Hospitalizations and emergency room visits for adolescents and young adults with muscular dystrophy living in South Carolina
Mann JR , Royer JA , McDermott S , Hardin JW , Ozturk O , Street N . Muscle Nerve 2015 52 (5) 714-21 INTRODUCTION: Transitioning from adolescence to adulthood can be problematic for individuals with rare disabilities such as muscular dystrophy (MD). METHODS: We identified a cohort of 220 individuals with MD and 440 matched comparison individuals and measured emergency room (ER) and inpatient (IP) encounters for the years 2000 through 2010, using all-payer hospital discharge uniform billing data. We compared ER and IP use rates for people with and without MD, and for 15-19-year-olds with MD to 20-24-year-olds with MD. RESULTS: ER and IP use rates were significantly higher among individuals with MD than the comparison group. In addition, ER and IP use rates were significantly higher in the 20-24-year age group than in the 15-19-year group. CONCLUSIONS: Additional research is needed to determine whether increased ER and IP use in young adults is attributable to difficulties in healthcare transition versus increased disease severity. Muscle Nerve 52: 714-721, 2015. |
Cumulative incidence of cancer among persons with HIV in North America: a cohort study
Silverberg MJ , Lau B , Achenbach CJ , Jing Y , Althoff KN , D'Souza G , Engels EA , Hessol NA , Brooks JT , Burchell AN , Gill MJ , Goedert JJ , Hogg R , Horberg MA , Kirk GD , Kitahata MM , Korthuis PT , Mathews WC , Mayor A , Modur SP , Napravnik S , Novak RM , Patel P , Rachlis AR , Sterling TR , Willig JH , Justice AC , Moore RD , Dubrow R . Ann Intern Med 2015 163 (7) 507-18 BACKGROUND: Cancer is increasingly common among persons with HIV. OBJECTIVE: To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status. DESIGN: Cohort study. SETTING: North American AIDS Cohort Collaboration on Research and Design during 1996 to 2009. PARTICIPANTS: 86 620 persons with HIV and 196 987 uninfected adults. MEASUREMENTS: Cancer type-specific cumulative incidence by age 75 years and calendar trends in cumulative incidence and hazard rates, each by HIV status. RESULTS: Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4% and 0.01%; non-Hodgkin lymphoma, 4.5% and 0.7%; lung cancer, 3.4% and 2.8%; anal cancer, 1.5% and 0.05%; colorectal cancer, 1.0% and 1.5%; liver cancer, 1.1% and 0.4%; Hodgkin lymphoma, 0.9% and 0.09%; melanoma, 0.5% and 0.6%; and oral cavity/pharyngeal cancer, 0.8% and 0.8%. Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (-9% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate. LIMITATION: Secular trends in screening, smoking, and viral co-infections were not evaluated. CONCLUSION: Cumulative cancer incidence by age 75 years, approximating lifetime risk in persons with HIV, may have clinical utility in this population. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation. PRIMARY FUNDING SOURCE: National Institutes of Health. |
Molecular Evidence of Sexual Transmission of Ebola Virus.
Mate SE , Kugelman JR , Nyenswah TG , Ladner JT , Wiley MR , Cordier-Lassalle T , Christie A , Schroth GP , Gross SM , Davies-Wayne GJ , Shinde SA , Murugan R , Sieh SB , Badio M , Fakoli L , Taweh F , de Wit E , van Doremalen N , Munster VJ , Pettitt J , Prieto K , Humrighouse BW , Stroher U , DiClaro JW , Hensley LE , Schoepp RJ , Safronetz D , Fair J , Kuhn JH , Blackley DJ , Laney AS , Williams DE , Lo T , Gasasira A , Nichol ST , Formenty P , Kateh FN , De Cock KM , Bolay F , Sanchez-Lockhart M , Palacios G . N Engl J Med 2015 373 (25) 2448-54 A suspected case of sexual transmission from a male survivor of Ebola virus disease (EVD) to his female partner (the patient in this report) occurred in Liberia in March 2015. Ebola virus (EBOV) genomes assembled from blood samples from the patient and a semen sample from the survivor were consistent with direct transmission. The genomes shared three substitutions that were absent from all other Western African EBOV sequences and that were distinct from the last documented transmission chain in Liberia before this case. Combined with epidemiologic data, the genomic analysis provides evidence of sexual transmission of EBOV and evidence of the persistence of infective EBOV in semen for 179 days or more after the onset of EVD. (Funded by the Defense Threat Reduction Agency and others.). |
A review of melioidosis cases in the Americas
Benoit TJ , Blaney DD , Doker TJ , Gee JE , Elrod MG , Rolim DB , Inglis TJ , Hoffmaster AR , Bower WA , Walke HT . Am J Trop Med Hyg 2015 93 (6) 1134-9 Melioidosis is a bacterial infection caused by Burkholderia pseudomallei, a gram-negative saprophytic bacillus. Cases occur sporadically in the Americas with an increasing number of cases observed among people with no travel history to endemic countries. To better understand the incidence of the disease in the Americas, we reviewed the literature, including unpublished cases reported to the Centers for Disease Control and Prevention. Of 120 identified human cases, occurring between 1947 and June 2015, 95 cases (79%) were likely acquired in the Americas; the mortality rate was 39%. Burkholderia pseudomallei appears to be widespread in South, Central, and North America. |
Scabies and bacterial superinfection among American Samoan children, 2011-2012
Edison L , Beaudoin A , Goh L , Introcaso CE , Martin D , Dubray C , Marrone J , Van Beneden C . PLoS One 2015 10 (10) e0139336 BACKGROUND: Scabies, a highly pruritic and contagious mite infestation of the skin, is endemic among tropical regions and causes a substantial proportion of skin disease among lower-income countries. Delayed treatment can lead to bacterial superinfection, and treatment of close contacts is necessary to prevent reinfestation. We describe scabies incidence and superinfection among children in American Samoa (AS) to support scabies control recommendations. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed 2011-2012 pharmacy records from the only AS pharmacy to identify children aged ≤14 years with filled prescriptions for permethrin, the only scabicide available in AS. Medical records of identified children were reviewed for physician-diagnosed scabies during January 1, 2011-December 31, 2012. We calculated scabies incidence, bacterial superinfection prevalence, and reinfestation prevalence during 14-365 days after first diagnosis. We used log binomial regression to calculate incidence ratios for scabies by age, sex, and county. Medical record review identified 1,139 children with scabies (incidence 29.3/1,000 children aged ≤14 years); 604 (53%) had a bacterial superinfection. Of 613 children who received a scabies diagnosis during 2011, 94 (15.3%) had one or more reinfestation. Scabies incidence varied significantly among the nine counties (range 14.8-48.9/1,000 children). Children aged <1 year had the highest incidence (99.9/1,000 children). Children aged 0-4 years were 4.9 times more likely and those aged 5-9 years were 2.2 times more likely to have received a scabies diagnosis than children aged 10-14 years. CONCLUSIONS/SIGNIFICANCE: Scabies and its sequelae cause substantial morbidity among AS children. Bacterial superinfection prevalence and frequent reinfestations highlight the importance of diagnosing scabies and early treatment of patients and close contacts. Investigating why certain AS counties have a lower scabies incidence might help guide recommendations for improving scabies control among counties with a higher incidence. We recommend interventions targeting infants and young children who have frequent close family contact. |
Sexually transmitted disease diagnoses among Hispanic immigrant and migrant men who have sex with men in the United States
Valverde EE , DiNenno EA , Schulden JD , Oster A , Painter T . Int J STD AIDS 2015 27 (13) 1162-1169 BACKGROUND: Hispanic immigrant/migrant men who have sex with men should be at higher risk for sexually transmitted disease/human immunodeficiency virus (STD/HIV) infections given individual-level factors associated with the migration process that have been theorised to increase susceptibility to STD/HIV infections among migrant populations, yet relatively little is known if these individual level factors are actually associated with a sexually transmitted disease infection among this population. METHODS: During 2005-2007, 2576 men and women foreign-born Hispanics were surveyed at three community-based organisations offering services to immigrant/migrant communities. We analysed demographic characteristics, sexual risk behaviours, migration patterns, and factors associated with a sexually transmitted disease diagnoses (syphilis, chlamydia, and gonorrhea) in the past 12 months among Hispanic immigrant/migrant men who have sex with men. RESULTS: Of 1482 Hispanic immigrant/migrant men surveyed who reported having sex in the past 12 months, 353 (24%) reported sex with a man, and of these, 302 answered questions regarding whether or not they had been diagnosed with a bacterial sexually transmitted disease in the past year. Of these 302 men, 25% reported being married; 42% self-identified as being heterosexual and 20% as bisexual. Twenty-nine (9.6%) men reported that they received a sexually transmitted disease diagnosis in the past year. In the multivariate logistic regression model, men who reported receiving money or goods for sex had increased odds of a self-reported sexually transmitted disease diagnosis. CONCLUSIONS: The prevalence of bacterial sexually transmitted diseases among Hispanic immigrant/migrant men who have sex with men is lower than the prevalence of bacterial sexually transmitted diseases among other men who have sex with men in the United States. Nevertheless, receiving money or goods for sex was significantly associated with a self-reported sexually transmitted disease diagnosis among Hispanic immigrant/migrant men who have sex with men. It is important to understand factors contributing to participation in exchange sex among this population. Human immunodeficiency virus/sexually transmitted disease prevention interventions tailored to non-gay identifying men who have sex with men are important for Hispanic immigrant/migrant men who have sex with men. |
State and territorial Ebola screening, monitoring, and movement policy statements - United States, August 31, 2015
Sunshine G , Pepin D , Cetron M , Penn M . MMWR Morb Mortal Wkly Rep 2015 64 (40) 1145-6 The 2014–2015 Ebola virus disease (Ebola) outbreak in West Africa is the largest in history, and as of October 4, 2015, had claimed 11,297 lives in Guinea, Liberia, and Sierra Leone (1). On August 7, 2014, CDC first posted guidance on monitoring and movement of persons who might have been exposed to Ebola virus to prevent the spread of Ebola into the United States. Since that time, the Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure (2) has been regularly updated based on the latest information available, most recently on May 13, 2015. On October 11, 2014, after the first case of Ebola was diagnosed in the United States, entry screening was implemented in five U.S. airports to identify travelers from countries with widespread Ebola transmission who might have been exposed to Ebola during the days before arrival or who had signs or symptoms of Ebola at the time of arrival (3). | On October 24, 2014, New York and New Jersey, both home to airports conducting entry screening, announced monitoring and movement policies for incoming travelers returning from Ebola-affected countries (4). The New York and New Jersey policies included mandatory quarantine for any person who had direct contact with a person with Ebola while in one of the Ebola-affected countries, including any medical personnel who had provided medical services for persons infected with Ebola, as well as active monitoring and possible quarantine for all persons with travel history to the affected countries, including those who had no direct contact with an infected person (4). |
Tuberculosis misclassification among immigrants
Painter JA , Posey DL , Phares C . Int J Tuberc Lung Dis 2015 19 (10) 1259-60 In a recent issue of the Journal, | 1 Evans et al. assess the | agreement between the overseas tuberculosis (TB) | classification at the time of pre-immigration screening with the stateside post-immigration classification, | two different classifications with two different goals. | For pre-immigration examinations, the primary goal | is to identify pulmonary TB disease and not latent | tuberculous infection (LTBI; not an inadmissible | condition). The examination results are classified | according to the Centers for Disease Control and | Prevention (CDC) technical instructions for immigration and post-immigration follow-up.2 Post-immigration, the examination is intended to guide | clinical care, including diagnosis and treatment of | LTBI, with results classified according to American | Thoracic Society (ATS) guidelines.3 Thus, the finding | of LTBI post-immigration among those not screened | for LTBI pre-immigration is not surprising |
Utilization of e-health services among U.S. adults with diabetes
Chou CF , Bullard KM , Saaddine JB , Devlin HM , Crews J , Imperatore G , McDivitt J , Albright A . Diabetes Care 2015 38 (12) e200-1 Electronic health (e-health) services have become increasingly important as a method to improve access to health care, including online renewal of prescription medications and making appointments. Healthy People 2020 includes objectives related to e-health to improve population health outcomes and to reduce health disparities, particularly to improve shared decision-making processes between patients and health care professionals (1). E-health services have been encouraged as part of the strategy to improve diabetes care and prevention (2,3). The adoption of these services among health care professionals has improved the quality and efficiency of care (4). However, e-health services may be underutilized among patients with diabetes. While research related to e-health services has been conducted in clinical and managed care settings (5), there are no national population estimates or trends for the utilization of e-health services among U.S. adults with diabetes. | We analyzed the 2009–2013 National Health Interview Survey (NHIS) (12,689 respondents aged ≥18 years with diabetes) self-reported data. NHIS is a cross-sectional household survey, using a multistage area probability design of the U.S. noninstitutionalized civilian population. NHIS is the first nationally representative household survey to include questions on the use of health information technology. Utilization of e-health services was defined as scheduling appointments, communicating with health care providers, and refilling prescription medications online. We calculated the predictive margins for the estimates of e-health utilization from multivariate logistic regression, controlling for age, sex, race/ethnicity, educational attainment, poverty-to-income ratio, health insurance coverage, having at least one visit to a doctor or health care professional in the past year, self-rated health status, history of other chronic diseases, diabetes duration, and diabetes medication. We used SAS-Callable SUDAAN 10.0.1 software to account for the complex sampling design of the NHIS. Differences were considered statistically significant at P values < 0.05. |
Lessons learned from delivering Imara, an HIV/STI risk reduction intervention for African American girls in juvenile detention
Davis TL , Boyce LS , Rose E , Swartzendruber A , DiClemente R , Gelaude D , Fasula AM , Carry M . Health Promot Pract 2015 17 (1) 31-9 A critical need exists for efficacious interventions to reduce sexual risk and sexually transmitted infections (STIs) among African American girls in juvenile detention. Adapting evidence-based interventions is one strategy for developing interventions that might protect detained African American girls from adverse sexual health outcomes. To support development and implementation of evidence-based HIV/STI prevention interventions for this population, this qualitative study describes lessons learned from delivering Imara, an adapted HIV/STI prevention intervention for detained African American girls. Program implementation includes one-on-one sessions in the detention facility that offer logistical advantages; provide intervention contact inside the facility, soon after release, and frequently thereafter; address STI treatment for girls and their sexual partners; tailor intervention content based on individual risk and learning needs; and identify and acknowledge girls' competing priorities. These lessons are discussed in the context of challenges encountered and solutions for addressing the challenges, and in terms of the structure and content of the intervention. The lessons learned from delivering Imara exemplify the continuous process of adapting an existing intervention for a new population and setting. |
(Not) measuring in the dark
Cain KP , Shah NS . Int J Tuberc Lung Dis 2015 19 (11) 1270 Do we really care about tuberculosis (TB) mortality? When one looks at global targets for disease control, it certainly seems that the answer is yes. Ambitious global targets were set to reduce TB deaths by 50% by 2015, and the World Health Organization post-2015 strategy includes a target of a 95%reduction in TB mortality by 2035.1 However, the opposite conclusion might be reached if gauged by the lack of robustness in global measurement of TB mortality. | In 2013, only 124 of 195 countries had vital registration systems that were deemed to be of sufficient completeness and quality to be usable for direct measurement of TB mortality. In addition, India and Viet Nam had conducted mortality surveys, yielding 126 countries with adequate measures of TB mortality. However, only 36% of estimated TB deaths occur in these 126 countries, and none of the countries are in sub-Saharan Africa, where TB-related death is most common.2 Further complicating our ability to determine the number of deaths attributable to TB is that deaths due to TB in people with human immunodeficiency virus (HIV) are recorded as HIV deaths in ICD-10. Therefore, even when vital registration or survey data do exist, estimates of TB mortality in people with HIV are limited. Taken together, it is clear that we lack accurate estimates of TB deaths worldwide. | The study by Omar et al. in this issue of the Journal suggests that mortality surveillance may not only be important, given the high burden of undiagnosed TB, it may also be feasible with minimally invasive methods.3 Post-mortem specimen collections were conducted within a median of 5 days by a trained nurse who obtained multiple respiratory samples through lung core biopsy and modified bronchoalveolar lavage (BAL). Overall, 32% of decedents had evidence of TB from at least one diagnostic test. |
Ebola RNA persistence in semen of Ebola virus disease survivors
Deen GF , Knust B , Broutet N , Sesay FR , Formenty P , Ross C , Thorson AE , Massaquoi TA , Marrinan JE , Ervin E , Jambai A , McDonald SL , Bernstein K , Wurie AH , Dumbuya MS , Abad N , Idriss B , Wi T , Bennett SD , Davies T , Ebrahim FK , Meites E , Naidoo D , Smith S , Banerjee A , Erickson BR , Brault A , Durski KN , Winter J , Sealy T , Nichol ST , Lamunu M , Stroher U , Morgan O , Sahr F . N Engl J Med 2015 377 (15) 1428-1437 BACKGROUND: Ebola virus has been detected in the semen of men after their recovery from Ebola virus disease (EVD), but little information is available about its prevalence or the duration of its persistence. We report the initial findings of a pilot study involving survivors of EVD in Sierra Leone. METHODS: We enrolled a convenience sample of 100 male survivors of EVD in Sierra Leone, at different times after their recovery from EVD, and recorded self-reported information about sociodemographic characteristics, the EVD episode, and health status. Semen specimens obtained at baseline were tested by means of a quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay with the use of the target-gene sequences of NP and VP40. RESULTS: A total of 93 participants provided an initial semen specimen for analysis, of whom 46 (49%) had positive results on quantitative RT-PCR. Ebola virus RNA was detected in the semen of all 9 men who had a specimen obtained 2 to 3 months after the onset of EVD, in the semen of 26 of 40 (65%) who had a specimen obtained 4 to 6 months after onset, and in the semen of 11 of 43 (26%) who had a specimen obtained 7 to 9 months after onset; the results for 1 participant who had a specimen obtained at 10 months were indeterminate. The median cycle-threshold values (for which higher values indicate lower RNA levels) were 32.0 with the NP gene target and 31.1 with the VP40 gene target for specimens obtained at 2 to 3 months, 34.5 and 32.3, respectively, for specimens obtained at 4 to 6 months, and 37.0 and 35.6, respectively, for specimens obtained at 7 to 9 months. CONCLUSIONS: These data showed the persistence of Ebola virus RNA in semen and declining persistence with increasing months since the onset of EVD. We do not yet have data on the extent to which positivity on RT-PCR is associated with virus infectivity. Although cases of suspected sexual transmission of Ebola have been reported, they are rare; hence the risk of sexual transmission of the Ebola virus is being investigated. (Funded by the World Health Organization and others.). |
Emergence of community-acquired, multidrug-resistant invasive nontyphoidal Salmonella disease in rural western Kenya, 2009-2013
Oneko M , Kariuki S , Muturi-Kioi V , Otieno K , Otieno VO , Williamson JM , Folster J , Parsons MB , Slutsker L , Mahon BE , Hamel MJ . Clin Infect Dis 2015 61 Suppl 4 S310-6 BACKGROUND: Nontyphoidal Salmonella (NTS), mainly serotypes Typhimurium and Enteritidis, cause invasive infections with high mortality in children in sub-Saharan Africa. Multidrug resistance is common, and resistance to third-generation cephalosporins has emerged. METHODS: We reviewed clinical features, outcomes, and antimicrobial resistance patterns in invasive NTS infections among children aged 6 weeks to 5 years participating in malaria vaccine studies in an area of high malaria and human immunodeficiency virus (HIV) transmission in Siaya, western Kenya. Blood culture was performed in hospitalized children and pediatric outpatients with prolonged fever. RESULTS: From July 2009 to December 2013, 1696 children aged 6 weeks to 17 months were enrolled into vaccine trials and followed for up to 53 months. We obtained 1692 blood cultures from 847 children. Of 134 bacterial pathogens isolated, 102 (76.1%) were Salmonella serogroup B or D. Invasive NTS disease occurred in 94 (5.5%) children, with an incidence of 1870, 4134, and 6510 episodes per 100 000 person-years overall, in infants, and in HIV-infected children, respectively. Malaria infection within the past 2 weeks occurred in 18.8% (3/16) of invasive NTS episodes in HIV-infected and 66.2% (53/80) in HIV-uninfected children. Case fatality rate was 3.1%. Salmonella group B resistant to ceftriaxone emerged in 2009 and 2010 (6.2% [2/32 isolates]), rising to 56.5% (13/23 isolates) in 2012 and 2013. CONCLUSIONS: Incidence of invasive NTS disease was high in this area of high malaria and HIV transmission, especially in HIV-infected children. Rapidly emerging resistance against ceftriaxone requires urgent reevaluation of antibiotic recommendations and primary prevention of exposure to Salmonella. |
Etiology and Incidence of Viral Acute Respiratory Infections Among Refugees Aged 5 Years and Older in Hagadera Camp, Dadaab, Kenya
Mohamed GA , Ahmed JA , Marano N , Mohamed A , Moturi E , Burton W , Otieno S , Fields B , Montgomery J , Kabugi W , Musa H , Cookson ST . Am J Trop Med Hyg 2015 93 (6) 1371-6 We used the Centers for Disease Control and Prevention-Kenya Medical Research Institute Acute Respiratory Infection (ARI) Surveillance System data to estimate severe acute respiratory infection (SARI) hospitalization rates, viral etiology, and associated complaints of influenza-like illnesses (ILI) and SARI conditions among those aged 5 years and older in Hagadera, Dadaab refugee camp, Kenya, for 2010-2012. A total of 471 patients aged ≥ 5 years met the case definition for ILI or SARI. SARI hospitalization rates per 10,000 person-years were 14.7 (95% confidence interval [CI] = 9.1, 22.2) for those aged 5-14 years; 3.4 (95% CI = 1.6, 7.2) for those aged 15-24 year; and 3.8 (95% CI = 1.6, 7.2) for those aged ≥ 25 years. Persons between the ages of 5 and 14 years had 3.5 greater odds to have been hospitalized as a result of SARI than those aged ≥ 25 years (odds ratio [OR] = 3.5, P < 0.001). Among the 419 samples tested, 169 (40.3%) were positive for one or more virus. Of those samples having viruses, 36.9% had influenza A; 29.9% had adenovirus; 20.2% had influenza B; and 14.4% had parainfluenza 1, 2, or 3. Muscle/joint pain was associated with influenza A (P = 0.002), whereas headache was associated with influenza B (P = 0.019). ARIs were responsible for a substantial disease burden in Hagadera camp. |
GYT: Get Yourself Tested campaign awareness: associations with sexually transmitted disease/HIV testing and communication behaviors among youth
Mcfarlane M , Brookmeyer K , Friedman A , Habel M , Kachur R , Hogben M . Sex Transm Dis 2015 42 (11) 619-24 BACKGROUND: The GYT: Get Yourself Tested campaign promotes sexually transmitted disease (STD) and HIV testing and communication with partners and providers among youth. We evaluated these behaviors in relation to campaign awareness among youth through a national survey. METHODS: We collected data from 4017 respondents aged 15 to 25 years through an online panel survey designed to be representative of the US population. The GYT campaign targeted 4 key behaviors: STD testing, HIV testing, talking to partners about testing, and talking to providers about testing. RESULTS: Respondents who were aware of the GYT campaign (24.4%) were more likely to report engaging in each of the 4 target behaviors. Associations remained significant when stratified by race and sex and when taking into account sexuality, sexual activity, age, insurance status, and use of campaign partner-provided services. CONCLUSIONS: Awareness of the GYT campaign is related to the 4 target behaviors promoted by the campaign, suggesting that health promotions campaigns oriented toward youth can be successful in increasing STD-related, health-seeking behavior, including among populations disproportionately affected by STD. |
HIV infection among people who inject drugs in the United States: geographically explained variance across racial and ethnic groups
Linton SL , Cooper HL , Kelley ME , Karnes CC , Ross Z , Wolfe ME , Jarlais DD , Semaan S , Tempalski B , DiNenno E , Finlayson T , Sionean C , Wejnert C , Paz-Bailey G . Am J Public Health 2015 105 (12) e1-e9 OBJECTIVES: We explored how variance in HIV infection is distributed across multiple geographical scales among people who inject drugs (PWID) in the United States, overall and within racial/ethnic groups. METHODS: People who inject drugs (n = 9077) were recruited via respondent-driven sampling from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance system. We used multilevel modeling to determine the percentage of variance in HIV infection explained by zip codes, counties, and MSAs where PWID lived, overall and for specific racial/ethnic groups. RESULTS: Collectively, zip codes, counties, and MSAs explained 29% of variance in HIV infection. Within specific racial/ethnic groups, all 3 scales explained variance in HIV infection among non-Hispanic/Latino White PWID (4.3%, 0.2%, and 7.5%, respectively), MSAs explained variance among Hispanic/Latino PWID (10.1%), and counties explained variance among non-Hispanic/Latino Black PWID (6.9%). CONCLUSIONS: Exposure to potential determinants of HIV infection at zip codes, counties, and MSAs may vary for different racial/ethnic groups of PWID, and may reveal opportunities to identify and ameliorate intraracial inequities in exposure to determinants of HIV infection at these geographical scales. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e9. doi:10.2105/AJPH.2015.302861). |
HIV testing, HIV positivity, and linkage and referral services in correctional facilities in the United States, 2009-2013
Seth P , Figueroa A , Wang G , Reid L , Belcher L . Sex Transm Dis 2015 42 (11) 643-9 BACKGROUND: Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)-funded HIV testing and service delivery in correctional facilities. METHODS: Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. RESULTS: Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. CONCLUSIONS: Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease. |
Homonegative attitudes and risk behaviors for HIV and other sexually transmitted infections among sexually active men in the United States
Jeffries WL4th , Johnson OD . Am J Public Health 2015 105 (12) e1-e7 OBJECTIVES: We examined associations between homonegative attitudes and HIV and other sexually transmitted infection (HIV/STI) risk behaviors among sexually active US men. METHODS: We used the 2006-2010 National Survey of Family Growth (n = 10 403) and multivariable logistic regression models to examine homonegative attitudes in relation to condom use, number of past-year sex partners, HIV/STI testing, and STI diagnoses. RESULTS: Among men who had sex with men, homonegative attitudes were associated with lower odds of condom use during anal sex with women (before the past year) and past-year STI testing. Among men who had sex with men and women, homonegative attitudes were associated with lower odds of condom use during vaginal sex and sex with men, having 4 or more partners, and HIV testing ever. Among men who had sex with women, homonegative attitudes were associated with lower odds of condom use during vaginal sex and sex with men (before the past year), HIV testing ever, and contracting herpes, human papillomavirus, or syphilis. CONCLUSIONS: Homonegative attitudes may promote HIV/STI acquisition and transmission among sexually active men of all sexual orientations. Interventions should address homonegative attitudes in the United States. |
Assessing the effect of decentralisation of laboratory diagnosis for drug-resistant tuberculosis in Kenya
Sharma A , Musau S , Heilig CM , Okumu AO , Opiyo EO , Basiye FL , Miruka FO , Kioko JK , Sitienei JK , Cain KP . Int J Tuberc Lung Dis 2015 19 (11) 1348-53 SETTING: Drug susceptibility testing (DST) is recommended in Kenya to identify multidrug-resistant tuberculosis (MDR-TB) in persons registered for tuberculosis (TB) retreatment. DST is performed at a central laboratory with a two-step growth-based process and a regional laboratory with a simultaneous molecular- and growth-based process. OBJECTIVE: To compare proportions of retreatment cases who underwent DST and turnaround times for hospitals referring to the central vs. regional laboratory. DESIGN: Cases were persons registered for TB retreatment from 1 January 2012 to 31 December 2013. Records of 11 hospitals and 7 hospitals referring patients to the regional and central laboratories, respectively, were reviewed. RESULTS: Respectively 238/432 (55%) and 88/355 (25%) cases from hospitals referring to the regional and central laboratories underwent DST. The mean time from case registration to receipt of DST results and initiation of MDR-TB treatment was quicker in hospitals referring to the regional laboratory. The time required for the transportation of specimens, specimen testing and receipt of DST results at hospitals was shorter for the regional laboratory (P < 0.05). CONCLUSION: Testing was faster and more complete at hospitals referring to the regional laboratory. A comprehensive review of MDR-TB detection in Kenya is required to increase the proportion of cases receiving DST. |
Burden of invasive nontyphoidal Salmonella disease in a rural and urban site in Kenya, 2009-2014
Verani JR , Toroitich S , Auko J , Kiplang'at S , Cosmas L , Audi A , Mogeni OD , Aol G , Oketch D , Odiembo H , Katieno J , Wamola N , Onyango CO , Juma BW , Fields BS , Bigogo G , Montgomery JM . Clin Infect Dis 2015 61 Suppl 4 S302-9 BACKGROUND: Invasive infections with nontyphoidal Salmonella (NTS) lead to bacteremia in children and adults and are an important cause of illness in Africa; however, few data on the burden of NTS bacteremia are available. We sought to determine the burden of invasive NTS disease in a rural and urban setting in Kenya. METHODS: We conducted the study in a population-based surveillance platform in a rural setting in western Kenya (Lwak), and an informal urban settlement in Nairobi (Kibera) from 2009 to 2014. We obtained blood culture specimens from participants presenting with acute lower respiratory tract illness or acute febrile illness to a designated outpatient facility in each site, or any hospital admission for a potentially infectious cause (rural site only). Incidence was calculated using a defined catchment population and adjusting for specimen collection and healthcare-seeking practices. RESULTS: A total of 12 683 and 9524 blood cultures were analyzed from Lwak and Kibera, respectively. Of these, 428 (3.4%) and 533 (5.6%) grew a pathogen; among those, 208 (48.6%) and 70 (13.1%) were positive for NTS in Lwak and Kibera, respectively. Overall, the adjusted incidence of invasive NTS disease was higher in Lwak (839.4 per 100 000 person-years of observation [PYO]) than in Kibera (202.5 per 100 000 PYO). The highest adjusted incidences were observed in children <5 years of age (Lwak 3914.3 per 100 000 PYO and Kibera 997.9 per 100 000 PYO). The highest adjusted annual incidence was 1927.3 per 100 000 PYO (in 2010) in Lwak and 220.5 per 100 000 PYO (in 2011) in Kibera; the lowest incidences were 303.3 and 62.5 per 100 000 PYO, respectively (in 2012). In both sites, invasive NTS disease incidence generally declined over the study period. CONCLUSIONS: We observed an extremely high burden of invasive NTS disease in a rural area of Kenya and a lesser, but still substantial, burden in an urban slum. Although the incidences in both sites declined during the study period, invasive NTS infections remain an important cause of morbidity in these settings, particularly among children <5 years old. |
Clinical and microbiological features of Salmonella meningitis in a South African population, 2003-2013
Keddy KH , Sooka A , Musekiwa A , Smith AM , Ismail H , Tau NP , Crowther-Gibson P , Angulo FJ , Klugman KP . Clin Infect Dis 2015 61 Suppl 4 S272-82 BACKGROUND: The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. METHODS: From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. RESULTS: Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0-118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2-12 months (OR, 4.8; 95% CI, 1.1-21.1; P = .039).Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5-17.2; P < .001). CONCLUSIONS: NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes. |
A cluster of ocular syphilis cases - Seattle, Washington, and San Francisco, California, 2014-2015
Woolston S , Cohen SE , Fanfair RN , Lewis SC , Marra CM , Golden MR . MMWR Morb Mortal Wkly Rep 2015 64 (40) 1150-1 From December 1, 2014, to January 30, 2015, in King County, Washington, four cases of ocular syphilis, defined as clinical signs or symptoms consistent with ocular disease (e.g., uveitis or vision loss) in a person with laboratory-confirmed syphilis of any stage, were reported. All four cases occurred in men who have sex with men (MSM), two of whom were sex partners. Median age of the four patients was 39 years (range = 29–52 years). Three of the patients were infected with human immunodeficiency virus (HIV). Among the three HIV-infected patients, the median CD4 count was 111 cells/ml, and the median HIV-RNA was 34,740 copies/ml. All four patients had visual symptoms, including vision loss, flashing lights, and blurry vision. Ophthalmologic examinations were performed and all four were diagnosed with uveitis. All four patients had positive serum from rapid plasma reagin (RPR) testing (titer range = 1:256–1:4096). Based on history, one patient had late latent syphilis, and the remaining three received diagnoses of early latent syphilis. The three patients with early latent syphilis had cerebrospinal fluid (CSF) analysis performed; two had positive CSF in venereal disease research laboratory (VDRL) testing. Three patients received treatment with aqueous crystalline penicillin G for 14 days, and one was treated with 10 days of procaine penicillin and probenecid. All four patients had initial improvement in ocular symptoms after treatment. However, one patient still had a blind spot in one eye 1 month after treatment, and two patients were considered legally blind after 5 months; the fourth patient was lost to follow-up. | Public Health–Seattle & King County has estimated that approximately 6–12 cases of symptomatic ocular syphilis occur annually in the county (1). The occurrence of four cases within 2 months led to a clinical advisory to medical providers and west coast health departments. |
Development of a community health inclusion index: an evaluation tool for improving inclusion of people with disabilities in community health initiatives
Eisenberg Y , Rimmer JH , Mehta T , Fox MH . BMC Public Health 2015 15 (1) 1050 BACKGROUND: Community health initiatives often do not provide enough supports for people with disabilities to fully participate in healthy, active living opportunities. The purpose of this study was to design an instrument that focused on integrating disability-related items into a multi-level survey tool that assessed healthy, active living initiatives. METHODS: The development and testing of the Community Health Inclusion Index (CHII) involved four components: (a) literature review of studies that examined barriers and facilitators to healthy, active living; (b) focus groups with persons with disabilities and professionals living in geographically diverse settings; (c) expert panel to establish a final set of critical items; and (d) field testing the CHII in 164 sites across 15 communities in 5 states to assess the instrument's reliability. RESULTS: Results from initial analysis of these data indicated that the CHII has good reliability. Depending on the subscale, Cronbach's alpha ranged from 0.700 to 0.965. The CHII's inter-rater agreement showed that 14 of the 15 venues for physical activity or healthy eating throughout a community had strong agreement (0.81 - 1.00), while one venue had substantial agreement (0.61 - 0.80). CONCLUSION: The CHII is the first instrument to operationalize community health inclusion into a comprehensive assessment tool that can be used by public health professionals and community coalitions to examine the critical supports needed for improving healthy, active living among people with disabilities. |
Trends in the use of prescription antibiotics: NHANES 1999-2012
Frenk SM , Kit BK , Lukacs SL , Hicks LA , Gu Q . J Antimicrob Chemother 2015 71 (1) 251-6 OBJECTIVES: The objectives of this study were: to examine trends in the use of prescription antibiotics overall and by population subgroups between 1999 and 2012; and to examine trends in the use of categories of antibiotics and individual antibiotics. METHODS: Use of antibiotics was examined among 71 444 participants in the nationally representative National Health and Nutrition Examination Survey (NHANES; 1999-2012). Use of an antibiotic in the past 30 days was the main outcome variable. Analyses of trends were conducted overall and separately by population subgroups (i.e. age, sex, race/Hispanic origin, health insurance status and respiratory conditions) across four time periods (1999-2002, 2003-06, 2007-10 and 2011-12). RESULTS: The percentage of the US population that used a prescription antibiotic in the past 30 days significantly declined from 6.1% in 1999-2002 to 4.1% in 2011-12 (P < 0.001). Declines were also identified for five age groups (0-1 year, 6-11 years, 12-17 years, 18-39 years and 40-59 years), both sexes, non-Hispanic white and non-Hispanic black persons, persons with and without insurance and among those who currently had asthma. Significant declines were also observed for three categories of antibiotics (penicillins, cephalosporins and macrolide derivatives). Of the most common antibiotics prescribed, only amoxicillin use decreased significantly. CONCLUSIONS: Overall, there was a significant decline in the use of antibiotics between 1999-2002 and 2011-12. Due to concerns about antimicrobial resistance, it is important to continue monitoring the use of antibiotics. |
Emergency department visits for adverse events related to dietary supplements
Geller AI , Shehab N , Weidle NJ , Lovegrove MC , Wolpert BJ , Timbo BB , Mozersky RP , Budnitz DS . N Engl J Med 2015 373 (16) 1531-40 BACKGROUND: Dietary supplements, such as herbal or complementary nutritional products and micronutrients (vitamins and minerals), are commonly used in the United States, yet national data on adverse effects are limited. METHODS: We used nationally representative surveillance data from 63 emergency departments obtained from 2004 through 2013 to describe visits to U.S. emergency departments because of adverse events related to dietary supplements. RESULTS: On the basis of 3667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year were attributed to adverse events related to dietary supplements. These visits resulted in an estimated 2154 hospitalizations (95% CI, 1342 to 2967) annually. Such visits frequently involved young adults between the ages of 20 and 34 years (28.0% of visits; 95% CI, 25.1 to 30.8) and unsupervised children (21.2% of visits; 95% CI, 18.4 to 24.0). After the exclusion of unsupervised ingestion of dietary supplements by children, 65.9% (95% CI, 63.2 to 68.5) of emergency department visits for single-supplement-related adverse events involved herbal or complementary nutritional products; 31.8% (95% CI, 29.2 to 34.3) involved micronutrients. Herbal or complementary nutritional products for weight loss (25.5%; 95% CI, 23.1 to 27.9) and increased energy (10.0%; 95% CI, 8.0 to 11.9) were commonly implicated. Weight-loss or energy products caused 71.8% (95% CI, 67.6 to 76.1) of supplement-related adverse events involving palpitations, chest pain, or tachycardia, and 58.0% (95% CI, 52.2 to 63.7) involved persons 20 to 34 years of age. Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits. CONCLUSIONS: An estimated 23,000 emergency department visits in the United States every year are attributed to adverse events related to dietary supplements. Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults. (Funded by the Department of Health and Human Services.). |
Urinary concentrations of bisphenol A and three other bisphenols in convenience samples of U.S. adults during 2000-2014
Ye X , Wong LY , Kramer J , Zhou X , Jia T , Calafat AM . Environ Sci Technol 2015 49 (19) 11834-9 Because of regulatory actions and public concerns, the use of bisphenol A (BPA) may decrease, while the use of BPA alternatives may increase. Although BPA alternatives are considered safer than BPA, their effects on health are still largely unknown. For risk assessment, understanding exposure to these chemicals is necessary. We measured the urinary concentrations of BPA and three bisphenol analogs, bisphenol S (BPS), bisphenol F (BPF), and bisphenol AF (BPAF), in 616 archived samples collected from convenience samplings of U.S. adults at eight time points between 2000 and 2014. We detected BPA at the highest frequency and geometric mean (GM) concentrations (74-99%, 0.36-2.07 mug/L), followed by BPF (42-88%, 0.15-0.54 mug/L) and BPS (19-74%, < 0.1-0.25 mug/L); BPAF was rarely detected (<3% of all samples). Although concentrations of BPF were generally lower than for other bisphenols, the 95th percentile concentration of BPF was often comparable or higher than that of BPA. We did not observe obvious exposure trends for BPF. However, the significant changes in GM concentrations of BPA and BPS suggest that exposures may be declining (BPA) or on the rise (BPS). Nationally representative data will be useful to confirm these findings and to allow monitoring future exposure trends to BPA and some of its bisphenol alternatives. |
Associations between paternal urinary phthalate metabolite concentrations and reproductive outcomes among couples seeking fertility treatment
Dodge LE , Williams PL , Williams , Missmer SA , Souter I , Calafat AM , Hauser R . Reprod Toxicol 2015 58 184-93 INTRODUCTION: Limited evidence suggests that male exposure to ubiquitous environmental phthalates may result in poor reproductive outcomes among female partners. METHODS: This analysis included male-female couples undergoing in vitro fertilization (IVF) and/or intrauterine insemination (IUI). We evaluated associations between the geometric mean of paternal specific gravity-adjusted urinary phthalate concentrations prior to the female partners' cycle and fertilization, embryo quality, implantation, and live birth using generalized linear mixed models. RESULTS: Two-hundred eighteen couples underwent 211 IVF and 195 IUI cycles. Trends were observed between paternal urinary mono-3-carboxypropyl phthalate (MCPP; P=0.01) and mono(carboxyoctyl) phthalate (MCOP; P=0.01) and decreased odds of implantation. MCPP and MCOP were also associated with decreased odds of live birth following IVF (P=0.01 and P=0.04, respectively), and monobutyl phthalate above the first quartile was significantly associated with decreased odds of live birth following IUI (P=0.04). However, most urinary phthalate metabolites were not associated with these reproductive outcomes. CONCLUSION: Selected phthalates were associated with decreased odds of implantation and live birth. |
Brominated flame retardants and other persistent organohalogenated compounds in relation to timing of puberty in a longitudinal study of girls
Windham GC , Pinney SM , Voss RW , Sjodin A , Biro FM , Greenspan LC , Stewart S , Hiatt RA , Kushi LH . Environ Health Perspect 2015 123 (10) 1046-52 BACKGROUND: Exposure to hormonally active chemicals could plausibly affect pubertal timing, so we are investigating this in the Breast Cancer and the Environment Research Program. OBJECTIVES: Our goal was to examine persistent organic pollutants (POPs) in relation to pubertal onset. METHODS: Ethnically diverse cohorts of 6- to 8-year-old girls (n = 645) provided serum for measure of polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), and lipids. Tanner stages [breast (B) and pubic hair (PH)], and body mass index (BMI) were measured at up to seven annual clinic visits. Using accelerated failure time models, we calculated time ratios (TRs) for age at Tanner stages 2 or higher (2+) and POPs quartiles (Q1-4), adjusting for confounders (race/ethnicity, site, caregiver education, and income). We also calculated prevalence ratios (PRs) of Tanner stages 2+ at time of blood sampling. RESULTS: Cross-sectionally, the prevalence of B2+ and PH2+ was inversely related to chemical serum concentrations; but after adjustment for confounders, only the associations with B2+, not PH2+, were statistically significant. Longitudinally, the age at pubertal transition was consistently older with greater chemical concentrations; for example: adjusted TR for B2+ and Q4 for SigmaPBDE = 1.05; 95% CI: 1.02, 1.08, for SigmaPCB = 1.05; 95% CI: 1.01, 1.08, and for SigmaOCP = 1.10; 95% CI: 1.06, 1.14, indicating median ages of about 6 and 11 months older than least exposed, and with similar effect estimates for PH2+. Adjusting for BMI attenuated associations for PCBs and OCPs but not for PBDEs. CONCLUSIONS: This first longitudinal study of puberty in girls with serum POPs measurements (to our knowledge) reveals a delay in onset with higher concentrations. |
The Dynamics of Genetic Interactions Between Vibrio metoecus and Vibrio cholerae, Two Close Relatives Co-Occurring in the Environment.
Orata FD , Kirchberger PC , Meheust R , Barlow EJ , Tarr CL , Boucher Y . Genome Biol Evol 2015 7 (10) 2941-2954 Vibrio metoecus is the closest relative of Vibrio cholerae, the causative agent of the potent diarrheal disease cholera. Although the pathogenic potential of this new species is yet to be studied in depth, it has been co-isolated with V. cholerae in coastal waters and found in clinical specimens in the USA. We used these two organisms to investigate the genetic interaction between closely related species in their natural environment. The genomes of twenty V. cholerae and four V. metoecus strains isolated from a brackish coastal pond on the US east coast, as well as four clinical V. metoecus strains were sequenced and compared to reference strains. Whole genome comparison shows 86-87% average nucleotide identity (ANI) in their core genes between the two species. On the other hand, the chromosomal integron, which occupies approximately 3% of their genomes, shows higher conservation in ANI between species than any other region of their genomes. The ANI of 93-94% observed in this region is not significantly greater within than between species, meaning that it does not follow species boundaries. V. metoecus does not encode toxigenic V. cholerae major virulence factors, the cholera toxin and toxin co-regulated pilus. However, some of the pathogenicity islands found in pandemic V. cholerae were either present in the common ancestor it shares with V. metoecus, or acquired by clinical and environmental V. metoecus in partial fragments. The virulence factors of V. cholerae are therefore both more ancient and more widespread than previously believed. There is high interspecies recombination in the core genome, which has been detected in 24% of the single-copy core genes, including genes involved in pathogenicity. V. metoecus was six times more often the recipient of DNA from V. cholerae as it was the donor, indicating a strong bias in the direction of gene transfer in the environment. |
Exploring Genomic, Geographic and Virulence Interactions among Epidemic and Non-Epidemic St. Louis Encephalitis Virus (Flavivirus) Strains.
Diaz LA , Goni SE , Iserte JA , Quaglia AI , Singh A , Logue CH , Powers AM , Contigiani MS . PLoS One 2015 10 (8) e0136316 St. Louis encephalitis virus (SLEV) is a re-emerging arbovirus in South America. In 2005, an encephalitis outbreak caused by SLEV was reported in Argentina. The reason for the outbreak remains unknown, but may have been related to virological factors, changes in vectors populations, avian amplifying hosts, and/or environmental conditions. The main goal of this study was to characterize the complete genome of epidemic and non-epidemic SLEV strains from Argentina. Seventeen amino acid changes were detected; ten were non-conservative and located in proteins E, NS1, NS3 and NS5. Phylogenetic analysis showed two major clades based on geography: the North America and northern Central America (NAnCA) clade and the South America and southern Central America (SAsCA) clade. Interestingly, the presence of SAsCA genotype V SLEV strains in the NAnCA clade was reported in California, Florida and Texas, overlapping with known bird migration flyways. This work represents the first step in understanding the molecular mechanisms underlying virulence and biological variation among SLEV strains. |
Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI): descriptive analysis of data reported to National Healthcare Safety Network (NHSN), 2013
Epstein L , See I , Edwards JR , Magill SS , Thompson ND . Infect Control Hosp Epidemiol 2015 37 (1) 1-6 OBJECTIVES: To determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line-associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN) DESIGN: Descriptive analysis of 2013 NHSN data SETTING: Selected inpatient locations in acute care hospitals METHODS: A descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type. RESULTS: From 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%. CONCLUSIONS: An understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest. |
Identification of population at risk for future Clostridium difficile infection following hospital discharge to be targeted for vaccine trials
Baggs J , Yousey-Hindes K , Ashley ED , Meek J , Dumyati G , Cohen J , Wise M , Clifford McDonald L , Lessa FC . Vaccine 2015 33 (46) 6241-9 BACKGROUND: Efforts to develop a Clostridium difficile vaccine are underway; identification of patients at risk for C. difficile infection (CDI) is critical to inform vaccine trials. We identified groups at high risk of CDI≥28 days after hospital discharge. METHODS: Hospital discharge data and pharmacy data from two large academic centers, in New York and Connecticut, were linked to active population-based CDI surveillance data from the Emerging Infections Program (EIP). Adult residents of the EIP surveillance area were included if they had an inpatient stay at a study hospital without prior history of CDI. The primary outcome was CDI by either toxin or molecular assay ≥28 days after an index hospitalization. Important predictors of CDI≥28 days post discharge were initially identified through a Cox proportional hazards model (stepwise backward selection) using a derivation cohort; final model parameters were used to develop a risk score evaluated in the validation cohort. RESULTS: Of the 35,186 index hospitalizations, 288 (0.82%) had CDI≥28 days post discharge. After parameter selection, age, number of hospitalizations in the prior 90 days, admission diagnosis, and the use of 3rd/4th generation cephalosporin, clindamycin or fluoroquinolone antibiotic classes remained in the model. Using the validation cohort, the risk score was predictive (p<0.001) with a c-score of 0.75. Based on the distribution of scores in the derivation cohort, we divided the patients into low and high risk groups. In the high risk group, 1.6% experienced CDI≥28 days post discharge compared to 0.3% among our low risk group. CONCLUSIONS: Our study identified specific parameters for a risk score that can be applied at discharge to identify a patient population whose risk of CDI≥28 days following an acute care hospitalization was 5 times greater than other patients. |
Sabin vaccine reversion in the field: a comprehensive analysis of Sabin-like poliovirus isolates in Nigeria.
Famulare M , Chang S , Iber J , Zhao K , Adeniji JA , Bukbuk D , Baba M , Behrend M , Burns CC , Oberste MS . J Virol 2015 90 (1) 317-31 To assess the dynamics of genetic reversion of live poliovirus vaccine in humans, we studied molecular evolution in Sabin-like poliovirus isolates from Nigerian acute flaccid paralysis cases obtained from routine surveillance. We employed a novel modeling approach to infer substitution and recombination rates from whole-genome sequences and information about poliovirus infection dynamics and individual vaccination history. We confirmed observations from a recent vaccine trial that VP1 substitution rates are increased for Sabin-like isolates relative to the wild-type rate due to increased non-synonymous substitution rates. We also inferred substitution rates for attenuating nucleotides and confirmed that reversion can occur in days to weeks after vaccination. We combine our observations for Sabin-like evolution with the wild-type circulating VP1 molecular clock to infer that the mean time from the initiating vaccine dose to the earliest detection of circulating vaccine-derived poliovirus (cVDPV) is 300 days for type 1, 210 days for type 2, and 390 days for type 3. Phylogenetic relationships indicated transient local transmission of Sabin 3 and possibly Sabin 1 during periods of low wild polio incidence. Comparison of Sabin-like recombinants with known Nigerian VDPV recombinants shows that while recombination with non-Sabin enteroviruses is associated with cVDPV, the recombination rates are similar for Sabin-Sabin and Sabin-non-Sabin enterovirus recombination after accounting for time from dose to detection. Our study provides a comprehensive picture of the evolutionary dynamics of oral polio vaccine in the field. IMPORTANCE: The global polio eradication effort has completed its twenty-sixth year. Despite success in eliminating wild poliovirus from most of the world, polio persists in populations where logistical, social, and political factors have not allowed for vaccination programs of sustained high quality. One issue of critical importance is eliminating circulating vaccine-derived poliovirus (cVDPV) that have properties indistinguishable from wild poliovirus and can cause paralytic disease. cVDPV emerges due to the genetic instability of the Sabin viruses used in oral polio vaccine (OPV) in populations that have low immunity to poliovirus. However, the dynamics responsible are incompletely understood because it has historically been difficult to gather and interpret data about OPV evolution in regions where cVDPV has occurred. This study is the first to combine whole-genome sequencing of poliovirus isolates collected during routine surveillance with knowledge about polio intra-host dynamics to provide quantitative insight into polio vaccine evolution in the field. |
Risk of anaphylaxis after vaccination in children and adults
McNeil MM , Weintraub ES , Duffy J , Sukumaran L , Jacobsen SJ , Klein NP , Hambidge SJ , Lee GM , Jackson LA , Irving SA , King JP , Kharbanda EO , Bednarczyk RA , DeStefano F . J Allergy Clin Immunol 2015 137 (3) 868-78 BACKGROUND: Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children. OBJECTIVE: We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis. METHODS: Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines. RESULTS: We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90-1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65-2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22-6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases). CONCLUSION: Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat. |
Long-term consistency in rotavirus vaccine protection: RV5 and RV1 vaccine effectiveness in US children, 2012-2013
Payne DC , Selvarangan R , Azimi PH , Boom JA , Englund JA , Staat MA , Halasa NB , Weinberg GA , Szilagyi PG , Chappell J , McNeal M , Klein EJ , Sahni LC , Johnston SH , Harrison CJ , Baker CJ , Bernstein DI , Moffatt ME , Tate JE , Mijatovic-Rustempasic S , Esona MD , Wikswo ME , Curns AT , Sulemana I , Bowen MD , Gentsch JR , Parashar UD . Clin Infect Dis 2015 61 (12) 1792-9 BACKGROUND: Using a multi-center, active surveillance network from two rotavirus seasons (2012 and 2013), we assessed the vaccine effectiveness of RV5 (RotaTeq) and RV1 (Rotarix) rotavirus vaccines in preventing rotavirus gastroenteritis hospitalizations and emergency department (ED) visits for numerous demographic and secular strata. METHODS: We enrolled children hospitalized or visiting the ED with acute gastroenteritis (AGE) for the 2012 and 2013 seasons at 7 medical institutions. Stool specimens were tested for rotavirus by enzyme immunoassay and genotyped, and rotavirus vaccination histories were compared for rotavirus-positive cases and rotavirus-negative AGE controls. We calculated the VE for preventing rotavirus associated hospitalizations and ED visits for each vaccine, stratified by vaccine dose, season, clinical setting, age, predominant genotype, and ethnicity. RESULTS: RV5-specific VE analyses included 2,961 subjects, 402 rotavirus cases (14%) and 2,559 rotavirus-negative AGE controls. RV1-specific VE analyses included 904 subjects, 100 rotavirus cases (11%) and 804 rotavirus-negative AGE controls. Over the two rotavirus seasons, the VE for a complete 3-dose vaccination with RV5 was 80% (CI= 74% - 84%), and VE for a complete 2-dose vaccination with RV1 was 80% (CI= 68% - 88%).Statistically significant VE was observed for each year of life for which sufficient data allowed analysis (7 years for RV5 and 3 years for RV1). Both vaccines provided statistically significant genotype-specific protection against predominant circulating rotavirus strains. CONCLUSION: In this large, geographically and demographically diverse sample of US children, we observed that RV5 and RV1 rotavirus vaccines each provided a lasting, and broadly heterologous protection against rotavirus gastroenteritis. |
Parent perception of provider interactions influences HPV vaccination status of adolescent females
Clark SJ , Cowan AE , Filipp SL , Fisher AM , Stokley S . Clin Pediatr (Phila) 2015 55 (8) 701-6 Human papillomavirus (HPV) vaccination coverage among adolescent females is well below national public health goals. Many known barriers to HPV vaccine receipt can be addressed in parent-physician conversations. This study sought to explore parent experiences and attitudes related to HPV vaccination of adolescent girls, focused on interactions with providers. We conducted a cross-sectional survey of parents using a nationally representative online panel. Among parents with ≥1 daughter aged 11 to 17 years, provider recommendations for HPV vaccine and specified age to begin the HPV vaccine series were associated with HPV vaccine status. Parents who reported their daughters were unlikely to complete the HPV series were more likely to have had no discussion of HPV vaccine with the provider. Efforts to increase HPV vaccination rates among adolescent females should continue to focus on improving provider discussion of HPV vaccine. |
Human papillomavirus vaccination coverage among school girls in a demonstration project - Botswana, 2013
Raesima MM , Forhan SE , Voetsch AC , Hewitt S , Hariri S , Wang SA , Pelletier AR , Letebele M , Pheto T , Ramogola-Masire D , El-Halabi S . MMWR Morb Mortal Wkly Rep 2015 64 (40) 1147-9 What is already known on this topic? Human papillomavirus (HPV) infection is common and aggressive in persons infected with human immunodeficiency virus (HIV). With an HIV prevalence of 28% among females aged 15-49, cervical cancer is the leading cause of cancer death among women in Botswana. Before 2013, HPV vaccine had not been used in the public sector in Botswana.What is added by this report? Efforts to expand services for cervical cancer through the Pink Ribbon Red Ribbon initiative focused on HPV-related disease in Botswana. A demonstration project for HPV vaccination was developed by the Ministry of Health for school girls aged >/=9 years in primary schools in one community. A total of 1,967 (79%) of 2,488 eligible girls received 3 doses of vaccine in the immunization effort that was centered in schools.What are the implications for public health practice? Preventing HPV infection in girls is an important component of a national comprehensive cervical cancer control program. HPV vaccination programming is challenging, and demonstration projects can prepare countries for national introduction. The success of the initial HPV vaccination effort in Botswana led to an expanded project in 2014, with implementation of nationwide rollout of the HPV vaccine in 2015. It might be beneficial for future HPV vaccination campaigns to include strategies to reach out-of-school girls. |
Indirect cohort analysis of 10-valent pneumococcal conjugate vaccine effectiveness against vaccine-type and vaccine-related invasive pneumococcal disease
Verani JR , Domingues CM , Moraes JC . Vaccine 2015 33 (46) 6145-8 We applied the indirect cohort method to estimate effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) among young children in Brazil. Cases of invasive pneumococcal disease (IPD), i.e., Streptococcus pneumoniae, detected in normally sterile fluid identified through laboratory-based surveillance and previously enrolled in a matched case-control effectiveness study are included. We estimated PCV10 effectiveness using multivariable logistic regression comparing PCV10 vaccination among children with vaccine-type or vaccine-related IPD vs. children with non-vaccine-type disease. The adjusted effectiveness of ≥1 doses against vaccine-type (72.8%, 95% confidence interval [CI] [44.1, 86.7]) and vaccine-related (61.3%, 95%CI [14.5, 82.5]) IPD were similar to the effectiveness observed in the original case-control study (which required enrollment >1200 controls). We also found significant protection of ≥1 dose against individual vaccine serotypes (14, 6B, 23F, 18C) and against vaccine-related serotype 19A. The indirect cohort methods leverages existing surveillance is a feasible approach for evaluating pneumococcal conjugate vaccines, particularly in resource-limited settings. |
Boosting immunity in recipients of live-attenuated zoster vaccine
Schmid DS . J Infect Dis 2015 213 (1) 1-2 Roughly a million cases of herpes zoster (HZ) occur annually in US adults, and nearly one third of these patients will experience postherpetic neuralgia (PHN) lasting for ≥1 month [1]. The burden of HZ is strongly influenced by age: the incidence of HZ increases many fold throughout adulthood, and among adults who experience HZ, the risk that PHN will develop increases several fold more after the age of 60 years [1]. These conditions are often sufficiently severe to compromise daily lifestyle, and PHN pain is frequently refractory to treatment [1]. | The initial report on the clinical trial for zoster vaccine indicated that it was partially protective in adults ≥60 years of age [2]. The placebo-controlled trial demonstrated that the vaccine prevented half of all HZ cases and 67% of PHN cases and reduced the burden of illness by 61% [2]. Two follow-up studies of the trial cohort have suggested a marked decline in HZ vaccine efficacy by 7–11 years after immunization [3, 4]. In one of the studies, vaccine efficacy had declined from 51% to 40% against HZ and from 67% to 60% against PHN 7 years after vaccination, although these differences were not statistically significant [3]. In the other study, protection had declined to 21% against HZ and to 35% against PHN 11 years after vaccination [4]. However, this longer-term study was conducted without a concurrent control group, so these results need to be verified. While neither of these studies evaluated concomitant declines in varicella zoster virus (VZV)–specific humoral and cell-mediated immune responses over time, it is well established that responsiveness to vaccines wanes with advancing age [5]. Although both arms of the acquired immune response likely contribute to anti-HZ immunity, there is solid evidence that cell-mediated immunity plays a particularly important role in resistance to HZ [6, 7]. |
Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians
Nett RJ , Witte TK , Holzbauer SM , Elchos BL , Campagnolo ER , Musgrave KJ , Carter KK , Kurkjian KM , Vanicek CF , O'Leary DR , Pride KR , Funk RH . J Am Vet Med Assoc 2015 247 (8) 945-55 OBJECTIVE: To evaluate the prevalence of suicide risk factors, attitudes toward mental illness, and practice-related stressors among US veterinarians. DESIGN: Cross-sectional survey. SAMPLE: 11,627 US veterinarians. PROCEDURES: Between July 1 and October 20, 2014, a Web-based questionnaire was made available through the Veterinary Information Network (VIN), VIN News Service, JAVMA News, and email messages to US veterinarians sent by a veterinary medical association, agriculture or livestock department, or health department of each state (except Maine) and Puerto Rico. RESULTS: Of 11,627 respondents, 3,628 (31%) were male. Modal age category was 30 to 39 years, and modal range for years practicing veterinary medicine was 10 to 19 years. There were 7,460 (64%) respondents who primarily practiced small animal medicine, and 4,224 (36%) who were practice owners. There were 1,077 (9%) respondents with current serious psychological distress. Since leaving veterinary school, 3,655 (31%) respondents experienced depressive episodes, 1,952 (17%) experienced suicidal ideation, and 157 (1%) attempted suicide. Currently, 2,228 (19%) respondents were receiving treatment for a mental health condition. Only 3,250 of 10,220 (32%) respondents somewhat or strongly agreed that people are sympathetic toward persons with mental illness. The most commonly reported practice-related stressor was demands of practice. CONCLUSIONS AND CLINICAL RELEVANCE: In this survey, approximately 1 in 11 veterinarians had serious psychological distress and 1 in 6 experienced suicidal ideation since leaving veterinary school. Implementing measures to help veterinarians cope with practice-related stressors and reducing barriers veterinarians face in seeking mental health treatment might reduce the risk for suicide among veterinarians. |
The association between youth violence exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of fifth-graders
Lewis T , Schwebel DC , Elliott MN , Visser SN , Toomey SL , McLaughlin KA , Cuccaro P , Tortolero Emery S , Banspach SW , Schuster MA . Am J Orthopsychiatry 2015 85 (5) 504-13 The purpose of the current study was to examine the association between violence exposures (no exposure, witness or victim only, and both witness and victim) and attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as the potential moderating role of gender. Data from 4,745 5th graders and their primary caregivers were drawn from the Healthy Passages study of adolescent health. Parent respondents completed the DISC Predictive Scales for ADHD, and youth provided information about exposure to violence. Results indicated that youth who reported both witnessing and victimization had more parent-reported ADHD symptoms and were more likely to meet predictive criteria for ADHD. Among those with both exposures, girls exhibited a steeper increase in ADHD symptoms and higher probability of meeting predictive criteria than did boys. Findings indicate that being both victim-of and witness-to violence is significantly associated with ADHD symptoms particularly among girls. (PsycINFO Database Record |
Contextual determinants of childhood injury: a systematic review of studies with multilevel analytic methods
McClure R , Kegler S , Davey T , Clay F . Am J Public Health 2015 105 (12) e1-e7 BACKGROUND: The definition of injury that underpins the contemporary approach to injury prevention is an etiological definition relating to bodily damage arising from transfer of energy to tissues of the body beyond the limits compatible with physiological function. Causal factors proximal to the energy transfer are nested within a more complex set of contextual determinants. For effective injury control, understanding of these determinants is critical. OBJECTIVES: The primary aims of this study were to describe the area-level determinants that have been included in multilevel analyses of childhood injury and to quantify the relationships between these area-level exposures and injury outcomes. SEARCH METHODS: We conducted a systematic review of peer-reviewed, English-language literature published in scientific journals between January 1997 and July 2014, reporting studies that employed multilevel analyses to quantify the eco-epidemiological causation of physical unintentional injuries to children aged 16 years and younger. We conducted and reported the review in accordance with the PRISMA guidelines. SELECTION CRITERIA: We included etiological studies of causal risk factors for unintentional traumatic injuries to children aged 0 to 16 years. Methodological inclusion criteria were as follows: * Epidemiological studies quantifying the relationship between risk factors (at various levels) and injury occurrence in the individual; *Studies that recognized individual exposure and at least 1 higher level of exposure with units at lower levels or microunits (e.g., individuals) nested within units at higher levels or macrounits (e.g., areas or neighborhoods); *Injury outcomes (dependent variable) examined at the individual level; and * Central analytic techniques belonging to the following categories: multilevel models, hierarchical models, random effects models, random coefficient models, covariance components models, variance components models, and mixed models. We combined criteria from the checklist described by the Cochrane Effective Practice and Organization of Care Review Group with factors in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement, and we used several quality assessment items from other injury-related systematic reviews to create a quality assessment checklist for this review. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and selected analysis features for the included studies by using preformatted tables. They extracted information as reported in the articles. We determined statistical significance of estimates and effects by using the conventional threshold, P < .05. Any differences in the information extracted were resolved by discussion between authors and by specifically rereading and rechecking the facts as reported in the relevant articles. We tabulated results from the final multilevel model(s) in each of the included articles with key aspects summarized in text. Interpretations of the results and identification of key issues raised by the collated material are reported in the Discussion section of this article. MAIN RESULTS: We identified 11 967 articles from the electronic search with only 14 being included in the review after a detailed screening and selection process. Nine of the 14 studies identified significant fixed effects at both the area and individual levels. The area-level variables most consistently associated with child injury rates related to poverty, education, employment, and access to services. There was some evidence that injury rates were lower in areas scoring well on area-level summary measures of neighborhood safety. There was marked variation in the methods used and in the mapping of measured variables onto the conceptual model of ecological causation. Author conclusions. These results help establish the scope for the public policy approach to injury prevention. More consistent reporting of multilevel study results would aid future interpretation and translation of such findings. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e7. doi:10.2105/AJPH.2015.302883). |
Silica coating influences the corona and biokinetics of cerium oxide nanoparticles
Konduru NV , Jimenez RJ , Swami A , Friend S , Castranova V , Demokritou P , Brain JD , Molina RM . Part Fibre Toxicol 2015 12 (1) 31 BACKGROUND: The physicochemical properties of nanoparticles (NPs) influence their biological outcomes. METHODS: We assessed the effects of an amorphous silica coating on the pharmacokinetics and pulmonary effects of CeO2 NPs following intratracheal (IT) instillation, gavage and intravenous injection in rats. Uncoated and silica-coated CeO2 NPs were generated by flame spray pyrolysis and later neutron-activated. These radioactive NPs were IT-instilled, gavaged, or intravenously (IV) injected in rats. Animals were analyzed over 28 days post-IT, 7 days post-gavage and 2 days post-injection. RESULTS: Our data indicate that silica coating caused more but transient lung inflammation compared to uncoated CeO2. The transient inflammation of silica-coated CeO2 was accompanied by its enhanced clearance. Then, from 7 to 28 days, clearance was similar although significantly more (141)Ce from silica-coated (35 %) was cleared than from uncoated (19 %) (141)CeO2 in 28 days. The protein coronas of the two NPs were significantly different when they were incubated with alveolar lining fluid. Despite more rapid clearance from the lungs, the extrapulmonary (141)Ce from silica-coated (141)CeO2 was still minimal (<1 %) although lower than from uncoated (141)CeO2 NPs. Post-gavage, nearly 100 % of both NPs were excreted in the feces consistent with very low gut absorption. Both IV-injected (141)CeO2 NP types were primarily retained in the liver and spleen. The silica coating significantly altered the plasma protein corona composition and enhanced retention of (141)Ce in other organs except the liver. CONCLUSION: We conclude that silica coating of nanoceria alters the biodistribution of cerium likely due to modifications in protein corona formation after IT and IV administration. |
Maternal polybrominated diphenyl ether (PBDE) exposure and thyroid hormones in maternal and cord sera: the HOME Study, Cincinnati, USA
Vuong AM , Webster GM , Romano ME , Braun JM , Zoeller RT , Hoofnagle AN , Sjodin A , Yolton K , Lanphear BP , Chen A . Environ Health Perspect 2015 123 (10) 1079-85 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) reduce blood concentrations of thyroid hormones in laboratory animals, but it is unclear whether PBDEs disrupt thyroid hormones in pregnant women or newborn infants. OBJECTIVES: We investigated the relationship between maternal PBDE levels and thyroid hormone concentrations in maternal and cord sera. METHODS: We used data from the Health Outcomes and Measures of the Environment (HOME)Study, a prospective birth cohort of 389 pregnant women in Cincinnati, Ohio, who were enrolled from 2003 through 2006 and delivered singleton infants. Maternal serum PBDE concentrations were measured at enrollment (16 +/- 3 weeks of gestation). Thyroid hormone concentrations were measured in maternal serum at enrollment (n = 187) and in cord serum samples (n = 256). RESULTS: Median maternal serum concentrations of BDEs 28 and 47 were 1.0 and 19.1 ng/g lipid, respectively. A 10-fold increase in BDEs 28 and 47 concentrations was associated with a 0.85-mug/dL [95% confidence interval (CI): 0.05, 1.64] and 0.82-mug/dL (95% CI: 0.12, 1.51) increase in maternal total thyroxine concentrations (TT4), respectively. Both congeners were also positively associated with maternal free thyroxine (FT4). We also observed positive associations between BDE-47 and maternal total and free triiodothyronine (TT3 and FT3). A 10-fold increase in BDE-28 was associated with elevated FT3 concentrations (beta = 0.14 pg/mL; 95% CI: 0.02, 0.26). In contrast, maternal PBDE levels were not associated with thyroid hormone concentrations in cord serum. CONCLUSIONS: These findings suggest that maternal PBDE exposure, particularly BDEs 28 and 47, are associated with maternal concentrations of T4 and T3 during pregnancy. |
Measurement of transport properties of aerosolized nanomaterials
Ku BK , Kulkarni P . J Aerosol Sci 2015 90 169-181 Airborne engineered nanomaterials such as single-walled carbon nanotubes (SWCNTs), multi-walled carbon nanotubes (MWCNTs), functionalized MWCNT, graphene, fullerene, silver and gold nanorods were characterized using a tandem system of a differential mobility analyzer and an aerosol particle mass analyzer to obtain their airborne transport properties and understand their relationship to morphological characteristics. These nanomaterials were aerosolized using different generation methods such as electrospray, pneumatic atomization, and dry aerosolization techniques, and their airborne transport properties such as mobility and aerodynamic diameters, mass scaling exponent, dynamic shape factor, and effective density were obtained. Laboratory experiments were conducted to directly measure mobility diameter and mass of the airborne nanomaterials using tandem mobility-mass measurements. Mass scaling exponents, aerodynamic diameters, dynamic shape factors and effective densities of mobility-classified particles were obtained from particle mass and the mobility diameter. Microscopy analysis using Transmission Electron Microscopy (TEM) was performed to obtain morphological descriptors such as envelop diameter, open area, aspect ratio, and projected area diameter. The morphological information from the TEM was compared with measured aerodynamic and mobility diameters of the particles. The results showed that aerodynamic diameter is smaller than mobility diameter below 500 nm by a factor of 2-4 for all nanomaterials except silver and gold nanorods. Morphologies of MWCNTs generated by liquid-based method, such as pneumatic atomization, are more compact than those of dry dispersed MWCNTs, indicating that the morphology depends on particle generation method. TEM analysis showed that projected area diameter of MWCNTs appears to be in reasonable agreement with mobility diameter in the size range from 100 to 400 nm. Principal component analysis of the obtained airborne particle properties also showed that the mobility diameter-based effective density and aerodynamic diameter are eigenvectors and can be used to represent key transport properties of interest. © 2015. |
Intranasal deposition of Accuspray aerosol in anatomically correct models of 2-, 5-, and 12-year-old children
Laube BL , Sharpless G , Vikani AR , Harrand V , Zinreich SJ , Sedberry K , Knaus D , Barry J , Papania M . J Aerosol Med Pulm Drug Deliv 2015 28 (5) 320-33 BACKGROUND: To our knowledge, quantification of intranasal deposition of aerosol generated by Accuspray (AS) in children has never been published. We hypothesized that deposition would vary significantly with age and with placement of the device within, or outside, of the nostril. METHODS: We tested these hypotheses in anatomically-correct physical models based on CT scans of 2-, 5-, and 12-year-old children with normal, intranasal airways. Models included a removable anterior nose (AN) with exterior facial features and interior nasal vestibule and nasal valve area and a main nasal airway (MNA), subdivided into upper (superior turbinates and olfactory area), middle (middle turbinates), and lower (inferior turbinates and nasopharynx) thirds. Aerosol was generated from distilled water admixed with (99m)technetium pertechnetate and administered during static airflow by AS inserted inside the right nostril (eight runs/model), or outside the right nostril (six runs/model). Mean aerosol Dv(50)+/-standard deviation was 67.8+/-24.7mum. Deposition was quantified by 2D gamma scintigraphy and expressed as percentage of the emitted dose. RESULTS: When placed inside the nostril, mean (+/-standard deviation) deposition within the MNA was significantly less in the 2-year-old, compared to the 5- and 12-year-old, averaging 46.8+/-33.8% (AN:55.4+/-29.9%), 75.4+/-26.7% (AN:23.3+/-13.6%), and 72.1+/-18.5% (AN:25.8+/-18.5%), respectively (p<0.05). When placed outside the nostril, MNA was significantly less in the 2- and 5-year-old compared to the 12-year-old, with 1.4+/-2.5% (AN:69.7+/-40.7%), 7.4+/-9.0% (AN:77.8+/-32.8%), and 21.1+/-29.1% (AN:29.2+/-19.3%), respectively (p<0.05). Deposition in the MNA of all age models was highest when AS was placed inside the nostril (p<0.05). Deposition in the lower third was significantly increased for the 5- and 12-year-old and in the middle third of the 5-year-old when AS was placed inside the nostril. CONCLUSIONS: These results indicate that age and device placement play important roles in terms of intranasal deposition, when administering aerosol with Accuspray to children. |
Desensitized morphological and cytokine response after stretch-shortening muscle contractions as a feature of aging in rats
Rader EP , Layner KN , Triscuit AM , Kashon ML , Gu JK , Ensey J , Baker BA . Exp Gerontol 2015 72 138-49 Recovery from contraction-induced injury is impaired with aging. At a young age, the secondary response several days following contraction-induced injury consists of edema, inflammatory cell infiltration, and segmental muscle fiber degeneration to aid in the clearance of damaged tissue and repair. This morphological response has not been wholly established at advanced age. Our aim was to characterize muscle fiber morphology 3 and 10days following stretch-shortening contractions (SSCs) varying in repetition number (i.e. 0, 30, 80, and 150) for young and old rats. For muscles of young rats, muscle fiber degeneration was overt at 3days exclusively after 80 or 150 SSCs and returned significantly closer to control values by 10days. For muscles of old rats, no such responses were observed. Transcriptional microarray analysis at 3days demonstrated that muscles of young rats differentially expressed up to 2144 genes while muscles of old rats differentially expressed 47 genes. Bioinformatic analysis indicated that cellular movement was a major biological process over-represented with genes that were significantly altered by SSCs especially for young rats. Protein levels in muscle for various cytokines and chemokines, key inflammatory factors for cell movement, increased 3- to 50-fold following high-repetition SSCs for young rats with no change for old rats. This age-related differential response was insightful given that for control (i.e. 0 SSCs) conditions, protein levels of circulatory cytokines/chemokines were increased with age. The results demonstrate ongoing systemic low-grade inflammatory signaling and subsequent desensitization of the cytokine/chemokine and morphological response to contraction-induced injury with aging - features which accompany age-related impairment in muscle recovery. |
Determination of Aflatoxin B1 in Smokeless Tobacco Products by Use of UHPLC-MS/MS
Zitomer N , Rybak ME , Li Z , Walters MJ , Holman MR . J Agric Food Chem 2015 63 (41) 9131-8 This work developed a UHPLC-MS/MS method for the detection and quantitation of aflatoxins in smokeless tobacco products, which was then used to determine aflatoxin B1 concentrations in 32 smokeless tobacco products commercially available in the United States. Smokeless tobacco products were dried, milled, and amended with 13C17-labeled internal standards, extracted in water/methanol solution in the presence of a surfactant, isolated through use of immunoaffinity column chromatography, and reconstituted in mobile phase prior to UHPLC-MS/MS analysis. The method was capable of baseline separation of aflatoxins B1, B2, G1, and G2 in a 2.5 min run by use of a fused core C18 column and a water/methanol gradient. MS/MS transition (m/z) 313.3 --> 241.2 was used for aflatoxin B1 quantitation, with 313.3 --> 285.1 used for confirmation. The limit of detection (LOD) for aflatoxin B1 was 0.007 parts per billion (ppb). Method imprecision for aflatoxin B1 (expressed as coefficient of variation) ranged from 5.5 to 9.4%. Spike recoveries were 105-111%. Aflatoxin B1 concentrations in the smokeless tobacco products analyzed ranged from <LOD to 0.271 ppb (dry mass). Aflatoxin B1 was most frequently detected in dry snuffs and chews, whereas all moist snuff products tested were below LOD. The amounts of aflatoxin B1 detected were low relative to the 20 ppb regulatory limit established by the U.S. Food and Drug Administration for foods and feeds. |
Diacetyl and 2,3-pentanedione exposure of human cultured airway epithelial cells: ion transport effects and metabolism of butter flavoring agents
Zaccone EJ , Goldsmith WT , Shimko MJ , Wells R , Schwegler-Berry D , Willard PA , Case SL , Thompson JA , Fedan JS . Toxicol Appl Pharmacol 2015 289 (3) 542-9 Inhalation of butter flavoring by workers in the microwave popcorn industry may result in “popcorn workers' lung.” In previous in vivo studies rats exposed for 6 h to vapor from the flavoring agents, diacetyl and 2,3-pentanedione, acquired flavoring concentration-dependent damage of the upper airway epithelium and airway hyporeactivity to inhaled methacholine. Because ion transport is essential for lung fluid balance, we hypothesized that alterations in ion transport may be an early manifestation of butter flavoring-induced toxicity. We developed a system to expose cultured human bronchial/tracheal epithelial cells (NHBEs) to flavoring vapors. NHBEs were exposed for 6 h to diacetyl or 2,3-pentanedione vapors (25 or ≥60 ppm) and the effects on short circuit current and transepithelial resistance (Rt) were measured. Immediately after exposure to 25 ppm both flavorings reduced Na+ transport, without affecting Cl− transport or Na+,K+-pump activity. Rt was unaffected. Na+ transport recovered 18 h after exposure. Concentrations (100–360 ppm) of diacetyl and 2,3-pentanedione reported earlier to give rise in vivo to epithelial damage, and 60 ppm, caused death of NHBEs 0 h post-exposure. Analysis of the basolateral medium indicated that NHBEs metabolize diacetyl and 2,3-pentanedione to acetoin and 2-hydroxy-3-pentanone, respectively. The results indicate that ion transport is inhibited transiently in airway epithelial cells by lower concentrations of the flavorings than those that result in morphological changes of the cells in vivo or in vitro. |
Utility of population-based birth defects surveillance for monitoring the health of infants and as a foundation for etiologic research
Moore CA , McCabe ER . Birth Defects Res A Clin Mol Teratol 2015 103 (11) 895-8 The National Birth Defects Prevention Network (NBDPN) is a nonprofit volunteer organization in the United States for individuals working on birth defects surveillance, research, and prevention (www.nbdpn.org) including, among others, public health officials, epidemiologists, clinicians, and parent advocates. NBDPN works to improve the quality of birth defects surveillance data, and to make these data more accessible both in publications and online. NBDPN also works to increase collaboration among surveillance programs and advance our understanding of the causes and risk factors for birth defects. In this year’s annual report from the NBDPN, 40 programs reported updated birth defects surveillance data on at least some of the 47 defects monitored by this organization. |
Location of usual source of care among children and adolescents in the United States, 1997-2013
Simon AE , Rossen LM , Schoendorf KC , Larson K , Olson LM . J Pediatr 2015 167 (6) 1409-14 OBJECTIVES: To examine national trends in the percentage of children whose usual source of care is at a clinic, health center, or hospital outpatient department (hereafter "clinics") and whether trends differ by sociodemographic subpopulations. STUDY DESIGN: Analysis of serial, cross-sectional, nationally representative in-person household surveys, the 1997-2013 National Health Interview Surveys, was conducted to identify children with a usual source of care (n = 190 571), and the percentage receiving that care in a clinic. We used joinpoint regression to identify changes in linear trends, and logistic regression with predictive margins to obtain per-year changes in percentages, both unadjusted and adjusted for sociodemographic factors. Interaction terms in logistic regressions were used to assess whether trends varied by sociodemographic subgroups. RESULTS: Of all children with a usual source of care, the percentage receiving that care in a clinic declined 0.44 percentage points per year (P < .001) from 22.97% in 1997 to 19.31% in 2002. Thereafter, it increased approximately 0.57 percentage points per year (P < .001), reaching 26.1% in 2013. Trends for some sociodemographic subgroups varied from these overall trends. No changes were observed between 2003 and 2013 for non-Hispanic black and Medicaid/State Children's Health Insurance Program insured children. CONCLUSIONS: This study shows that, although the percentage of children with a usual source of care in a clinic declined between 1997 and 2002, it has steadily increased since that time. |
Biomarkers of nutrition for development - folate review
Bailey LB , Stover PJ , McNulty H , Fenech MF , Gregory JF 3rd , Mills JL , Pfeiffer CM , Fazili Z , Zhang M , Ueland PM , Molloy AM , Caudill MA , Shane B , Berry RJ , Bailey RL , Hausman DB , Raghavan R , Raiten DJ . J Nutr 2015 145 (7) 1636S-80S The Biomarkers of Nutrition for Development (BOND) project is designed to provide evidence-based advice to anyone with an interest in the role of nutrition in health. Specifically, the BOND program provides state-of-the-art information and service with regard to selection, use, and interpretation of biomarkers of nutrient exposure, status, function, and effect. To accomplish this objective, expert panels are recruited to evaluate the literature and to draft comprehensive reports on the current state of the art with regard to specific nutrient biology and available biomarkers for assessing nutrients in body tissues at the individual and population level. Phase I of the BOND project includes the evaluation of biomarkers for 6 nutrients: iodine, iron, zinc, folate, vitamin A, and vitamin B-12. This review represents the second in the series of reviews and covers all relevant aspects of folate biology and biomarkers. The article is organized to provide the reader with a full appreciation of folate's history as a public health issue, its biology, and an overview of available biomarkers (serum folate, RBC folate, and plasma homocysteine concentrations) and their interpretation across a range of clinical and population-based uses. The article also includes a list of priority research needs for advancing the area of folate biomarkers related to nutritional health status and development. |
Dietary intake of polyunsaturated fatty acids and fish among US children 12-60 months of age
Keim SA , Branum AM . Matern Child Nutr 2015 11 (4) 987-98 This study aimed to estimate intake of individual polyunsaturated fatty acids (PUFAs), identify major dietary sources of PUFAs and estimate the proportion of individuals consuming fish among US children 12-60 months of age, by age and race and ethnicity. The study employed a cross-sectional design using US National Health and Nutrition Examination Survey data. Representative sample of US population based on selected counties. SUBJECTS: 2496 US children aged 12-60 months. Mean daily intake of n-6 PUFAs and eicosapentaenoic acid (EPA) varied by age, with children 12-24 months of age having lower average intakes (mg or g day(-1) ) than children 49-60 months of age and the lowest n6 : n3 ratio, upon adjustment for energy intake. Docosahexaenoic acid (DHA) intake was low (20 mg day(-1) ) compared to typical infant intake and did not change with age. Compared to non-Hispanic white children, Mexican American children had higher DHA and arachidonic acid (AA) intake. In the previous 30 days, 53.7% of children ever consumed fish. Non-Hispanic black children were more likely than non-Hispanic white children to have consumed fish (64.0% vs. 53.0%). Results indicate low prevalence of fish intake and key n-3 PUFAs, relative to n-6 fatty acids, which suggests room for improvement in the diets of US children. More research is needed to determine how increasing dietary intakes of n-3 PUFAs like DHA could benefit child health. |
What do firefighters desire from the next generation of personal protective equipment? outcomes from an international survey
Lee JY , Park J , Park H , Coca A , Kim JH , Taylor NA , Son SY , Tochihara Y . Ind Health 2015 53 (5) 434-44 The purpose of this study was to investigate smart features required for the next generation of personal protective equipment (PPE) for firefighters in Australia, Korea, Japan, and the USA. Questionnaire responses were obtained from 167 Australian, 351 Japanese, 413 Korean, and 763 U.S. firefighters (1,611 males and 61 females). Preferences concerning smart features varied among countries, with 27% of Korean and 30% of U.S. firefighters identifying 'a location monitoring system' as the most important element. On the other hand, 43% of Japanese firefighters preferred 'an automatic body cooling system' while 21% of the Australian firefighters selected equally 'an automatic body cooling system' and 'a wireless communication system'. When asked to rank these elements in descending priority, responses across these countries were very similar with the following items ranked highest: 'a location monitoring system', 'an automatic body cooling system', 'a wireless communication system', and 'a vision support system'. The least preferred elements were 'an automatic body warming system' and 'a voice recording system'. No preferential relationship was apparent for age, work experience, gender or anthropometric characteristics. These results have implications for the development of the next generation of PPE along with the international standardisation of the smart PPE. |
Fatal work-related injuries: southeastern United States, 2008-2011
Brinker K , Jacobs T , Shire J , Bunn T , Chalmers J , Dang G , Flammia D , Higgins S , Lackovic M , Lavender A , Lewis JS , Li Y , Harduar Morano L , Porter A , Rauscher K , Slavova S , Watkins S , Zhang L , Funk R . Workplace Health Saf 2015 64 (4) 135-40 In 2008, the work-related injury fatality rate was 3.8 per 100,000 workers in the United States but was 5.2 per 100,000 workers for the southeast region. Work-related fatalities in the southeast were examined for the period 2008 to 2011. Median work-related injury fatality rates are reported for the southeast region, each of the 12 states, and the United States. The percentages of employees in high fatality industries and work-related fatalities by cause were calculated. Finally, the Occupational Safety and Health Administration's database was searched for fatality reports. States with the highest rates (per 100,000 workers) included Arkansas (7.2), Louisiana (6.8), and West Virginia (6.6). Arkansas, Louisiana, Mississippi, and West Virginia each had more than 20% of their employees in high fatality industries. Forty percent of work-related injury fatalities were from transportation incidents in the southeast and the United States. Future analyses should include work-related injury fatality rates by industry and compare rates with other U.S. regions. |
Comparative respiratory morbidity of former and current US coal miners
Halldin CN , Wolfe AL , Laney AS . Am J Public Health 2015 105 (12) e1-e2 We compared the prevalence of pneumoconiosis and impaired lung function in former and current US coal miners. We collected prevalence ratios (PRs) of respiratory disease from chest radiographs and lung functions collected from 2009 to 2013 among miners of the Appalachian and Interior US coalfields. Significantly higher prevalences of pneumoconiosis (PR = 1.5; 95% confidence interval = 1.2, 2.0) and impaired lung function were observed among former miners compared with active miners. Former miners continue to suffer negative health effects from occupational coal mine dust exposure. The respiratory health of active and former miners is a global concern because international coal production is projected to increase for decades to come. |
Evaluation of case management of uncomplicated malaria in Haiti: a national health facility survey, 2012
Landman KZ , Jean SE , Existe A , Akom EE , Chang MA , Lemoine JF , Mace KE . Malar J 2015 14 (1) 394 BACKGROUND: Malaria is a public health concern in Haiti, although there are limited data on its burden and case management. National malaria guidelines updated in 2012 recommend treatment with chloroquine and primaquine. In December 2012, a nationally-representative cross-sectional survey of health facilities (HFs) was conducted to determine malaria prevalence among febrile outpatients and malaria case management quality at baseline before scale-up of diagnostics and case management training. METHODS: Among all 833 HFs nationwide, 30 were selected randomly, in proportion to total HFs per region, for 2-day evaluations. Survey teams inventoried HF material and human resources. Outpatients of all ages were screened for temperature >37.5 degrees C or history of fever; those without severe symptoms were consented and enrolled. Providers evaluated and treated enrolled patients according to HF standards; the survey teams documented provider-ordered diagnostic tests and treatment decisions. Facility-based test results [microscopy and malaria rapid diagnostic tests (RDTs)] were collected from HF laboratories. Blood smears for gold-standard microscopy, and dried blood spots for polymerase chain reaction (PCR) were obtained. RESULTS: Malaria diagnostic capacity, defined as completing a test for an enrolled patient or having adequate resources for RDTs or microscopy, was present in 11 (37 %) HFs. Among 459 outpatients screened, 257 (56 %) were febrile, of which 193 (75 %) were eligible, and 153 (80 %) were enrolled. Among 39 patients with facility-level malaria test results available on the survey day, 11 (28 %) were positive, of whom 6 (55 %) were treated with an anti-malarial. Twenty-seven (95 %) of the 28 patients testing negative were not treated with an anti-malarial. Of 114 patients without test results available, 35 (31 %) were presumptively treated for malaria. Altogether, 42 patients were treated with an anti-malarial, one (2 %) according to Haiti's 2012 guidelines. Of 140 gold-standard smears, none were positive, although one patient tested positive by PCR, a more sensitive technique. The national prevalence of malaria among febrile outpatients is estimated to be 0.5 % (95 % confidence interval 0-1.7 %). CONCLUSIONS: Malaria is an uncommon cause of fever in Haitian outpatients, and limited, often inaccurate, diagnostic capacity at baseline contributes to over diagnosis. Scale-up of diagnostics and training on new guidelines should improve malaria diagnosis and treatment in Haiti. |
Intravenous artesunate for the treatment of severe and complicated malaria in the United States: clinical use under an investigational new drug protocol
Twomey PS , Smith BL , McDermott C , Novitt-Moreno A , McCarthy W , Kachur SP , Arguin PM . Ann Intern Med 2015 163 (7) 498-506 BACKGROUND: Quinidine gluconate, the only U.S. Food and Drug Administration-approved treatment for life-threatening malaria in the United States, has a problematic safety profile and is often unavailable in hospitals. OBJECTIVE: To assess the safety and clinical benefit of intravenous artesunate as an alternative to quinidine. DESIGN: Retrospective case series. SETTING: U.S. hospitals. PATIENTS: 102 patients aged 1 to 72 years (90% adults; 61% men) with severe and complicated malaria. Patients received 4 weight-based doses of intravenous artesunate (2.4 mg/kg) under a treatment protocol implemented by the Centers for Disease Control and Prevention between January 2007 and December 2010. At baseline, 35% had evidence of cerebral malaria, and 17% had severe hepatic impairment. Eligibility required the presence of microscopically confirmed malaria, need for intravenous treatment, and an impediment to quinidine. MEASUREMENTS: Clinical and laboratory data from each patient's hospital records were abstracted retrospectively, including information from baseline through a maximum 7-day follow-up, and presented before a physician committee to evaluate safety and clinical benefit outcomes. RESULTS: 7 patients died (mortality rate, 6.9%). The most frequent adverse events were anemia (65%) and elevated hepatic enzyme levels (49%). All deaths and most adverse events were attributed to the severity of malaria. Patients' symptoms generally improved or resolved within 3 days, and the median time to discharge from the intensive care unit was 4 days, even for patients with severe liver disease or cerebral malaria. More than 100 concomitant medications were used, with no documented drug-drug interactions. LIMITATION: Potential late-presenting safety issues might occur outside the 7-day follow-up. CONCLUSION: Artesunate was a safe and clinically beneficial alternative to quinidine. PRIMARY FUNDING SOURCE: Office of the Surgeon General, Department of the U.S. Army. |
Do patients at sites with high RCT enrollment propensity have better outcomes?
O'Malley AJ , Zelevinsky K , He Y , Busch AB . Med Care 2015 53 (11) 989-95 BACKGROUND: Concerns about randomized controlled trial (RCT) generalizability typically center on characteristics of RCT patient participants. Possibly there are RCT site characteristics that distinguish RCT outcomes from those that can be expected in non-RCT settings. OBJECTIVES: To examine whether site propensity toward RCT enrollment is associated with recovery outcomes for patients and whether the association differs between patients who participate in a RCT compared with those who remain in an observational (OBS) treatment environment. DATA: Study participants with acute bipolar depression from The Systematic Treatment Enhancing Program for Bipolar Disorder acute depression pharmacotherapy RCT (N=337) and OBS treatment arm (N=1581). METHODS: A longitudinal OBS study comparing the likelihood of recovery in the RCT to the OBS arm, allowing effect modification by site high RCT enrollment propensity (defined as >the median) and other predictors over a 6-month follow-up period. RESULTS: Non-RCT participants who received care in sites with high RCT enrollment propensity had a higher probability of recovering from their bipolar-depression episode compared with participants from low propensity sites [odds ratio (95% confidence interval)=2.13 (1.28-3.55)]. RCT enrollment propensity was not associated with recovery outcomes for RCT participants [1.03 (0.35-3.03)]. CONCLUSIONS: Sites with high propensity to enroll patients in RCTs appear to have unobserved characteristics, which play a significant role in outcomes for non-RCT patients. For RCT participants in low-enrollment sites, possibly RCT protocols, which proscribe care delivery and monitoring, attenuate this effect. These results have implications for future research to improve outcomes in nonresearch care settings. |
State legislators' sources and use of information: bridging the gap between research and policy
Dodson EA , Geary NA , Brownson RC . Health Educ Res 2015 30 (6) 840-8 Research can inform policymakers of public health issues and shape policy decisions, hopefully benefiting public health; thus, improving dissemination of research to policymakers is important for developing effective public health policies that improve health and health equity. However, the utilization of research among policymakers is often not fully realized. This study builds upon current knowledge about what types of information legislators seek when working on health issues and where they go for information. Further, it explores what kinds of information legislators find most helpful and if there are ways researchers could better provide this evidence. Key-informant interviews were conducted with 25 U.S. state legislators holding health committee leadership positions between July and November, 2010. Regarding types of information sought, most legislators discussed their desire for data and statistics when working on health-related issues. When asked about their most trusted sources of information, participants mentioned government sources as well as advocacy, lobby and industry groups. A few mentioned universities and healthcare professionals. Results from this study offer public health researchers and practitioners' insights into the types of information that may be most helpful to policymakers. Insights gathered may improve the dissemination of research and bridge the gap between knowledge users and knowledge producers. |
Do state community health worker laws align with best available evidence?
Barbero C , Gilchrist S , Chriqui JF , Martin MA , Wennerstrom A , VanderVeur J , Prewitt K , Brownstein JN . J Community Health 2015 41 (2) 315-25 Community health workers (CHWs) are expected to improve patient care and population health while reducing health care costs. Law is a tool states are using to build a supportive infrastructure for the CHW workforce. This study assessed the extent existing state law pertaining to the CHW workforce aligned with best available evidence. We used the previously developed Quality and Impact of Component (QuIC) Evidence Assessment method to identify and prioritize those components that could comprise an evidence-informed CHW policy at the state level. We next assessed the extent codified statutes and regulations in effect as of December 31, 2014 for the 50 states and D.C. included the components identified in the evidence assessment. Fourteen components of an evidence-informed CHW policy were identified; eight had best, three had promising, and three had emerging evidence bases. Codified law in 18 states (35.3 % of 51) pertained to the CHW workforce. Fifteen of these 18 states authorized at least one of the 14 components from the evidence assessment (maximum: nine components, median: 2.5). The most frequently authorized component was a defined scope of practice for CHWs (authorized by eight states) followed by a standard core competency curriculum and inclusion of CHWs in multidisciplinary health care teams (each authorized by six states). States could consider the components presented in this article when developing new or strengthening existing law. |
Trends in quit attempts among adult cigarette smokers - United States, 2001-2013
Lavinghouze SR , Malarcher A , Jama A , Neff L , Debrot K , Whalen L . MMWR Morb Mortal Wkly Rep 2015 64 (40) 1129-35 What is already known on this topic? Quitting smoking is beneficial to health at any age, and cigarette smokers who quit before age 35 years have mortality rates similar to those of persons who never smoked. What is added by this report?During 2001-2010, the proportion of adult cigarette smokers who had made a quit attempt in the past year increased significantly in 29 states and the U.S. Virgin Islands. During 2011-2013, the proportion who had made a quit attempt increased in Hawaii and Puerto Rico and decreased in New Mexico. In 2013, the proportion who had made a quit attempt ranged from 56.2% (Kentucky) to 76.4% (Puerto Rico and Guam) with a median of 65.9%, and was generally lower in older age groups. What are the implications for public health practice? Continued implementation of effective evidence-based public health interventions can reduce the health and costs impacts of smoking-related disease and death and accelerate progress toward meeting the Healthy People 2020 target to increase to >/=80% the proportion of U.S. adult cigarette smokers who made a quit attempt in the past year. These interventions include increasing the price of tobacco products, implementing comprehensive smoke-free laws, conducting educational mass media campaigns, and providing insurance coverage for all effective cessation treatments as well as access to quitlines. |
Google searches or quit attempts as a success measure for an antismoking campaign
McAfee T , Davis KC , Cox SN , Beistle DM . Am J Prev Med 2015 49 (6) e131-2 In a recent study by Ayers et al.,1 the authors analyzed Google search patterns associated with health conditions depicted in CDC’s national tobacco education campaign, Tips From Former Smokers (Tips). Although examining search trends to inform the effectiveness of health campaigns holds promise, the authors make a number of statements that we, as the principal scientists and campaign managers, disagree with. | First, the authors state that “Tips is the nation’s most costly tobacco control initiative.” To put the cost of Tips (approximately $50 million annually) into perspective, this amount represents less than 2 days of what the tobacco industry spends in a year ($8 billion) on tobacco promotion. States also spend approximately $500 million yearly on integrated tobacco control. A recent study2 demonstrated that the Tips campaign was a highly cost-effective initiative, based on often-used benchmarks for public health interventions. | Second, the authors state that “little is known about [the Tips campaign’s] effectiveness,” citing a 2013 study published in Lancet.3 However, this study was a rigorous evaluation of campaign effectiveness, based on a large, nationally representative, longitudinal cohort of smokers and nonsmokers in the U.S. The campaign was responsible for approximately 1.6 million new quit attempts, with an estimated 100,000 of these sustained for at least 6 months. In addition, the 2012 Tips campaign was associated with increased knowledge of the health conditions featured in Tips ads, increased motivation to quit, and increased smoking-related concerns about health.4 | Third, the authors posit that Tips was no longer effective in 2013. CDC has closely tracked calls to the 1-800-QUIT-NOW quitline, which showed increases directly associated with campaign tags in 2012 and 2013.5 In 2013, there were marked increases in calls in the alternating weeks the campaign was on the air (Figure 1). In addition, an independent prospective cohort study of smokers found that 71% saw at least one 2013 Tips ad and the campaign increased awareness of health risks and cessation resources.6 |
Cigarette smoking prevalence among adults working in the health care and social assistance sector, 2008 to 2012
Syamlal G , Mazurek JM , Storey E , Dube SR . J Occup Environ Med 2015 57 (10) 1107-12 OBJECTIVE: The primary objective of this study was to estimate current smoking among workers in the health care and social assistance sector. METHODS: We analyzed the 2008 to 2012 National Health Interview Survey data for adults (age 18 years or more) working in health care and social assistance sector who reported current cigarette smoking. RESULTS: Of the approximately 18.9 million health care and social assistance workers, 16.0% were current cigarette smokers. Smoking prevalence was highest in women (16.9%) and among workers: age 25 to 44 years (17.7%); with a high school education or less (24.4%); with income less than $35,000 (19.5%); with no health insurance (28.5%); in the nursing and residential care facilities (26.9%) industry; and in the material recording, scheduling, dispatching, and distributing (34.7%) occupations. CONCLUSIONS: These findings suggest that specific group of workers in the health care and social assistance sector might particularly benefit from cessation programs and incentives to quit smoking. |
Cigarette, cigar, and marijuana use among high school students - United States, 1997-2013
Rolle IV , Kennedy SM , Agaku I , Jones SE , Bunnell R , Caraballo R , Xu X , Schauer G , McAfee T . MMWR Morb Mortal Wkly Rep 2015 64 (40) 1136-41 What is already known on this topic? Since 2010, the proportion of U.S. 12th grade students who reported using marijuana during the preceding 30 days (21.4%) has surpassed the proportion reporting use of cigarettes during the preceding 30 days (19.2%).What is added by this report? During 1997-2013, the proportion of white, black, and Hispanic high school students overall who were exclusive cigarette or cigar users decreased 64%, from 20.5% to 7.4%. The proportion of white, black, and Hispanic students who were exclusive marijuana users more than doubled from 4.2% to 10.2%, and among cigarette or cigar users, marijuana use increased, with considerable increases identified among black and Hispanic students toward the end of the study period.What are the implications for public health practice? Despite significant declines since 1997, approximately 30% of white, black, and Hispanic U.S. high school students were current users of cigarettes, cigars, or marijuana in 2013. Policy and programmatic efforts might benefit from integrated approaches that focus on reducing the use of tobacco and marijuana among youths. |
Controlled substance prescribing patterns - Prescription Behavior Surveillance System, eight states, 2013
Paulozzi LJ , Strickler GK , Kreiner PW , Koris CM . MMWR Surveill Summ 2015 64 (9) 1-14 PROBLEM/CONDITION: Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of >100 morphine milligram equivalents (MMEs) per day. PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. POPULATION: Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. RESULTS: In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines. Prescribing rates by drug class varied widely by state: twofold for opioids, fourfold for stimulants, almost twofold for benzodiazepines, and eightfold for carisoprodol, a muscle relaxant. Rates for opioids and benzodiazepines were substantially higher for females than for males in all states. In most states, opioid prescribing rates peaked in either the 45-54 years or the 55-64 years age group. Benzodiazepine prescribing rates increased with age. Louisiana ranked first in opioid prescribing, and Delaware and Maine had relatively high rates of use of long-acting (LA) or extended-release (ER) opioids. Delaware and Maine ranked highest in both mean daily opioid dosage and in the percentage of opioid prescriptions written for >100 MMEs per day. The top 1% of prescribers wrote one in four opioid prescriptions in Delaware, compared with one in eight in Maine. For the five states whose PDMPs collected the method of payment, the percentage of controlled substance prescriptions paid for in cash varied almost threefold, and the percentage paid by Medicaid varied sixfold. In West Virginia, for 1 of every 5 days of treatment with an opioid, the patient also was taking a benzodiazepine. Multiple-provider episode rates were highest in Ohio and lowest in Louisiana. INTERPRETATION: This report presents rates of population-based prescribing and behavioral measures of drug misuse in the general population that have not been available previously for comparison among demographic groups and states. The higher prescribing rates for opioids among women compared with men are consistent with a higher self-reported prevalence of certain common types of pain, such as lower back pain among women. The trend in opioid prescribing rates with age is consistent with an increase in the prevalence of chronic pain with age, but the increasing prescribing rates of benzodiazepines with age is not consistent with the fact that anxiety is most common among persons aged 30-44 years. The variation among states in the type of opioid or benzodiazepine of choice is unexplained. Most opioid prescribing occurs among a small minority of prescribers. Most of the prescriptions by top-decile prescribers probably are written by general, family medicine, internal medicine, and midlevel practitioners. The source of payment varied by state, for reasons that are unclear. Persons who are prescribed opioids also are commonly prescribed benzodiazepine sedatives despite the risk for additive depressant effects. PUBLIC HEALTH ACTIONS: States can use their prescription drug monitoring programs to generate population-based measures for the prescribing of controlled substances and for behaviors that suggest their misuse. Comparing data with other states and tracking changes in these measures over time can be useful in measuring the effect of policies designed to reduce prescription drug misuse. |
Improving mortality data in Jordan: a 10 year review
Dababneh F , Nichols EK , Asad M , Haddad Y , Notzon F , Anderson R . Bull World Health Organ 2015 93 (10) 727-731 PROBLEM: Before 2003 there was substantial underreporting of deaths in Jordan. The death notification form did not comply with World Health Organization (WHO) guidelines and information on the cause of death was often missing, incomplete or inaccurate. APPROACH: A new mortality surveillance system to determine the causes of death was implemented in 2003 and a unit for coding causes of death was established at the ministry of health. LOCAL SETTING: Jordan is a middle-income country with a population of 6.4 million people. Approximately 20 000 deaths were registered per year between 2005 and 2011. RELEVANT CHANGES: In 2001, the ministry of health organized the first meeting on Jordan’s mortality system, which yielded a five-point plan to improve mortality statistics. Using the recommendations produced from this meeting, in 2003 the ministry of health initiated a mortality statistics improvement project in collaboration with international partners. Jordan has continued to improve its mortality reporting system, with annual reporting since 2004. Reports are based on more than 70% of reported deaths. The quality of cause-of-death information has improved, with only about 6% of deaths allocated to symptoms and ill-defined conditions – a substantial decrease from the percentage before 2001 (40%). Mortality information is now submitted to WHO following international standards. LESSONS LEARNT: After 10 years of mortality surveillance in Jordan, the reporting has improved and the information has been used by various health programmes throughout Jordan. |
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