Utility of dysphagia screening results in predicting poststroke pneumonia
Lakshminarayan K , Tsai AW , Tong X , Vazquez G , Peacock JM , George MG , Luepker RV , Anderson DC . Stroke 2010 41 (12) 2849-54 BACKGROUND AND PURPOSE: Dysphagia screening before oral intake (DS) is a stroke care quality indicator. The value of DS is unproven. Quality adherence and outcome data from the Paul Coverdell National Acute Stroke Registry were examined to establish value of DS. METHODS: Adherence to the DS quality indicator was examined in patients with stroke discharged from Paul Coverdell National Acute Stroke Registry hospitals between March 1 and December 31, 2009. Patients were classified as unscreened (US), screened and passed (S/P), and screened and failed. Associations between screening status and pneumonia rate were assessed by logistic regression models after adjustment for selected variables. RESULTS: A total of 18,017 patients with stroke discharged from 222 hospitals in 6 states were included. A total of 4,509 (25%) were US; 8,406 (47%) were S/P, and 5,099 (28%) were screened and failed. Compared with US patients, screened patients were significantly more impaired. Pneumonia rates were: US 4.2%, S/P 2.0%, and screened and failed 6.8%. After adjustment for demographic and clinical features, US patients were at a higher risk of pneumonia (OR, 2.2; 95% CI, 1.7 to 2.7) compared with S/P patients. CONCLUSIONS: Data suggest that patients are selectively screened based on stroke severity. Pneumonia rate was higher in US patients compared with S/P patients. Clinical judgment regarding who should be screened is imperfect. S/P patients have a lower pneumonia rate indicating that DS adds accuracy in predicting pneumonia risk. The Joint Commission recently retired DS as a performance indicator for Primary Stroke Center certification. These results suggest the need to implement a DS performance measure for patients with acute stroke. |
Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality and prediabetes prevalence
Boyle JP , Thompson TJ , Gregg EW , Barker LE , Williamson DF . Popul Health Metr 2010 8 (29) BACKGROUND: People with diabetes can suffer from diverse complications that seriously erode quality of life. Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years. Accurate projections of diabetes burden are essential to policymakers planning for future health care needs and costs. METHODS: Using data on prediabetes and diabetes prevalence in the United States, forecasted incidence, and current US Census projections of mortality and migration, the authors constructed a series of dynamic models employing systems of difference equations to project the future burden of diabetes among US adults. A three-state model partitions the US population into no diabetes, undiagnosed diabetes, and diagnosed diabetes. A four-state model divides the state of "no diabetes" into high-risk (prediabetes) and low-risk (normal glucose) states. A five-state model incorporates an intervention designed to prevent or delay diabetes in adults at high risk. RESULTS: The authors project that annual diagnosed diabetes incidence (new cases) will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050. Assuming low incidence and relatively high diabetes mortality, total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. However, if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by 2050. Intervention can reduce, but not eliminate, increases in diabetes prevalence. CONCLUSIONS: These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Effective strategies will need to be undertaken to moderate the impact of these factors on national diabetes burden. Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population can considerably reduce, but not eliminate, future increases in diabetes prevalence. |
Meningococcal disease: the organism, clinical presentation, and worldwide epidemiology
Al-Tawfiq JA , Clark TA , Memish ZA . J Travel Med 2010 17 Suppl 3-8 Globally, Neisseria meningitidis is an important cause of vaccine‐preventable morbidity and mortality. 1 Each case requires urgent medical and public health intervention to prevent death, disability, and secondary transmission. Sporadic and endemic cases occur worldwide. The meningococcus is also the cause of epidemic meningitis. Epidemic meningococcal meningitis, first described by Vieusseux in Geneva in 1805, remains a public health concern and a challenge for reducing mortality in sub‐Saharan Africa. |
Nipah virus outbreak with person-to-person transmission in a district of Bangladesh, 2007
Homaira N , Rahman M , Hossain MJ , Epstein JH , Sultana R , Khan MS , Podder G , Nahar K , Ahmed B , Gurley ES , Daszak P , Lipkin WI , Rollin PE , Comer JA , Ksiazek TG , Luby SP . Epidemiol Infect 2010 138 (11) 1630-6 In February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of northwest Bangladesh affected seven people, three of whom died. All subsequent cases developed illness 7-14 days after close physical contact with the index case while he was ill. Cases were more likely than controls to have been in the same room (100% vs. 9.5%, OR undefined, P<0.001) and to have touched him (83% vs. 0%, OR undefined, P<0.001). Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to NiV confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission. Risk of NiV infection in family caregivers highlights the need for infection control practices to limit transmission of potentially infectious body secretions. |
Preefficacy use and sharing of antiretroviral medications to prevent sexually-transmitted HIV infection among US men who have sex with men
Mansergh G , Koblin BA , Colfax GN , McKirnan DJ , Flores SA , Hudson SM . J Acquir Immune Defic Syndr 2010 55 (2) e14-6 Preexposure and postexposure prophylaxis (PrEP and PEP, respectively) of HIV infection with antiretroviral therapy (ART) may reduce HIV infection through sexual contact.1 Although laboratory2,3 and mother-to-child4 transmission research have found that ART is effective in reducing HIV infection through nonoccupational exposure, human efficacy studies for preexposure prevention of sexual transmission are still underway. Men who have sex with men (MSM) will be a target population for ART prophylaxis if this strategy is found to be efficacious because they account for most HIV infections in the United States and are the only risk group with increasing incidence.5,6 We examined recent use and sharing of ART medications for the purposes of PrEP and PEP among high-risk substance-using MSM. | A convenience sample of HIV-negative and HIV-positive MSM who reported unprotected anal sex and substance use during anal sex in the previous 6 months were enrolled in a behavioral intervention trial (Project MIX) in Chicago, Los Angeles, New York City, and San Francisco.7 Men participated in a baseline and 12-month follow-up assessment (2006-2008). In multivariate analytic models, we examined baseline demographic variables (race/ethnicity, age group, education level, city), unprotected anal sex, treatment optimism (ie, “less concerned” about HIV infection because of effective treatments), and PrEP (ie, used “before sex”) and PEP (ie, used “only after sex”) use to prevent HIV infection via sexual exposure within the previous 6 months. The analytic sample (n = 1011) consisted of men with data at the 12-month follow-up (84% retention of n = 1204 at baseline) and was diverse in terms of race/ethnicity (33% black, 18% Hispanic, 38% white, 11% other), age group (22% 18-29 years, 35% 30-39 years, 43% 40+ years), and education level (31% high school equivalency or less, 34% some post high school education, 35% college degree or more). Analyses were stratified by respondent HIV status (n = 454 HIV negative, n = 557 HIV positive). At baseline, two-thirds of the men (59% of HIV negative and 74% of HIV positive men, P < 0.0001) had engaged in unprotected anal sex during their most recent anal sex encounter (prior 3 months), and over one-third (35% of HIV negative and 39% of HIV positive men, P = 0.22) had unprotected anal sex with a partner of unknown or different HIV status than their own. |
Gender and age patterns in HSV-2 and HIV infection among non-injecting drug users in New York City
Des Jarlais DC , Arasteh K , McKnight C , Perlman D , Hagan H , Semaan S , Friedman SR . Sex Transm Dis 2010 37 (10) 637-43 OBJECTIVE: To examine prevalence of and associations between herpes simplex virus type 2 (HSV-2) infection and HIV infection among never-injecting heroin and cocaine drug users (NIDUs) in New York City. METHODS: Subjects were recruited from patients entering the Beth Israel drug detoxification program. Informed consent was obtained, a structured questionnaire including demographics, drug use history, and sexual risk behavior was administered, and a blood sample was collected for HIV and HSV-2 antibody testing. RESULTS: A total of 1418 subjects who had never (lifetime) injected drugs (NIDUs) were recruited between July 2005 through June 2009. Subjects were primarily male (76%), and black (67%) or Hispanic (25%), reported recent crack cocaine use (74%), and had a mean age of 42 years. Eleven percent of males reported male-with-male sexual (MSM) behavior. The prevalence of both viruses was high: for HSV-2, 61% among the total sample, 50% among non-MSM males, 85% among females, and 72% among MSM; for HIV, 16% among the total sample, 12% among non-MSM males, 20% among females, and 46% among MSM. HSV-2 was associated with HIV (OR = 3.2, 95% CI: 2.3-4.5; PR = 2.7, 95% CI: 2.0-3.7). Analyses by gender and age groups indicated different patterns in mono- and coinfection for the 2 viruses. DISCUSSION: HSV-2 and HIV rates among these NIDUs are comparable with rates in sub-Saharan Africa. Additional prevention programs, tailored to gender and age groups, are urgently needed. New platforms for providing services to NIDUs are also needed. |
Hepatitis B. General information
Centers for Disease Control and Prevention . J Pract Nurs 2010 60 (2) 5-6 Hepatitis means inflammation of the liver. Hepatitis is most often caused by one of several viruses, such as hepatitis A virus, hepatitis B virus, or hepatitis C virus. Toxins, bacterial infections, certain drugs, other diseases, and heavy alcohol use can also cause hepatitis. |
Is sexual contact a major mode of hepatitis C virus transmission?
Tohme RA , Holmberg SD . Hepatology 2010 52 (4) 1497-505 Medical opinion varies considerably regarding the transmission of hepatitis C virus (HCV) through sexual contact. Based on the study design, representativeness of the study population, and the methods used for case ascertainment, we analyzed 80 qualifying reports regarding the evidence for or against sexual transmission. Regarding heterosexual transmission, the weight of evidence is that there is no increased risk of sexual transmission of HCV among heterosexual couples in regular relationships. This risk increases among persons with multiple sexual partners (adjusted odds ratio [aOR] 2.2-2.9), but this association may be confounded by increased likelihood of injection drug use with increased number of partners. There appears to be a real increased risk for women coinfected with human immunodeficiency virus (HIV) or other sexually transmitted infections (aOR 3.3-3.9) and especially for HIV-infected gay men who are having sex with one another compared with HIV-uninfected men (aOR 4.1-5.7). HIV-infected gay men increase their risk of such transmission in association with practices that lead to mucosal trauma (multiple sexual partners, fisting, use of sex toys) and the presence of genital ulcerative disease. CONCLUSION: This review should inform, and not distract from, recommendations to reduce the risk of HCV transmission. Health care providers need to pay special attention to sexual transmission of HCV among HIV-infected individuals. |
A historical overview of the United States-Mexico border Diabetes Prevention and Control Project
Diaz-Kenney RV , Ruiz-Holguin R , de Cosio FG , Ramos R , Rodriguez B , Beckles GL , Valdez R , Thompson-Reid PE . Rev Panam Salud Publica 2010 28 (3) 143-50 Diabetes is a serious public health problem in the border region between the United States of America and Mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. The U.S.-Mexico Border Diabetes Prevention and Control Project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 U.S. and Mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. This report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned. |
Tracking origins and spread of sulfadoxine-resistant Plasmodium falciparum dhps alleles in Thailand
Alam MT , Vinayak S , Congpuong K , Wongsrichanalai C , Satimai W , Slutsker L , Escalante AA , Barnwell JW , Udhayakumar V . Antimicrob Agents Chemother 2010 55 (1) 155-64 The emergence and spread of drug resistant Plasmodium falciparum has been a major impediment for the control of malaria worldwide. Earlier studies have shown that similar to chloroquine (CQ) resistance, high levels of pyrimethamine resistance in P. falciparum originated independently 4-5 times globally, including one origin on the Thailand-Cambodia border. In this study we describe the origins and spread of sulfadoxine-resistance conferring dihydropteroate synthase (dhps) alleles in Thailand. The dhps mutations and flanking microsatellite loci were genotyped in P. falciparum isolates collected from 11 Thai provinces along the Burma, Cambodia and Malaysia borders. Results indicated that resistant dhps alleles were fixed in Thailand, predominantly being the SGEGA, AGEAA and SGNGA triple mutants; and the AGKAA double mutant. These alleles had different geographical distributions. The SGEGA alleles were mostly found on the Burma border, while the SGNGA alleles occurred mainly on the Cambodia border and nearby provinces. Microsatellite data suggested that there were two major genetic lineages of the triple mutants in Thailand, one common for SGEGA/SGNGA alleles and another independent for AGEAA. Importantly, the newly reported SGNGA alleles have possibly originated on the Thailand-Cambodia border. All parasites in Yala province (Malaysia border) had AGKAA alleles with almost identical flanking microsatellites haplotypes. They were also identical at putatively neutral loci on chromosomes 2 and 3, suggesting clonal nature of the parasite population in Yala. In summary, this study suggests multiple and independent origins of the resistant dhps alleles in Thailand. |
New rabies virus variant found during an epizootic in white-nosed coatis from the Yucatan Peninsula
Arechiga-Ceballos N , Velasco-Villa A , Shi M , Flores-Chavez S , Barron B , Cuevas-Dominguez E , Gonzalez-Origel A , Aguilar-Setien A . Epidemiol Infect 2010 138 (11) 1586-9 In February 2008, three white-nosed coatis (Nasua narica) were found dead in a recreational park in Cancun, Mexico. The diagnosis of rabies virus (RABV) infection was confirmed by direct immunofluorescence test. The phylogenetic analysis performed with the complete RABV nucleoprotein gene positioned this isolate close to a sequence of a human rabies case reported during 2008 from Oaxaca, Mexico, sharing 93% similarity. In turn, these two variants are related to another variant found in rabid Tadarida brasiliensis mexicana bats across North America. Anti-RABV neutralizing activity (1.3 IU/ml) was found in the serum of one white-nosed coati captured with another five that cohabited with the dead animals. Enhanced rabies surveillance and pathogenesis studies should be conducted in coatis and insectivorous bats of the region to clarify the role of these species as potential emergent or long-term unidentified RABV reservoirs. |
Global environmental health: sustainability
Sabogal R . J Environ Health 2010 73 (3) 26-27 One defi nition of “sustainability” is | the capacity to endure. In the realm | of global environmental health, sustainable health interventions—for example, | water, sanitation, and hygiene education | programs—are community investments that | should not only improve health, but should | continue to provide benefi ts over time. | Goal 7 of the Millennium Development | Goals (MDGs) (United Nations, 2009) by | the United Nations seeks to ensure environmental sustainability and reverse the loss of | environmental resources. Specifi cally, one | target for 2015 is to “reduce by half the proportion of people without sustainable access | to safe drinking water and basic sanitation.” | The problem is that traditionally, after these | interventions have been provided, little information becomes available on the longevity of their health-related effects and behavior changes. |
Widening gap in age at muscular dystrophy-associated death between blacks and whites, 1986-2005
Kenneson A , Vatave A , Finkel R . Neurology 2010 75 (11) 982-9 BACKGROUND: Muscular dystrophies (MDs), characterized by progressive muscle wasting, are associated with 1 in 2,500 deaths in the United States. Although treatments slow the progression, these disorders lead to early death, usually due to cardiac or respiratory failure. METHODS: We analyzed death record data from 18,315 MD-associated deaths that occurred in the United States in 1986 through 2005 to assess trends in the age at death of people with MDs. RESULTS: From 1986 through 2005, the MD-associated mortality rate did not change among blacks, whites, males, or females. The median age at death among white females with MDs was 12 years higher than among black females. The frequency of reported cardiomyopathy increased among white but not black male decedents with MDs, although cardiomyopathy remained more commonly reported among black males. Among white males, the median age at death increased by 0.2 annually for those with and 1.3 for those without indications of cardiomyopathy. Among black males, the median age at death increased 0.3 years annually among those without reported cardiomyopathy. Among white males, the frequencies of pulmonary failure and pulmonary infection decreased significantly over time. CONCLUSIONS: Changes in age at death and reported clinical comorbidities reflect improvements in the treatment of MDs. White males with MDs have shown a greater increase in age at death over time than black males. Contributing factors to this difference might include differences in types of MDs, rates of genetic and environmental modifiers, natural history, socioeconomic factors, and access to and use of treatment options. |
Accuracy of assisted reproductive technology information on the Massachusetts birth certificate, 1997-2000
Zhang Z , Macaluso M , Cohen B , Schieve L , Nannini A , Chen M , Wright V . Fertil Steril 2010 94 (5) 1657-61 OBJECTIVE: To evaluate the accuracy of assisted reproductive technology (ART) reporting on the Massachusetts birth certificate and to explore the individual and hospital-level characteristics associated with ART reporting. DESIGN: Validity analysis of population-based data. SETTING: Live-birth deliveries by Massachusetts-resident mothers during 1997-2000. PATIENT(S): Live births and delivery mothers. INTERVENTION(S): The ART data maintained by the Centers for Disease Control and Prevention were linked with the live birth-infant death records in Massachusetts. Successfully linked records were used as the gold standard for ART-related deliveries in evaluating the validity of the ART information reported on the Massachusetts birth certificate. MAIN OUTCOME MEASURE(S): Sensitivity and specificity. RESULT(S): The sensitivity of ART reporting on the birth certificate was 27% and the specificity >99%. Sensitivity of ART reporting was higher among women with multiple deliveries (twins: 32%; triplets+: 43%) and preterm deliveries (36%). CONCLUSION(S): During the period evaluated, reporting of ART information on the birth certificate was incomplete, and ART births identified through the birth certificate were a biased sample of the population of ART births. Using delivery hospital data as the sole source of ART information for the standard birth certificate may yield inaccurate information. |
The accuracy of cancer mortality statistics based on death certificates in the United States
German RR , Fink AK , Heron M , Stewart SL , Johnson CJ , Finch JL , Yin D . Cancer Epidemiol 2010 35 (2) 126-31 BACKGROUND: One measure of the accuracy of cancer mortality statistics is the concordance between cancer defined as the underlying cause of death from death certificates and cancer diagnoses recorded in central, population-based cancer registries. Previous studies of such concordance are outdated. OBJECTIVE: To characterize the accuracy of cancer mortality statistics from the concordance between cancer cause of death and primary cancer site at diagnosis. DESIGN: Central cancer registry records from California, Colorado, and Idaho in the U.S. were linked with state vital statistics data and evaluated by demographic and tumor information across 79 site categories. A retrospective arm (confirmation rate per 100 deaths) compared death certificate data from 2002 to 2004 with cancer registry diagnoses from 1993 to 2004, while a prospective arm (detection rate per 100 deaths) compared cancer registry diagnoses from 1993 to 1995 with death certificate data from 1993 to 2004 by International Statistical Classification of Diseases and Related Health Problems (ICD) version used to code deaths. RESULTS: With n=265,863 deaths where cancer was recorded as the underlying cause based on the death certificate, the overall confirmation rate for ICD-10 was 82.8% (95% confidence interval [CI], 82.6-83.0%), the overall detection rate for ICD-10 was 81.0% (95% CI, 80.4-81.6%), and the overall detection rate for ICD-9 was 85.0% (95% CI, 84.8-85.2%). These rates varied across primary sites, where some rates were <50%, some were 95% or greater, and notable differences between confirmation and detection rates were observed. CONCLUSIONS: Important unique information on the quality of cancer mortality data obtained from death certificates is provided. In addition, information is provided for future studies of the concordance of primary cancer site between population-based cancer registry data and data from death certificates, particularly underlying causes of death coded in ICD-10. |
Mental- and physical-health indicators and sexually explicit media use behavior by adults
Weaver III JB , Weaver SS , Mays D , Hopkins GL , Kannenberg W , McBride D . J Sex Med 2010 8 (3) 764-72 INTRODUCTION: Converging evidence from culturally diverse contexts indicates that sexually explicit media use behavior (SEMB; i.e., pornography consumption) is associated with risky sexual health perceptions and behaviors, many that involve high risks of HIV/STD transmission. AIM: Essentially unexplored, and the focus here, are potential relationships between SEMB and nonsexual mental- and physical-health indicators. MAIN OUTCOME MEASURES: Variability in six continuously measured health indicators (depressive symptoms, mental- and physical-health diminished days, health status, quality of life, and body mass index) was examined across two levels (users, nonusers) of SEMB. METHODS: A sample of 559 Seattle-Tacoma Internet-using adults was surveyed in 2006. Multivariate general linear models parameterized in a SEMB by respondent gender (2 x 2) factorial design were computed incorporating adjustments for several demographics. RESULTS: SEMB was reported by 36.7% (n = 205) of the sample. Most SEMB users (78%) were men. After adjusting for demographics, SEMB users, compared to nonusers, reported greater depressive symptoms, poorer quality of life, more mental- and physical-health diminished days, and lower health status. CONCLUSIONS: The findings show that mental- and physical-health indicators vary significantly across SEMB, suggesting the value of incorporating these factors in future research and programmatic endeavors. In particular, the findings suggest that evidence-based sexual health promotion strategies simultaneously addressing individuals' SEMB and their mental health needs might be a useful approach to improve mental health and address preventable sexual health outcomes associated with SEMB. |
Actions taken to reduce sodium intake among adults with self-reported hypertension: HealthStyles survey, 2005 and 2008
Ayala C , Tong X , Valderrama A , Ivy A , Keenan N . J Clin Hypertens (Greenwich) 2010 12 (10) 793-799 Consuming high amounts of dietary sodium is associated with hypertension. The authors analyzed the HealthStyles 2005 and 2008 survey for behaviors to lower blood pressure related to dietary sodium, including the reduction of sodium intake and reading food labels for sodium content among hypertensives. All estimates were based on self-reported data. The relative percent change (RPC) in the prevalence of these behaviors between 2005 and 2008 was assessed. During the 3-year period, there were increases in the prevalence of reducing dietary sodium (RPC=17.2%, 56.6% in 2008 vs 48.3% in 2005; P<.05) and reading food labels for sodium content (RPC=7.9%, 53.0% vs 49.1%; P<.05). In 2005, the proportion of hypertensive adults who reported reducing dietary sodium was higher for persons 65 years and older, for blacks, for those with income <$25,000, and for those with more than a high school education compared with those in their comparison groups. In 2008, those aged 65 years and older had the highest percentage, while Hispanics and blacks had essentially the same percentage for reducing sodium. Based on 2005 and 2008 HealthStyles surveys, about half of hypertensive patients reported reducing their intake of sodium and reading food labels for salt. Health care providers should emphasize the importance of knowing the daily recommended limit for dietary sodium to help adults lower this intake. 2010 Wiley Periodicals, Inc. |
Spontaneous diffusion of an effective skin cancer prevention program through Web-based access to program materials
Hall DM , Escoffery C , Nehl E , Glanz K . Prev Chronic Dis 2010 7 (6) A125 INTRODUCTION: Little information exists about the diffusion of evidence-based interventions, a process that can occur naturally in organized networks with established communication channels. This article describes the diffusion of an effective skin cancer prevention program called Pool Cool through available Web-based program materials. METHODS: We used self-administered surveys to collect information from program users about access to and use of Web-based program materials. We analyzed the content of e-mails sent to the official Pool Cool Web site to obtain qualitative information about spontaneous diffusion. RESULTS: Program users were dispersed throughout the United States, most often learning about the program through a Web site (32%), publication (26%), or colleague (19%). Most respondents (86%) reported that their pool provided educational activities at swimming lessons. The Leader's Guide (59%) and lesson cards (50%) were the most commonly downloaded materials, and most respondents reported using these core items sometimes, often, or always. Aluminum sun-safety signs were the least frequently used materials. A limited budget was the most commonly noted obstacle to sun-safety efforts at the pool (85%). Factors supporting sun safety at the pool centered around risk management (85%) and health of the pool staff (78%). CONCLUSION: Diffusion promotes the use of evidence-based health programs and can occur with and without systematic efforts. Strategies such as providing well-packaged, user-friendly program materials at low or no cost and strategic advertisement of the availability of program materials may increase program use and exposure. Furthermore, highlighting the benefits of the program can motivate potential program users. |
Prevalence of self-reported hypertension, advice received from health care professionals, and actions taken to reduce blood pressure among US adults - HealthStyles, 2008
Valderrama AL , Tong X , Ayala C , Keenan NL . J Clin Hypertens (Greenwich) 2010 12 (10) 784-792 Lifestyle changes, such as changes in diet and exercise, are recommended to lower blood pressure (BP) in adults. Using data from the 2008 HealthStyles survey, the authors estimated the prevalence of self-reported hypertension, advice received from health professionals, and actions taken to reduce BP. Among 5399 respondents, 25.8% had hypertension and 79.8% of these were currently taking antihypertensive medications. Overall, 21.0% to 24.4% reported receiving advice to adopt specific behavior changes, with younger adults and women having a lower prevalence of receiving advice. Blacks had the highest prevalence among the racial/ethnic groups of receiving advice, and household income was associated with receiving advice. More than half of respondents took action following the receipt of advice. Women were more likely than men to follow advice to go on a diet. Although many patients were following advice from their health professional and making lifestyle changes to decrease BP, the proportion of patients making changes remains suboptimal. Receiving advice from health professionals and following recommendations to reduce or control high BP are essential to hypertension management. Counseling on lifestyle modification should continue to be an integral component of visits to health professionals. 2010 Wiley Periodicals, Inc. |
Health care-associated infections studies project: Case 3
Wright MO , Hebden JN , Allen-Bridson K , Morrell GC , Horan T . Am J Infect Control 2010 38 (8) 642-3 This is the third in a series of clinical case studies published in AJIC to aid Infection Preventionists (IP) in applying the Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) surveillance definitions of health care–associated infections (HAIs). These cases reflect some of the complex patient scenarios that IPs encounter in their daily surveillance of HAIs using NHSN definitions. With each case, a link to an online survey is provided, where you may answer the questions posed and receive immediate feedback in the form of answers and explanations. All individual participants’ answers will remain confidential, although we hope to share a summary of our findings at a later date. All cases, answers, and explanations have been reviewed and approved by the NHSN. |
Urinary and serum metabolites of di-n-pentyl phthalate in rats
Silva MJ , Furr J , Samandar E , Preau Jr JL , Gray LE , Needham LL , Calafat AM . Chemosphere 2010 82 (3) 431-6 Di-n-pentyl phthalate (DPP) is used mainly as a plasticizer in nitrocellulose. At high doses, DPP acts as a potent testicular toxicant in rats. We administered a single oral dose of 500mgkg(-1)bw of DPP to adult female Sprague-Dawley rats (N=9) and collected 24-h urine samples 1d before and 24- and 48-h after DPP was administered to tentatively identify DPP metabolites that could be used as exposure biomarkers. At necrosis, 48h after dosing, we also collected serum. The metabolites were extracted from urine or serum, resolved with high performance liquid chromatography, and detected by mass spectrometry. Two DPP metabolites, phthalic acid (PA) and mono(3-carboxypropyl) phthalate (MCPP), were identified by using authentic standards, whereas mono-n-pentyl phthalate (MPP), mono(4-oxopentyl) phthalate (MOPP), mono(4-hydroxypentyl) phthalate (MHPP), mono(4-carboxybutyl) phthalate (MCBP), mono(2-carboxyethyl) phthalate (MCEP), and mono-n-pentenyl phthalate (MPeP) were identified based on their full scan mass spectrometric fragmentation pattern. The omega-1 oxidation product, MHPP, was the predominant urinary metabolite of DPP. The median urinary concentrations (mugmL(-1)) of the metabolites in the first 24h urine collection after DPP administration were 993 (MHPP), 168 (MCBP), 0.2 (MCEP), 222 (MPP), 47 (MOPP), 26 (PA), 16 (MPeP), and 9 (MCPP); the concentrations of metabolites in the second 24h urine collection after DPP administration were significantly lower than in the first collection. We identified some urinary metabolic products in the serum, but at much lower levels than in urine. Because of the similarities in metabolism of phthalates between rats and humans, based on our results and the fact that MHPP can only be formed from the metabolism of DPP, MHPP would be the most adequate DPP exposure biomarker for human exposure assessment. Nonetheless, based on the urinary levels of MHPP, our preliminary data suggest that human exposure to DPP in the United States is rather limited. |
Variola and monkeypox utilize conserved mechanisms of virion motility and release that depend on Abl- and Src-family tyrosine kinases
Reeves PM , Smith SK , Olson VA , Thorne SH , Bornmann W , Damon IK , Kalman D . J Virol 2010 85 (1) 21-31 Vaccinia virus (VacV) enters mammalian cells, replicates extranuclearly, and produces virions that move to the cell surface along microtubules, fuse with the plasma membrane, and move from infected cells towards apposing cells on actin-filled membranous protrusions or actin tails. To form actin tails, cell-associated enveloped virions (CEV) require Abl- and Src-family tyrosine kinases. Further, release of CEV from the cell requires Abl- but not Src-family tyrosine kinases, and is blocked by imatinib mesylate (STI-571; Gleevec), an Abl-family kinase inhibitor used to treat chronic myelogenous leukemia in humans. Here we demonstrate that the Poxviridae family members Monkeypox (MPX) and Variola (VarV) used conserved mechanisms for actin motility and EEV release. Furthermore, we show that imatinib mesylate is effective in a mouse model of infection with VacV, whether delivered prophylactically or post-infection, and restricts spread of virions from the site of innoculation. While inhibitors of both Src- and Abl-family kinases, such as dasatinib (BMS-354825, Sprycel), are effective in limiting dissemination VacV, VarV, and MPX in vitro, members of this class of drugs appear to have immunosuppressive effects in vivo that preclude their use as anti-infectives. Together, these data suggest a possible utility for imatinib mesylate in treating smallpox or MPX infections, or complications associated with vaccination. |
Lipopolysaccharide hyperpolarizes guinea pig airway epithelium by increasing the activities of the epithelial Na(+) channel and the Na(+)-K(+) pump
Dodrill MW , Fedan JS . Am J Physiol Lung Cell Mol Physiol 2010 299 (4) L550-8 Earlier, we found that systemic administration of lipopolysaccharide (LPS; 4 mg/kg) hyperpolarized the transepithelial potential difference (V(t)) of tracheal epithelium in the isolated, perfused trachea (IPT) of the guinea pig 18 h after injection. As well, LPS increased the hyperpolarization component of the response to basolateral methacholine, and potentiated the epithelium-derived relaxing factor-mediated relaxation responses to hyperosmolar solutions applied to the apical membrane. We hypothesized that LPS stimulates the transepithelial movement of Na(+) via the epithelial sodium channel (ENaC)/Na(+)-K(+) pump axis, leading to hyperpolarization of V(t). LPS increased the V(t)-depolarizing response to amiloride (10 muM), i.e., offset the effect of LPS, indicating that Na(+) transport activity was increased. The functional activity of ENaC was measured in the IPT after short-circuiting the Na(+)-K(+) pump with basolateral amphotericin B (7.5 muM). LPS had no effect on the hyperpolarization response to apical trypsin (100 U/ml) in the Ussing chamber, indicating that channel-activating proteases are not involved in the LPS-induced activation of ENaC. To assess Na(+)-K(+) pump activity in the IPT, ENaC was short-circuited with apical amphotericin B. The greater V(t) in the presence of amphotericin B in tracheas from LPS-treated animals compared with controls revealed that LPS increased Na(+)-K(+) pump activity. This finding was confirmed in the Ussing chamber by inhibiting the Na(+)-K(+) pump via extracellular K(+) removal, loading the epithelium with Na(+), and observing a greater hyperpolarization response to K(+) restoration. Together, the findings of this study reveal that LPS hyperpolarizes the airway epithelium by increasing the activities of ENaC and the Na(+)-K(+) pump. |
MChip, a low density microarray, differentiates among seasonal human H1N1, North American swine H1N1, and the 2009 pandemic H1N1
Heil GL , McCarthy T , Yoon KJ , Liu S , Saad MD , Smith CB , Houck JA , Dawson ED , Rowlen KL , Gray GC . Influenza Other Respir Viruses 2010 4 (6) 411-416 BACKGROUND: The MChip uses data from the hybridization of amplified viral RNA to 15 distinct oligonucleotides that target the influenza A matrix (M) gene segment. An artificial neural network (ANN) automates the interpretation of subtle differences in fluorescence intensity patterns from the microarray. The complete process from clinical specimen to identification including amplification of viral RNA can be completed in <8 hours for under US$10. OBJECTIVES: The work presented here represents an effort to expand and test the capabilities of the MChip to differentiate influenza A/H1N1 of various species origin. METHODS: The MChip ANN was trained to recognize fluorescence image patterns of a variety of known influenza A viruses, including examples of human H1N1, human H3N2, swine H1N1, 2009 pandemic influenza A H1N1, and a wide variety of avian, equine, canine, and swine influenza viruses. Robustness of the MChip ANN was evaluated using 296 blinded isolates. RESULTS: Training of the ANN was expanded by the addition of 71 well-characterized influenza A isolates and yielded relatively high accuracy (little misclassification) in distinguishing unique H1N1 strains: nine human A/H1N1 (88.9% correct), 35 human A/H3N2 (97.1% correct), 31 North American swine A/H1N1 (80.6% correct), 14 2009 pandemic A/H1N1 (87.7% correct), and 23 negative samples (91.3% correct). Genetic diversity among the swine H1N1 isolates may have contributed to the lower success rate for these viruses. CONCLUSIONS: The current study demonstrates the MChip has the capability to differentiate the genetic variations among influenza viruses with appropriate ANN training. Further selective enrichment of the ANN will improve its ability to rapidly and reliably characterize influenza viruses of unknown origin. |
An evaluation of the methods for deriving representative frequency response functions of the human whole-body system
Dong RG , McDowell TW , Welcome DE , Wu JZ . Ind Health 2010 48 (5) 596-605 The biodynamic response functions of the human whole-body system measured with subjects participating in an experiment are commonly arithmetically averaged and used to represent their mean response functions in many studies. The reported means were further averaged to form the reference means for standardization and various applications. The objectives of this study are to clarify whether this response-based averaging process could significantly misrepresent the characteristics of the original functions, and to explore appropriate methods for deriving representative functions. A set of reported mechanical-equivalent models for 12 subjects was used to derive the vertical and fore-and-aft cross-axis response functions expressed in apparent mass. The response-based average was directly compared with the response derived from a property-based derivation method. This study found that the response-based average could differ from the property-based mean response by more than 30%, especially in the fore-and-aft cross-axis response functions. This study also theoretically demonstrated that the discrepancies result from the non-linear relationship between the apparent mass and the properties of a dynamic system. Therefore, the discrepancies depend on the variability of the subjects' dynamic properties. Practically, the discrepancies in the vertical response could be reduced to an acceptable level (e.g., <10%) if a sufficient number of subjects with similar body weights are selected or grouped in the measurement. However, it is very difficult to reduce the discrepancies in the fore-and-aft cross-axis to such a level. While more demanding than the response-based method, the property-based method is theoretically more reliable for deriving the representative response functions for each axis. |
Interpretation of HIV serologic testing results: Commentary
Branson BM . Clin Chem 2010 56 (10) 1527-1527 This case illustrates a scenario that clinicians are likely to encounter more frequently as HIV screening becomes increasingly integrated into routine clinical care. Nonspecific antibody cross-reactivity with the HIV p24 antigen in persons who are not infected is the most common cause for repeatedly reactive HIV-screening assay and indeterminate Western blot results. However, because third-generation (IgM-sensitive) screening assays such as the EHIV (Siemens) detect antibodies 2 or more weeks before bands appear on the Western blot, indeterminate results can also indicate very recent HIV infection. Usually, p24 or gp41 bands are the first to appear on the Western blot after infection. Further complicating this presentation, influenza vaccination has also been implicated as a cause of a reactive HIV screening assay with indeterminate Western blot results. Such cases, however, are usually characterized by Western blot reactivity to the gp160 (precursor) or gp41 (transmembrane) proteins because of the striking homology between the transmembrane molecules of the HIV-1 envelope proteins and the influenza envelope protein hemagglutinin. Despite the absence of classical risk factors for HIV, it remains important to ensure that patients with indeterminate Western blot results are not infected. Recent observations have demonstrated that as many as 50% of persons whose HIV infection is discovered during routine screening do not manifest traditional risk factors. Resolution of an indeterminate Western blot result requires either the qualitative RNA diagnostic assay or quantitative RNA viral load to document absence of HIV RNA or a repeat Western blot after 4 weeks. Negative RNA results or repeatedly indeterminate Western blot results ≥4 weeks apart confirm the absence of HIV infection and allow patients to be reassured that they are uninfected. |
Determination of mean recency period for estimation of HIV type 1 incidence with the BED-capture EIA in persons infected with diverse subtypes
Parekh BS , Hanson DL , Hargrove J , Branson B , Green T , Dobbs T , Constantine N , Overbaugh J , McDougal JS . AIDS Res Hum Retroviruses 2010 27 (3) 265-73 The IgG capture BED enzyme immunoassay (BED-CEIA) was developed to detect recent HIV-1 infection for the estimation of HIV-1 incidence from cross-sectional specimens. The mean time interval between seroconversion and reaching a specified assay cutoff value [referred to here as the mean recency period (omega)], an important parameter for incidence estimation, is determined for some HIV-1 subtypes, but testing in more cohorts and new statistical methods suggest the need for a revised estimation of omega in different subtypes. A total of 2927 longitudinal specimens from 756 persons with incident HIV infections who had been enrolled in 17 cohort studies was tested by the BED-CEIA. The omega was determined using two statistical approaches: (1) linear mixed effects regression (omega(1)) and (2) a nonparametric survival method (omega(2)). Recency periods varied among individuals and by population. At an OD-n cutoff of 0.8, omega(1) was 176 days (95% CL 164-188 days) whereas omega(2) was 162 days (95% CL 152-172 days) when using a comparable subset of specimens (13 cohorts). When method 2 was applied to all available data (17 cohorts), omega(2) ranged from 127 days (Thai AE) to 236 days (subtypes AG, AD) with an overall omega(2) of 197 days (95% CL 173-220). About 70% of individuals reached a threshold OD-n of 0.8 by 197 days (mean omega) and 95% of people reached 0.8 OD-n by 480 days. The determination of omega with more data and new methodology suggests that omega of the BED-CEIA varies between different subtypes and/or populations. These estimates for omega may affect incidence estimates in various studies. |
Prenatal environmental tobacco smoke exposure and early childhood body mass index
Braun JM , Daniels JL , Poole C , Olshan AF , Hornung R , Bernert JT , Khoury J , Needham LL , Barr DB , Lanphear BP . Paediatr Perinat Epidemiol 2010 24 (6) 524-534 Maternal smoking during pregnancy is associated with increased risk of childhood overweight body mass index (BMI). Less is known about the association between prenatal secondhand tobacco smoke (SHS) exposure and childhood BMI. We followed 292 mother-child dyads from early pregnancy to 3 years of age. Prenatal tobacco smoke exposure during pregnancy was quantified using self-report and serum cotinine biomarkers. We used linear mixed models to estimate the association between tobacco smoke exposure and BMI at birth, 4 weeks, and 1, 2 and 3 years. During pregnancy, 15% of women reported SHS exposure and 12% reported active smoking, but 51% of women had cotinine levels consistent with SHS exposure and 10% had cotinine concentrations indicative of active smoking. After adjustment for confounders, children born to active smokers (self-report or serum cotinine) had higher BMI at 2 and 3 years of age, compared with unexposed children. Children born to women with prenatal serum cotinine concentrations indicative of SHS exposure had higher BMI at 2 (mean difference [MD] 0.3 [95% confidence interval -0.1, 0.7]) and 3 (MD 0.4 [0, 0.8]) years compared with unexposed children. Using self-reported prenatal exposure resulted in non-differential exposure misclassification of SHS exposures that attenuated the association between SHS exposure and BMI compared with serum cotinine concentrations. These findings suggest active and secondhand prenatal tobacco smoke exposure may be related to an important public health problem in childhood and later life. In addition, accurate quantification of prenatal secondhand tobacco smoke exposures is essential to obtaining valid estimates. |
Transmission of influenza A viruses between pigs and people, Iowa, 2002-2004
Terebuh P , Olsen CW , Wright J , Klimov A , Karasin A , Todd K , Zhou H , Hall H , Xu X , Kniffen T , Madsen D , Garten R , Bridges CB . Influenza Other Respir Viruses 2010 4 (6) 387-96 BACKGROUND: Triple-reassortant (tr) viruses of human, avian, and swine origin, including H1N1, H1N2, and H3N2 subtypes, emerged in North American swine herds in 1998 and have become predominant. While sporadic human infections with classical influenza A (H1N1) and with tr-swine influenza viruses have been reported, relatively few have been documented in occupationally exposed swine workers (SW). METHODS: We conducted a 2-year (2002-2004) prospective cohort study of transmission of influenza viruses between pigs and SW from a single pork production company in Iowa. Respiratory samples were collected and tested for influenza viruses from SW and from pigs under their care through surveillance for influenza-like illnesses (ILI). Serial blood samples from study participants were tested by hemagglutination inhibition (HI) for antibody seroconversion against human and swine influenza viruses (SIV), and antibody seroprevalence was compared to age-matched urban Iowa blood donors. RESULTS: During the first year, 15 of 88 SW had ILI and were sampled; all were culture-negative for influenza. During the second year, 11 of 76 SW had ILI and were sampled; one was culture-positive for a human seasonal H3N2 virus. Among 20 swine herd ILI outbreaks sampled, influenza A virus was detected by rRT-PCR from 17 with 11 trH1N1 and five trH3N2 virus isolates cultured. During both years, HI geometric mean titers were significantly higher among SW compared to blood donor controls for three SIV: classical swine Sw/WI/238/97 (H1N1), tr Sw/IN/9K035/99 (H1N2), and trSw/IA/H02NJ56371/02 (H1N1)] (P < 0.0001). CONCLUSIONS: SW had serologic evidence for infection with both swine and human influenza viruses and were exposed to diverse influenza virus strains circulating in pigs. Influenza virus surveillance among pigs and SW should be encouraged to better understand cross-species transmission and diversity of influenza viruses at the human-swine interface. |
A method for analyzing vibration power absorption density in human fingertip
Wu JZ , Dong RG , Welcome DE , Xu XYS . J Sound Vib 2010 329 (26) 5600-5614 In the current study, we hypothesize that the vibration power absorption density (VPAD) is a good measure for the vibration exposure intensity of the soft tissues of the fingers. In order to calculate the VPAD at a fingertip, we proposed a hybrid modeling approach, which combines a 2D finite element (FE) model with a lumped parameter model. Whereas the lumped components are used to represent the global biodynamic characteristics of the hand-arm system, the FE component is used to predict the detailed stresses, strains, and VPAD in the fingertip. The lumped parameters are determined by using the vibration transmissibilities measured at the fingertip, while the material parameters of the soft and hard tissues of the FE model are adopted from the published experimental data. The proposed model was applied to predict the distributions of dynamic displacement, velocity, and VPAD in the soft tissues of the fingertip. Furthermore, we have derived the frequency weighting based on the VPAD of the soft tissue. The preliminary analysis indicated that the VPAD-based frequency weighting is substantially different from the ISO weighting in that the ISO frequency weighting emphasizes the effect of the vibration at frequencies lower than 25 Hz whereas the VPAD-based weighting generally emphasizes the resonant responses of the finger. Our analysis indicated that the VPAD-based weighting was fairly consistent with the finger surface vibration transmissibility at frequencies greater than the first resonance, suggesting that the finger surface transmissibility may be used as an alternative frequency weighting for assessing the finger vibration exposure. The proposed method provides a practical and efficient tool to simulate the detailed biodynamic responses of a complex biological system to vibration. Published by Elsevier Ltd. |
Occupational fatalities in the United States commercial fishing industry, 2000-2009
Lincoln JM , Lucas DL . J Agromedicine 2010 15 (4) 343-50 The occupational fatality rate among commercial fishermen decreased in the United States during 1992-2008; however, commercial fishing continues to be one of the most dangerous occupations in the United States, with an average annual fatality rate of 129 deaths per 100,000 fishermen in 2008. By contrast, the average annual occupational fatality rate among all US workers during the same period was four deaths per 100,000 workers. During the 1990s, numerous safety interventions were developed for Alaska fisheries that resulted in a significant decline in the state's commercial fishing fatality rate. In 2007, the National Institute for Occupational Safety and Health (NIOSH) expanded surveillance of commercial fishing fatalities to the rest of the United States. The purpose of this report is to identify the hazards and risk factors for all causes of occupational mortality in the US commercial fishing industry, and to explore how those hazards and risk factors differ among fisheries and locations. During 2000-2009, 504 commercial fishing fatalities occurred in the United States. Most (261, 52%) occurred following a vessel disaster (defined as a sinking, capsizing, or other event in which the crew was forced to abandon ship) or a fall overboard (155, 31%). Fatalities occurred in Alaska (133, 26%), Northeast (124, 25%), Gulf of Mexico (116, 23%), West Coast (83, 16%), and the Mid- and South Atlantic (41, 8%) regions. Fatalities occurred most commonly while fishing for shellfish (226, 47%), groundfish (144, 30%) and pelagic fish (97, 20%). Average annual fatality rates were calculated for selected fisheries. The Northeast multispecies groundfish fleet had the highest average annual fatality rate (600 deaths per 100,000 full-time equivalent [FTE] fishermen) followed by the Atlantic scallop fleet (425 deaths per 100,000 FTE fishermen) and the West Coast Dungeness crab fleet (310 deaths per 100,000 FTE fishermen). To reduce fatalities among fishermen at greatest risk, additional prevention measures tailored to specific high-risk fisheries should be considered. |
A persistent high human cost of protein: commercial fishing and aquaculture
Conway GA . J Agromedicine 2010 15 (4) 335-6 Commercial fishing, despite many years of effort to make it safer, and some major regional successes in mitigation, remains a very hazardous type of work. Much more nuanced than the view provided by the current glare of electronic media, this special issue of the Journal of Agromedicine presents a collection of articles on the varied hazards of commercial fishing in the United States, as well as three articles on the rapidly expanding seafood farming industry. The scope of subjects from machinery to culture, and geography from Alaska to the southeastern US describes a complex landscape of human effort to better understand, in order to make this time-honored work safer. |
Interpreting borderline BeLPT results
Middleton DC , Mayer AS , Lewin MD , Mroz MM , Maier LA . Am J Ind Med 2010 54 (3) 205-9 BACKGROUND: The beryllium lymphocyte proliferation test (BeLPT) identifies persons sensitized to beryllium (BeS) and thus at risk for chronic beryllium disease (CBD). BeLPT test results are abnormal (AB), borderline (BL), or normal (NL). This manuscript addresses the predictive value and interpretation of BL BeLPT results. METHODS: The various three-result combinations that meet or exceed a nominal referral criteria of 1 AB + 1 BL are assessed with probability modeling and compared. RESULTS: At 2% prevalence, the three-result combinations that meet or exceed this referral criteria and associated probabilities of BeS are: (a) 1 AB + 1 BL + 1 NL (72%); (b) 3 BL (91%); (c) 2 AB + 1 NL (95%); (d) 1 AB + 2 BL (99%); (e) 2 AB + 1 BL (100%); and (f) 3 AB (100%). CONCLUSION: These results suggest that BL results are meaningful and that three BL results predict BeS across a broad range of population prevalences. An analysis of longitudinal BeLPT results and clinical findings from an actual surveillance program is warranted to confirm the model's predictions. Am. J. Ind. Med. (c) 2010 Wiley-Liss, Inc. |
Allergic contact dermatitis to synthetic rubber gloves: changing trends in patch test reactions to accelerators
Cao LY , Taylor JS , Sood A , Murray D , Siegel PD . Arch Dermatol 2010 146 (9) 1001-7 BACKGROUND: Rubber gloves are one of the most frequent causes of occupational allergic contact dermatitis, especially in health care workers. OBSERVATIONS: We describe 23 patients with allergic contact dermatitis due to rubber accelerators in rubber gloves, some with disseminated dermatitis, treated during a 2-year period. Three had IgE-mediated latex allergies. Sixteen were health care workers from a single institution whose dermatitis was temporally related to the switch to latex-safe gloves. Each had positive patch test reactions to 1 or more rubber accelerators, including carbamates, thiurams, 2-mercaptobenzothiazole, and 1,3-diphenylguanidine. Chemical analysis of 6 glove samples identified 2-mercaptobenzothiazole in 4 and zinc diethyldithiocarbamate in 1. There were discordances between patch test results for glove chemicals and glove swatches and between available information on chemicals used during glove production and chemicals detected during glove analysis. Although these factors may complicate the search for culprit and alternative gloves, dermatitis cleared in each of 9 patients with follow-up data and for whom alternative gloves were provided based on published information of glove composition. CONCLUSIONS: Allergic contact dermatitis due to synthetic rubber gloves occurs even with the use of latex-safe products. More knowledge about chemicals present in these gloves, to which the skin is exposed during use, is necessary to prevent and treat allergic contact dermatitis. |
Cohort mortality study of workers at seven beryllium processing plants: update and associations with cumulative and maximum exposure
Schubauer-Berigan MK , Couch JR , Petersen MR , Carreon T , Jin Y , Deddens JA . Occup Environ Med 2010 68 (5) 345-53 OBJECTIVES: To extend follow-up of cause-specific mortality in workers at seven beryllium processing plants and to estimate associations between mortality risk and beryllium exposure. METHODS: 9,199 workers were followed for mortality from 1940 through 2005. Standardised mortality ratios (SMRs) were estimated based on US population comparisons for lung, nervous system and urinary tract cancers, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and categories containing chronic beryllium disease (CBD) and cor pulmonale. Associations with maximum and cumulative exposure were calculated for a subset of the workers. RESULTS: Overall mortality in the cohort compared with the US population was elevated for lung cancer (SMR 1.17; 95% CI 1.08 to 1.28), COPD (SMR 1.23; 95% CI 1.13 to 1.32), and the categories containing CBD (SMR 7.80; 95% CI 6.26 to 9.60) and cor pulmonale (SMR 1.17; 95% CI 1.08 to 1.26). Mortality rates for most diseases of interest increased with time-since-hire. For the category including CBD, rates were substantially elevated compared to the US population across all exposure groups. Workers whose maximum beryllium exposure was ≥10 mug/m(3) had higher rates of lung cancer, urinary tract cancer, COPD and the category containing cor pulmonale than workers with lower exposure. Significant positive trends with cumulative exposure were observed for nervous system cancers (p=0.0006) and, when short-term workers were excluded, lung cancer (p=0.01), urinary tract cancer (p=0.003) and COPD (p<0.0001). CONCLUSION: These findings reaffirm that lung cancer and CBD, and suggest that COPD and nervous system and urinary tract cancers, are related to beryllium exposure. Cigarette smoking and exposure to other lung carcinogens are unlikely to explain these elevations. |
Focusing on solid partnerships across multiple sectors for population health improvement
Bailey SB . Prev Chronic Dis 2010 7 (6) A115 Partnerships create a way forward when no clear solution exists and no single entity can claim the necessary expertise, authority, or resources to bring about change. Cross-sectoral partnerships are needed to mobilize community action and improve population health. | The Mobilizing Action Toward Community Health (MATCH) articles in this issue of Preventing Chronic Disease reveal compelling themes, issues, and recommendations for improving population health. These include many challenges, such as how to scale up successful partnership efforts (1,2), determine if and how partnership activity can be correlated with changing health metrics (1-5), expand the use of incentives for improvement (1,3,4,6), and strengthen groups' distributive leadership and governance (1,2,4-6). |
Cigarette smoking women of reproductive age who use oral contraceptives: results from the 2002 and 2004 Behavioral Risk Factor Surveillance Systems
McClave AK , Hogue CJ , Brunner Huber LR , Ehrlich AC . Womens Health Issues 2010 20 (6) 380-5 BACKGROUND: Despite health warnings about the increased risk of cerebrovascular disease among women who smoke while using oral contraceptives (OCs), prior research suggests that OC use is still prevalent among women who smoke cigarettes. Our objective was to investigate the prevalence of OC use among cigarette smoking women of reproductive age in the United States. STUDY DESIGN: We extracted data from the 2002 and 2004 Behavioral Risk Factor Surveillance System surveys of 76,544 women between 18 and 44 years of age who reported using some form of contraception. OC use, or self-reported use of "the pill," was examined among those who currently smoke, either everyday or some days. Multivariable logistic regression models were used to compare OC use between smoking and nonsmoking women. RESULTS: One fourth (26.9%) of U.S. women who smoke compared with 34.6% of nonsmoking women reported currently using OCs. After adjusting for age, race/ethnicity, marital status, education level, binge drinking, and health care coverage, women who smoke were 0.6 (95% confidence interval [CI], 0.6-0.7) times as likely to use OCs as nonsmoking women. Among women aged 35 to 44 years, the odds of OC use among smokers was even further reduced (odds ratio [OR], 0.3; 95% CI, 0.3-0.4) compared with nonsmokers. CONCLUSION: Among U.S. women of reproductive age who use contraception, particularly among women aged 35 to 44 years, those who smoke cigarettes are significantly less likely to use OCs than those who do not. |
Sex differences in relational and overt aggression in the late elementary school years
Kistner J , Counts-Allan C , Dunkel S , Drew CH , David-Ferdon C , Lopez C . Aggress Behav 2010 36 (5) 282-91 Sex differences in relational and overt aggression among 3rd (n=176), 4th (n=179), and 5th graders (n=145) from three public schools (n=500; 278 girls) were examined. Nominations of relational aggression increased over time among 4th and 5th grade girls, but not among boys or 3rd grade girls. Among 3rd graders, boys received more nominations for relational aggression than girls. By the end of the 5th grade, girls received more relational aggression nominations than boys. There was also a significant rise in nominations of overt aggression among 5th grade girls, but not among 5th grade boys or younger boys and girls. As expected, boys were more likely than girls to be nominated for overt aggression at all grade levels. The findings are helpful for explaining inconsistencies of earlier research pertaining to sex differences in relational aggression and for advancing our understanding of the causes of aggression. |
Adverse childhood experiences and frequent headaches in adults
Anda R , Tietjen G , Schulman E , Felitti V , Croft J . Headache 2010 50 (9) 1473-1481 BACKGROUND: A variety of studies have linked childhood maltreatment to headaches, including migraines, and to headache severity. This study assesses the relationship of adverse childhood experiences (ACEs) to frequent headaches during adulthood. METHODS: We used data from the Adverse Childhood Experiences (ACE) study, which included 17,337 adult members of the Kaiser Health Plan in San Diego, CA who were undergoing a comprehensive preventive medical evaluation. The study assessed 8 ACEs including abuse (emotional, physical, sexual), witnessing domestic violence, growing up with mentally ill, substance abusing, or criminal household members, and parental separation or divorce. Our measure of headaches came from the medical review of systems using the question: "Are you troubled by frequent headaches?" We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to the prevalence and risk of frequent headaches. RESULTS: Each of the ACEs was associated with an increased prevalence and risk of frequent headaches. As the ACE score increased the prevalence and risk of frequent headaches increased in a "dose-response" fashion. The risk of frequent headaches increased more than 2-fold (odds ratio 2.1, 95% confidence interval 1.8-2.4) in persons with an ACE score ≥5, compared to persons with and ACE score of 0. The dose-response relationship of the ACE score to frequent headaches was seen for both men and women. CONCLUSIONS: The number of ACEs showed a graded relationship to frequent headaches in adults. Future studies should examine general populations with headache, and carefully classify them. A better understanding of the link between ACEs and migraine may lead to new knowledge regarding pathophysiology and enhanced additional therapies for headache patients. |
Molecular characterization of Cryptosporidium spp. in native calves in Nigeria
Ayinmode AB , Olakunle FB , Xiao L . Parasitol Res 2010 107 (4) 1019-21 Most studies on the distribution of Cryptosporidium species in cattle were done with dairy breeds in industrialized nations. In this study, 65 fecal samples from randomly selected 12-24-week-old diarrheic calves in four white Fulani herds in southwestern Nigeria were screened for Cryptosporidium spp. using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) analysis of the small subunit rRNA gene. Thirty-four (52.3%) of the samples were positive for Cryptosporidium. RFLP analysis of PCR products showed that 18 (27.7%) and five (7.7%) of the positive samples had Cryptosporidium bovis and Cryptosporidium ryanae, respectively, and 11 (16.9%) had mixed infections of the two species. The absence of C. parvum suggests that the age group of calves studied is not likely to be source of zoonotic infection to humans. |
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