Accuracy of NHANES periodontal examination protocols
Eke PI , Thornton-Evans GO , Wei L , Borgnakke WS , Dye BA . J Dent Res 2010 89 (11) 1208-13 This study evaluates the accuracy of periodontitis prevalence determined by the National Health and Nutrition Examination Survey (NHANES) partial-mouth periodontal examination protocols. True periodontitis prevalence was determined in a new convenience sample of 454 adults ≥ 35 years old, by a full-mouth "gold standard" periodontal examination. This actual prevalence was compared with prevalence resulting from analysis of the data according to the protocols of NHANES III and NHANES 2001-2004, respectively. Both NHANES protocols substantially underestimated the prevalence of periodontitis by 50% or more, depending on the periodontitis case definition used, and thus performed below threshold levels for moderate-to-high levels of validity for surveillance. Adding measurements from lingual or interproximal sites to the NHANES 2001-2004 protocol did not improve the accuracy sufficiently to reach acceptable sensitivity thresholds. These findings suggest that NHANES protocols produce high levels of misclassification of periodontitis cases and thus have low validity for surveillance and research. |
An outbreak of hepatitis A among primary and secondary contacts of an international adoptee
Pelletier AR , Mehta PJ , Burgess DR , Bondeson LM , Carson PJ , Rea VE , Sharapov UM , Hu DJ . Public Health Rep 2010 125 (5) 642-6 The Advisory Committee on Immunization Practices recommends that susceptible people traveling to developing countries receive hepatitis A vaccine or immune globulin prior to departure. Until 2009, the recommendations did not address non-traveling family members or other close contacts of international adoptees. We report an outbreak of hepatitis A in 2008 that occurred in Maine. Eight members of an extended family developed hepatitis A following the arrival of an asymptomatic infant from Ethiopia who was brought to the United States by an adoption agency. Two children in the family attended an elementary school where five additional cases of hepatitis A were subsequently identified. Only three (1%) of 208 students at the school had previously been immunized against hepatitis A. This outbreak highlights the need to immunize household members and other close contacts of families adopting children from countries where hepatitis A is endemic, as well as all children at one year of age. |
Guidelines for the laboratory diagnosis of trichomoniasis in East European countries
Domeika M , Zhurauskaya L , Savicheva A , Frigo N , Sokolovskiy E , Hallen A , Unemo M , Ballard RC . J Eur Acad Dermatol Venereol 2010 24 (10) 1125-1134 The laboratory diagnosis of sexually transmitted infections in many Eastern European countries remains suboptimal. The main objective of the present evidence-based guidelines is to provide comprehensive information regarding the laboratory diagnosis of infections caused by Trichomonas vaginalis in East European countries. In particular, the present guidelines recommend: (i) to encourage examination of the wet mounts of vaginal exudates, instead of stained smears, at all clinical settings; (ii) nucleic acid amplification tests (NAATs) or culture could be employed if no trichomonads are detected on microscopic examination of the wet preparation and there is a strong indication of infection and (iii) the use of NAATs is encouraged in screening, using non-invasive specimens, or high volume testing situations. In the absence of internationally recognized commercial NAAT systems, tests developed in-house should be validated using obtainable international standards and quality assured strictly. Individual East European countries may be required to make minor national adjustments to these guidelines as a result of lack of accessibility to some reagents or equipment, or laws in a specific country. |
Bloodstream infections among HIV-infected outpatients, Southeast Asia
Varma JK , McCarthy KD , Tasaneeyapan T , Monkongdee P , Kimerling ME , Buntheoun E , Sculier D , Keo C , Phanuphak P , Teeratakulpisarn N , Udomsantisuk N , Dung NH , Lan NT , Yen NT , Cain KP . Emerg Infect Dis 2010 16 (10) 1569-1575 Bloodstream infections (BSIs) are a major cause of illness in HIV-infected persons. To evaluate prevalence of and risk factors for BSIs in 2,009 HIV-infected outpatients in Cambodia, Thailand, and Vietnam, we performed a single Myco/F Lytic blood culture. Fifty-eight (2.9%) had a clinically significant BSI (i.e., a blood culture positive for an organism known to be a pathogen). Mycobacterium tuberculosis accounted for 31 (54%) of all BSIs, followed by fungi (13 [22%]) and bacteria (9 [16%]). Of patients for whom data were recorded about antiretroviral therapy, 0 of 119 who had received antiretroviral therapy for ≥14 days had a BSI, compared with 3% of 1,801 patients who had not. In multivariate analysis, factors consistently associated with BSI were fever, low CD4+ T-lymphocyte count, abnormalities on chest radiograph, and signs or symptoms of abdominal illness. For HIV-infected outpatients with these risk factors, clinicians should place their highest priority on diagnosing tuberculosis. |
Sampling frequency differentially influences interpretation of zoonotic pathogen and host dynamics: Sin Nombre virus and deer mice
Carver S , Mills JN , Kuenzi A , Flietstra T , Douglass R . Vector Borne Zoonotic Dis 2010 10 (6) 575-83 Reports of novel emerging and resurging wildlife and zoonotic diseases have increased. Consequently, integration of pathogen sampling into wildlife monitoring programs has grown. Sampling frequency influences interpretations of coupled host-pathogen dynamics, with direct implication to human exposure risk, but has received little empirical attention. To address this, a 15-year study, based on monthly sampling, of deer mouse (Peromyscus maniculatus) populations and Sin Nombre virus (SNV; a virulent disease in humans) dynamics was evaluated. Estimates of deer mouse abundance, number infected with SNV, and SNV prevalence from sampling less frequently than each month (achieved by deletion of months and recalculation of these parameters) were compared to monthly sampling frequencies. Deer mouse abundance was underestimated (10%-20%), SNV prevalence was overestimated when prevalence was high (>15%), and fewer annual extremes of abundance and infection were detected when sampling frequency was less than monthly. Effort necessary to detect temporal dynamics of SNV differed from effort to detect demographic patterns in deer mouse abundance. Findings here are applicable to sampling strategies for other host-pathogen dynamics and have direct implications for allocation of public health resources and intervention programs. |
Fatal apophysomyces elegans infection transmitted by deceased donor renal allografts
Alexander BD , Schell WA , Siston AM , Rao CY , Bower WA , Balajee SA , Howell DN , Moore ZS , Noble-Wang J , Rhyne JA , Fleischauer AT , Maillard JM , Kuehnert M , Vikraman D , Collins BH , Marroquin CE , Park BJ . Am J Transplant 2010 10 (9) 2161-7 Two patients developed renal mucormycosis following transplantation of kidneys from the same donor, a near-drowning victim in a motor vehicle crash. Genotypically, indistinguishable strains of Apophysomyces elegans were recovered from both recipients. We investigated the source of the infection including review of medical records, environmental sampling at possible locations of contamination and query for additional cases at other centers. Histopathology of the explanted kidneys revealed extensive vascular invasion by aseptate, fungal hyphae with relative sparing of the renal capsules suggesting a vascular route of contamination. Disseminated infection in the donor could not be definitively established. A. elegans was not recovered from the same lots of reagents used for organ recovery or environmental samples and no other organ transplant-related cases were identified. This investigation suggests either isolated contamination of the organs during recovery or undiagnosed disseminated donor infection following a near-drowning event. Although no changes to current organ recovery or transplant procedures are recommended, public health officials and transplant physicians should consider the possibility of mucormycosis transmitted via organs in the future, particularly for near-drowning events. Attention to aseptic technique during organ recovery and processing is re-emphasized. |
Selecting adequate exposure biomarkers of diisononyl and diisodecyl phthalates: Data from the 2005-2006 National Health and Nutrition Examination Survey
Calafat AM , Wong LY , Silva MJ , Samandar E , Preau JJ , Jia LT , Needham LL . Environ Health Perspect 2010 119 (1) 50-5 BACKGROUND: High-molecular weight phthalates, such as diisononyl phthalate (DINP) and diisodecyl phthalate (DIDP), are used primarily as polyvinylchloride plasticizers. OBJECTIVES: To assess exposure to DINP and DIDP in a representative sample of persons aged 6 years and older in the U.S. general population from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). METHODS: We analyzed 2,548 urine samples by using online solid-phase extraction coupled to isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. RESULTS: We detected monocarboxyisooctyl phthalate (MCOP), a metabolite of DINP, and monocarboxyisononyl phthalate (MCNP), a metabolite of DIDP, in 95.2% and 89.9% of the samples, respectively. We detected monoisononyl phthalate (MNP), a minor metabolite of DINP, much less frequently (12.9%) and at concentration ranges (>0.8 microg/L-148.1 microg/L) much lower than MCOP (>0.7 microg/L- 4,961 microg/L). Adjusted geometric mean concentrations of MCOP and MCNP were significantly higher (P<0.01) among children than among adolescents and adults. CONCLUSIONS: The general U.S. population, including children, was exposed to DINP and DIDP. In previous NHANES cycles, the occurrence of human exposure to DINP by using MNP as the sole urinary biomarker has been underestimated, thus illustrating the importance of selecting the most adequate biomarkers for exposure assessment. |
Alkyllead compounds and their environmental toxicology
Abadin HG , Pohl HR . Met Ions Life Sci 2010 7 153-64 Alkyllead compounds are man-made compounds in which a carbon atom of one or more organic molecules is bound to a lead atom. Tetraethyllead and tetramethyllead are the most common alkyllead compounds that were used primarily as gasoline additives for many years. Consequently, auto emissions have accounted for a major part of lead environmental pollution. Alkyllead compounds can readily enter living organisms as they are well absorbed via all major routes of entry. Because of their lipid solubility, the alkylleads can also readily cross the blood-brain barrier. The toxicokinetic information on organic lead can be used as biomarkers of exposure for monitoring exposed individuals. The organic alkyllead compounds are more toxic than the inorganic forms of lead. Neurotoxicity is the predominant effect of lead (both for organic and inorganic forms), although lead affects almost every organ of the body. The use of alkyllead compounds has declined over the last 20 years, due to the worldwide effort to eliminate the use of leaded gasoline. This achievement can be viewed as a great accomplishment of public health preventive measures. |
Using birth certificate data to determine medically indicated induction rates
Callaghan WM . Am J Obstet Gynecol 2010 203 (3) 190-1 Induction of labor is increasing in the United States; the most recent national estimate is that approximately 1 in 5 births follow a labor that was medically induced.1 Although the reasons for this increase are not entirely clear, labor induction when there is no medical indication to effect delivery may play a role in this increase. The issue of elective induction is particularly important for deliveries at late preterm and early term gestations. Late preterm births (34-36 weeks of gestation) make up 71% of all preterm births in the United States.2 Although infants who are born at 37-38 weeks of gestation traditionally are considered to be “term,” neonatal morbidity continues to decrease with each week of gestation until 39 weeks.3 Hence, the American College of Obstetricians and Gynecologists clinical management guidelines require that there be documentation of gestational age of at least 39 weeks at the time of induction in the absence of maternal and/or fetal indications for delivery.4 In this context, it is an important public health issue to be able to track late preterm and early term births accurately after induced labor where there is no apparent medical reason for delivery and to use that information to inform clinical policy. |
An expanded public health role for birth defects surveillance
Correa A , Kirby RS . Birth Defects Res A Clin Mol Teratol 2010 88 (12) 1004-7 Through the early 20th century, the human uterus was thought to protect the developing fetus from maternal infections and environmental exposures. However, in the 1940s the first case reports of maternal rubella infection being linked to birth defects appeared in the literature, and, in the early 1960s, it was understood that maternal use of thalidomide caused an epidemic of limb deficiencies. These sentinel events led to the realization that maternal infections and other environmental factors could cause birth defects. This realization, in turn, led to the establishment of birth defects surveillance systems in the United States and other countries. | Public health surveillance is defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health in the population (Thacker and Berkelman, 1992; CDC, 2001). Birth defects surveillance data have been used for public health action, program planning and evaluation, and formulating research hypotheses. Some examples of the types of public health action for which birth defects surveillance data have been used include the following: | Guiding action for issues of public health importance or concern. Birth defects surveillance data have been useful in evaluating community concerns about specific environmental exposures (e.g., water fluoridation, airport noise, air pollution) and birth defects (Erickson et al., 1976; Edmonds et al., 1979; Strickland et al., 2009), as well as for addressing concerns about clusters of birth defects possibly associated with less well-defined environmental factors (Calvert et al., 2007; Kucik et al., 2008). | Quantifying the burden of disease. Birth defects surveillance data have been useful in documenting the prevalence of major birth defects in the population (Correa et al., 2007; Rynn et al., 2008), the birth prevalence for specific defects such as Down syndrome, neural tube defects, and heart defects (Siffel et al., 2004; Canfield et al., 2006; Reller et al., 2008), as well as the prevalence of spina bifida and Down syndrome among children and adolescents (Shin et al., 2008; Shin et al., 2009). | Identifying populations at risk and/or health disparities. Birth defects surveillance data have been useful in identifying a higher prevalence of neural tube defects among Hispanics as compared to non-Hispanic whites in the United States (Kirby et al., 2000; Canfield et al., 2006). Similarly, linkages of birth defects surveillance data with vital status data have been useful in identifying race/ethnic disparities in survival for several defects (Dott et al., 2003; Rasmussen et al., 2006; Yang et al., 2006). Such studies have stimulated more research into possible determinants of such disparities in prevalence and survival. | Monitoring trends in the prevalence of birth defects. Birth defects surveillance data have been important in documenting decreasing trends in the prevalence of congenital rubella in relation to declining prevalence of maternal rubella infections (Cochi et al., 1989), trends in prevalence of selected birth defects before and after folic acid fortification (Canfield et al., 2005; Botto et al., 2006), and trends in the prevalence of gastroschisis (Williams et al., 2005; Loane et al., 2007), hypospadias (Carmichael et al., 2003; Dolk et al., 2004; Nassar et al., 2007), and congenital heart defects (Botto et al., 2001). | Evaluating outcomes among children with birth defects. Birth defects surveillance data have been useful in population-based evaluations of whether children with birth defects have an increased prevalence of developmental disorders (Decoufle et al., 2001; Yazdy et al., 2008) and the survival experience of children with birth defects (Nembhard et al., 2001; Wong and Paulozzi, 2001; Cleves et al., 2003; Rasmussen et al., 2006; Copeland and Kirby, 2007; Fixler et al., 2010). | Guiding the planning, implementation, and evaluation of programs to prevent birth defects and adverse exposures. Birth defects surveillance data on the prevalence of neural tube defects and in the variation of such prevalence by race/ethnic groups in the population have been instrumental in the development, implementation, and evaluation of policies for folic acid fortification for the prevention of neural tube defects (Canfield et al., 2005; Botto et al., 2006; Bower, 2006). | Serving as case registries for epidemiologic research. Several birth defects surveillance systems have served as cases registries for epidemiologic studies, including studies of possible associations of birth defects with paternal Vietnam Veteran status (Erickson et al., 1984), maternal vitamin supplement use (Mulinare et al., 1988), diabetes (Correa et al., 2008), obesity (Watkins et al., 2003; Waller et al., 2007; Gilboa et al., 2010), smoking (Honein et al., 2007; Malik et al., 2008), assisted reproductive technologies (Bower and Hansen, 2005; Reefhuis et al., 2009), and certain medications (Reefhuis et al., 2006; Caton et al., 2009; Alwan et al., 2010). |
Improving foodborne disease prevention
Selman CA . J Environ Health 2010 73 (2) 28-9 Data for action is a simple public | health defi nition of surveillance. By | this defi nition, one form of surveillance is when food safety regulatory programs collect environmental assessment data | from food establishment inspections and | foodborne illness outbreak responses. These | environmental assessments provide valuable | data concerning the causes and antecedents | of outbreaks. Program offi cials take action, | such as a regulatory, educational, or other response, based on these data. |
Family history of diabetes and prevalence of the metabolic syndrome in U.S. adults without diabetes: 6-year results from the National Health and Nutrition Examination Survey (1999-2004).
Ghosh A , Liu T , Khoury MJ , Valdez R . Public Health Genomics 2010 13 (6) 353-9 BACKGROUND/AIMS: Type 2 diabetes and cardiovascular disease share risk factors. The influence of family history of diabetes on the odds of having metabolic syndrome has not been estimated for the U.S. population. Our objective was to quantify this association in a national sample of U.S. adults without diabetes. METHODS: The sample included 4,937 individuals from the National Health and Nutrition Examination Survey (NHANES) (1999-2004). Familial risk of diabetes was classified in 3 strata according to the combination of relatives affected. Metabolic syndrome was defined according to guidelines issued by 4 groups or organizations. The prevalence and odds of this syndrome were compared among familial risk strata after controlling for relevant risk factors. RESULTS: Overall, depending on the definition and after controlling for key variables, people with a moderate familial risk of diabetes, and people with a high familial risk of diabetes were between 1.4 and 1.6, and 1.6 and 1.8 times as likely, respectively, to have metabolic syndrome compared to people with average familial risk. CONCLUSION: In a nationally representative sample of U.S. adults without diabetes, family history of diabetes shows a significant, independent association with metabolic syndrome and its traits. This association supports the idea that shared genes and environment contribute to the expression of complex traits such as diabetes and the metabolic syndrome. |
PLoS currents: evidence on genomic tests - At the crossroads of translation.
Gwinn M , Dotson WD , Khoury MJ . PLoS Curr 2010 2 Evidence on Genomic Tests is an open access publication option for communicating high-quality, scientific information that is needed to evaluate health applications of genomic research. By using Google’s knol platform, we aim to reduce conventional barriers to sharing, updating, and accessing the results of knowledge synthesis and to increase the benefits to authors and users alike. |
Tumor gene expression profiling in women with breast cancer. Test category: prognostic.
Bellcross C , Dotson WD . PLoS Curr 2010 2 Differences in the expression of specific genes within breast tumors have been associated with risk of recurrence after treatment. Most women with Stage I or II node-negative breast cancer (especially when estrogen-receptor positive and treated with tamoxifen) remain disease-free at 10 years. Information on risk of recurrence could help identify women most likely to benefit from chemotherapy. Several clinically available gene expression profiles (GEP) provide "recurrence risk scores" that are intended to supplement information used by clinicians and patients in treatment decision-making. |
Testing of VKORC1 and CYP2C9 alleles to guide warfarin dosing. Test category: pharmacogenomic (treatment).
Grossniklaus D . PLoS Curr 2010 2 Warfarin is an oral anticoagulant that is widely prescribed to prevent thromboembolic events in persons at increased risk. The optimal dose is difficult to establish because it can vary 10-fold among individuals due to clinical and demographic factors. Testing for variants of the vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) genes has been proposed for use in guiding the initial dose of warfarin, thus achieving optimal dosing more quickly and with lower risk of bleeding. |
Risk behavior disclosure during HIV test counseling
Torrone EA , Thomas JC , Maman S , Pettifor AE , Kaufman JS , Sena AC , Hightow-Weidman LB . AIDS Patient Care STDS 2010 24 (9) (9) 551-561 Individualized risk assessments during HIV testing are an integral component of prevention counseling, a currently recommended behavioral intervention for patients in high-risk settings. Additionally, aggregate risk assessment data are the source of aggregate behavioral statistics that inform prevention programs and allocation of resources. Consequently, inaccurate or incomplete risk behavior disclosure during test counseling may impact the efficacy of the counseling intervention, as well as bias aggregate behavioral statistics. To quantify client-reported accuracy during the risk assessment and identify barriers and facilitators to risk behavior disclosure, we interviewed young men accessing HIV testing services in a southeastern United States city using mixed methodology. Data were collected from August 2007 to April 2008. Based on data collected via an audio and computer-assisted self-interview (n=203), over 30% of men reported that they were not accurate during the risk assessment. Participants reported numerous interpersonal facilitators to complete disclosure. During qualitative interviews (n=25), participants revealed that many did not understand the purpose of the risk assessment. Findings suggest that risk assessments completed during HIV test counseling may be incomplete. Modifications to the risk assessment process, including better explaining the role of the risk assessment in prevention counseling, may increase the validity of the data. Mary Ann Liebert, Inc. |
Sexual intercourse and oral sex among public middle school students: prevalence and correlates
De Rosa CJ , Ethier KA , Kim DH , Cumberland WG , Afifi AA , Kotlerman J , Loya RV , Kerndt PR . Perspect Sex Reprod Health 2010 42 (3) 197-205 CONTEXT: Early sexual initiation is associated with elevated teenage pregnancy and STD risk, yet little is known about the prevalence and correlates of sexual behavior among young adolescents. Better information is needed to guide interventions to prevent early sexual debut. METHODS: Data from a 2005 survey of 4,557 sixth-, seventh- and eighth-grade students at 14 urban public schools in Southern California were analyzed using chi-square tests and logistic regression, to identify correlates of oral sex, intercourse and both. RESULTS: Overall, 9% of youth had ever had sexual intercourse, and 8% had had oral sex. Three percent reported having had oral sex only, 4% intercourse only and 5% both. Among those who reported intercourse, 69% had used a condom at last intercourse, and 43% had had multiple partners. Being male, being black and having at least one friend who had ever been involved in a pregnancy were positively associated with having had intercourse only and both intercourse and oral sex (odds ratios, 1.7–4.2). Being in eighth grade, expecting to have intercourse in the next six months and currently having a boyfriend or girlfriend were positively associated with all three outcomes (2.1–7.2). Intercourse and oral sex were highly correlated. CONCLUSIONS: Interventions addressing oral sex, intercourse and multiple partners should begin before sixth grade and continue throughout the middle school years. Health professionals should target adolescent risk reduction counseling toward males, blacks, youth with a boyfriend or girlfriend, and those with a friend who has been involved in a pregnancy. |
Associations of selected health risk behaviors with self-rated health status among U.S. high school students
Foti K , Eaton D . Public Health Rep 2010 125 (5) 771-81 Self-rated health status (SRHS) reflects both objective information about physical and mental health and subjective interpretation of that information.1,2 Although SRHS may differ from physician ratings of health status, among adults, SRHS is a valuable predictor of health-care utilization1 and has been shown in numerous studies to predict subsequent morbidity and mortality, independent of known medical risk factors.3–5 | While the determinants and predictive value of SRHS among adults have been studied extensively, adolescent SRHS is not as well understood. Despite having much lower rates of chronic disease and disability, adolescents report only marginally better SRHS than adults.6 This discrepancy suggests that adolescent SRHS may be influenced by factors more salient to adolescents, such as health risk behavior participation,2 psychological well-being, and competence in areas such as school achievement, sports, and exercise.6–8 Patterns of health risk behaviors are often established during adolescence, extend into adulthood, and are precursors for health-care use, morbidity, and mortality among young people and adults.9,10 Adolescence is also a crucial period in the formation of health status ratings,7,10,11 which studies show remain moderately stable into young adulthood; for example, during a one- or four-year period, adolescents' initial SRHS was a stronger predictor of future SRHS than initial physical or mental health or changes in physical or mental health.12,13 Therefore, it is important to identify factors associated with adolescent SRHS, as they may have implications for current and future health-care utilization, morbidity, and mortality. |
Divorce and sexual risk among U.S. women: findings from the National Survey of Family Growth
Liddon N , Leichliter JS , Habel MA , Aral SO . J Womens Health (Larchmt) 2010 19 (11) 1963-7 BACKGROUND: Most research focusing on marital status and sexual risk has compared married and single midadult women without differentiating single women by their ever married status. We elucidate differences in sexual risk among divorced and never married women. METHODS: Data from the National Survey of Family Growth (NSFG) (n=5,081) were analyzed to compare divorced and never married women in terms of recent and lifetime sex partners, condom use at last vaginal sex, and other sexual risk behaviors. RESULTS: Overall, 13.1% of the women were currently divorced or separated, 62.1% were currently married, 8.3% were cohabitating, and 16.4% were never married. Divorced/separated women were more likely to report 5 or more lifetime sex partners and 2 or more sex partners in the past year than never married women. They were less likely to report condom use. CONCLUSIONS: Current findings expose sexual behavioral discrepancies within the single category of women and the need to redefine risk groups for surveillance and intervention efforts. |
New directions in research on public health and health literacy
Baur C . J Health Commun 2010 15 Suppl 2 42-50 Numerous calls for a public health approach to health literacy and visions of a health literate society have appeared in recent years. Yet, many gaps in what we know about and do to improve health literacy remain. Major developments at the national level in the last decade help define the role of health literacy in creating better public health and have set the stage for new investigations in public health and health literacy. Four frameworks are examined for their usefulness in posing new questions about public health and health literacy: Healthy People, the Ten Essential Public Health Functions, health promotion, and health disparities. Each of the frameworks generates questions and uses methods that can produce new findings about health literacy. Using the frameworks will open new investigations into population health and health literacy improvement at multiple levels. |
Health care-associated infections studies project: case 2
Wright MO , Hebden JN , Allen-Bridson K , Morrell GC , Horan T . Am J Infect Control 2010 38 (7) (7) 557-558 Welcome to the second publication of a joint effort between the American Journal of Infection Control and the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). This collaboration is a series of case studies representing surveillance scenarios faced everyday by infection preventionists (IPs) using NHSN definitions. Please refer to the June 2010 issue for more information.1 | With each case, a link to an online survey will be provided, where you may answer the questions posed and receive immediate feedback in the form of answers and explanations. Each participant's answers will remain confidential, although we hope to share a summary of our findings at a later date. The content development was a partnership between the listed authors, and all cases, answers, and explanations have been reviewed and approved by the NHSN. |
The impact of indirect benefits of vaccination on postlicensure vaccine effectiveness estimates: a scenario analysis
Patel MM , Tate J , Cortese M , Payne D , Armstrong G , Parashar UD , Lopman B . Vaccine 2010 28 (50) 7987-92 Vaccine efficacy is measured in randomized, prelicensure clinical trials where vaccination typically affords only direct protection to the vaccinated individual. Vaccine effectiveness is measured in postlicensure observational studies where vaccination might provide indirect benefits to a population as a whole in addition to directly protecting the vaccinated individual. The potential discrepancy in effectiveness and efficacy estimates would depend on the postlicensure study design. We developed a mathematical model to assess the impact of indirect benefits on vaccine effectiveness as measured by the common cohort study design under scenarios of homogenous and heterogenous vaccine allocation. We found that under the cohort design, effectiveness estimates equaled efficacy if either the indirect effects were assumed to be negligible or vaccine allocation in the community was homogenous. However, in presence of indirect benefits, effectiveness estimates would be biased upward compared with vaccine efficacy if one of the two sub-populations in the same study had a higher rate of vaccination. Because of indirect effects of vaccination, even in studies where other biases can be eliminated, the presence of distinct sub-populations with varying rates of vaccination can lead to discrepancies between effectiveness and efficacy estimates. |
Exploring the associations between intimate partner violence and women's mental health: evidence from a population-based study in Paraguay
Ishida K , Stupp P , Melian M , Serbanescu F , Goodwin M . Soc Sci Med 2010 71 (9) 1653-61 Using a nationally representative sample from the 2008 Paraguayan National Survey of Demography and Sexual and Reproductive Health, we examine the association between emotional, physical, and sexual intimate partner violence (IPV) and mental health among women aged 15-44 years who have ever been married or in a consensual union. The results from multivariate logistic regression models demonstrate that controlling for women's socioeconomic and marital status and history of childhood abuse and their male partners' unemployment and alcohol consumption, IPV is independently associated with an increased risk for common mental disorders (CMD) and suicidal ideation measured by the Self Reporting Questionnaire (SRQ-20). IPV variables substantially improve the explanatory power of the models, particularly for suicidal ideation. Emotional abuse, regardless of when it occurred, is associated with the greatest increased risk for CMD whereas recent physical abuse is associated with the greatest increased risk for suicidal ideation. These findings suggest that efforts to identify women with mental health problems, particularly suicidal ideation, should include screening for the types and history of IPV victimization. |
Genetic testing for CYP450 polymorphisms to predict response to clopidogrel: current evidence and test availability. Application: pharmacogenomics.
Ned RM . PLoS Curr 2010 2 The anti-platelet agent clopidogrel bisulfate (sold under the trade name Plavix in the United States) is a widely prescribed medication for the prevention of blood clots in patients with acute coronary syndrome, in those who have suffered other cardiovascular disease-related events such as ischemic stroke, and in patients who are undergoing percutaneous coronary intervention. Response to clopidogrel varies substantially due to genetic and acquired factors. Patients who experience recurrent cardiovascular ischemic or thrombotic events while taking clopidogrel are typically described as non-responsive or resistant. The drug's oxidation is mainly dependent on the cytochrome P450 enzyme 2C19 (CYP2C19). Patients with certain genetic variants in CYP2C19 have been found to have lower levels of the active metabolite, less platelet inhibition, and greater risk of major adverse cardiovascular events such as heart attack, stroke, and death. Testing for CYP2C19 polymorphisms may identify patients who will not respond adequately to the standard clopidogrel regimen and who should, consequently, be given an alternate treatment strategy. This article outlines the evidence concerning pharmacogenetic testing for clopidogrel response, including data on clinical validity and clinical utility, and summarizes the currently available tests marketed for this purpose. |
Surface immunolabeling and consensus computational framework to identify candidate rare outer membrane proteins of Treponema pallidum
Cox DL , Luthra A , Dunham-Ems S , Desrosiers DC , Salazar JC , Caimano MJ , Radolf JD . Infect Immun 2010 78 (12) 5178-94 Treponema pallidum reacts poorly with the antibodies present in rabbit and human syphilitic sera, a property attributed to the paucity of proteins in its outer membrane. To better understand the basis for the syphilis spirochete's "stealth pathogenicity", we used a dual-label, 3-step amplified assay in which treponemes encapsulated in gel microdroplets were probed with syphilitic sera in parallel with anti-FlaA antibodies. A small (approx. 5-10%) but reproducible fraction of intact treponemes bound IgG and/or IgM antibodies. Three lines of evidence supported that the surface antigens were likely beta-barrel-forming outer membrane proteins (OMPs): (i) surface-labeling with anti-lipoidal (VDRL) antibodies was not observed, (ii) immunoblot analysis confirmed prior results that T. pallidum glycolipids are not immunoreactive, and (iii) labeling of intact organisms was not appreciably affected by proteinase K (PK) treatment. With this method, we also demonstrate that TprK (TP0897), an extensively studied candidate OMP, and TP0136, a lipoprotein recently reported to be surface-exposed, are both periplasmic. Consistent with the immunolabeling studies, TprK also was found to lack amphiphilicity, a characteristic property of beta-barrel-forming proteins. Using a consensus computational framework that combined subcellular localization and beta-barrel structural prediction tools, we generated ranked groups of candidate rare OMPs, the predicted T. pallidum outer membrane proteome (OMPeome), which we postulate includes the surface-exposed molecules detected by our enhanced gel microdroplet assay. In addition to underscoring the syphilis spirochete's remarkably poor surface antigenicity, our findings help to explain the complex and shifting balance between pathogen and host defenses that characterizes syphilitic infection. |
Topology of the disulfide bonds in the antiviral lectin scytovirin
Moulaei T , Stuchlik O , Reed M , Yuan W , Pohl J , Lu W , Haugh-Krumpe L , O'Keefe BR , Wlodawer A . Protein Sci 2010 19 (9) (9) 1649-1661 The antiviral lectin scytovirin (SVN) contains a total of five disulfide bonds in two structurally similar domains. Previous reports provided contradictory results on the disulfide pairing in each individual domain, and we have now re-examined the disulfide topology. N-terminal sequencing and mass spectrometry were used to analyze proteolytic fragments of native SVN obtained at acidic pH, yielding the assignment as Cys7-Cys55, Cys20-Cys32, Cys26-Cys38, Cys68-Cys80, and Cys74-Cys86. We also analyzed the N-terminal domain of SVN (SD1, residues 1-48) prepared by expression/oxidative folding of the recombinant protein and by chemical synthesis. The disulfide pairing in the chemically synthesized SD1 was forced into predetermined topologies: SD1A (Cys20-Cys26, Cys32-Cys38) or SD1B (Cys20-Cys32, Cys26-Cys38). The topology of native SVN was found to be in agreement with the SD1B and the one determined for the recombinant SD1 domain. Although the two synthetic forms of SD1 were distinct when subjected to chromatography, their antiviral properties were indistinguishable, having low nM activity against HIV. Tryptic fragments, the "cystine clusters" [Cys20-Cys32/Cys26-Cys38; SD1] and [Cys68-Cys80/Cys74-C-86; SD2], were found to undergo rapid disulfide interchange at pH 8. This interchange resulted in accumulation of artifactual fragments in alkaline pH digests that are structurally unrelated to the original topology, providing a rational explanation for the differences between the topology reported herein and the one reported earlier (Bokesh et al., Biochemistry 2003;42:2578-2584). Our observations emphasize the fact that proteins such as SVN, with disulfide bonds in close proximity, require considerable precautions when being fragmented for the purpose of disulfide assignment. Published by Wiley-Blackwell. 2010 The Protein Society. |
A two-stage, multilevel quality control system for serological assays in anthrax vaccine clinical trials
Soroka SD , Schiffer JM , Semenova VA , Li H , Foster L , Quinn CP . Biologicals 2010 38 (6) 675-83 A two-stage, multilevel assay quality control (QC) system was designed and implemented for two high stringency QC anthrax serological assays; a quantitative anti-PA IgG enzyme-linked immunosorbent assay (ELISA) and an anthrax lethal toxin neutralization activity (TNA) assay. The QC system and the assays were applied for the congressionally mandated Centers for Disease Control and Prevention (CDC) Phase 4 human clinical trial of anthrax vaccine adsorbed (AVA, BioThrax). A total of 57,284 human serum samples were evaluated by anti-PA enzyme-linked immunosorbent assay (ELISA) and 11,685 samples by anthrax lethal toxin neutralization activity (TNA) assay. The QC system demonstrated overall sample acceptance rates of 86% for ELISA and 90% for the TNA assays respectively. Monitoring of multiple assay and test sample variables showed no significant long term trends or degradation in any of the critical assay reagents or reportable values for both assays. Assay quality control data establish the functionality of the quality control system and demonstrates the reliability of the serological data generated using these assays. |
A method for rapid, non-targeted screening for environmental contaminants in household dust
Hilton DC , Jones RS , Sjodin A . J Chromatogr A 2010 1217 (44) 6851-6 Household dust can be a major source of human exposure to environmental contaminants such as polybrominated diphenyl ethers, pesticides, and other compounds. This work shows a screening technique that may be used to identify components in an environmental sample as xenobiotics based on mass spectral characteristics of classes of compounds that may be expected to be present in the environment. Household dust (SRM-2585) from the National Institute of Standards and Technology (NIST) was extracted with hexane using accelerated solvent extraction. Large molecules, such as triglycerides and fatty acids were removed with gel permeation chromatography. The extract was then concentrated and analyzed by comprehensive two dimensional gas chromatography coupled to a time of flight mass spectrometer. The resulting peak table was automatically filtered to identify compound classes such as phthalates, polycyclic aromatic hydrocarbons and their heterocyclic analogs, chlorinated compounds, brominated compounds, and nitro compounds. While phthalates can be identified by abundances at specific masses, the identification of the remaining classes is based on the identification of the molecular ion and identification of isotope clusters or other spectral characteristics. The technique detected compounds identified and quantified by NIST as well as compounds not identified by NIST in the sample. By comparison with concentrations determined by NIST for the analytes found, the technique is able to identify analytes in these compound classes at concentrations as low as 10-20ng/g dust. |
Multiplex assay detection of immunoglobulin G antibodies that recognize Giardia intestinalis and Cryptosporidium parvum antigens
Priest JW , Moss DM , Visvesvara GS , Jones CC , Li A , Isaac-Renton JL . Clin Vaccine Immunol 2010 17 (11) 1695-707 Giardiasis and cryptosporidiosis are common enteric parasitic diseases that have similar routes of transmission. In this work, we have identified epitopes within the Giardia variant-specific surface protein (VSP) sequences that are recognized by IgG antibodies from 13/14 (93%) stool-confirmed giardiasis patient sera. The conserved epitopes are shared among VSPs from both of the assemblages that commonly infect humans, and they are likely to be structural as both sodium dodecylsulfate treatment and dithiothreitol reduction decrease antibody recognition. In a multiplex bead assay (MBA), we have used three VSP fragments from an Assemblage A Giardia strain, three VSP fragments from Assemblage B strains, and the alpha-1 giardin structural antigen to detect IgG antibodies to Giardia and have used the recombinant 17- and 27-kDa antigens to simultaneously detect IgG antibodies to Cryptosporidium. The MBA differentiated between sera from Giardia and Cryptosporidium outbreaks and also identified a giardiasis outbreak that may have included cryptosporidiosis cases. Approximately 40% of cryptosporidiosis outbreak samples had high MBA responses for both the 27- and 17-kDa antigens, while <10% of non-outbreak and giardiasis outbreak samples were high responders. At least 60% of giardiasis outbreak samples were positive for antibodies to multiple Giardia antigens, while ≤12% of non-outbreak samples and samples from US and British Columbia cryptosporidiosis outbreaks met our definition for Giardia seropositivity. MBA using multiple parasite antigens may prove useful in the epidemiologic analysis of future waterborne or foodborne outbreaks of diarrheal disease. |
High redundancy draft sequencing of 15 clinical and environmental Burkholderia strains
Mukhopadhyay S , Thomason MP , Lentz S , Nolan N , Willner K , Gee JE , Glass MB , Inglis TJ , Merritt A , Levy A , Sozhamannan S , Mateczun A , Read TD . J Bacteriol 2010 192 (23) 6313-4 The Gram negative Burkholderia genus includes several species of intracellular bacterial pathogens that pose substantial risk to humans. In this study we have generated draft genome sequences of 15 strains of B. oklahomensis, B. pseudomallei, B. thailandensis and B. ubonensis to an average sequence read coverage of 25-40 fold. |
High-throughput sample preparation for the quantitation of acephate, methamidophos, omethoate, dimethoate, ethylenethiourea, and propylenethiourea in human urine using 96-well-plate automated extraction and high-performance liquid chromatography-tandem mass spectrometry
Jayatilaka NK , Montesano AM , Whitehead Jr RD , Schloth SJ , Needham LL , Barr DB . Arch Environ Contam Toxicol 2010 61 (1) 59-67 Acephate, methamidophos, o-methoate, and dimethoate are organophosphorus pesticides, and ethylenethiouria and propylenethiourea are two metabolites from the bisdithiocarbamate fungicide family. They are some of the most widely used pesticides and fungicides in agriculture both domestically and abroad. The existing high-performance liquid chromatography (HPLC)-tandem mass spectrometry (MS/MS) method for the measurement of these compounds in human urine was improved by using a 96-well plate format sample preparation; the use of HPLC-MS/MS was comparable with a concentration range of 0.125 to 50 ng/ml. Deuterium-labeled acephate, ethylenethiouria, and methamidophos were used as internal standards. The sample preparation procedure, in the 96-well format with a 0.8-ml urine sample size, uses lyophilization of samples, followed by extraction with dichloromethane. The analytes were chromatographed on a Zorbax SB-C3 (4.6 x 150 mm, 5.0-mum) column with gradient elution by using 0.1% formic acid in aqueous solution (solvent A) and 0.1% formic acid in methanol (solvent B) mobile phase at a flow rate of 1 ml/min. Quantitative analysis was performed by atmospheric pressure chemical ionization source in positive ion mode using multiple-reaction monitoring of the precursor-to-product ion pairs for the analytes on a TSQ Quantum Ultra HPLC-MS/MS. Repeated analyses of urine samples spiked with high (15 ng/ml), medium (5 ng/ml), and low (1 ng/ml) concentrations of the analytes gave relative SDs of <13%. The limits of detection were in the range of 0.004-0.01 ng/ml. The method also has high accuracy, high precision, and excellent extraction recovery. Furthermore, the improved sample preparation method decreased the cost and labor required while effectively doubling the analytic throughput with minimal matrix effect. |
A candidate H1N1 pandemic influenza vaccine elicits protective immunity in mice
Steitz J , Barlow PG , Hossain J , Kim E , Okada K , Kenniston T , Rea S , Donis RO , Gambotto A . PLoS One 2010 5 (5) (5) 1-6 BACKGROUND: In 2009 a new pandemic disease appeared and spread globally. The recent emergence of the pandemic influenza virus H1N1 first isolated in Mexico and USA raised concerns about vaccine availability. We here report our development of an adenovirus-based influenza H1N1 vaccine tested for immunogenicity and efficacy to confer protection in animal model. METHODS: We generated two adenovirus(Ad5)-based influenza vaccine candidates encoding the wildtype or a codonoptimized hemagglutinin antigen (HA) from the recently emerged swine influenza isolate A/California/04/2009 (H1N1)pdm. After verification of antigen expression, immunogenicity of the vaccine candidates were tested in a mouse model using dose escalations for subcutaneous immunization. Sera of immunized animals were tested in microneutalization and hemagglutination inhibition assays for the presence of HA-specific antibodies. HA-specific T-cells were measured in IFN Elispot assays. The efficiency of the influenza vaccine candidates were evaluated in a challenge model by measuring viral titer in lung and nasal turbinate 3 days after inoculation of a homologous H1N1 virus. CONCLUSIONS/SIGNIFICANCE: A single immunization resulted in robust cellular and humoral immune response. Remarkably, the intensity of the immune response was substantially enhanced with codon-optimized antigen, indicating the benefit of manipulating the genetic code of HA antigens in the context of recombinant influenza vaccine design. These results highlight the value of advanced technologies in vaccine development and deployment in response to infections with pandemic potential. Our study emphasizes the potential of an adenoviral-based influenza vaccine platform with the benefits of speed of manufacture and efficacy of a single dose immunization. 2010 Steitz et al. |
Serologically determined in utero exposure to oral pathogens may be associated with increased risk for neonatal intensive care unit (NICU) admissions and length of stay
Eke PI . J Evid Based Dent Pract 2010 10 (3) 172-3 This study reports on the associations between fetal exposure to oral bacteria and NICU admissions, and length of stay. The authors investigated this association by undertaking secondary analysis of OCAP prospective study data. Fetal exposure to oral bacteria was determined by the presence or absence of IgM antibody to one or more oral organisms in fetal umbilical cord serum. |
Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006
Parker SE , Mai CT , Canfield MA , Rickard R , Wang Y , Meyer RE , Anderson P , Mason CA , Collins JS , Kirby RS , Correa A . Birth Defects Res A Clin Mol Teratol 2010 88 (12) 1008-16 BACKGROUND: The National Birth Defects Prevention Network collects state-specific birth defects surveillance data for annual publication of prevalence estimates and collaborative research projects. In 2006, data for 21 birth defects from 1999 through 2001 were presented as national birth prevalence estimates. The purpose of this report was to update these estimates using data from 2004 through 2006. METHODS: Population-based data from 11 active case-finding programs, 6 passive case-finding programs with case confirmation, and 7 passive programs without case confirmation were used in this analysis. Pooled birth prevalence estimates for 21 birth defects, stratified by case ascertainment approach, were calculated. National prevalence estimates, adjusted for maternal race/ethnicity and maternal age (trisomy 13, trisomy 18, and Down syndrome only) were determined using data from 14 programs. The impact of pregnancy outcomes on prevalence estimates was also assessed for five specific defects. RESULTS: National birth defects prevalence estimates ranged from 0.72 per 10,000 live births for common truncus to 14.47 per 10,000 live births for Down syndrome. Stratification by type of surveillance system showed that active programs had a higher prevalence of anencephaly, anophthalmia/microphthalmia, cleft lip with or without cleft palate, reduction defect of upper limbs, and trisomy 18. The birth prevalence of anencephaly, trisomy 13, and trisomy 18 also varied substantially with inclusion of elective terminations. CONCLUSION: Accurate and timely national estimates of the prevalence of birth defects are needed for monitoring trends, assessing prevention efforts, determining service planning, and understanding the burden of disease due to birth defects in the United States. Birth Defects Research (Part A), 2010. (c) 2010 Wiley-Liss, Inc. |
Fifty years of the Teratology Society: honoring past accomplishments and a view to a promising future
Rasmussen SA , Chambers C , Hales BF . Birth Defects Res A Clin Mol Teratol 2010 88 (10) 763-5 In 2010, the Teratology Society is celebrating its 50th anniversary. The society was founded at a meeting on April 10, 1960, in New York, following an informal planning discussion held one year earlier by Drs. F. Clarke Fraser, Josef Warkany, and James Wilson, who delineated the need for such an organization. The original focus of the organization was similar to that of the present-day Teratology Society: to promote and coordinate research in the area of teratology (Wilson and Warkany, 1985). Another key goal identified by founders of the fledgling society was to bring together investigators with a common interest in birth defects from a wide variety of disciplines. As noted by Dr. Warkany, the society's first president, at the first annual meeting in 1961 (Warkany, 1974), “There is a great need for a common language, mutual understanding, and cross-fertilization in this area where students in the basic sciences, clinicians, sociologists and public health workers should meet.” During the ensuing years, the society built a laudable reputation as the lead organization for research in the field of teratology, and it continues to attract investigators with expertise in a broad range of areas, all working toward a common goal of understanding the causes of birth defects and working toward prevention of birth defects. | To commemorate this auspicious occasion, this special issue of Birth Defects Research Part A, as one of the society's three journals, was assembled with the goal of honoring past accomplishments and looking forward to the future of the Teratology Society. To honor the past, we invited Dr. Jan Friedman to write an article entitled The Principles of Teratology: Are They Still True? This article reviews the principles of teratology initially proposed by Wilson (1959) and later modified (Wilson, 1977). Dr. Friedman concludes that the principles put forward more than 30 years ago have stood the test of time. Furthermore, Dr. Friedman focuses on the major progress that has been made in improving the understanding of mechanisms that are important in embryonic development. Much of the progress in this improved understanding of mechanisms has been led by the Teratology Society and its members, emphasizing the key role that the society plays in the field. |
Increases in breastfeeding in Latin America and the Caribbean: an analysis of equity
Lutter CK , Chaparro CM , Grummer-Strawn LM . Health Policy Plan 2010 26 (3) 257-65 BACKGROUND: Breastfeeding has large benefits for mothers and infants. The short-term benefits for child survival and reduced morbidity differ by population subgroup because of differences in underlying risk factors. Although breastfeeding is more common among poor than well-off women, how breastfeeding patterns change between these subgroups is important from a policy perspective as the poor will benefit more from increased duration of breastfeeding. METHODS: We use nationally representative data from eight countries in Latin America and the Caribbean to document changes in breastfeeding duration between 1986 and 2005, and separate the overall change into the portion attributable to changing population characteristics and the portion resulting from changing breastfeeding behaviour within population subgroups. RESULTS: Breastfeeding duration increased in six out of the eight countries and the changes observed are largely explained by changing behaviour within population subgroups rather than changing population characteristics. Changes in breastfeeding duration did not tend to be equitably distributed, but in four countries (Bolivia, Brazil, Colombia and Peru) the population subgroups whose children are most at risk for mortality and increased morbidity from not being breastfed were least likely to show improvements in breastfeeding duration. Between 1986 and 2004 in Peru, breastfeeding duration declined by 0.6 months among rural women while increasing by 9.7 months among urban women; it increased by 6.3 months among women with prenatal care but only by 3.7 months among women with no prenatal care. Changes in breastfeeding in Guatemala and Haiti tended to favour the well-off compared with the poor, though not consistently. In Nicaragua changes in breastfeeding duration tended to favour the less well-off. DISCUSSION: While promoting breastfeeding is a must for all women, to maximize its benefits for child survival and health, additional efforts are needed to reach poorly educated and rural women with little access to health care. |
Behind international rankings of infant mortality: how the United States compares with Europe
MacDorman MF , Mathews TJ . Int J Health Serv 2010 40 (4) 577-588 In 2005, the United States ranked 30th in the world in infant mortality. Infant mortality rates for preterm (<37 weeks of gestation) infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 or more weeks of gestation are higher in the United States than in most European countries. One in 8 births in the United States were preterm in 2005, compared with 1 in 18 births in Ireland and Finland, and 1 in 16 in France and Sweden. If the United States had Sweden's distribution of births by gestational age, nearly 8,000 infant deaths in the United States would be averted each year, and the U.S. infant mortality rate would be one-third lower. The main cause of the United States' high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States, the period when infant mortality is greatest. |
Utilization of surgical resources during the USNS COMFORT humanitarian mission to the Americas, June to October 2007
Hartgerink BJ , Chapman LE , Stevenson J , Donahue TF , Pagliara C . Mil Med 2010 175 (9) 638-646 In 2007, the United States Navy Ship (USNS) COMFORT (T-AH 20), a full-capability medical treatment facility, departed for Partnership for the Americas, her first large-scale humanitarian civic assistance (HCA) mission. Analysis of operational data describes surgical resource utilization. Lessons from previous military humanitarian assistance operations were helpful when placed in the cultural context of Latin America. Premission planning decisions that included time in each port and funding determined the services that were offered to host nations. Surgical, dental, immunizations, preventive medicine, and biomedical repair services had lasting impacts. COMFORT and similar hospital ships are a superior platform to combatant vessels in providing comprehensive surgical care. Medical planning is heavily dependent upon statistics. Collection of additional clinical data on subsequent HCA missions could aid future planning decisions regarding manning, equipment, supplies, and objectives. |
Obstetrical intervention and the singleton preterm birth rate in the United States from 1991-2006
MacDorman MF , Declercq ER , Zhang J . Am J Public Health 2010 100 (11) 2241-7 OBJECTIVES: We examined the relationship between obstetrical intervention and preterm birth in the United States between 1991 and 2006. METHODS: We assessed changes in preterm birth, cesarean delivery, labor induction, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention after risk adjustment. RESULTS: From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI]=1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor. CONCLUSIONS: Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Health Behavior and Risk
- Health Communication and Education
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Military Medicine and Health
- Public Health Leadership and Management
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure