hall IJ , Rim SH , Johnson-Turbes CA , Vanderpool R , Kamalu NN . J Womens Health (Larchmt) 2012 21 (11) 1107-13 For decades, black radio has reached African American communities with relevant, culturally appropriate information, and it continues to be an ideal communication channel to use for contemporary health promotion. In an effort to combat excess breast cancer mortality rates and help eliminate cancer disparities among low-income African American women, the Centers for Disease Control and Prevention's (CDC) Division of Cancer Prevention and Control designed, implemented, and evaluated the African American Women and Mass Media (AAMM) pilot campaign. The AAMM campaign uses black radio, radio stations with broad African American listenership, as a platform for targeted, culturally competent health promotion and outreach to low-income, African American women. The AAMM campaign uses radio advertisements and print materials disseminated in predominantly African American neighborhoods to promote awareness of breast cancer, early detection, and the CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Evaluation of the AAMM campaign found that the campaign successfully reached its target audience of low-income, African American women and increased women's awareness of breast cancer screening services through the Breast and Cervical Cancer Program in Savannah and Macon, Georgia. |
Reducing the global burden of congenital rubella syndrome
Reef SE , Chu SY , Cochi SL , Kezaala R , van den Ent M , Gay A , de Quadros C , Strebel PM . Lancet 2012 380 (9848) 1145-6 In their Correspondence letter (July 21, p 217),1 F T Cutts and colleagues highlight challenges to rubella vaccination programmes that might arise with GAVI Alliance support for eligible countries to introduce rubella-containing vaccines. We wholeheartedly agree that expansion of rubella vaccination programmes cannot be “business as usual”. | Issues such as disparities in coverage, pockets of susceptibility, and targeted vaccination of women of childbearing age highlighted by Cutts and colleagues were also addressed in a recently published WHO position paper on rubella vaccine.2 The position paper stresses the need for strong routine vaccination programmes and supplemental immunisation activities to achieve high rubella vaccination coverage (≥80%), and efforts to reach women of childbearing age. Although GAVI Alliance support does not directly fund strategies for vaccination of such women, the board called on governments to fund additional vaccination efforts for this group. |
Monitoring of rotavirus vaccination in Morocco: establishing the baseline burden of rotavirus disease
Benhafid M , Rguig A , Trivedi T , Elqazoui M , Teleb N , Mouane N , Maltouf AF , Parashar U , Patel M , Aouad RE . Vaccine 2012 30 (46) 6515-20 BACKGROUND: Rotavirus is a leading cause of childhood morbidity and mortality worldwide. Clinical trials for two rotavirus vaccines recommended by the WHO for global use since 2009 have successfully demonstrated the safety and efficacy of these vaccines in a wide range of countries. To control the burden of severe and fatal diarrheal disease, the Ministry of Health of Morocco introduced the single strain rotavirus vaccine into their national immunization program in 2010. METHODS: We employed a standard WHO case definition to identify children under 5 hospitalized with AGE at four hospitals from June 2006 to May 2010 to establish baseline burden of rotavirus disease before introduction of vaccine. Stool samples were collected and tested for rotavirus using a standard enzyme immunoassay. RESULTS: Overall, 40% (741 of 1841) of the children hospitalized with AGE tested positive for rotavirus, making it the single most common cause of severe gastroenteritis among children in Morocco. Applying this prevalence to the estimates of diarrheal hospitalizations and deaths in Morocco, we estimate that rotavirus annually causes 19,646 hospitalizations and 1604 deaths in children under 5 years of age. DISCUSSION: On the basis of these surveillance data, we estimate that 1 in 389 Moroccan children died and 1 in 32 was hospitalized due to rotavirus before their fifth birthday. A considerable proportion of these deaths and hospitalizations should be preventable through vaccination, and the 4 years of stable prevaccine surveillance in Morocco will be a tremendously useful platform for assessing potential changes in the epidemiology of rotavirus disease and measuring impact of the new rotavirus vaccine program in Morocco. |
A systematic meta-review of evaluations of youth violence prevention programs: common and divergent findings from 25years of meta-analyses and systematic reviews
Matjasko JL , Vivolo-Kantor AM , Massetti GM , Holland KM , Holt MK , Dela Cruz J . Aggress Violent Behav 2012 17 (6) 540-552 Violence among youth is a pervasive public health problem. In order to make progress in reducing the burden of injury and mortality that result from youth violence, it is imperative to identify evidence-based programs and strategies that have a significant impact on violence. There have been many rigorous evaluations of youth violence prevention programs. However, the literature is large, and it is difficult to draw conclusions about what works across evaluations from different disciplines, contexts, and types of programs. The current study reviews the meta-analyses and systematic reviews published prior to 2009 that synthesize evaluations of youth violence prevention programs. This meta-review reports the findings from 37 meta-analyses and 15 systematic reviews; the included reviews were coded on measures of the social ecology, prevention approach, program type, and study design. A majority of the meta-analyses and systematic reviews were found to demonstrate moderate program effects. Meta-analyses yielded marginally smaller effect sizes compared to systematic reviews, and those that included programs targeting family factors showed marginally larger effects than those that did not. In addition, there are a wide range of individual/family, program, and study moderators of program effect sizes. Implications of these findings and suggestions for future research are discussed. |
Anterior cruciate ligament injury prevention and primary prevention of knee osteoarthritis
Hootman JM , Albohm MJ . J Athl Train 2012 47 (5) 589-90 After decades of epidemiologic and mechanistic research, anterior cruciate ligament (ACL) injuries are clearly a growing problem among active youth and adults. On average each year, there are approximately 113 000 ambulatory health care visits for initial care of cruciate ligament injuries and about 75 000 outpatient surgical reconstructions.1 Assuming that the average surgical cost of reconstruction is $25 000,2 then surgical costs over a 10-year period exceed $18.7 billion. However, these simple estimates do not take into account either the physical pain, lost school and work days, activity limitations, and disability associated with ACL injuries or the possible long-term sequelae of a major joint injury, such as posttraumatic osteoarthritis. | Prior knee injury is one of the strongest risk factors for the development of osteoarthritis: 1 in 2 adults with a serious knee injury will develop knee osteoarthritis over his or her lifetime.3 In fact, more than 50% of ACL-injured knees will develop osteoarthritis in as few as 10 years.4,5 This figure is alarming given the numbers of ACL injuries occurring every year, most in adolescents and young adults during sport and recreation activities. A teenage soccer player who injures a knee at age 16 may develop osteoarthritis by his or her early 30s. With the average annual cost (both direct and indirect) of knee osteoarthritis among primary care patients older than age 55 at $5700,6 this young adult may expend more than $285 000 over a lifetime. In addition, a proportion of patients will develop knee osteoarthritis severe enough to require total knee replacement. In 2009, 679 260 total knee replacements7 for osteoarthritis were performed at an average cost of $47 179 per procedure, totaling more than $34 million. Clearly, the human and financial costs of both ACL injury and knee osteoarthritis are staggering. |
Comparison of Ahlstrom grade 226, Munktell TFN, and Whatman 903 filter papers for dried blood spot specimen collection and subsequent HIV-1 load and drug resistance genotyping analysis.
Rottinghaus E , Bile E , Modukanele M , Maruping M , Mine M , Nkengasong J , Yang C . J Clin Microbiol 2012 51 (1) 55-60 BACKGROUND: Dried blood spots (DBS) collected on filter paper have eased the difficulty of blood collection in resource-limited settings. Currently Whatman 903 (W-903) is the only filter paper that has been used for HIV viral load (VL) and HIV drug resistance (HIVDR) testing. We therefore evaluated two additional commercially available filter papers, Ahlstrom grade 226 (A-226) and Munktell TFN (M-TFN) for VL and HIVDR genotyping using W-903 as a comparison group. METHODS: DBS specimens were generated from 344 adult ART-patients in Botswana. VL was measured with NucliSENS EasyQ HIV-1 v2.0 and genotyping was performed for those specimens with a detectable VL (≥ 2.90 log10 copies/ml) using an in-house method. RESULTS: Bland-Altman analysis revealed strong concordance in quantitative VL analysis between W-903 and A-226 (bias= -0.034 +/- 0.246 log10 copies/ml [Mean difference +/- SD]) and M-TFN (bias = -0.028+/- 0.186 log10 copies/ml) while qualitative VL analysis for virological failure determination, defined as VL ≥ 3.00 log10 copies/ml, showed low sensitivities for A-266 (71.54%) and M-TFN (65.71%) when compared to W-903. DBS collected on M-TFN had the highest genotyping efficiency (100%) compared to W-903 and A-226 (91.7%), and appear more sensitive in detecting major HIVDR mutations. CONCLUSIONS: DBS collected on A-226 and M-TFN filter papers performed similarly to W-903 for quantitative VL analysis and HIVDR detection. Together, the encouraging genotyping results and the variability observed in determining virological failure from this small pilot study warrant further investigation of A-226 and M-TFN as specimen collection devices for HIVDR monitoring surveys. |
Multilocus sequence typing of Histoplasma capsulatum in formalin-fixed paraffin-embedded tissues from cats living in non-endemic regions reveals a new phylogenetic clade.
Balajee SA , Hurst SF , Chang LS , Miles M , Beeler E , Hale C , Kasuga T , Benedict K , Chiller T , Lindsley MD . Med Mycol 2012 51 (4) 345-51 Infections caused by Histoplasma capsulatum are found most often in endemic regions of North, Central, and South America. H. capsulatum has been divided into eight geographic clades by multi-locus sequence typing (MLST). Recently, one isolate and five formalin-fixed paraffin-embedded (FFPE) tissue samples were received from six of 15 suspected cases of histoplasmosis in cats residing in areas not known to be endemic for H. capsulatum. Polymerase chain reaction (PCR) amplification and sequence analysis of the rDNA ITS-2 region confirmed the diagnosis of H. capsulatum. Since these cases were not, as noted, from the accepted endemic areas, it was of interest to understand the molecular epidemiology of these isolates. Results of molecular analysis indicated that the H. capsulatum recovered from the cats were most closely related to the North American-1 clade, but clustered separately outside this clade, suggesting that the H. capsulatum infecting the animals may represent a separate clade or phylogenetic species. This study also demonstrated the utility of obtaining valuable molecular subtype data directly from archived FFPE tissue blocks, particularly when a fungus culture was not performed or is otherwise unavailable. |
Recovery of diverse microbes in high turbidity surface water samples using dead-end ultrafiltration
Mull B , Hill VR . J Microbiol Methods 2012 91 (3) 429-33 Dead-end ultrafiltration (DEUF) has been reported to be a simple, field-deployable technique for recovering bacteria, viruses, and parasites from large-volume water samples for water quality testing and waterborne disease investigations. While DEUF has been reported for application to water samples having relatively low turbidity, little information is available regarding recovery efficiencies for this technique when applied to sampling turbid water samples such as those commonly found in lakes and rivers. This study evaluated the effectiveness of a DEUF technique for recovering MS2 bacteriophage, enterococci, Escherichia coli, Clostridium perfringens, and Cryptosporidium parvum oocysts in surface water samples having elevated turbidity. Average recovery efficiencies for each study microbe across all turbidity ranges were: MS2 (66%), C. parvum (49%), enterococci (85%), E. coli (81%), and C. perfringens (63%). The recovery efficiencies for MS2 and C. perfringens exhibited an inversely proportional relationship with turbidity, however no significant differences in recovery were observed for C. parvum, enterococci, or E. coli. Although ultrafilter clogging was observed, the DEUF method was able to process 100-Liter surface water samples at each turbidity level within 60minutes. This study supports the use of the DEUF method for recovering a wide array of microbes in large-volume surface water samples having medium to high turbidity. |
Release of beryllium into artificial airway epithelial lining fluid
Stefaniak AB , Virji MA , Day GA . Arch Environ Occup Health 2012 67 (4) 219-28 Inhaled beryllium particles that deposit in the lung airway lining fluid may dissolve and interact with immune-competent cells resulting in sensitization. As such, solubilization of 17 beryllium-containing materials (ore, hydroxide, metal, oxide, alloys, and process intermediates) was investigated using artificial human airway epithelial lining fluid. The maximum beryllium release in 7 days was 11.78% (from a beryl ore melter dust), although release from most materials was < 1%. Calculated dissolution half-times ranged from 30 days (reduction furnace material) to 74,000 days (hydroxide). Despite rapid mechanical clearance, billions of beryllium ions may be released in the respiratory tract via dissolution in airway lining fluid. Beryllium-containing particles that deposit in the respiratory tract dissolve in artificial lung epithelial lining fluid, thereby providing ions for absorption in the lung and interaction with immune-competent cells in the respiratory tract. |
Simultaneous analysis of 28 urinary VOC metabolites using ultra high performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (UPLC-ESI/MSMS)
Alwis KU , Blount BC , Britt AS , Patel D , Ashley DL . Anal Chim Acta 2012 750 152-60 Volatile organic compounds (VOCs) are ubiquitous in the environment, originating from many different natural and anthropogenic sources, including tobacco smoke. Long-term exposure to certain VOCs may increase the risk for cancer, birth defects, and neurocognitive impairment. Therefore, VOC exposure is an area of significant public health concern. Urinary VOC metabolites are useful biomarkers for assessing VOC exposure because of non-invasiveness of sampling and longer physiological half-lives of urinary metabolites compared with VOCs in blood and breath. We developed a method using reversed-phase ultra high performance liquid chromatography (UPLC) coupled with electrospray ionization tandem mass spectrometry (ESI/MSMS) to simultaneously quantify 28 urinary VOC metabolites as biomarkers of exposure. We describe a method that monitors metabolites of acrolein, acrylamide, acrylonitrile, benzene, 1-bromopropane, 1,3-butadiene, carbon-disulfide, crotonaldehyde, cyanide, N,N-dimethylformamide, ethylbenzene, ethylene oxide, propylene oxide, styrene, tetrachloroethylene, toluene, trichloroethylene, vinyl chloride and xylene. The method is accurate (mean accuracy for spiked matrix ranged from 84 to104%), sensitive (limit of detection ranged from 0.5 to 20ngmL(-1)) and precise (the relative standard deviations ranged from 2.5 to 11%). We applied this method to urine samples collected from 1203 non-smokers and 347 smokers and demonstrated that smokers have significantly elevated levels of tobacco-related biomarkers compared to non-smokers. We found significant (p<0.0001) correlations between serum cotinine and most of the tobacco-related biomarkers measured. These findings confirm that this method can effectively quantify urinary VOC metabolites in a population exposed to volatile organics. |
Utility of IgM ELISA, TaqMan real-time PCR, reverse transcription PCR, and RT-LAMP assay for the diagnosis of Chikungunya fever
Reddy V , Ravi V , Desai A , Parida M , Powers AM , Johnson BW . J Med Virol 2012 84 (11) 1771-1778 Chikungunya fever a re-emerging infection with expanding geographical boundaries, can mimic symptoms of other infections like dengue, malaria which makes the definitive diagnosis of the infection important. The present study compares the utility of four laboratory diagnostic methods viz. IgM capture ELISA, an in house reverse transcription PCR for the diagnosis of Chikungunya fever, TaqMan real-time PCR, and a one step reverse transcription-loop mediated isothermal amplification assay (RT-LAMP). Out of the 70 serum samples tested, 29 (41%) were positive for Chikungunya IgM antibody by ELISA and 50 (71%) samples were positive by one of the three molecular assays. CHIKV specific nucleic acid was detected in 33/70 (47%) by reverse transcription PCR, 46/70 (66%) by TaqMan real-time PCR, and 43/70 (62%) by RT-LAMP assay. A majority of the samples (62/70; 89%) were positive by at least one of the four assays used in the study. The molecular assays were more sensitive for diagnosis in the early stages of illness (2-5 days post onset) when antibodies were not detectable. In the later stages of illness, the IgM ELISA is a more sensitive diagnostic test. In conclusion we recommend that the IgM ELISA be used as an initial screening test followed one of the molecular assays in samples that are collected in the early phase of illness and negative for CHIKV IgM antibodies. Such as approach would enable rapid confirmation of the diagnosis and implementation of public health measures especially during outbreaks. (2012 Wiley Periodicals, Inc.) |
Longitudinal assessment of pigtailed macaque lower genital tract microbiota by pyrosequencing reveals dissimilarity to the genital microbiota of healthy humans
Spear GT , Kersh E , Guenthner P , Vishwanathan SA , Gilbert D , Zariffard MR , Mirmonsef P , Landay A , Zheng L , Gillevet P . AIDS Res Hum Retroviruses 2012 28 (10) 1244-9 Vaginal bacterial communities play an important role in human health and have been shown to influence HIV infection. Pigtailed macaques (Macaca nemestrina) are used as an animal model of HIV vaginal infection of women. Since the bacterial microbiota could influence retrovirus infection of pigtailed macaques, the genital microbiota in 10 cycling macaques was determined by pyrosequencing. The microbiota of all macaques was polymicrobial with a median of 13 distinct genera. Strikingly, the genera Sneathia and Fusobacterium, both in the phylum Fusobacteria, accounted for 18.9% and 13.3% of sequences while the next most frequent were Prevotella (5.6%), Porphyromonas (4.1%), Atopobium (3.6%), and Parvimonas (2.6%). Sequences corresponding to Lactobacillus comprised only 2.2% of sequences on average and were essentially all L. amylovorus. Longitudinal sampling of the 10 macaques over an 8-week period, which spanned at least one full ovulatory cycle, showed a generally stable presence of the major types of bacteria with some exceptions. These studies show that the microbiota of the pigtailed macaques is substantially dissimilar to that found in most healthy humans, where the genital microbiota is usually dominated by Lactobacillus sp. The polymicrobial makeup of the macaque bacterial populations, the paucity of lactobacilli, and the specific types of bacteria present suggest that the pigtailed macaque microbiota could influence vaginal retrovirus infection. |
Molecular characterization of invasive meningococcal isolates from countries in the African meningitis belt before introduction of a serogroup A conjugate vaccine
Caugant DA , Kristiansen PA , Wang X , Mayer LW , Taha MK , Ouedraogo R , Kandolo D , Bougoudogo F , Sow S , Bonte L . PLoS One 2012 7 (9) e46019 BACKGROUND: The serogroup A conjugate meningococcal vaccine, MenAfriVac, was introduced in mass vaccination campaigns in December 2010 in Burkina Faso, Mali and Niger. In the coming years, vaccination will be extended to other African countries at risk of epidemics. To document the molecular characteristics of disease-causing meningococcal strains circulating in the meningitis belt of Africa before vaccine introduction, the World Health Organization Collaborating Centers on Meningococci in Europe and United States established a common strain collection of 773 isolates from cases of invasive meningococcal disease collected between 2004 and 2010 from 13 sub-Saharan countries. METHODOLOGY: All isolates were characterized by multilocus sequence typing, and 487 (62%) were also analyzed for genetic variation in the surface antigens PorA and FetA. Antibiotic susceptibility was tested for part of the collection. PRINCIPAL FINDINGS: Only 19 sequence types (STs) belonging to 6 clonal complexes were revealed. ST-5 clonal complex dominated with 578 (74.8%) isolates. All ST-5 complex isolates were remarkably homogeneous in their PorA (P1.20,9) and FetA (F3-1) and characterized the serogroup A strains which have been responsible for most epidemics during this time period. Sixty-eight (8.8%) of the 773 isolates belonged to the ST-11 clonal complex which was mainly represented by serogroup W135, while an additional 38 (4.9%) W135 isolates belonged to the ST-175 complex. Forty-eight (6.2%) serogroup X isolates from West Africa belonged to the ST-181 complex, while serogroup X cases in Kenya and Uganda were caused by an unrelated clone, ST-5403. Serogroup X, ST-181, emerged in Burkina Faso before vaccine introduction. CONCLUSIONS: In the seven years preceding introduction of a new serogroup A conjugate vaccine, serogroup A of the ST-5 clonal complex was identified as the predominant disease-causing strain. |
Nanoscale reference materials for environmental, health, and safety measurements: needs, gaps, and opportunities
Stefaniak AB , Hackley VA , Roebben G , Ehara K , Hankin S , Postek MT , Lynch I , Fu WE , Linsinger TP , Thunemann AF . Nanotoxicology 2012 7 (8) 1325-37 We critically reviewed published lists of nano-objects and their physico-chemical properties deemed important for risk assessment and discuss metrological challenges associated with the development of nanoscale reference materials (RMs). Five lists were identified that contained 25 (classes of) nano-objects; only four (gold, silicon dioxide, silver, titanium dioxide) appeared on all lists. Twenty three properties were identified for characterization; only (specific) surface area appeared on all lists. The key themes that emerged from our review were: 1) various groups have prioritized nano-objects for development as 'candidate RMs' with limited consensus; 2) a lack of harmonized terminology hinders accurate description of many nano-object properties; 3) many properties identified for characterization are ill-defined or qualitative and hence are not metrologically traceable; 4) standardized protocols are critically needed for characterization of nano-objects as delivered in relevant media and as administered to toxicological models; 5) the measurement processes being used to characterize a nano-object must be understood because instruments may measure a given sample in a different way; 6) appropriate RMs should be used for both accurate instrument calibration and for more general testing purposes (e.g., protocol validation); 7) there is a need to clarify that where RMs are not available, if '(representative) test materials' that lack reference or certified values may be useful for toxicology testing; and, 8) there is a need for consensus building within the nanotechnology and environmental, health and safety communities to prioritize RM needs and better define the required properties and (physical or chemical) forms of the candidate materials. |
Identification of cellular proteins required for replication of human immunodeficiency virus type 1
Dziuba N , Ferguson MR , O'Brien WA , Sanchez A , Prussia AJ , McDonald NJ , Friedrich BM , Li G , Shaw MW , Sheng J , Hodge TW , Rubin DH , Murray JL . AIDS Res Hum Retroviruses 2012 28 (10) 1329-39 Cellular proteins are essential for human immunodeficiency virus type 1 (HIV-1) replication and may serve as viable new targets for treating infection. Using gene trap insertional mutagenesis, a high-throughput approach based on random inactivation of cellular genes, candidate genes were found that limit virus replication when mutated. Disrupted genes (N=87) conferring resistance to lytic infection with several viruses were queried for an affect on HIV-1 replication by utilizing small interfering RNA (siRNA) screens in TZM-bl cells. Several genes regulating diverse pathways were found to be required for HIV-1 replication, including DHX8, DNAJA1, GTF2E1, GTF2E2, HAP1, KALRN, UBA3, UBE2E3, and VMP1. Candidate genes were independently tested in primary human macrophages, toxicity assays, and/or Tat-dependent beta-galactosidase reporter assays. Bioinformatics analyses indicated that several host factors present in this study participate in canonical pathways and functional processes implicated in prior genome-wide studies. However, the genes presented in this study did not share identity with those found previously. Novel antiviral targets identified in this study should open new avenues for mechanistic investigation. |
Dustiness of fine and nanoscale powders
Evans DE , Turkevich LA , Roettgers CT , Deye GJ , Baron PA . Ann Occup Hyg 2012 57 (2) 261-77 Dustiness may be defined as the propensity of a powder to form airborne dust by a prescribed mechanical stimulus; dustiness testing is typically intended to replicate mechanisms of dust generation encountered in workplaces. A novel dustiness testing device, developed for pharmaceutical application, was evaluated in the dustiness investigation of 27 fine and nanoscale powders. The device efficiently dispersed small (mg) quantities of a wide variety of fine and nanoscale powders, into a small sampling chamber. Measurements consisted of gravimetrically determined total and respirable dustiness. The following materials were studied: single and multiwalled carbon nanotubes, carbon nanofibers, and carbon blacks; fumed oxides of titanium, aluminum, silicon, and cerium; metallic nanoparticles (nickel, cobalt, manganese, and silver) silicon carbide, Arizona road dust; nanoclays; and lithium titanate. Both the total and respirable dustiness spanned two orders of magnitude (0.3-37.9% and 0.1-31.8% of the predispersed test powders, respectively). For many powders, a significant respirable dustiness was observed. For most powders studied, the respirable dustiness accounted for approximately one-third of the total dustiness. It is believed that this relationship holds for many fine and nanoscale test powders (i.e. those primarily selected for this study), but may not hold for coarse powders. Neither total nor respirable dustiness was found to be correlated with BET surface area, therefore dustiness is not determined by primary particle size. For a subset of test powders, aerodynamic particle size distributions by number were measured (with an electrical low-pressure impactor and an aerodynamic particle sizer). Particle size modes ranged from approximately 300nm to several micrometers, but no modes below 100nm, were observed. It is therefore unlikely that these materials would exhibit a substantial sub-100nm particle contribution in a workplace. |
Extent of maternal morbidity in a managed care population in Georgia
Bruce FC , Berg CJ , Joski PJ , Roblin DW , Callaghan WM , Bulkley JE , Bachman DJ , Hornbrook MC . Paediatr Perinat Epidemiol 2012 26 (6) 497-505 BACKGROUND: Although maternal deaths are among the most tragic events related to pregnancy, they are uncommon in the US and, therefore, inadequate indicators of a woman's pregnancy-related health. Maternal morbidity has become a more useful measure for surveillance and research. Traditional attempts to monitor maternal morbidity have used hospital discharge data, which include data only on complications that resulted in hospitalisation, underestimating the frequency and scope of complications. METHODS: To obtain a more accurate assessment of morbidity, we applied a validated computerised algorithm to identify pregnancies and pregnancy-related complications in a defined population enrolled in a health maintenance organisation in the south-eastern US. We examined the most common morbidities by pregnancy outcome and maternal characteristics. RESULTS: We identified 37,741 pregnancies; in half (50.7%), at least one complication occurred. The five most common were urinary tract infections, anaemia, mental health conditions, pelvic and perineal complications, and obstetrical infections. Complications were more likely in women with low socio-economic status (SES), and among non-Hispanic Black women compared with non-Hispanic White women. Multivariable models stratified by race/ethnicity indicated that in pregnancies among non-Hispanic White women, low SES had a modest effect on the odds of having preexisting medical conditions [adjusted odd ratio (AOR) 1.3 [95% confidence interval (CI) 1.2, 1.5]] or having any morbidity (AOR 1.3 [95% CI 1.2, 1.4]). Low SES had little effect on complications among non-Hispanic Black women. CONCLUSION: Our findings suggest that comprehensive health insurance coverage may lessen the unfavourable impact of socio-economic disadvantage on the risk of maternal morbidity. |
Self-reported hand symptoms: a role in monitoring health care workers for latex sensitization?
Wang ML , Kelly KJ , Klancnik M , Petsonk EL . Ann Allergy Asthma Immunol 2012 109 (5) 314-8 BACKGROUND: The use of powdered natural rubber latex (NRL) gloves increased greatly in the 1980s because of concerns about transmission of blood-borne infections and the subsequent implementation of universal precautions. The most common clinical reactions to glove use are irritant and T-cell-mediated contact dermatitis. However, IgE-mediated immediate reactions to latex have become a serious concern for health care workers (HCWs). The diagnosis of latex allergy requires a comprehensive medical history and diagnostic tests. The skin prick test is the preferred diagnostic method, although it can be time-consuming. OBJECTIVE: To determine the role of hand symptoms reported on questionnaires in monitoring HCWs for latex sensitization. METHODS: Questionnaires were completed by 804 HCWs at 2 hospitals. Using a positive skin prick test (SPT) result as a criterion standard of latex sensitization, the diagnostic performance of hand symptoms was evaluated. RESULTS: Increasing latex glove use was strongly related to increasing reports of hand symptoms. Hand symptoms were highly associated with glove-related respiratory and systemic symptoms. A positive SPT result was seen in 5% of HCWs and increased with the number of hand symptoms: 0 (1.6%), 1 to 2 (3.4%), and 3 to 7 (19.0%). Participants reporting more than 2 hand symptoms were 11 times more likely to have positive SPT results compared with those with 2 or fewer hand symptoms. CONCLUSION: Hand symptoms are closely associated with latex sensitization. Questionnaires should be useful in health monitoring for HCWs who use latex gloves. |
A proposed theory on biodynamic frequency weighting for hand-transmitted vibration exposure
Dong RG , Welcome DE , McDowell TW , Xu XS , Krajnak K , Wu JZ . Ind Health 2012 50 (5) 412-24 The objective of this study is to propose a theory on the biodynamic frequency weighting for studying hand-transmitted vibration exposures and vibration-induced effects. We hypothesize that the development of a vibration effect is the result of two consecutive but synergistic processes: biodynamic responses to input vibration and biological responses to the biomechanical stimuli resulting from the biodynamic responses. Hence, we further hypothesize that the frequency-dependency (W) of the effect generally includes two components: a biodynamic frequency weighting (W1) and a biological frequency weighting (W2), or W=W1* W2. These hypotheses are consistent with the stress and strain analysis theory and methods widely used in structural dynamics and biomechanics. The factorization may make it easier to study the complex frequency-dependency using different approaches: the biodynamic frequency weighting depends on the passive physical response of the system to vibration, and it can thus be determined by examining the biodynamic response of the system using various engineering methods; on the other hand, the biological frequency weighting depends on the biological mechanisms of the effects, and it can be investigated by studying the psychophysical, physiological, and pathological responses. To help test these hypotheses, this study reviewed and further developed methods to derive the finger biodynamic frequency weighting. As a result, preliminary finger biodynamic frequency weightings are proposed. The implications of the proposed theory and the preliminary biodynamic frequency weightings are also discussed. |
Frequency-dependent effects of vibration on physiological systems: experiments with animals and other human surrogates
Krajnak K , Riley DA , Wu J , McDowell T , Welcome DE , Xu XS , Dong RG . Ind Health 2012 50 (5) 343-53 Occupational exposure to vibration through the use of power- and pneumatic hand-tools results in cold-induced vasospasms, finger blanching, and alterations in sensorineural function. Collectively, these symptoms are referred to as hand-arm vibration syndrome (HAVS). Currently the International Standards Organization (ISO) standard ISO 5349-1 contains a frequency-weighting curve to help workers and employers predict the risk of developing HAVS with exposure to vibration of different frequencies. However, recent epidemiological and experimental evidence suggests that this curve under-represents the risk of injuries to the hands and fingers induced by exposure to vibration at higher frequencies (>100 Hz). To improve the curve, better exposure-response data need to be collected. The goal of this review is to summarize the results of animal and computational modeling studies that have examined the frequency-dependent effects of vibration, and discuss where additional research would be beneficial to fill these research gaps. |
Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine: the controversy continues
Gutman J . Clin Infect Dis 2012 55 (8) 1103-5 Each year, approximately 32 million pregnancies occur in malaria-endemic areas of Africa [1]. Malaria in pregnancy (MiP) is a serious condition that contributes to both maternal and infant morbidity and mortality. It is estimated that up to 200 000 infant deaths occur annually as a result of MiP (http://www.who.int/features/2003/04b/en/). In order to decrease the risk of Plasmodium falciparum infection in pregnancy and subsequent morbidity and mortality, the World Health Organization (WHO) recommends intermittent preventive treatment in pregnancy (IPTp) with at least 2 doses of sulfadoxine-pyrimethamine (SP) 1 month apart after quickening. As resistance of Plasmodium falciparum, the most important malaria species in MiP, to SP has increased in the past 2 decades with a concomitant decrease in the efficacy of SP for treatment of children <5 years of age, the continued benefit of providing IPTp-SP has been questioned [2]. IPTp-SP continues to provide benefit to mothers and infants in areas where the rate of treatment failure in children is up to 39% [3]; however, where treatment failure rates are higher, and when coverage with insecticide-treated bednets is high, IPTp-SP appears to provide less benefit [4, 5]. More worrisome are data from Muheza, Tanzania, suggesting that IPTp-SP may be harmful, exacerbating placental malaria and contributing to fetal anemia [6, 7]. If this finding is replicated in other areas, it will have significant implications, as it would suggest that the practice of providing IPTp-SP to women in areas with high levels of SP resistance should be discontinued immediately, rather than continuing this practice until an alternate drug for prophylaxis in pregnancy is found. |
Meaningful, measurable, and manageable approaches to evaluating healthy food financing initiatives: an overview of resources and approaches
Fleischhacker SE , Flournoy R , Moore LV . J Public Health Manag Pract 2012 19 (6) 541-9 More than 23 million Americans have limited access to grocery stores. Healthy food financing initiatives have been emerging at local, state, and federal levels to address grocery gaps. Through public-private partnerships, retailers have been awarded funding to open or renovate a variety of food outlets. Preliminary findings have reported increased access to healthy foods, as well as improved community and economic development. As policy makers continue to consider enacting or expanding these initiatives and as all program stakeholders increasingly seek information on program impacts, this article provides guidance on using meaningful, measurable, and manageable methods to evaluate program's multifaceted outcomes. |
Evaluating the awareness, access, and use of the State Indicator Report on Physical Activity, 2010
Mattran K , Harris C , Jernigan J , Fulton J . J Phys Act Health 2012 10 (6) 863-70 BACKGROUND: The State Indicator Report on Physical Activity, 2010 (SIRPA) and accompanying resources provide information for practitioners to promote physical activity. This study evaluated awareness, access, and use of materials among physical activity practitioners. METHODS: A Web-based survey assessed awareness, access and use among respondents. The 26-item questionnaire assessed the usability of products developed by the federal government. Response frequencies and 95% confidence intervals were reported. RESULTS: Response rate was 27% (135 of 508). Awareness of material was from e-mail (35.6%) or partner Web sites (37.8%). One third of respondents (33.3%) accessed materials at least once a month, but 39.3% reported no use. The SIRPA (44.4%) and state-specific action guides (34.1%) were used the most. Materials were used to compare state-specific to national data (57.0%) and to present data to the public (41.5%). Most respondents (83%) reported public health partners as a target audience, and 91.8% were likely to share information in the future. CONCLUSIONS: SIRPA awareness was primarily through electronic communication, and two thirds of respondents used the materials. Respondents accessed materials for state comparisons and public distribution. Increasing the use of federal physical activity promotion materials involves considering design and dissemination features related to the needs of practitioners. |
Convergence of non-communicable and infectious diseases in low- and middle-income countries
Remais JV , Zeng G , Li G , Tian L , Engelgau MM . Int J Epidemiol 2012 42 (1) 221-7 The convergence of non-communicable disease (NCD) and infectious disease (ID) in low- and middle-income countries (LMICs) presents new challenges and new opportunities to enact responsive changes in policy and research. Most LMICs have significant dual disease burdens of NCDs such as cardiovascular disease, diabetes and cancer, and IDs including tuberculosis, HIV/AIDS and parasitic diseases. A combined strategy is needed in surveillance and disease control; yet, experts, institutions and policies that support prevention and control of these two overarching disease categories have limited interaction and alignment. NCDs and IDs share common features, such as long-term care needs and overlapping high-risk populations, and there are also notable direct interactions, such as the association between certain IDs and cancers, as well as evidence of increased susceptibility to IDs in individuals with NCDs. Enhanced simultaneous surveillance of NCD and ID comorbidity in LMIC populations would generate the empirical data needed to better understand the dual burden, and to target coordinated care. Where IDs and NCDs are endemic, focusing on vulnerable populations by strengthening social protections and improving access to health services is crucial, as is the re-alignment of efforts to combine NCD and ID screening, treatment programmes, and the assessment of their impact. Integrating public health activities for ID and NCD should extend beyond health care services to prevention, which is widely seen as crucial to successful NCD and ID control campaigns alike. The convergence of NCD and ID in LMICs has the potential to overstretch already strained health systems. With some LMICs now focused on major health system reforms, a unique opportunity is available to address NCD and ID challenges with newfound urgency and novel approaches. |
Effects of gastric bypass surgery on female reproductive function
Legro RS , Dodson WC , Gnatuk CL , Estes SJ , Kunselman AR , Meadows JW , Kesner JS , Krieg EF Jr , Rogers AM , Haluck RS , Cooney RN . J Clin Endocrinol Metab 2012 97 (12) 4540-8 CONTEXT: Reproductive function may improve after bariatric surgery, although the mechanisms and time-related changes are unclear. OBJECTIVE: The objective of the study was to determine whether ovulation frequency/quality as well as associated reproductive parameters improve after Roux en Y gastric bypass surgery. DESIGN: This was a prospective cohort study that enrolled female subjects from 2005 to 2008 with study visits at baseline and then 1, 3, 6, 12, and up to 24 months after surgery. SETTING: The study was conducted at an academic health center. PATIENTS: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. MAIN OUTCOME MEASURES: The primary outcome was integrated levels of urinary progestin (pregnanediol 3-glururonide) from daily urinary collections at 12 months postoperatively. Secondary outcomes were changes in vaginal bleeding, other biometric, hormonal, ultrasound, dual-energy x-ray absorptiometry measures, and Female Sexual Function Index. RESULTS: Ninety percent of patients with morbid obesity had ovulatory cycles at baseline, and the ovulatory frequency and luteal phase quality (based on integrated pregnanediol 3-glururonide levels) were not modified by bariatric surgery. The follicular phase was shorter postoperatively [6.5 d shorter at 3 months and 7.9-8.9 d shorter at 6-24 months (P < 0.01)]. Biochemical hyperandrogenism improved, largely due to an immediate postoperative increase in serum SHBG levels(P < 0.01), with no change in clinical hyperandrogenism (sebum production, acne, hirsutism). Bone density was preserved, contrasting with a significant loss of lean muscle mass and fat (P < 0.001), reflecting preferential abdominal fat loss (P < 0.001). Female sexual function improved 28% (P = 0.02) by 12 months. CONCLUSIONS: Ovulation persists despite morbid obesity and the changes from bypass surgery. Reproductive function after surgery is characterized by a shortened follicular phase and improved female sexual function. |
Blood pressure measurement prior to initiating hormonal contraception: a systematic review
Tepper NK , Curtis KM , Steenland MW , Marchbanks PA . Contraception 2012 87 (5) 631-8 BACKGROUND: Women with hypertension who use hormonal methods of contraception may have an increased risk for cardiovascular events. This review was conducted to evaluate the evidence regarding whether blood pressure should be measured prior to initiating hormonal contraceptives. STUDY DESIGN: The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning blood pressure measurement prior to initiation of hormonal contraceptives. Articles were included if they reported on women with and without blood pressure measurement prior to current hormonal contraceptive usage and assessed cardiovascular outcomes. The quality of each study was assessed using the United States Preventive Services Task Force grading system. RESULTS: Six fair-quality articles from three studies met inclusion criteria for this review. Three case-control studies showed that women who did not have blood pressure measurement prior to initiating combined oral contraceptives (COCs) had a higher risk for acute myocardial infarction (AMI) than women who did have blood pressure measurement. Two case-control studies showed that women who did not have blood pressure measurement prior to initiating COCs had a higher risk for ischemic stroke than women who did have blood pressure measurement. One case-control study showed no difference in the risk for hemorrhagic stroke among women who initiated COCs based on whether or not blood pressure was measured. CONCLUSIONS: Fair-quality evidence from five reports showed that women who did not have blood pressure measurement prior to COC initiation had a higher risk for AMI and ischemic stroke than women who did have blood pressure measurement. One fair-quality study showed no increased risk for hemorrhagic stroke based on whether or not blood pressure was measured. Studies that examined hormonal contraceptive methods other than COCs were not identified. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Behavior and Risk
- Health Communication and Education
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Parasitic Diseases
- Program Evaluation
- Public Health Leadership and Management
- Reproductive Health
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure