Association of hypertension treatment and control with all-cause and cardiovascular disease mortality among US adults with hypertension
Gu Q , Dillon CF , Burt VL , Gillum RF . Am J Hypertens 2009 23 (1) 38-45 BACKGROUND: Clinical trials have provided convincing evidence that blood pressure (BP) lowering treatment reduces the risk of cardiovascular disease (CVD) and total mortality. OBJECTIVE: to examine the association of hypertension treatment, control, and BP indexes with all-cause and cardiovascular mortality among US adults with hypertension. METHODS: Persons aged ≥18 years from the Third National Health and Nutrition Examination Survey (NHANES III) were identified as hypertensives based on a BP ≥140/90 mm Hg or current treatment for hypertension. Vital status in 2006 was ascertained by passive follow-up using the National Death Index. Cox regression models were used to assess correlates of survival. RESULTS: At baseline, 52% of hypertensive adults reported currently taking prescription medicine for high BP and 38% of treated persons had BP controlled. Compared to treated controlled hypertensives, treated uncontrolled hypertensives had a 1.57-fold (95% confidence interval (CI) 1.28-1.91) and 1.74-fold (95% CI 1.36-2.22) risk of all-cause and cardiovascular mortality; untreated hypertensives had a 1.34-fold (95% CI 1.12-1.62) and 1.37-fold (95% CI 1.04-1.81) risk of all-cause and cardiovascular mortality, respectively. The association persisted after further excluding persons with pre-existing hypertension comorbidities. Mortality risk was linearly increased with systolic BP (SBP), pulse pressure (PP), and mean arterial pressure (MBP), whereas diastolic BP (DBP) was not a significant predictor of cardiovascular mortality overall. No significant associations were observed between drug classes and mortality risk. CONCLUSIONS: This study indicates that uncontrolled and untreated hypertension was associated with increased risk of total and cardiovascular mortality among the general hypertensive population.American Journal of Hypertension 2009; doi:10.1038/ajh.2009.191. |
Diabetic retinopathy, dilated eye examination, and eye care education among African Americans, 1997 and 2004
Zhang X , Williams DE , Beckles GL , Gregg EW , Barker L , Luo H , Rutledge SA , Saaddine JB . J Natl Med Assoc 2009 101 (10) 1015-21 OBJECTIVE: To examine diabetic retinopathy, dilated eye examination, and eye care education among African Americans before and after a community-level public health intervention. METHODS: We analyzed data from Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) participants with self-reported diabetes (617 in 1996-1997 and 672 in 2003-2004) in Raleigh (intervention community) and Greensboro (comparison community), North Carolina. All analyses were weighted to adjust for the complex sample design of pre and post cross-sectional surveys. Estimates were age standardized to the 2000 US Census population. We used multivariate logistic regression to calculate odds ratios and corresponding 95% confidence intervals. RESULTS: We found no significant difference in prevalence of diabetic retinopathy between the control and intervention communities (p > .05). However, after adjusting for other confounders, receipt of eye care education (OR, 1.59; 95% CI, 1.19-2.13) was independently associated with receipt of dilated eye examination among African Americans with diabetes. Compared with individuals without diabetic retinopathy, those with diabetic retinopathy were more likely to use eye care services (OR, 1.89; 95% CI, 1.41-2.54). CONCLUSIONS: Diabetic retinopathy is a considerable problem among African American communities. Community intervention efforts, such as comprehensive eye care education, that specifically target improvement in diabetic retinopathy and use of eye are services could help better serve this population. |
The epidemiology of triple-negative breast cancer, including race
Trivers KF , Lund MJ , Porter PL , Liff JM , Flagg EW , Coates RJ , Eley JW . Cancer Causes Control 2009 20 (7) 1071-82 OBJECTIVE: Predictors of intrinsic breast cancer subtypes, including the triple-negative (TN) subtype, are largely unknown. We evaluated whether anthropometrics, demographics, and reproductive history were associated with distinct breast cancer subtypes. METHODS: Invasive breast tumors from a population-based case-control study of 476 (116 black and 360 white) Atlanta women aged 20-54, diagnosed between 1990 and 1992, were centrally reviewed and immunohistochemically analyzed for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2); then grouped [TN (ER-PR-HER2-); ER-PR-HER2+; ER/PR+HER2+; ER/PR+HER2- (case-only reference group)]. Data were from interviews and anthropometric measurements; adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression, including both case-only and case-control comparisons. RESULTS: From the case-only analyses and compared with the ER/PR+HER2- subtype, women with TN tumors were more likely to be obese than normal/underweight [OR = 1.89 (95% CI = 1.22, 2.92)]. Regardless of HER2 status, ER-PR- tumors were associated with black race, young age at first birth, having a recent birth, and being overweight. CONCLUSIONS: Distinct breast cancer subtypes have unique sociodemographic, anthropometric and reproductive characteristics and possibly different pathways for development. |
Introduction: charting the landscape of cancer survivors' health-related outcomes and care
Pollack LA , Rowland JH , Crammer C , Stefanek M . Cancer 2009 115 4265-9 The field of cancer survivorship is characterized by a complex and rapidly evolving landscape. This supplement presents a series of data-driven articles selected to highlight the breadth of new knowledge in this area of the cancer control continuum that were presented at the Fourth Biennial Cancer Survivorship Research Conference in Atlanta, Georgia, June 2008. Included in the volume is research on the biobehavioral impact of cancer; studies on quality-of-life and economic outcomes; and work focused on caregivers, understudied populations, and healthcare providers. |
JNK1, a potential therapeutic target for hepatocellular carcinoma
Chen F , Beezhold K , Castranova V . Biochim Biophys Acta 2009 1796 (2) 242-251 Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. Despite tremendous efforts to diagnose and institute new treatment regimens, the prognosis is still extremely poor. Therefore, knowledge of the molecular mechanisms governing the initiation, maintenance and progression of HCC is urgently needed. Recently, several groups have attributed an important role for c-Jun N-terminal kinase 1 (JNK1) in the pathogenesis of human HCC and its close association with the expression of HCC signature genes. In this review the various associations between JNK1 and HCC are discussed with the hope that targeting this pivotal kinase may lead to novel therapeutic approaches for this fatal disease. Published by Elsevier B.V. |
Nontuberculous mycobacteria infections and anti-tumor necrosis factor-alpha therapy
Winthrop KL , Chang E , Yamashita S , Iademarco MF , Lobue PA . Emerg Infect Dis 2009 15 (10) 1556-61 Patients receiving anti-tumor necrosis factor-oc (anti-TNF-oc) therapy are at increased risk for tuberculosis and other granulomatous diseases, but little is known about illness caused by nontuberculous mycobacteria (NTM) in this setting. We reviewed the US Food and Drug Administration MedWatch database for reports of NTM disease in patients receiving anti-TNF-oc therapy. Of 239 reports collected, 105 (44%) met NTM disease criteria. Median age was 62 years; the majority of patients (66, 65%) were female, and most (73, 70%) had rheumatoid arthritis. NTM infections were associated with infliximab (n = 73), etanercept (n = 25), and adalimumab (n = 7); most patients were taking prednisone (n = 68, 65%) or methotrexate (n = 58, 55%) concurrently. Mycobacteria avium (n = 52, 50%) was most commonly implicated, and 9 patients (9%) had died at the time their infections were reported. A high rate of extrapulmonary manifestations (n = 46, 44%) was also reported. |
Prevalence of Streptococcus pneumoniae serotype 6C among invasive and carriage isolates in metropolitan Salvador, Brazil, from 1996 to 2007
Campos LC , Carvalho Mda G , Beall BW , Cordeiro SM , Takahashi D , Reis MG , Ko AI , Reis JN . Diagn Microbiol Infect Dis 2009 65 (2) 112-5 The newly described Streptococcus pneumoniae serotype 6C accounted for 2.3% (16/709) of meningitis cases and 3.2% (3/95) of nasopharyngeal isolates from healthy individuals in Brazil. The strains were multidrug resistant (18.8%) and genetically diverse. Despite low serotype 6C prevalence, continuous surveillance is necessary to guide vaccine strategies. |
Estimation of the reproductive number and the serial interval in early phase of the 2009 influenza A/H1N1 pandemic in the USA
White LF , Wallinga J , Finelli L , Reed C , Riley S , Lipsitch M , Pagano M . Influenza Other Respir Viruses 2009 3 (6) 267-276 BACKGROUND: The United States was the second country to have a major outbreak of novel influenza A/H1N1 in what has become a new pandemic. Appropriate public health responses to this pandemic depend in part on early estimates of key epidemiological parameters of the virus in defined populations. METHODS: We use a likelihood-based method to estimate the basic reproductive number (R-0) and serial interval using individual level U.S. data from the Centers for Disease Control and Prevention (CDC). We adjust for missing dates of illness and changes in case ascertainment. Using prior estimates for the serial interval we also estimate the reproductive number only. RESULTS: Using the raw CDC data, we estimate the reproductive number to be between 2 center dot 2 and 2 center dot 3 and the mean of the serial interval (mu) between 2 center dot 5 and 2 center dot 6 days. After adjustment for increased case ascertainment our estimates change to 1 center dot 7 to 1 center dot 8 for R-0 and 2 center dot 2 to 2 center dot 3 days for mu. In a sensitivity analysis making use of previous estimates of the mean of the serial interval, both for this epidemic (mu = 1 center dot 91 days) and for seasonal influenza (mu = 3 center dot 6 days), we estimate the reproductive number at 1 center dot 5 to 3 center dot 1. CONCLUSIONS: With adjustments for data imperfections we obtain useful estimates of key epidemiological parameters for the current influenza H1N1 outbreak in the United States. Estimates that adjust for suspected increases in reporting suggest that substantial reductions in the spread of this epidemic may be achievable with aggressive control measures, while sensitivity analyses suggest the possibility that even such measures would have limited effect in reducing total attack rates. |
Fine-scale identification of the most likely source of a human plague infection
Colman RE , Vogler AJ , Lowell JL , Gage KL , Morway C , Reynolds PJ , Ettestad P , Keim P , Kosoy MY , Wagner DM . Emerg Infect Dis 2009 15 (10) 1623-5 We describe an analytic approach to provide fine-scale discrimination among multiple infection source hypotheses. This approach uses mutation-rate data for rapidly evolving multiple locus variable-number tandem repeat loci in probabilistic models to identify the most likely source. We illustrate the utility of this approach using data from a North American human plague investigation. |
HIV infection among internally displaced women and women residing in river populations along the Congo River, Democratic Republic of Congo
Kim AA , Malele F , Kaiser R , Mama N , Kinkela T , Mantshumba JC , Hynes M , De Jesus S , Musema G , Kayembe PK , Hawkins Reed K , Diaz T . AIDS Behav 2009 13 (5) 914-20 We conducted a reproductive health assessment among women aged 15-49 years residing in an internally displaced persons (IDP) camp and surrounding river populations in the Democratic Republic of Congo. After providing informed consent, participants were administered a behavioral questionnaire on demographics, sexual risk, reproductive health behavior, and a history of gender based violence. Participants provided a blood specimen for HIV and syphilis testing and were referred to HIV counseling and testing services established for this study to learn their HIV status. HIV prevalence was significantly higher among women in the IDP population compared to women in the river population. Sexually transmitted infection symptoms in the past 12 months and a history of sexual violence during the conflict were associated with HIV infection the river and IDP population, respectively. Targeted prevention, care, and treatment services are urgently needed for the IDP population and surrounding host communities during displacement and resettlement. |
HIV-1 incidence rates and risk factors in agricultural workers and dependents in rural Kenya: 36-month follow-up of the Kericho HIV cohort study
Shaffer DN , Ngetich IK , Bautista CT , Sawe FK , Renzullo PO , Scott PT , Kibaya RM , Imbuki KO , Michael NL , Birx DL , Wasunna MK , Robb ML . J Acquir Immune Defic Syndr 2009 53 (4) 514-21 BACKGROUND: Incidence data from prospective cohort studies using rigorous laboratory methods are important in designing and evaluating HIV vaccine and therapeutic clinical trials and health care programs. We report 36-month HIV-1 incidence rates and demographic and psychosocial risks from the Kericho cohort in rural Kenya's southern Rift Valley Province. METHODS: Thirty-six month, prospective, closed, observational cohort study of adult plantation workers and dependents followed biannually. HIV-1 incidence rates per 100 person-years (py) were calculated, and Cox regression analyses were used to estimate hazards ratios (HR) associated with seroconversion. RESULTS: Two thousand four hundred volunteers (mean age +/- SD = 30.1 +/- 8.5 years; 36.5% women) participated. Twenty-nine new HIV cases were identified in year 1 of follow-up, which increased to cumulative totals of 49 and 63 cases in years 2 and 3, respectively. The corresponding 1-, 2-, and 3-year incidence rates were 1.41 [95% confidence interval (CI) = 0.95-2.02], 1.16 (95% CI = 0.86-1.54), and 1.00 (95% CI = 0.77-1.28) per 100 py. Risk factors associated with HIV seroconversion included the following: of the Luo tribe (HR = 3.31; 95% CI = 1.65-6.63), marriage more than once (HR = 2.83; 95% CI = 1.20-6.69), self-reported male circumcision (HR = 0.32; 95% CI = 0.17-0.60), history of sexually transmitted infection (HR = 2.40; 95% CI = 1.09-5.26), history of substance abuse during sex (HR = 2.44; 95% CI = 1.16-5.13), and history of transactional sex (HR = 3.30; 95% CI = 1.79-6.09). CONCLUSIONS: HIV-1 incidence rates were relatively low in adult plantation workers and dependents in rural Kenya. Cohorts including higher risk populations (eg, commercial sex workers) warrant consideration for regional HIV preventive vaccine trials. Even low incidence, well-described cohorts generate valuable epidemiological clinical trial data. |
Partner notification in the clinician's office: patient health, public health and interventions
Hogben M , Burstein GR , Golden MR . Curr Opin Obstet Gynecol 2009 21 (5) 365-70 PURPOSE OF REVIEW: Partner notification is an essential element of sexually transmitted disease infection control. Patients may be interviewed by public health staff, followed by public health staff notification of those partners (provider referral), or they receive some form of instruction to notify and refer their own partners (patient referral). In this review, we review partner notification and current research and programmatic activity. RECENT FINDINGS: Resource limitations restrain provider referral to a minority of cases. Patient referral is far more widely practiced and is the subject of some recent enhancements. Foremost among these is the growing practice of expedited partner therapy, in which partner treatment may occur through the provision of medications or prescriptions prior to a clinical evaluation. Trials in which patients took medications to their partners have been supported, and the practice is gaining acceptance nationally. Other counseling also increases patient referral efficacy. Finally, the role of the internet in both provider and patient referral has received increasing attention and is being incorporated into program practice. SUMMARY: Clinical providers can intervene at the point of care to serve both patients as individuals and infection control more broadly. Cooperation between public health agencies, other organizations and clinical providers can facilitate both goals. |
Active communities for youth and families: using research to create momentum for change
Lee SM , Sallis JF , Biddle SJ . Prev Med 2009 50 S3-5 Regular physical activity and healthy eating are essential components of a healthy lifestyle that can play a powerful role in preventing such chronic diseases as heart disease, cancer, and stroke – the three leading causes of death – as well as obesity (US Department of Health and Human Services [USDHHS], 2001; Lichtenstein et al., 2006). Obesity in children and adults has become a worldwide public health epidemic (World Health Organization, 2000). In the United States specifically, 17.0% of 6- to 11-year-olds and 17.6% of 12- to 19-year-olds are considered obese; these numbers have doubled and tripled, respectively, in the last 30 years (Ogden et al., 2008). Obese children are more likely to be at risk for heart disease than their normal-weight peers (Freedman et al., 2007). The National Health and Nutrition Examination Survey (NHANES) observed the highest prevalence of obesity among non-Hispanic black girls aged 12–19 years (27.7%) and Mexican-American boys aged 6–11 years (27.5%; Ogden et al., 2008). A greater percentage of adolescents from poor families are obese (23.3%) than are those from non-poor families (14.4%; Miech et al., 2006). |
County-level social environment determinants of health-related quality of life among US adults: a multilevel analysis
Jia H , Moriarty DG , Kanarek N . J Community Health 2009 34 (5) 430-9 To show that an individual's health-related quality of life (HRQOL) is not determined only by their personal-level characteristics, but also is socially determined by both physical and social environmental characteristics of their communities. This analysis examined the association of selected county-level indicators on respondents' unhealthy days and assessed the utility of mean unhealthy days for US counties as community health indicators. Data came from the 1999-2001 Behavioral Risk Factor Surveillance System. We used multilevel models to calculate the proportion of between-county variation in HRQOL that was explained by county-level contextual variables and examine the causal heterogeneity of some personal-level factors modified by these contextual variables. Counties with worse socioeconomic indicators, high mortality rate, and low life expectancy were associated with higher numbers of unhealthy days. These indicators explained 13-22% variance of county-level physically unhealthy days and 4.5-9.5% variance of county-level mentally unhealthy days. The GINI index, suicide rate, percent uninsured, primary care facilities-to-population ratio, and most county-level demographic and housing indicators also had significant but smaller impact on respondents' unhealthy days. Also, the counties with poorer socioeconomic scores had additional negative HRQOL impact on older persons. This study provides important new empirical information on whether various commonly-measured characteristics of the social environment, which are believed to be social determinants of health, are in fact associated with the perceived physical and mental health of its residents. Our findings provide additional support for the construct validity of county-level HRQOL as a community health indicator. |
Emerging clinical issues in refugees
Stauffer WM , Weinberg M . Curr Opin Infect Dis 2009 22 (5) 436-42 PURPOSE OF REVIEW: The world's population is becoming increasing mobile. Each mobile population (e.g. immigrants, refugees, travelers) has certain characteristics that determine public health risk and infectious disease burden. Refugees present unique challenges to public health officials and infectious disease specialists. RECENT FINDINGS: Refugee migration to the United States represents the most controlled population movement between countries from a health perspective. Medical screening and programs that provide presumptive treatment for highly prevalent infectious diseases both prior to and after migration alter the infectious disease epidemiology in these populations. SUMMARY: Infectious disease specialists must recognize that different characteristics of distinct mobile populations will alter infectious disease burden. This article specifically highlights how recent public health approaches have altered the epidemiology and clinical presentation of malaria, intestinal parasites and tuberculosis in refugee populations. |
Maternal pregnancy levels of polychlorinated biphenyls and risk of hypospadias and cryptorchidism in male offspring
McGlynn KA , Guo X , Graubard BI , Brock JW , Klebanoff MA , Longnecker MP . Environ Health Perspect 2009 117 (9) 1472-6 BACKGROUND: The etiologies of the male urogenital anomalies cryptorchidism and hypospadias are poorly understood. It has been suggested, however, that in utero hormone levels may be related to risk. Endocrine-disrupting chemicals, including polychlorinated biphenyl (PCB) compounds, may alter hormone levels and thereby affect the fetus. OBJECTIVES: To examine whether in utero PCB exposure is related to cryptorchidism and hypospadias, we examined PCB levels among pregnant women enrolled in the Collaborative Perinatal Project (CPP). METHODS: The CPP enrolled pregnant women at 12 U.S. medical centers between 1959 and 1965. For the present research, we analyzed third-trimester serum samples from the mothers of 230 sons with cryptorchidism, 201 sons with hypospadias, and 593 sons with neither condition. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression and examined the associations of each anomaly with individual PCB congener levels, sum of PCBs, and several functional groupings of PCBs. RESULTS: In general, the ORs for cryptorchidism or hypospadias showed no notable associations with individual PCB congener levels or functional groupings of PCBs. However, the ORs and 95% CIs for the sum of PCBs associated with hypospadias were as follows: 0-1.9 microg/L, reference group; 2-2.9 microg/L, OR = 1.57, 95% CI, 1.05-2.34; 3-3.9 microg/L, OR = 1.45, 95% CI, 0.90-2.34; and > or = 4.0 microg/L, OR = 1.69, 95% CI, 1.06-2.68; p-value for trend = 0.08. CONCLUSIONS: Given the large number of associations examined, these findings do not strongly support the hypothesis that PCBs are associated with cryptorchidism or hypospadias. Because population serum PCB levels at the time of sample collection were considerably higher than levels at present, it is unlikely that current PCB exposure is related to the development of either anomaly. |
Perinatal exposure to perchlorate, thiocyanate, and nitrate in New Jersey mothers and newborns
Blount BC , Rich DQ , Valentin-Blasini L , Lashley S , Ananth CV , Murphy E , Smulian JC , Spain BJ , Barr DB , Ledoux T , Hore P , Robson M . Environ Sci Technol 2009 43 (19) 7543-9 Perchlorate is a commonly occurring environmental toxicant that may be transported across the placental barrier by the sodium-iodide symporter (NIS), possibly resulting in both increased perchlorate exposure and decreased iodide uptake by the fetus. Therefore, we measured levels of three physiologically relevant NIS-inhibitors (perchlorate, nitrate, and thiocyanate) and iodide in maternal and fetal fluids collected during cesarean-section surgeries on 150 U.S. women. Geometric means of perchlorate, thiocyanate, and nitrate levels in maternal urine (2.90, 947, and 47900 microg/L, respectively) were similar to previously published results, while urinary iodide levels (1420 microg/L) were significantly higher (p < 0.0001), likely because of prevalent prenatal vitamin use in the study population (74%). Thiocyanate levels were higher in the maternal serum, cord serum, and amniotic fluid of smokers compared to women with environmental tobacco smoke exposure and nonsmokers (p-values of 0.0006, 0.0011, and 0.0026, respectively). Perchlorate was detected in most samples: urine (100%), maternal serum (94%), cord serum (67%), and amniotic fluid (97%). Maternal urinary perchlorate levels were positively correlated with perchlorate levels in amniotic fluid (r = 0.57), indicating that maternal urine perchlorate is an effective biomarker of fetal perchlorate exposure. Maternal serum perchlorate was generally higher than cord serum perchlorate (median ratio 2.4:1 for paired samples), and maternal urine perchlorate was always higher than fetal amniotic fluid perchlorate levels (mean ratio 22:1); conversely, iodide levels were typically higher in fetal fluids compared to maternal fluids. We found no evidence of either disproportionate perchlorate accumulation or lack of iodide in the fetal compartment. In this panel of healthy infants, we found no association between cord blood levels of these anions and newborn weight length, and head circumference. |
Polycarbonate bottle use and urinary bisphenol A concentrations
Carwile JL , Luu HT , Bassett LS , Driscoll DA , Yuan C , Chang JY , Ye X , Calafat AM , Michels KB . Environ Health Perspect 2009 117 (9) 1368-72 BACKGROUND: Bisphenol A (BPA) is a high-production-volume chemical commonly used in the manufacture of polycarbonate plastic. Low-level concentrations of BPA in animals and possibly in humans may cause endocrine disruption. Whether ingestion of food or beverages from polycarbonate containers increases BPA concentrations in humans has not been studied. OBJECTIVES: We examined the association between use of polycarbonate beverage containers and urinary BPA concentrations in humans. METHODS: We conducted a nonrandomized intervention of 77 Harvard College students to compare urinary BPA concentrations collected after a washout phase of 1 week to those taken after an intervention week during which most cold beverages were consumed from polycarbonate drinking bottles. Paired t-tests were used to assess the difference in urinary BPA concentrations before and after polycarbonate bottle use. RESULTS: The geometric mean urinary BPA concentration at the end of the washout phase was 1.2 microg/g creatinine, increasing to 2.0 microg/g creatinine after 1 week of polycarbonate bottle use. Urinary BPA concentrations increased by 69% after use of polycarbonate bottles (p < 0.0001). The association was stronger among participants who reported > or = 90% compliance (77% increase; p < 0.0001) than among those reporting < 90% compliance (55% increase; p = 0.03), but this difference was not statistically significant (p = 0.54). CONCLUSIONS: One week of polycarbonate bottle use increased urinary BPA concentrations by two-thirds. Regular consumption of cold beverages from polycarbonate bottles is associated with a substantial increase in urinary BPA concentrations irrespective of exposure to BPA from other sources. |
Risk factors associated with clinic visits during the 1999 forest fires near the Hoopa Valley Indian Reservation, California, USA
Lee TS , Falter K , Meyer P , Mott J , Gwynn C . Int J Environ Health Res 2009 19 (5) 315-327 Forest fires burned near the Hoopa Valley Indian Reservation in northern California from late August until early November in 1999. The fires generated particulate matter reaching hazardous levels. We assessed the relationship between patients seeking care for six health conditions and PM10 exposure levels during the 1999 fires and during the corresponding period in 1998 when there were no fires. Multivariate logistic regression analysis indicated that daily PM10 levels in 1999 were significant predictors for patients seeking care for asthma, coronary artery disease and headache after controlling for potential risk factors. Stratified multivariate logistic regression models indicated that daily PM10 levels in 1999 were significant predictors for patients seeking care for circulatory illness among residents of nearby communities and new patients, and for respiratory illness among residents of Hoopa and those of nearby communities. |
Serum polybrominated diphenyl ether (PBDE) levels are higher in children (2-5 years of age) than in infants and adults
Toms LM , Sjodin A , Harden F , Hobson P , Jones R , Edenfield E , Mueller JF . Environ Health Perspect 2009 117 (9) 1461-5 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in many products and have been detected in human samples worldwide. Limited data show that concentrations are elevated in young children. OBJECTIVES: We investigated the association between PBDEs and age with an emphasis on young children from Australia in 2006-2007. METHODS: We collected human blood serum samples (n = 2,420), which we stratified by age and sex and pooled for analysis of PBDEs. RESULTS: The sum of BDE-47, -99, -100, and -153 concentrations ( summation operator(4)PBDE) increased from 0-0.5 years (mean +/- SD, 14 +/- 3.4 ng/g lipid) to peak at 2.6-3 years (51 +/- 36 ng/g lipid; p < 0.001) and then decreased until 31-45 years (9.9 +/- 1.6 ng/g lipid). We observed no further significant decrease among ages 31-45, 45-60 (p = 0.964), or > 60 years (p = 0.894). The mean summation operator(4)PBDE concentration in cord blood (24 +/- 14 ng/g lipid) did not differ significantly from that in adult serum at ages 15-30 (p = 0.198) or 31-45 years (p = 0.140). We found no temporal trend when we compared the present results with Australian PBDE data from 2002-2005. PBDE concentrations were higher in males than in females; however, this difference reached statistical significance only for BDE-153 (p = 0.05). CONCLUSIONS: The observed peak concentration at 2.6-3 years of age is later than the period when breast-feeding is typically ceased. This suggests that in addition to the exposure via human milk, young children have higher exposure to these chemicals and/or a lower capacity to eliminate them. |
A national survey of adult asthma prevalence by urban-rural residence U.S. 2005
Morrison T , Callahan D , Moorman J , Bailey C . J Asthma 2009 46 (8) 751-8 OBJECTIVES: We analyzed national data to estimate asthma prevalence among U.S. adults by urban-rural residence and to determine the relative contributions of sociodemographic and health behavior characteristics on the probability of reporting asthma. METHODS: We linked the 2005 Behavioral Risk Factor Surveillance System (BRFSS) to Urban Influence Codes (UICs), categorizing respondents into four urban-rural groups: metropolitan, adjacent metropolitan, micropolitan, and remote. BRFSS collects health data from all 50 states. UICs classify respondent's county as urban or rural based on population size and proximity to metropolitan areas. We calculated asthma prevalence estimates and generated odds ratios (ORs) for the probability of reporting asthma. RESULTS: Overall asthma prevalence (7.9%; 95%CI = 7.73-8.08) was not statistically different (p = 0.28) by urban-rural residence. After adjusting for selected characteristics, adjacent metropolitan (OR = 0.96; 95%CI = 0.90-1.02) and remote (OR = 0.95; 95%CI = 0.85-1.05) residents were less likely--and micropolitan (OR = 1.04; 95%CI = 0.93-1.16) residents were more likely--to report asthma compared with metropolitan residents; but confidence intervals included null. CONCLUSIONS: Asthma prevalence is as high in rural as in urban areas. Certain demographic, behavioral, and health care characteristics unique to place of residence might affect asthma prevalence. Because these results substantially change our understanding of asthma prevalence in rural areas, further investigation is needed to determine geographic-related risk factors. |
Pediatric influenza-associated myositis - Nebraska, 2001-2007
Buss BF , Shinde VM , Safranek TJ , Uyeki TM . Influenza Other Respir Viruses 2009 3 (6) 277-285 OBJECTIVE: Influenza-associated myositis (IAM), characterized by severe lower-extremity myalgia and reluctance to walk, is a complication of influenza among children. We investigated IAM in Nebraska during six influenza seasons, 2001-2007. METHODS: During 2006-2007, we requested reports of severe influenza illness among persons aged < 18 years and investigated medical records to identify and confirm IAM cases defined as severe myalgia with elevated serum creatinine kinase level in a patient aged < 18 years, occurring within 7 days of laboratory confirmed influenza illness onset. Statewide hospital discharge data (HDD) were reviewed to identify retrospectively confirmed IAM cases during 2006-2007 and five previous seasons, by using surveillance data to define periods of influenza activity. Statewide IAM incidence was estimated for 2001-2002 through 2006-2007. RESULTS: During 2006-2007, a total of 13 IAM cases were confirmed by enhanced surveillance. Median age was 6 years (range, 4-11 years). Influenza diagnosis was established by viral isolation from six patients (one influenza A and five influenza B) and rapid diagnostic tests for seven. Twelve (92%) patients, including one who died, were hospitalized for a median of 3 days (range, 1-4 days). Review of HDD identified 12 retrospectively confirmed IAM cases during 2006-2007, including four not reported through enhanced surveillance, and only one during five previous seasons (2003-2004). The HDD-derived, retrospectively confirmed statewide IAM incidence estimates/1 00 000 population aged < 18 years were 2 center dot 693 and 0 center dot 225 during 2006-2007 and 2003-2004, respectively. CONCLUSION: An IAM epidemic occurred in Nebraska during the 2006-2007 influenza season. |
BMI measurement in schools
Nihiser AJ , Lee SM , Wechsler H , McKenna M , Odom E , Reinold C , Thompson D , Grummer-Strawn L . Pediatrics 2009 124 S89-97 BACKGROUND AND OBJECTIVE: School-based BMI measurement has attracted attention across the nation as a potential approach to address obesity among youth. However, little is known about its impact or effectiveness in changing obesity rates or related physical activity and dietary behaviors that influence obesity. This article describes current BMI-measurement programs and practices, research, and expert recommendations and provides guidance on implementing such an approach. METHODS: An extensive search for scientific articles, position statements, and current state legislation related to BMI-measurement programs was conducted. A literature and policy review was written and presented to a panel of experts. This panel, comprising experts in public health, education, school counseling, school medical care, and parenting, reviewed and provided expertise on this article. RESULTS: School-based BMI-measurement programs are conducted for surveillance or screening purposes. Thirteen states are implementing school-based BMI-measurement programs as required by legislation. Few studies exist that assess the utility of these programs in preventing increases in obesity or the effects these programs may have on weight-related knowledge, attitudes, and behaviors of youth and their families. Typically, expert organizations support school-based BMI surveillance; however, controversy exists over screening. BMI screening does not currently meet all of the American Academy of Pediatrics' criteria for determining whether screening for specific health conditions should be implemented in schools. CONCLUSION: Schools initiating BMI-measurement programs should adhere to safeguards to minimize potential harms and maximize benefits, establish a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating. |
Factors associated with differences in mortality and self-reported health across states in the United States
Chen Z , Roy K , Haddix AC , Thacker SB . Health Policy 2009 94 (3) 203-10 OBJECTIVE: Recent studies indicate continuing health disparities across geographic units in the US. This paper provides updated estimates of the association between socioeconomic factors and population health using a new state-level dataset and panel econometric methods that account for state-specific effects and autoregressive error structure. METHODS: Data from multiple sources for the 50 US states and the District of Columbia are merged. The dependent variables are age-adjusted all-cause mortality, self-assessed health status, and number of healthy days. Panel econometric models are used to accommodate state-specific unobserved factors and to incorporate autoregressive random disturbances to provide consistent and robust estimates. RESULTS: A 1-unit increase in the number of physicians per 1000 population is associated with a reduction in mortality by 30/100,000. The effects of physician-to-population ratio on self-reported health measures are mixed. Socioeconomic, demographic, as well as the prevalence of smoking and obesity have varying effects on mortality and self-reported measures of health. CONCLUSIONS: The new estimate of the association between physician supply and lower mortality suggests continuing efforts to assess the need for policies and incentives to induce physician labor supply in underserved states. Strategies and policies to reduce health disparities should address social, economic and individual risk factors. |
Introduction to issues and implications of screening, surveillance, and reporting of children's BMI
Dietz WH , Story MT , Leviton LC . Pediatrics 2009 124 S1-2 On January 16 and 17, 2008, the Robert Wood Johnson Foundation convened a forum of researchers and practitioners working on the issue of childhood obesity to discuss the issues related to surveillance, screening, and reporting of children's BMI. Because obesity has become a major concern of the foundation, it seemed essential to understand the use and limitations of the BMI measurement on which the diagnosis of obesity depended. The goals of the meeting were to gather and review experience in the collection of BMI data and to understand how to communicate BMI results to parents. In addition, the group explored cultural differences in how the BMI was interpreted, and considered the legal and confidentiality implications of collecting and reporting BMI data. | Because of the ease and reliability of measures of height and weight that are used to calculate BMI, BMI is the recommended measure for the identification of overweight and obesity. Obesity in children and adolescents, defined as a BMI at ≥95th percentile for age and gender, provides a useful measure of risk of metabolic complications and persistence. Furthermore, weight increases above the 95th percentile almost always reflect increases in body fatness. Overweight, defined as a BMI between the 85th and 95th percentiles for age and gender, is associated with a lower risk of metabolic complications or persistence. |
Issues and implications of screening, surveillance, and reporting of children's BMI
Dietz WH , Story MT , Leviton LC . Pediatrics 2009 124 S98-101 A robust discussion followed the presentation of each paper at the forum. In the sections below we have tried to capture the most salient points raised during the discussion. As a result, many of these points were not considered in the articles that comprise this supplement but are highly relevant to the screening, surveillance, and reporting of BMI. |
Phenopedia and Genopedia: disease-centered and gene-centered views of the evolving knowledge of human genetic associations.
Yu W , Clyne M , Khoury MJ , Gwinn M . Bioinformatics 2009 26 (1) 145-6 SUMMARY: We developed Web-based applications that encourage the exploration of the literature on human genetic associations by using a database that is continuously updated from PubMed. These applications provide user-friendly interfaces for searching summarized information on human genetic associations, using either genes or diseases as the starting point. AVAILABILITY: Phenopedia and Genopedia can be freely accessed at http://www.hugenavigator.net/HuGENavigator/startPagePhenoPedia.do and http://www.hugenavigator.net/HuGENavigator/startPagePedia.do, respectively. CONTACT: wby0@cdc.gov. |
The phylogenetics and ecology of the orthopoxviruses endemic to North America
Emerson GL , Li Y , Frace MA , Olsen-Rasmussen MA , Khristova ML , Govil D , Sammons SA , Regnery RL , Karem KL , Damon IK , Carroll DS . PLoS One 2009 4 (10) e7666 The data presented herein support the North American orthopoxviruses (NA OPXV) in a sister relationship to all other currently described Orthopoxvirus (OPXV) species. This phylogenetic analysis reaffirms the identification of the NA OPXV as close relatives of "Old World" (Eurasian and African) OPXV and presents high support for deeper nodes within the Chordopoxvirinae family. The natural reservoir host(s) for many of the described OPXV species remains unknown although a clear virus-host association exists between the genus OPXV and several mammalian taxa. The hypothesized host associations and the deep divergence of the OPXV/NA OPXV clades depicted in this study may reflect the divergence patterns of the mammalian faunas of the Old and New World and reflect a more ancient presence of OPXV on what are now the American continents. Genes from the central region of the poxvirus genome are generally more conserved than genes from either end of the linear genome due to functional constraints imposed on viral replication abilities. The relatively slower evolution of these genes may more accurately reflect the deeper history among the poxvirus group, allowing for robust placement of the NA OPXV within Chordopoxvirinae. Sequence data for nine genes were compiled from three NA OPXV strains plus an additional 50 genomes collected from Genbank. The current, gene sequence based phylogenetic analysis reaffirms the identification of the NA OPXV as the nearest relatives of "Old World" OPXV and presents high support for deeper nodes within the Chordopoxvirinae family. Additionally, the substantial genetic distances that separate the currently described NA OPXV species indicate that it is likely that many more undescribed OPXV/NA OPXV species may be circulating among wild animals in North America. |
Measurement of influenza vaccination coverage among healthcare personnel in US hospitals
Lindley MC , Yonek J , Ahmed F , Perz JF , Williams Torres G . Infect Control Hosp Epidemiol 2009 30 (12) 1150-7 OBJECTIVE: To characterize practices related to measuring influenza vaccination rates among healthcare personnel in US hospitals. DESIGN: Descriptive survey. SETTING: Nonfederal, short-stay hospitals that provide general medical and surgical services, identified by use of the 2004 American Hospital Association Annual Survey Database. PARTICIPANTS: Healthcare personnel from 996 randomly sampled US hospitals stratified by region and bed size. METHODS: A self-administered questionnaire was distributed in 2006 to infection control coordinators to gather data on policies and practices related to the provision of the influenza vaccine and on the measurement and reporting of influenza vaccination rates. Descriptive statistics and associations were calculated, and logistic regression was conducted. RESULTS: The response rate was 56% (ie, 555 of 996 US hospitals responded to the questionnaire). Weighting accounted for sampling design and nonresponse. Most hospitals provided the influenza vaccine to employees (100%), credentialed medical staff (ie, independent practitioners; 94%), volunteers (86%), and contract staff (83%); provision for students and residents was less frequent (58%). Only 69% of hospitals measured vaccination rates (mean coverage rate, 55%). Most hospitals that measured coverage included employees (98%) in the vaccination rates, whereas contract staff (53%), credentialed medical staff (56%), volunteers (56%), and students and residents (30%) were less commonly included. Among hospitals measuring coverage, 44% included persons for which vaccine was contraindicated, and 51% included persons who refused vaccination. After adjustment for region and size, hospitals with vaccination plans written into policy (odds ratio, 2.0 [95% confidence interval, 1.22-7.67]) or that addressed internally reporting coverage (odds ratio, 4.8 [95% confidence interval, 2.97-7.66]) were more likely to measure coverage than were hospitals without such plans. CONCLUSIONS: Hospitals vary in terms of the groups of individuals included in influenza vaccination coverage measurements. Standardized measures may improve comparability of hospital-reported vaccination rates. Measuring coverage in a manner that facilitates identification of occupational groups with low vaccination rates may inform development of targeted interventions. |
A multinational, randomized, placebo-controlled trial to assess the immunogenicity, safety, and tolerability of live attenuated influenza vaccine coadministered with oral poliovirus vaccine in healthy young children
Breiman RF , Brooks WA , Goswami D , Lagos R , Borja-Tabora C , Lanata CF , Londono JA , Lum LC , Rappaport R , Razmpour A , Walker RE , Gruber WC , Forrest BD . Vaccine 2009 27 (40) 5472-9 Live attenuated influenza vaccine (LAIV) provides a useful tool to rapidly immunize populations in the developing world to prevent influenza outbreaks. In this noninferiority trial conducted in Asia and South America, where oral poliovirus vaccine (OPV) is still used, 2503 children aged 6 to <36 months with three polio immunizations were randomized to receive LAIV+OPV, placebo+OPV, or LAIV only. Immune responses in children receiving concomitant LAIV+OPV were noninferior to those observed in recipients of either vaccine alone. Response rates for different poliovirus types were similar in recipients of LAIV+OPV and placebo+OPV. Response rates to all influenza strains were similar in LAIV+OPV and LAIV-only recipients. Concomitant OPV and LAIV were safely administered to young children. |
Secular variation in United States rotavirus disease rates and serotypes: implications for assessing the rotavirus vaccination program
Payne DC , Szilagyi PG , Staat MA , Edwards KM , Gentsch JR , Weinberg GA , Hall CB , Curns AT , Clayton H , Griffin MR , Fairbrother G , Parashar UD . Pediatr Infect Dis J 2009 28 (11) 948-953 BACKGROUND: Since 2006, we have conducted population-based surveillance for rotavirus disease in children seen in hospitals and emergency departments (EDs) in Monroe County, NY (Rochester), Hamilton County, OH (Cincinnati), and Davidson County, TN (Nashville). METHODS: During the 2006 and 2007 rotavirus seasons, clinical information and stool specimens were obtained from county children who were <3 years presenting with diarrhea and/or vomiting to the hospital or ED of the only children's hospital in each county. Specimens were tested for rotavirus and genotyped, and rates of hospitalization and ED visits were calculated. RESULTS: While aggregate rotavirus hospitalization rates for the 3 sites were similar in 2006 and 2007 (22.5/10,000 and 26.8/10,000, respectively), individual rates for the 3 counties differed considerably. The rotavirus hospitalization rate in Rochester between 2006 and 2007 increased 3-fold, but decreased by 33% in Cincinnati and 41% in Nashville over the 2 study years. G1 strains accounted for >80% of strains at all 3 sites in 2006. However, in 2007, the uncommon P[8], G12 strain was detected in 69% of Rochester specimens, while the P[8], G1 strain remained predominant in the other 2 sites. No subjects received rotavirus vaccine in 2006 and coverage with 2 to 3 vaccine doses reached 15% in all 3 communities by June 2007. CONCLUSIONS: During the 2006 and 2007 rotavirus seasons, with only limited vaccine use, remarkable variability was observed in the population-based rates of severe rotavirus and in the rotavirus serotypes across the 3 sites. This natural secular variability in rotavirus disease must be considered in the assessment of the impact of vaccine on disease rates and rotavirus serotypes. |
Successful immunization of an allogeneic bone marrow transplant recipient with live, attenuated yellow fever vaccine
Yax JA , Farnon EC , Cary Engleberg N . J Travel Med 2009 16 (5) 365-7 Vaccination against yellow fever is effective, but available live virus vaccines are not recommended for use in immunocompromised or elderly patients. We report the successful and uneventful immunization of a 62-year-old man with a history of allogeneic bone marrow transplant and discuss evidence for this recommendation. |
Development of a new candidate H5N1 avian influenza virus for pre-pandemic vaccine production
Dong J , Matsuoka Y , Maines TR , Swayne DE , O'Neill E , Davis CT , Van-Hoven N , Balish A , Yu HJ , Katz JM , Klimov A , Cox N , Li DX , Wang Y , Guo YJ , Yang WZ , Donis RO , Shu YL . Influenza Other Respir Viruses 2009 3 (6) 287-295 BACKGROUND: Highly pathogenic H5N1 avian influenza viruses currently circulating in birds have caused hundreds of human infections, and pose a significant pandemic threat. Vaccines are a major component of the public health preparedness for this likely event. The rapid evolution of H5N1 viruses has resulted in the emergence of multiple clades with distinct antigenic characteristics that require clade-specific vaccines. A variant H5N1 virus termed clade 2.3.4 emerged in 2005 and has caused multiple fatal infections. Vaccine candidates that match the antigenic properties of variant viruses are necessary because inactivated influenza vaccines elicit strain-specific protection. OBJECTIVE: To address the need for a suitable seed for manufacturing a clade 2.3.4 vaccine, we developed a new H5N1 pre-pandemic candidate vaccine by reverse genetics and evaluated its safety and replication in vitro and in vivo. METHODS: A reassortant virus termed, Anhui/PR8, was produced by reverse genetics in compliance with WHO pandemic vaccine development guidelines and contains six genes from A/Puerto Rico/8/34 as well as the neuraminidase and hemagglutinin (HA) genomic segments from the A/Anhui/01/2005 virus. The multi-basic cleavage site of HA was removed to reduce virulence. RESULTS: The reassortant Anhui/PR8 grows well in eggs and is avirulent to chicken and ferrets but retains the antigenicity of the parental A/Anhui/01/2005 virus. CONCLUSION: These results indicate that the Anhui/PR8 reassortant lost a major virulent determinant and it is suitable for its use in vaccine manufacturing and as a reference vaccine virus against the H5N1 clade 2.3.4 viruses circulating in eastern China, Vietnam, Thailand, and Laos. |
Intussusception and rotavirus vaccination: a review of the available evidence
Patel MM , Haber P , Baggs J , Zuber P , Bines JE , Parashar UD . Expert Rev Vaccines 2009 8 (11) 1555-64 Two live oral rotavirus vaccines (RotaTeq) and Rotarix) have recently been recommended by the WHO for inclusion into the national immunization programs of countries worldwide. Owing to the association of the withdrawn Rotashield vaccine with intussusception, these two new rotavirus vaccines underwent large clinical trials of over 60,000 infants each to assess safety with regard to this medical condition. For these two new vaccines, clinical trials and available postmarketing safety monitoring data do not indicate a risk of intussusception after vaccination, although a low-level risk cannot be excluded at present. We review these safety data for the new vaccines and for Rotashield to provide background information relevant for considering age recommendations for rotavirus vaccination. |
Molecular Epidemiology of Genogroup II-Genotype 4 Noroviruses in the United States between 1994 and 2006
Zheng DP , Widdowson MA , Glass RI , Vinje J . J Clin Microbiol 2009 48 (1) 168-77 Human noroviruses (NoVs) of genogroup II, genotype 4 (GII.4) are the most common strains detected in outbreaks of acute gastroenteritis worldwide. To gain insight into the epidemiology and genetic variation of GII.4 strains, we analyzed 773 NoV-outbreaks reported to CDC from 1994-2006. Of these, 629 (81.4%) were caused by GII viruses and 342 (44.2%) were GII.4 strains. The proportion of GII.4-outbreaks increased from 5% in 1994 to 85% in 2006 but distinct annual differences were noted including sharp increases in 1996, 2003, and 2006 each associated with newly emerging GII.4 strains. Sequence analysis of complete VP1 gene of GII.4 strains identified in this study and from GenBank segregated these viruses into at least 9 distinct sub-clusters which had 1.3-3.2% amino acid variation between strains in different sub-clusters. We propose that GII.4 sub-clusters be defined as having > 5% sequence variation between strains. Our data confirm other studies on the rapid emergence and displacement of highly virulent GII.4 strains. |
Mouse pulmonary dose- and time course-responses induced by exposure to multi-walled carbon nanotubes
Porter DW , Hubbs AF , Mercer RR , Wu N , Wolfarth MG , Sriram K , Leonard S , Battelli L , Schwegler-Berry D , Friend S , Andrew M , Chen BT , Tsuruoka S , Endo M , Castranova V . Toxicology 2009 269 136-47 Carbon nanotubes come in a variety of types, but one of the most common forms is multi-walled carbon nanotubes (MWCNT). MWCNT have potential applications in many diverse commercial processes, and thus human exposures are considered to be likely. In order to investigate the pulmonary toxicity of MWCNT, we conducted an in vivo dose-response and time course study of MWCNT in mice in order to assess their ability to induce pulmonary inflammation, damage, and fibrosis using doses that approximate estimated human occupational exposures. MWCNT were dispersed in dispersion medium (DM) and male C57BL/6J mice (7 weeks old) received either DM (vehicle control), 10, 20, 40 or 80mug MWCNT by aspiration exposure. At 1, 7 28 and 56 days post-exposure, MWCNT-induced pulmonary toxicity was investigated. Bronchoalveolar lavage (BAL) studies determined pulmonary inflammation and damage was dose-dependent and peaked at 7 days post-exposure. By 56 days post-exposure, pulmonary inflammation and damage markers were returning to control levels, except for the 40mug MWCNT dose, which was still significantly higher than vehicle control. Histopathological studies determined that MWCNT-exposure caused rapid development of pulmonary fibrosis by 7 days post-exposure, that granulomatous inflammation persisted throughout the 56 day post-exposure period, and also demonstrated that MWCNT can reach the pleura after pulmonary exposure. In summary, the data reported here indicate that MWCNT-exposure rapidly produces significant adverse health outcomes in the lung. Furthermore, the observation that MWCNT reach the pleura after aspiration exposure indicate that more extensive investigations are needed to fully assess if pleural penetration results in any adverse health outcomes. |
Preliminary proficiency testing results for succinylacetone in dried blood spots for newborn screening for tyrosinemia type I
Adam BW , Lim TH , Hall EM , Hannon WH . Clin Chem 2009 55 (12) 2207-13 BACKGROUND: Succinylacetone (SUAC) is the primary metabolite accumulated in tyrosinemia type I-an inborn error of metabolism that, if untreated, can cause death from liver failure during the first months of life. Newborn screening laboratories measure SUAC in dried blood spot (DBS) samples to detect asymptomatic tyrosinemia type I. We used panels of SUAC-enriched DBSs to compare and evaluate the performance of these screening tests. METHODS: We prepared sets of DBS materials enriched with predetermined SUAC concentrations and distributed samples of these materials, along with a screening practices questionnaire, to laboratories that perform SUAC tests. We compared their reported SUAC concentrations and questionnaire responses to identify screening practices that affect SUAC test outcomes. RESULTS: Data from 2 pilot surveys showed large differences among laboratories in SUAC recoveries, reproducible within-laboratory recoveries, and stable performance of the DBS materials. Results from 257 proficiency test analyses contained a total of 6 false-negative misclassifications. Reported recoveries of added SUAC ranged from 0 to >200%. Low-biased SUAC recoveries were associated with 1 method used by 5 laboratories. All laboratories that reported SUAC recoveries ≥100% used DBS matrix calibrators. CONCLUSIONS: The wide ranges of SUAC concentrations reported for pilot and proficiency testing specimens demonstrate a need to harmonize quantitative results among laboratories. Although DBS matrix calibrators are important for optimizing SUAC recoveries, the preparation of these calibrators is not standardized among laboratories. Certified DBS-based SUAC calibrators are needed for accuracy and harmonization. |
Vaccination to induce antibodies blocking RSV G protein CX3C-CX3CR1 interaction reduces pulmonary inflammation and virus replication in mice
Zhang W , Choi Y , Haynes LM , Harcourt JL , Anderson LJ , Jones LP , Tripp RA . J Virol 2009 84 (2) 1148-57 Respiratory syncytial virus (RSV) infection causes substantial morbidity and some deaths in the young and elderly worldwide. There is no safe and effective vaccine available, although it is possible to reduce the hospitalization in high risk children with anti-RSV antibody prophylaxis. RSV has been shown to modify the immune response to infection, a feature linked in part to RSV G protein CX3C chemokine mimicry. This study determined if vaccination with G protein polypeptides or peptides spanning the central conserved region of the G protein could induce antibodies that blocked G protein CX3C-CX3CR1 interaction and disease pathogenesis mediated by RSV infection. The results show that mice vaccinated with G protein peptides or polypeptides containing the CX3C motif generate antibodies that inhibit G protein CX3C-CX3CR1 binding and chemotaxis, reduce lung virus titers, and prevent body weight loss and pulmonary inflammation. The results suggest that RSV vaccines that induce antibodies that block G protein CX3C-CX3CR1 interaction may offer a new safe and efficacious RSV vaccine strategy. |
Crimean-Congo hemorrhagic fever virus-encoded ovarian tumor (OTU) protease activity is dispensable for virus RNA polymerase function
Bergeron E , Albarino CG , Khristova ML , Nichol ST . J Virol 2009 84 (1) 216-26 Crimean Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus (genus Nairovirus, family Bunyaviridae) associated with high case fatality disease outbreaks in regions of Africa, Europe and Asia. The CCHFV genome consists of three negative strand RNA segments, S, M and L. The unusually large virus L polymerase protein and the need for BSL4 containment conditions for work with infectious virus have hampered the study of CCHFV replication. The L protein has an ovarian tumor (OTU) protease domain located in the N-terminus which has led to speculation that the protein may be autoproteolytically cleaved to generate the active virus L polymerase and additional functions. We report the successful development of efficient CCHFV helper virus-independent S, M and L segment minigenome systems for analysis of virus RNA and protein features involved in replication. The virus RNA segment S, M and L UTRs were found to be similar in support of replication of the respective minigenomes. In addition, the OTU domain located in the N-terminus of the expressed virus L protein was shown to be a functional protease. However, no evidence of L protein autoproteolytic processing was found, and the OTU protease activity was dispensable for virus RNA replication. Finally, physiologically relevant doses of ribavirin inhibited CCHFV minigenome replication. These results demonstrated the utility of the minigenome system for use in BSL2 laboratory settings to analyze CCHFV biology, and in antiviral drug discovery programs for this important public health and bioterrorism threat. |
Development and analytical validation of immunoassay for quantifying serum anti-pertussis toxin antibodies resulting from Bordetella pertussis infection
Menzies SL , Kadwad V , Pawloski L , Lin TL , Baughman AL , Martin M , Tondella ML , Meade BD . Clin Vaccine Immunol 2009 16 (121) 1781-8 Adequately sensitive and specific methods to diagnose pertussis in adolescents and adults are not widely available. Currently, no Food and Drug Administration approved diagnostic assays are available for the serodiagnosis of Bordetella pertussis. Since concentrations of B. pertussis-specific antibodies tend to be high during the later-phases of disease, a simple, rapid, easily transferable serodiagnostic test was developed. This paper describes test development, initial evaluation of a prototype kit enzyme-linked immunosorbent assay (ELISA) in an inter-laboratory collaborative study, and the analytical validation. The data presented here demonstrate that the kit met all pre-specified criteria for precision, linearity, and accuracy for samples with anti-pertussis toxin (PT) immunoglobulin G (IgG) antibody concentrations in the range of 50 to 150 ELISA units (EU)/mL, the range believed to be most relevant for serodiagnosis. The assay met the precision and linearity criteria for a wider range, namely from 50 to 200 EU/mL, however, the accuracy criterion was not met at 200 EU/mL. When the newly adopted World Health Organization International Standard for pertussis antiserum (human) reference reagent was used to evaluate accuracy, the accuracy criteria were met from 50 to 200 international units (IU)/mL. In conclusion, the IgG anti-PT ELISA assay met all assay validation parameters within the range considered most relevant for serodiagnosis. This ELISA was developed and analytically validated to be a user-friendly kit that can be used in both qualitative and quantitative formats. The technology for producing the kit is transferrable to public health laboratories. |
Immunolocalization and challenge studies using a recombinant Vibrio cholerae ghost expressing Trypanosoma brucei Ca(2+) ATPase (TBCA2) antigen
Ramey K , Eko FO , Thompson WE , Armah H , Igietseme JU , Stiles JK . Am J Trop Med Hyg 2009 81 (3) 407-15 Human African trypanosomiasis is a neglected disease caused by Trypanosoma brucei spp. A parasite cation pump (Ca(2+) ATPase; TBCA2) essential for survival and cation homeostasis was identified and characterized. It was hypothesized that targeting this pump using a Vibrio cholerae ghost (VCG)-based vaccine could protect against murine T. brucei infection. mRNA and protein expression of TBCA2 was differentially expressed in blood and insect stages of parasites and immunolocalized in the pericellular membrane and the flagellar pocket of bloodstream forms. Antigen-specific antibodies and Th1 cytokines, interleukin-2, interferon-gamma, and tumor necrosis factor-alpha were induced in rVCG-TBCA2-immunized mice and in vitro on antigen stimulation of splenic immune T cells, but the corresponding Th2-type response was unremarkable. Despite an increased median survival of 6 days in vaccinated mice, the mice were not protected against infection. Thus, immunization of mice produced robust parasite-specific antibodies but failed to protect mice against parasite challenge. |
Prenatal diagnosis of orofacial clefts, National Birth Defects Prevention Study, 1998-2004
Johnson CY , Honein MA , Hobbs CA , Rasmussen SA . Prenat Diagn 2009 29 (9) 833-9 OBJECTIVE: The aims of this study were to determine how frequently orofacial clefts were diagnosed prenatally and to investigate factors associated with prenatal diagnosis. METHODS: We included 2298 mothers from the National Birth Defects Prevention Study, each of whom gave birth to a child with an orofacial cleft, and assessed associated factors using logistic regression. RESULTS: The frequencies of prenatal diagnosis for cleft lip and palate, cleft lip only, and cleft palate only were 33.3%, 20.3%, and 0.3%, respectively. Among cases with cleft lip with or without cleft palate, cleft type, geographic location, maternal body mass index, household income, year of infant's birth, and presence of multiple birth defects were significantly associated with receiving a prenatal diagnosis. CONCLUSION: In the majority of infants with orofacial clefts, a prenatal diagnosis was not made. Receiving a prenatal diagnosis was significantly associated with several infant and maternal characteristics. |
The validity of BMI as an indicator of body fatness and risk among children
Freedman DS , Sherry B . Pediatrics 2009 124 S23-34 PURPOSE OF REVIEW: Although the prevalence of childhood obesity, as assessed by BMI (kg/m(2)), has tripled over the last 3 decades, this index is a measure of excess weight rather than excess body fatness. In this review we focus on the relation of BMI to body fatness and health risks, particularly on the ability of BMI for age >or=95th Centers for Disease Control and Prevention [CDC] percentile to identify children who have excess body fatness. We also examine whether these associations differ according to race/ethnicity and whether skinfold and circumference measurements provide additional information on body fatness or health risks. RESULTS: The accuracy of BMI varies according to the degree of body fatness. Among relatively fat children, BMI is a good indicator of excess adiposity, but differences in the BMIs of relatively thin children can be largely due to fat-free mass. Although the accuracy of BMI in identifying children with excess body fatness depends on the chosen cut points, we have found that a high BMI-for-age has a moderately high (70%-80%) sensitivity and positive predictive value, along with a high specificity (95%). Children with a high BMI are much more likely to have adverse risk factor levels and to become obese adults than are thinner children. Skinfold thicknesses and the waist circumference may be useful in identifying children with moderately elevated levels of BMI (85th to 94 th percentiles) who truly have excess body fatness or adverse risk factor levels. CONCLUSION: A BMI for age at >or=95th percentile of the CDC reference population is a moderately sensitive and a specific indicator of excess adiposity among children. |
Laboratory worker knowledge, attitudes and practices towards smallpox vaccine
Benzekri N , Goldman E , Lewis F , Johnson CC , Reynolds SM , Reynolds MG , Damon IK . Occup Med (Lond) 2009 60 (1) 75-7 BACKGROUND: Recent cases of laboratory-acquired vaccinia virus (VV) infection highlight the need for laboratory safety. AIMS: To determine laboratory worker adherence to the Advisory Committee for Immunization Practices smallpox vaccination recommendations, assess potential barriers to vaccination and determine the influence of training on laboratory worker attitudes. METHODS: Ninety-two laboratory workers in Pennsylvania were contacted and asked to complete an online survey about VV usage; 45 responded. RESULTS: Eighty-seven per cent had received a smallpox vaccination in their lifetime; 73% received vaccination in the past 10 years. More workers had been given training regarding the potential risks, versus the potential benefits of vaccination, and most perceived that adverse outcomes were more likely to occur following vaccination versus accidental infection. CONCLUSIONS: The results of this study suggest that the main barrier to vaccination may be fear associated with possible vaccine adverse effects and a willingness to risk accidental infection rather than be vaccinated. More information and training about the potential benefits of vaccination, as well as the potential adverse outcomes associated with accidental infection, is therefore warranted. |
Prevalence of chronic obstructive pulmonary disease in the U.S. working population: an analysis of data from the 1997-2004 National Health Interview Survey
Bang KM , Syamlal G , Mazurek JM . COPD 2009 6 (5) 380-7 To estimate the prevalence and the population attributable fraction of chronic obstructive pulmonary disease (COPD) in the U.S. adult workers, we analyzed data obtained from the National Health Interview Surveys for the period 1997-2004. The overall COPD prevalence was 4.0% (95% confidence interval [CI] 3.9-4.1%). The prevalence was higher in females (5.4%, 95% CI 5.3-5.6%) than in males (2.8%, 95% CI 2.7-2.9%); in Whites (4.2%, 95% CI 4.1-4.3%) than in Blacks (3.4%, 95% CI 3.1-3.7%) and other races (2.4%, 95% CI 2.1-2.8%). Compared with insurance, real estate and other finance industry, the top three industries associated with significantly higher prevalence odds ratios (PORs) (adjusted for age, sex, race, and smoking) were other educational services (POR = 1.5, 95% CI 1.0-2.3); transportation equipment (POR = 1.4, 95% CI 1.1-1.8); and social services, religious and membership organizations (POR = 1.4, 95% CI 1.1-1.7). Compared with managers and administrators, except public administration occupation, the top three occupations with significantly higher PORs were health service (1.8, 95% CI 1.5-2.1), other protective service (POR = 1.6, 95% CI 1.2-2.2), and material moving equipment operators (POR = 1.6, 95% CI 1.1-2.3). The overall population attributable fraction for association of COPD with employment was 12.2% for industry and 17.4% for occupation. Further studies are needed to determine specific risk factors associated with COPD in industries and occupations with elevated prevalence and POR. |
Excessive longitudinal FEV1 decline and risks to future health: A case-control study
Wang ML , Avashia BH , Wood J , Petsonk EL . Am J Ind Med 2009 52 (12) 909-15 BACKGROUND: Accelerated loss of forced expiratory volume in 1 s (FEV(1)) in an individual is considered an indicator of developing lung disease. METHODS: We investigated longitudinal FEV(1) slopes, calculated by simple linear regression, and adverse health outcomes after 10-30 years, among 1,428 chemical plant workers. Cases were defined by FEV(1) slopes below 5th percentile values for the cohort. Cases were matched with controls (107 pairs) for race, gender, smoking status, year of birth, age, height, and calendar year at first test. Matched pair statistics were used for comparisons. RESULTS: Cases had a higher proportion, compared to controls, of diagnosis of COPD or emphysema (17.8% vs. 1.9%, P = 0.0002), medication use for respiratory diseases (24.3% vs. 4.7%, P < 0.0001), dyspnea (15% vs. 3.7%, P = 0.0042), and wheezing or rhonchi on examination (10.3% vs. 1.9%, P = 0.0225). CONCLUSIONS: Chemical plant workers who experienced accelerated FEV(1) declines experienced four to nine times as many adverse health conditions over 10-30 years. Am. J. Ind. Med. (c) 2009 Wiley-Liss, Inc. |
Mining haul truck cab noise: an evaluation of three acoustical environments
Bealko SB . Min Eng 2009 61 (10) 36-42 Mining haul trucks comprise the majority of the equipment used in underground limestone mining operations and are known to emit high levels of noise. A previous study conducted by the National Institute for Occupational Safety and Health (NIOSH) indicates that 70-90 % of all miners have a noise-induced hearing loss (NIHL) great enough to be classifi ed as a hearing disability by retirement age. These results demonstrate the public health need to protect the hearing of workers in the mining industry, including haul truck drivers. Cab enclosures present an opportunity to isolate the haul truck operator from both truck and other noise in the mining environment. A total of 25 haul truck cabs were studied. They were divided into three style (treatment) categories determined by soundproofi ng features and technology for noise reduction: old-, new- and retrofi tted-style. This study examines the contribution of cab acoustics, operator performance and maintenance to noise reduction for each cab style. Dosimeters were used to measure eight-hour time weighted average sound pressure levels (TWA8 SPLs) inside and outside the cabs. The main objective was to determine the noise levels inside of the three types of cabs (with different acoustical treatments) and determine if the noise levels were signifi cantly different. Adherence to the Mine Safety and Health Administration (MSHA) permis- Introduction This study investigates haul truck cab noise in underground limestone mines that employ nearly 2,000 workers at 117 mines across the United States. In this industry, hazardous noise is present from drilling, blasting, rock crushing operations and the predominance of large and noisy equipment. Continued exposure of miners to high noise levels can cause damage to the inner ear. The result of this damage is a permanent shift in the hearing threshold, known as a noise-induced hearing loss (NIHL). A NIHL makes it diffi cult to hear and understand everyday speech and is irreversible. Of special interest is the haul truck (Fig. 1) because it comprises of the largest class of equipment used in the underground limestone industry. With these trucks and most diesel-powered equipment, the engine is generally a major source of noise. Engine noise may emanate from the exhaust, the intake and the cooling fan. Other signifi cant noise sources include the transmission, drive train and hydraulic system. Noise from these sources reaches the ear via several paths, both directly, by airborne paths and indirectly, by refl ections from various surfaces. In addition, sound in the form of vibrations may travel along or through structures (Daniel et al., 1981). An approach to eliminate or control noise at its source, engineering controls, is through the use of muffl ers, gaskets and control of reflected noise. Another way to lower noise levels is to identify, isolate and treat the many paths along which noise travels with barriers, absorbers and dampers. Control of haul truck cab noise is important because haul truck operators spend a majority of their time inside the cab. Most mine policies require haul truck operators to remain inside their cab throughout the entire shift except for restroom use, attendance at safety meetings, during maintenance and sometimes during lunch breaks. Therefore, it is typical for operators to spend almost the entire shift (eight to 10 hours) inside the haul truck cab. According to Daniel et al., “Cab enclosures generally sible exposure limit (PEL) of 90 dB TWA8 (with a 90 dB threshold) was used as the main indicator of overall noise reduction achieved. Dosimetery results indicated that all but two samples measured outside of the cab exceeded the MSHA PEL. However, only 2% of the samples measured inside of the cabs exceeded the PEL, but samples could still be reduced much further. Descriptive and comparative statistics indicate that noise levels inside the new-style cabs are signifi cantly lower than the other two cab styles. Also, data suggest that there is no difference in noise exposures when comparing the old-style to retrofi tted cab styles. Operator infl uence (opening doors and windows) was a signifi cant factor for increasing noise exposure. This paper demonstrates that properly designed cabs can achieve major noise reductions, but noise levels could still be reduced much further below the MSHA PEL. New-style cabs, equipped with modern noise-reduction treatments, exhibit much lower noise exposures than the other two cabs styles, and the effectiveness of the current noise-reduction treatments for retrofi tted cabs is questionable. Haul truck driver observations indicate that improved noise exposure reduction training is needed. Finally, specifi c targets for future noise reduction research are suggested that will further contribute to the prevention of hearing loss for haul truck operators. |
Moving forward with workforce development research in public health
Summerfelt WT , Tilson HH , Crawford CA . J Public Health Manag Pract 2009 15 S1-2 We are proud to have had the opportunity to bring this supplemental issue to fruition. It represents directly the culmination of months of planning; an interactive and lively conference; and the hard work of many. The idea of bringing select social science perspectives and tools into the discussion of public health workforce (PHW) began with a conversation between David Meltzer of the University of Chicago (UC) and Carol Crawford of the Centers for Disease Control and Prevention (CDC). The conversation grew into a joint CDC/UC working group charged with identifying a small cadre of social scientists whose ideas or methodologies might hold promise for application to PHW issues with the intent of bringing these social scientists together with some PHW leaders in a conference format. | The significance of PHW research has increased as the role of public health in the United States has expanded in scope and sophistication.1,2 Emerging infectious diseases (eg, HIV/AIDS, SARS, swine flu); health epidemics (eg, obesity, diabetes); the persistence of racial and ethnic health disparities (eg, breast health, infant/fetal mortality, prostate cancer); terrorism and bioterrorism (eg, anthrax scare, events of September 11, 2001); and natural disasters (eg, 2004 tsunami, Hurricane Katrina in 2005, California forest fires) have redefined and heightened the importance of the role of public health in both citizen health and national security. As the role of public health has changed, the necessary call to understand and develop a workforce that is adequate in size and capable in skills has come and researchers have struggled to provide answers. Existing literature depicts a wide range of challenges to developing a research agenda in PHW such as understanding succession planning for an aging workforce, consensual definition of the PHW, enumerating the PHW, scope of duties of the PHW, public or private sponsorship, and implications of the responsive nature of the role of public health.3,4 |
Perspectives on public health workforce research
Crawford CA , Summerfelt WT , Roy K , Chen ZA , Meltzer DO , Thacker SB . J Public Health Manag Pract 2009 15 S5-S15 The Centers for Disease Control and Prevention Office of Workforce and Career Development is committed to developing a competent, sustainable, and diverse public health workforce through evidence-based training, career and leadership development, and strategic workforce planning to improve population health outcomes. This article reviews the previous efforts in identifying priorities of public health workforce research, which are summarized as eight major research themes. We outline a strategic framework for public health workforce research that includes six functional areas (ie, definition and standards, data, methodology, evaluation, policy, and dissemination and translation). To conceptualize and prioritize development of an actionable public health research agenda, we constructed a matrix of key challenges in workforce analysis by public health workforce categories. Extensive reviews were conducted to identify valuable methods, models, and approaches to public health workforce research. We explore new tools and approaches for addressing priority areas for public health workforce and career development research and assess how tools from multiple disciplines of social sciences can guide the development of a research framework for advancing public health workforce research and policy. |
Workforce science: a critical component to ensuring future of health
Popovic T . J Public Health Manag Pract 2009 15 S3-4 The trust in public health, its sceince, and scientists has never been more important than today, when we as a nation, and as a global community, are facing challenges beyond any expectations and predictions during which the public health enterprise is taking a lead in protecting people's health. We are witnessing an unprecedented intersection of environmental factors (natural disasters, global warming, pollution), new and reemerging infectious diseases (three-fourths of which are zoonotic), specific health-related needs of an aging US population (with estimates that starting in 2011, 10000 people will turn 65 every day for the next 20 years) and complex economic issues at home and abroad with dir econsequences on employment rates, standard of living, and ultimately quality of life. Economic recoviery will be difficult to achieve without the economic driving force - it is healthy and productive workforce. Because many of the biggest opportunities for ptrotecting and improving people's health today fall outside the traditional healthcare system, we must leverage our resources and invest both in access to quality healthcare when health needs to be restored and in creating physical, social, and economic conditions that embrace health promotion, including policies that support health and well-being. With that in mind, it is important to emphasize that our nation's public health infrastructure, including our public health workforce, is a core foundation of our ability to aceive the latter (protect people's health and improve quality of life). |
Economic perspective on strategic human capital management and planning for the Centers for Disease Control and Prevention
Roy K , Chen ZA , Crawford CA . J Public Health Manag Pract 2009 15 S79-89 An organization's workforce--or human capital--is its most valuable asset. The 2002 President's Management Agenda emphasizes the importance of strategic human capital management by requiring all federal agencies to improve performance by enhancing personnel and compensation systems. In response to these directives, the Centers for Disease Control and Prevention (CDC) drafted its strategic human capital management plan to ensure that it is aligned strategically to support the agency's mission and its health protection goals. In this article, we explore the personnel economics literature to draw lessons from research studies that can help CDC enhance its human capital management and planning. To do so, we focus on topics that are of practical importance and empirical relevance to CDC's internal workforce and personnel needs with an emphasis on identifying promising research issues or methodological approaches. The personnel economics literature is rich with theoretically sound and empirically rigorous approaches for shaping an evidence-based approach to human capital management that can enhance incentives to attract, retain, and motivate a talented federal public health workforce, thereby promoting the culture of high-performance government. |
Guide for applied public health workforce research: an evidence-based approach to workforce development
Thacker SB . J Public Health Manag Pract 2009 15 S109-12 Essential to achievement of the public health mission is a knowledgeable, competent, and prepared workforce; yet, there is little application of science and technical knowledge to ensuring the effectiveness of that workforce, be it governmental or private. In this article, I review the evidence for effective workforce development and argue for an increased emphasis on an evidence-based approach to ensuring an effective workforce by encouraging the generation of the evidence base that is required. To achieve this, I propose the appointment of an independent Task Force on Public Health Workforce Practice to oversee the development of a Guide for Public Health Workforce Research and Practice (Workforce Guide), a process that will generate and bring together the workforce evidence base for use by public health practitioners. |
Fertility decline in Paraguay
Ishida K , Stupp P , Melian M . Stud Fam Plann 2009 40 (3) 227-34 Recent reproductive health surveys show that the fertility rate in Paraguay decreased precipitously from 4.3 lifetime births per woman in 1995-98 to 2.9 births in 2001-04. In this study, we establish data consistency between the 1998 and 2004 surveys by comparing a series of cohort-specific period rates and use the Bongaarts framework of proximate determinants of fertility to demonstrate that an increase in the contraceptive prevalence rate (CPR) between 1998 and 2004 fully accounts for the fertility decline. Decomposition of rates shows that changes in group-specific CPRs explain a greater proportion of the change in the overall CPR than do changes in population composition by educational attainment, urban residence, region, and language spoken at home. Finally, we show that younger cohorts of women in 2004 reported ideal completed fertility desires of less than 2.9 births, suggesting that the fertility rate is likely to continue to decrease. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Immunity and Immunization
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Public Health Leadership and Management
- Reproductive Health
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