Association of birthplace and self-reported hypertension by racial/ethnic groups among US adults - National Health Interview Survey, 2006-2010
Fang J , Ayala C , Loustalot F . J Hypertens 2012 30 (12) 2285-92 BACKGROUND: Over the past few decades, the proportion of US adults who were foreign-born has been increasing, as has the overall prevalence of hypertension. Here, we compared the prevalence of self-reported hypertension among native-born adults with that among foreign-born adults, classified by racial/ethnic group. METHODS: Using 2006-2010 data from the National Health Interview Survey (NHIS), we compared the age-adjusted prevalence of hypertension among native-born adults to foreign-born adults, specified by continent of birthplace and race/ethnicity. Results are expressed as unadjusted odds ratios (ORs) and three sets of adjusted odds ratios (AORs) adjusted for selected sociodemographic, behavioral and health-related characteristics. All results accounted for NHIS sampling design variables. RESULTS: The analytic sample was 124 260 with 16.3% foreign-born adults. Among the foreign-born adults, 56% were from Central or South America, 22% from Asia, 13% from Europe, and 4% from Africa. Overall and after adjustment, hypertension prevalence was significantly higher among US-born adults than among foreign-born adults (AOR: 1.28, 95% CI: 1.21-1.36). By race/ethnicity, hypertension prevalence was higher among US-born non-Hispanic blacks than either foreign-born non-Hispanic blacks (AOR: 1.24, 95%CI: 1.02-1.50) or all Africa-born immigrants of any race/ethnicity [AOR: 1.45, 95% confidence interval (CI): 1.07-1.97]. Among foreign-born adults, duration of US residence was positively associated with the likelihood of hypertension. CONCLUSION: Hypertension prevalence was higher among US-born adults than among foreign-born adults and higher among US-born non-Hispanic blacks than in any other group. Among foreign-born adults, hypertension risk increased with the number of years they had lived in the United States. |
Scale-up of HIV treatment through PEPFAR: a historic public health achievement
El-Sadr WM , Holmes CB , Mugyenyi P , Thirumurthy H , Ellerbrock T , Ferris R , Sanne I , Asiimwe A , Hirnschall G , Nkambule RN , Stabinski L , Affrunti M , Teasdale C , Zulu I , Whiteside A . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S96-104 Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems. |
The study of HIV and antenatal care integration in pregnancy in Kenya: design, methods, and baseline results of a cluster-randomized controlled trial
Turan JM , Steinfeld RL , Onono M , Bukusi EA , Woods M , Shade SB , Washington S , Marima R , Penner J , Ackers ML , Mbori-Ngacha D , Cohen CR . PLoS One 2012 7 (9) e44181 BACKGROUND: Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma. METHODOLOGY/PRINCIPAL FINDINGS: A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC clinics at government health facilities in rural Kenya. Twelve facilities were randomized to provide either fully integrated services (ANC, PMTCT, and HIV treatment services all delivered in the ANC clinic) or non-integrated services (ANC clinics provided ANC and basic PMTCT services and referred clients to a separate HIV clinic for HIV treatment). During June 2009- March 2011, 1,172 HIV-positive pregnant women were enrolled in the study. The main study outcomes are rates of maternal enrollment in HIV care and treatment, infant HIV testing uptake, and HIV-free infant survival. Baseline results revealed that the intervention and control cohorts were similar with respect to socio-demographics, male partner HIV testing, sero-discordance of the couple, obstetric history, baseline CD4 count, and WHO Stage. Challenges faced while conducting this trial at low-resource rural health facilities included frequent staff turnover, stock-outs of essential supplies, transportation challenges, and changes in national guidelines. CONCLUSIONS/SIGNIFICANCE: This is the first randomized trial of ANC and HIV service integration to be conducted in rural Africa. It is expected that the study will provide critical evidence regarding the implementation and effectiveness of this service delivery strategy, with important implications for programs striving to eliminate vertical transmission of HIV and improve maternal health. TRIAL REGISTRATION: ClinicalTrials.gov NCT00931216 NCT00931216. |
Substitution of rifapentine for rifampin during intensive phase treatment of pulmonary tuberculosis: study 29 of the Tuberculosis Trials Consortium
Dorman SE , Goldberg S , Stout JE , Muzanyi G , Johnson JL , Weiner M , Bozeman L , Heilig CM , Feng PJ , Moro R , Narita M , Nahid P , Ray S , Bates E , Haile B , Nuermberger EL , Vernon A , Schluger NW . J Infect Dis 2012 206 (7) 1030-1040 BACKGROUND: Rifapentine administered 5 days per week has potent activity in mouse models of antituberculosis chemotherapy, but efficacy and safety data are limited in humans. We compared the antimicrobial activity and safety of rifapentine vs rifampin during the first 8 weeks of pulmonary tuberculosis treatment. METHODS: In total, 531 adults with sputum smear-positive pulmonary tuberculosis were randomized to rifapentine 10 mg/kg/dose or rifampin 10 mg/kg/dose, administered 5 days per week for 8 weeks (intensive phase), with isoniazid, pyrazinamide, and ethambutol. Coprimary outcomes were negative sputum culture on liquid and on solid media at completion of intensive phase. RESULTS: Negative cultures on solid media occurred in 145 of 174 participants (83.3%) in the rifampin group and 171 of 198 participants (86.4%) in the rifapentine group (difference, 3.0%; 95% confidence interval [CI]: - 4.3, 10.5); negative cultures in liquid media occurred in 110 of 169 (65.1%) in the rifampin group and 133 of 196 (67.9%) in the rifapentine group (difference, 2.8%; 95% CI: -6.9, 12.4). Among 529 participants who received study therapy, 40 of 254 participants (15.7%) in the rifampin group and 40 of 275 participants (14.5%) in the rifapentine group prematurely discontinued treatment (P = .79). CONCLUSIONS: The rifapentine regimen was safe but not significantly more active than a standard rifampin regimen, by the surrogate endpoint of culture status at completion of intensive phase. Assessment of higher exposures to rifapentine for tuberculosis treatment is warranted. Clinical Trials registration. NCT00694629. |
Tackling multidrug-resistant gonorrhea: how should we prepare for the untreatable?
Kidd S , Kirkcaldy R , Weinstock H , Bolan G . Expert Rev Anti Infect Ther 2012 10 (8) 831-3 If cephalosporin resistance develops and spreads, successful treatment of gonorrhea will be extremely challenging, especially in settings without access to antimicrobial susceptibility testing to guide treatment decisions. | Control of Neisseria gonorrhoeae infection continues to represent a significant public health challenge worldwide. Globally, an estimated 88 million new cases of gonorrhea occur annually [1]. In addition to causing urethritis and cervicitis, N. gonorrhoeae infection can result in serious complications such as pelvic inflammatory disease, chronic pelvic pain, tubal infertility and ectopic pregnancy in women, and can facilitate HIV transmission [2]. Timely and effective treatment for gonorrhea prevents severe complications in the individual and limits transmission of the disease in the community by shortening the duration of infection. However, N. gonorrhoeae has progressively acquired resistance to each of the antimicrobial agents that have been recommended for treatment over the past 70 years, and the remaining treatment options are dwindling. | Since gonorrhea was first treated with sulfalinamide at the beginning of the antimicrobial era, N. gonorrhoeae has systematically developed resistance to sulfonamides, penicillins, tetracyclines and, most recently, the fluoroquinolones [3]. Third-generation cephalosporins are one of the last classes of antimicrobials that remain highly effective against gonorrhea. They are the recommended first-line treatment for gonorrhea in many countries, including the USA; however, there is evidence that cephalosporin-resistant N. gonorrhoeae may be on the horizon. The first reports of possible cephalosporin treatment failures associated with decreased in vitro susceptibility came from Japan during 2001–2003, and decreasing susceptibility of N. gonorrhoeae to third-generation cephalosporins has been observed in east Asia for more than 10 years [4]. Recently, cases of possible cefixime treatment failures in Europe were reported in 2010–2011 [5–9], and decreasing susceptibility to third-generation cephalosporins has been observed in Europe, Canada and the USA [10–12]. |
Monitoring HIV testing at visits to emergency departments in the United States: very low rate of HIV testing
Hoover JB , Tao G , Heffelfinger JD . J Acquir Immune Defic Syndr 2012 62 (1) 90-4 BACKGROUND: Early diagnosis and treatment of HIV infection results in improved clinical outcomes and decreased transmission, yet many infected persons are unaware of their infection or diagnosed late. The Centers for Disease Control and Prevention (CDC) recommends routine opt-out testing of all persons aged 13-64 in high prevalence settings. STUDY OBJECTIVE: To describe methods to estimate HIV testing rates at visits to emergency departments (EDs) for monitoring adherence to recommendations for opt-out testing. METHODS: We analyzed data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS). In 2009, two questions were added to the survey about HIV status and testing. We estimated the frequency of HIV testing at ED visits made by persons aged 13-64 years not known to be HIV infected. RESULTS: In 2009, 90.5 million visits were made to EDs, including 60.0% by whites, 24.5% by blacks, and 12.1% by Hispanics; and 38.4% by privately insured, 25.7% by Medicaid insured, and 21.4% by uninsured persons. Among 89.9 million visits by patients not known to be HIV infected, HIV testing was performed at only 0.2% of visits. Among 3.4 million visits made by persons in whom targeted testing is recommended-those with increased risk for HIV and other sexually transmitted diseases, or pregnancy-only 2.3% were tested for HIV. CONCLUSIONS: NHAMCS can be a useful tool to monitor trends in HIV testing in U.S. emergency departments. A high proportion of visits to EDs in the United States were made by persons in historically medically underserved populations and routine HIV testing was a rare event during ED visits. |
PEPFAR scale-up of pediatric HIV services: innovations, achievements, and challenges
Abrams EJ , Simonds RJ , Modi S , Rivadeneira E , Vaz P , Kankasa C , Tindyebwa D , Phelps BR , Bowsky S , Teasdale CA , Koumans E , Ruff AJ . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S105-12 HIV/AIDS has had a profound impact on children around the world since the start of the epidemic. There are currently 3.4 million children under the age of 15 years living with HIV globally, and more than 450,000 children currently receiving lifesaving antiretroviral treatment. This article describes efforts supported by the President's Emergency Plan for AIDS Relief (PEPFAR) to expand access to treatment for children living with HIV in high-burden countries. The article also highlights a series of case studies that illustrate the impact that the PEPFAR initiative has had on the pediatric HIV epidemic. Through its support of host governments and partner organizations, the PEPFAR initiative has expanded HIV testing and treatment for pregnant women to reduce vertical transmission of HIV, increased access to early infant diagnosis for HIV-exposed infants, improved training and resources for clinicians who provide pediatric care and antiretroviral treatment, and, through public-private partnerships with pharmaceutical manufacturers, helped increase the number of medications available for the treatment of HIV-infected children in resource-limited settings. |
PEPFAR support for the scaling up of collaborative TB/HIV activities
Howard AA , Gasana M , Getahun H , Harries A , Lawn SD , Miller B , Nelson L , Sitienei J , Coggin WL . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S136-44 The US President's Emergency Plan for AIDS Relief (PEPFAR) has supported a comprehensive package of care in which interventions to address HIV-related tuberculosis (TB) have received increased funding and support in recent years. PEPFAR's TB/HIV programming is based on the World Health Organization's 12-point policy for collaborative TB/HIV activities, which are integrated into PEPFAR annual guidance. PEPFAR implementing partners have provided crucial support to TB/HIV collaboration, and as a result, PEPFAR-supported countries in sub-Saharan Africa have made significant gains in HIV testing and counseling of TB patients and linkages to HIV care and treatment, intensified TB case finding, and TB infection control. PEPFAR's support of TB/HIV integration has also included significant investment in health systems, including improved laboratory services and educating and enlarging the workforce. The scale-up of antiretroviral therapy along with support of programs to increase HIV counseling and testing and improve linkage and retention in HIV care may have considerable impact on TB morbidity and mortality, if used synergistically with isoniazid preventive therapy, intensified case finding, and infection control. Issues to be addressed by future programming include accelerating implementation of isoniazid preventive therapy, increasing access and ensuring appropriate use of new TB diagnostics, supporting early initiation of antiretroviral therapy for HIV-infected TB patients, and strengthening systems to monitor and evaluate program implementation. |
PEPFAR, health system strengthening, and promoting sustainability and country ownership
Palen J , El-Sadr W , Phoya A , Imtiaz R , Einterz R , Quain E , Blandford J , Bouey P , Lion A . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S113-9 Evidence demonstrates that scale-up of HIV services has produced stronger health systems and, conversely, that stronger health systems were critical to the success of the HIV scale-up. Increased access to and effectiveness of HIV treatment and care programs, attention to long-term sustainability, and recognition of the importance of national governance, and country ownership of HIV programs have resulted in an increased focus on structures that compromise the broader health system. Based on a review published literature and expert opinion, the article proposes 4 key health systems strengthening issues as a means to promote sustainability and country ownership of President's Emergency Plan for AIDS Relief and other global health initiatives. First, development partners need provide capacity building support and to recognize and align resources with national government health strategies and operational plans. Second, investments in human capital, particularly human resources for health, need to be guided by national institutions and supported to ensure the training and retention of skilled, qualified, and relevant health care providers. Third, a range of financing strategies, both new resources and improved efficiencies, need to be pursued as a means to create more fiscal space to ensure sustainable and self-reliant systems. Finally, service delivery models must adjust to recent advancements in areas of HIV prevention and treatment and aim to establish evidence-based delivery models to reduce HIV transmission rates and the overall burden of disease. The article concludes that there needs to be ongoing efforts to identify and implement strategic health systems strengthening interventions and address the inherent tension and debate over investments in health systems. |
PEPFAR's evolving HIV prevention approaches for key populations--people who inject drugs, men who have sex with men, and sex workers: progress, challenges, and opportunities
Needle R , Fu J , Beyrer C , Loo V , Abdul-Quader AS , McIntyre JA , Li Z , Mbwambo JK , Muthui M , Pick B . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S145-51 In most countries, the burden of HIV among people who inject drugs, men who have sex with men, and sex workers is disproportionately high compared with that in the general population. Meanwhile, coverage rates of effective interventions among those key populations (KPs) are extremely low, despite a strong evidence base about the effectiveness of currently available interventions. In its first decade, President's Emergency Plan for AIDS Relief (PEPFAR) is making progress in responding to HIV/AIDS, its risk factors, and the needs of KPs. Recent surveillance, surveys, and size estimation activities are helping PEPFAR country programs better estimate the HIV disease burden, understand risk behavior trends, and determine coverage and resources required for appropriate scale-up of services for KPs. To expand country planning of programs to further reduce HIV burden and increase coverage among KPs, PEPFAR has developed a strategy consisting of technical documents on the prevention of HIV among people who inject drugs (July 2010) and prevention of HIV among men who have sex with men (May 2011), linked with regional meetings and assistance visits to guide the adoption and scale-up of comprehensive packages of evidence-based prevention services for KPs. The implementation and scaling up of available and targeted interventions adapted for KPs are important steps in gaining better control over the spread and impact of HIV/AIDS among these populations. |
Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief
Chi BH , Adler MR , Bolu O , Mbori-Ngacha D , Ekouevi DK , Gieselman A , Chipato T , Luo C , Phelps BR , McClure C , Mofenson LM , Stringer JS . J Acquir Immune Defic Syndr 2012 60 Suppl 3 S78-87 In June 2011, the Joint United Nations Programme on HIV/AIDS, the US President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators outlined a transformative plan to virtually eliminate pediatric AIDS worldwide. The ambitious targets of this initiative included a 90% reduction in new pediatric HIV infections and a 50% reduction in HIV-related maternal mortality--all by 2015. PEPFAR has made an unprecedented commitment to the expansion and improvement of prevention of mother-to-child HIV transmission (PMTCT) services globally and is expected to play a critical role in reaching the virtual elimination target. To date, PEPFAR has been instrumental in the success of many national programs, including expanded coverage of PMTCT services, an enhanced continuum of care between PMTCT and HIV care and treatment, provision of more efficacious regimens for antiretroviral prophylaxis, design of innovative but simplified PMTCT approaches, and development of new strategies to evaluate program effectiveness. These accomplishments have been made through collaborative efforts with host governments, United Nations agencies, other donors (eg, the Global Fund for AIDS, Tuberculosis, and Malaria), nongovernmental organizations, and private sector partners. To successfully meet the ambitious global targets to prevent new infant HIV infections, PEPFAR must continue to leverage the existing PMTCT platform, while developing innovative approaches to rapidly expand quality HIV services. PEPFAR must also carefully integrate PMTCT into the broader combination prevention agenda for HIV, so that real progress can be made toward an "AIDS-free generation" worldwide. |
HIV incidence among vulnerable populations in Honduras: results from an integrated behavioral and biologic survey among female sex workers, men who have sex with men, and Garifuna in Honduras, 2006
Kim AA , Morales Miranda S , Lorenzana de Rivera I , Paredes M , Juarez SI , Alverez B , Liu X , Parekh B , Monterroso E , Paz Bailey G . AIDS Res Hum Retroviruses 2012 29 (3) 516-9 BACKGROUND: Honduras has one of the highest HIV prevalence rates in Central America. Data on HIV incidence is needed to identify groups at greatest need of prevention interventions to inform the HIV response. METHODS: We applied a test for recent infection to HIV-positive specimens from a biologic and behavioral survey to estimate assay-derived incidence among men who have sex with men (MSM), female sex workers (FSW), and the Garifuna population in Honduras. Assay-derived estimates were compared to the mathematically modeled estimates in the same populations to assess plausibility of the assay-based estimates. RESULTS: Assay-derived incidence estimates were 1.1% (95% CI 0.2 - 2.0) among MSM, 0.4% (95% CI 0.1 - 0.8) among the Garifuna, and 0% (95% CI 0 - 0.01) among FSWs. The modeled incidence estimates were similar at 1.03% among MSM, 0.30% among the Garifuna, and 0.23% among FSWs. DISCUSSION: HIV incidence was highest among MSM in Honduras, lowest among FSWs, and similar to modeled incidence in these groups. Targeted programs on HIV prevention, care, and treatment are urgently needed for the MSM population. Continued support for existing prevention programs for FSWs and Garifuna are recommended. |
Influenza-related mortality among adults aged 25-54 years with AIDS in South Africa and the United States of America
Cohen C , Simonsen L , Sample J , Kang JW , Miller M , Madhi SA , Campsmith M , Viboud C . Clin Infect Dis 2012 55 (7) 996-1003 BACKGROUND: Data are limited on human immunodeficiency virus (HIV)-associated influenza burden in sub-Saharan Africa and the impact of highly active antiretroviral therapy (HAART). We compared influenza-related mortality in adults with AIDS in South Africa and the United States in the pre-HAART era and evaluated mortality trends after HAART introduction in the United States. METHODS: Monthly all-cause and pneumonia and influenza (P&I) mortality rates were compiled for adults with AIDS aged 25-54 years in South Africa (1998-2005) and the United States (pre-HAART era, 1987-1994; HAART era, 1997-2005). We estimated influenza-related deaths as excess mortality above a model baseline during influenza epidemic periods. Influenza-related mortality rates in adults with AIDS were compared with rates for age peers in the general population and adults ≥65 years old. RESULTS: In the United States before HAART, influenza-related mortality rates in adults with AIDS were 150 (95% confidence interval [CI], 49-460) and 208 (95% CI, 74-583) times greater than in the general population for all-cause and P&I deaths, respectively, and 2.5 (95% CI, 0.9-7.2) and 4.1 (95% CI, 1.4-13) times higher than in elderly adults. After HAART introduction , influenza-related mortality in adults with AIDS dropped 3-6-fold but remained elevated compared with the general population (all-cause relative risk [RR], 44 [95% CI, 16-121]); P&I RR, 73 [95% CI, 47-113]). Influenza-related mortality in South African adults with AIDS in recent years was similar to that in the United States in the pre-HAART era. CONCLUSIONS: Adults with AIDS experience substantially elevated influenza-associated mortality, which declines with widespread HAART introduction but does not disappear. These data support increased access to HAART and influenza vaccination for HIV-infected adults. |
Considerations regarding antiretroviral chemoprophylaxis and heterosexuals in generalized epidemic settings
Paxton LA . Curr Opin HIV AIDS 2012 7 (6) 557-62 PURPOSE OF REVIEW: To discuss the factors pertinent to the use of pre-exposure prophylaxis (PrEP) by at-risk heterosexuals in countries with generalized HIV epidemics. RECENT FINDINGS: PrEP will have the greatest prevention effect if targeted to those at highest risk, but identifying and engaging such persons is challenging. Serodiscordant couples account for a high proportion of new infections and are an appropriate target for PrEP, but the proportion of people in such relationships is small and outside partnerships are common. Differences in adherence coupled to pharmacology of the drugs may account for differences in efficacy seen in the trials. Mathematical modeling indicates that the benefits of PrEP in highly endemic settings outweigh the risk of induced viral resistance. Behavioral risk compensation was not observed in the trials, but current open-label studies will better determine if disinhibition will be an important problem. CONCLUSIONS: PrEP is a potentially useful HIV-prevention strategy for generalized heterosexual epidemics. Optimal implementation will require learning more about ways to improve acceptability and adherence and how best to deliver PrEP within the context of limited resource availability. |
Efficacy of indoor residual spraying using lambda-cyhalothrin for controlling nontarget vector fleas (Siphonaptera) on commensal rats in a plague endemic region of northwestern Uganda
Borchert JN , Eisen RJ , Atiku LA , Delorey MJ , Mpanga JT , Babi N , Enscore RE , Gage KL . J Med Entomol 2012 49 (5) 1027-34 Over the past two decades, the majority of human plague cases have been reported from areas in Africa, including Uganda. In an effort to develop affordable plague control methods within an integrated vector control framework, we evaluated the efficacy of indoor residual spraying (IRS) techniques commonly used for mosquito control for controlling fleas on hut-dwelling commensal rodents in a plague-endemic region of Uganda. We evaluated both the standard IRS spraying (walls and ceiling) and a modified IRS technique that included insecticide application on not only on walls and ceiling but also a portion of the floor of each treated hut. Our study demonstrated that both the standard and modified IRS applications were effective at significantly reducing the flea burden and flea infestation of commensal rodents for up to 100 d after application, suggesting that IRS could potentially provide simultaneous control of mosquito and fleaborne diseases. |
Survey and genetic characterization of wastewater in Tunisia for Cryptosporidium spp., Giardia duodenalis, Enterocytozoon bieneusi, Cyclospora cayetanensis and Eimeria spp.
Ben Ayed L , Yang W , Widmer G , Cama V , Ortega Y , Xiao L . J Water Health 2012 10 (3) 431-44 The microbial diversity of wastewater used for irrigation and fertilization was assessed using specific polymerase chain reaction (PCR) assays to detect and genotype several pathogenic protists including Cryptosporidium spp., Giardia duodenalis, Cyclospora spp., Eimeria spp. and Enterocytozoon bieneusi. A total of 220 wastewater samples (110 raw, 110 treated) and 12 sludge samples were collected from 2005 to 2008 from 18 treatment plants located throughout Tunisia. Except for Cyclospora, which was detected only once, E. bieneusi (61%), G. duodenalis (28%), Cryptosporidium spp. (27%) and Eimeria spp. (45%) were frequently observed in wastewater and sludge. Sequencing of PCR products showed that C. hominis, C. andersoni, G. duodenalis sub-assemblage A-II and E. bieneusi genotypes D and IV were the most prevalent. An analysis of the distribution of 209 internal transcribed spacer sequences of E. bieneusi originating from wastewater at the 18 treatment plants showed a similar genetic diversity, regardless of the geographical location. The identification of these parasite species and genotypes and of host-specific Eimeria species indicates that the microbial quality of wastewater was impacted by humans, livestock and rodents. Given the public health risks that some of these parasites represent, guidelines on wastewater usage are needed to minimize human exposure to these pathogens. |
Genome sequences for six Rhodanobacter strains, isolated from soils and the terrestrial subsurface, with variable denitrification capabilities.
Kostka JE , Green SJ , Rishishwar L , Prakash O , Katz LS , Marino-Ramirez L , Jordan IK , Munk C , Ivanova N , Mikhailova N , Watson DB , Brown SD , Palumbo AV , Brooks SC . J Bacteriol 2012 194 (16) 4461-2 We report the first genome sequences for six strains of Rhodanobacter species isolated from a variety of soil and subsurface environments. Three of these strains are capable of complete denitrification and three others are not. However, all six strains contain most of the genes required for the respiration of nitrate to gaseous nitrogen. The nondenitrifying members of the genus lack only the gene for nitrate reduction, the first step in the full denitrification pathway. The data suggest that the environmental role of bacteria from the genus Rhodanobacter should be reevaluated. |
Personalized medicine in major depressive disorder -- opportunities and pitfalls.
Miller DB , O'Callaghan JP . Metabolism 2012 62 Suppl 1 S34-9 The sequencing of the human genome in the early days of this millennium was greeted with great fanfare as this accomplishment was expected to revolutionize medicine and result in individualized treatments based on the genetic make-up of the patient. The ultimate promise of personalized medicine would be fulfilled with the identification of disease biomarkers that would be widely available for use in diagnosis and treatment. Progress, however, has been slow in providing disease biomarkers or approved diagnostic tests. This is true for major depressive disorder (MDD), despite its prevalence in the general population and the widespread acceptance of its biological basis. Studies using strategies like genome-wide association and candidate gene analyses have identified a number of possible biomarkers of MDD, including serum levels of neurotrophic factors, inflammatory cytokines and HPA axis hormones, but none have proven sufficiently powerful for clinical use. The lack of biologically based tests available for use in identifying patients with MDD is a significant impediment to personalized and more effective treatment, because it means diagnosis continues to be driven by subjective symptoms. While genetic studies of MDD have not yet led to diagnostic and treatment biomarkers, progress in determining the role of the genome in drug metabolism heralds the first effort in personalized prescribing for the antidepressants. The FDA suggested and approved genotyping tests for common variants of drug metabolism genes, such as the cytochrome p450s. By using these tests a physician can select an appropriate antidepressant for a given patient, as differences in clearance, half-life, and peak blood concentrations are controlled by genetic variability in drug metabolism. Personalization in drug choice can be achieved because these tests: (1) identify responders and non-responders; (2) provide alerts to possible adverse drug events; and (3) help optimize dose. Improved ways of diagnosing and prescribing effective treatments for MDD are needed, as the available methods are inadequate and symptom based. In the foreseeable future, further interrogation of the genome may serve as the basis for development of new personalized medicine strategies for diagnosis and treatment of MDD. |
Association of nucleotide polymorphisms within the O-antigen gene cluster of Escherichia coli O26, O45, O103, O111, O121, and O145 with serogroups and genetic subtypes.
Norman KN , Strockbine NA , Bono JL . Appl Environ Microbiol 2012 78 (18) 6689-703 Shiga toxin-producing Escherichia coli (STEC) strains are important food-borne pathogens capable of causing hemolytic-uremic syndrome. STEC O157:H7 strains cause the majority of severe disease in the United States; however, there is a growing concern for the amount and severity of illness attributable to non-O157 STEC. Recently, the Food Safety and Inspection Service (FSIS) published the intent to regulate the presence of STEC belonging to serogroups O26, O45, O103, O111, O121, and O145 in nonintact beef products. To ensure the effective control of these bacteria, sensitive and specific tests for their detection will be needed. In this study, we identified single nucleotide polymorphisms (SNPs) in the O-antigen gene cluster that could be used to detect STEC strains of the above-described serogroups. Using comparative DNA sequence analysis, we identified 22 potentially informative SNPs among 164 STEC and non-STEC strains of the above-described serogroups and designed matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) assays to test the STEC allele frequencies in an independent panel of bacterial strains. We found at least one SNP that was specific to each serogroup and also differentiated between STEC and non-STEC strains. Differences in the DNA sequence of the O-antigen gene cluster corresponded well with differences in the virulence gene profiles and provided evidence of different lineages for STEC and non-STEC strains. The SNPs discovered in this study can be used to develop tests that will not only accurately identify O26, O45, O103, O111, O121, and O145 strains but also predict whether strains detected in the above-described serogroups contain Shiga toxin-encoding genes. |
Health behaviors and cancer screening among Californians with a family history of cancer.
Townsend JS , Steele CB , Richardson LC , Stewart SL . Genet Med 2012 15 (3) 212-21 PURPOSE: The purpose of this study was to compare health behaviors and cancer screening among Californians with and without a family history of cancer. METHODS: We analyzed data from the 2005 California Health Interview Survey to ascertain cancer screening test use and to estimate the prevalence of health behaviors that may reduce the risk of cancer. We used logistic regression to control for demographic factors and health-care access. RESULTS: Women with a family history of breast or ovarian cancer were more likely to be up to date with mammography as compared with women with no family history of cancer (odds ratio = 1.69, 95% confidence interval (1.39, 2.04)); their health behaviors were similar to other women. Men and women with a family history of colorectal cancer were more likely to be up to date with colorectal cancer screening as compared with individuals with no family history of cancer (odds ratio = 2.77, 95% confidence interval (2.20, 3.49)) but were less likely to have a body mass index <25 kg/m(2) (odds ratio = 0.80, 95% confidence interval (0.67, 0.94)). CONCLUSION: Innovative methods are needed to encourage those with a moderate-to-strong familial risk for breast cancer and colorectal cancer to increase their physical activity levels, strive to maintain a healthy weight, quit smoking, and reduce alcohol use. |
Advancing infection control in dental care settings: factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention
Cleveland JL , Foster M , Barker L , Brown GG , Lenfestey N , Lux L , Corley TJ , Bonito AJ . J Am Dent Assoc 2012 143 (10) 1127-38 BACKGROUND AND OVERVIEW: The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings-2003. METHODS: In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling. RESULTS: Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied. CONCLUSIONS: Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines. |
Report on the international workshop on alternative methods for human and veterinary rabies vaccine testing: state of the science and planning the way forward
Stokes W , McFarland R , Kulpa-Eddy J , Gatewood D , Levis R , Halder M , Pulle G , Kojima H , Casey W , Gaydamaka A , Miller T , Brown K , Lewis C , Chapsal JM , Bruckner L , Gairola S , Kamphuis E , Rupprecht CE , Wunderli P , McElhinney L , De Mattia F , Gamoh K , Hill R , Reed D , Doelling V , Johnson N , Allen D , Rinckel L , Jones B . Biologicals 2012 40 (5) 369-81 Potency testing of most human and veterinary rabies vaccines requires vaccination of mice followed by a challenge test using an intracerebral injection of live rabies virus. NICEATM, ICCVAM, and their international partners organized a workshop to review the availability and validation status of alternative methods that might reduce, refine, or replace the use of animals for rabies vaccine potency testing, and to identify research and development efforts to further advance alternative methods. Workshop participants agreed that general anesthesia should be used for intracerebral virus injections and that humane endpoints should be used routinely as the basis for euthanizing animals when conducting the mouse rabies challenge test. Workshop participants recommended as a near-term priority replacement of the mouse challenge with a test validated to ensure potency, such as the mouse antibody serum neutralization test for adjuvanted veterinary rabies vaccines for which an international collaborative study was recently completed. The workshop recommended that an in vitro antigen quantification test should be a high priority for product-specific validation of human and non-adjuvanted veterinary rabies vaccines. Finally, workshop participants recommended greater international cooperation to expedite development, validation, regulatory acceptance, and implementation of alternative test methods for rabies vaccine potency testing. |
Physician attitudes regarding school-located vaccinations
McCormick EV , Durfee J , Vogt TM , Daley MF , Hambidge SJ , Shlay J . Pediatrics 2012 130 (5) 887-96 OBJECTIVE: To assess physician attitudes regarding school-located adolescent vaccination and influenza vaccination. METHODS: From July through September 2010, a 20-item survey was mailed to 1337 practicing Colorado family physicians and pediatricians. Standard statistical methods were used to examine unadjusted and adjusted odds ratios of factors associated with physician support for school-located vaccination programs. RESULTS: Overall, 943 physicians were survey-eligible, and 584 (62%) responded. More than half of physicians supported both school-located influenza and adolescent vaccination. However, fewer physicians supported school-located adolescent vaccination compared with influenza vaccination. More physicians supported school-located vaccination for their publicly insured patients compared with their privately insured patients. Some family physicians (32%) and pediatricians (39%) believed that school-located vaccination would make their patients less likely to attend well-child visits, and half of respondents believed that school-located vaccination would have a negative financial impact on their practice. In multivariate analyses, physicians concerned about the financial impact of school-located vaccination were less likely to support such programs. CONCLUSIONS: Although a majority of Colorado physicians supported influenza and adolescent vaccination at school, they expressed concerns regarding the implications on their practice. Lesser support for vaccination of their privately insured patients and concerns regarding attendance at well-child visits suggests the perceived financial impact from school-located vaccination is a barrier and merits additional examination. |
Effectiveness of 1 dose of influenza A (H1N1) 2009 monovalent vaccines in preventing reverse-transcription polymerase chain reaction-confirmed H1N1 infection among school-aged children in Maine
Uzicanin A , Thompson M , Smith P , Chaves SS , Foster L , Dube N , Graitcer S , Jackson R , Ferdinands J , Gargiullo P , Mills D , Monto AS , Shay DK . J Infect Dis 2012 206 (7) 1059-1068 BACKGROUND: In late October 2009, school-located pandemic vaccination was initiated in Maine before or concurrent with 2009 pandemic influenza A (H1N1) virus (pH1N1) peak activity. METHODS: A case-control evaluation of 2009 H1N1 vaccine effectiveness was conducted in schools in Cumberland County, Maine. A case was a child who had an acute respiratory illness during 2 November-18 December 2009, and who tested positive for pH1N1 by real-time reverse-transcription polymerase chain reaction (rRT-PCR). For each case, ≥4 event time-matched controls were sampled among classmates present in school during the study period who did not have an influenza-like illness. Vaccine effectiveness was calculated as (1 - adjusted odds ratio [aOR]) 100%; aOR was estimated by using weighted logistic regression. RESULTS: After adjusting for a diagnosis of asthma, 1 dose of 2009 H1N1 vaccine provided 69% protection (95% confidence interval (CI), 13-89) against rRT-PCR-confirmed H1N1 infection. Vaccine effectiveness estimates for live attenuated and inactivated vaccine were 81% (95% CI, -37 to 97), and 58% (95% CI: -39 to 87), respectively. CONCLUSIONS: One dose of monovalent pandemic vaccine provided substantial protection against pH1N1 infection among school-aged children. |
Effectiveness of seasonal influenza vaccines in the United States during a season with circulation of all three vaccine strains
Treanor JJ , Talbot HK , Ohmit SE , Coleman LA , Thompson MG , Cheng PY , Petrie JG , Lofthus G , Meece JK , Williams JV , Berman L , Breese Hall C , Monto AS , Griffin MR , Belongia E , Shay DK . Clin Infect Dis 2012 55 (7) 951-959 BACKGROUND: Influenza vaccines may be reformulated annually because of antigenic drift in influenza viruses. However, the relationship between antigenic characteristics of circulating viruses and vaccine effectiveness (VE) is not well understood. We conducted an assessment of the effectiveness of US influenza vaccines during the 2010-2011 season. METHODS: We performed a case-control study comparing vaccination histories between subjects with acute respiratory illness with positive real-time reverse transcription polymerase chain reaction for influenza and influenza test-negative controls. Subjects with acute respiratory illness of ≤7 days duration were enrolled in hospitals, emergency departments, or outpatient clinics in communities in 4 states. History of immunization with the 2010-2011 vaccine was ascertained from vaccine registries or medical records. Vaccine effectiveness was estimated in logistic regression models adjusted for study community, age, race, insurance status, enrollment site, and presence of a high-risk medical condition. RESULTS: A total of 1040 influenza-positive cases and 3717 influenza-negative controls were included from the influenza season, including 373 cases of influenza A(H1N1), 334 cases of influenza A(H3N2), and 333 cases of influenza B. Overall adjusted VE was 60% (95% confidence interval [CI], 53%-66%). Age-specific VE estimates ranged from 69% (95% CI, 56%-77%) in children aged 6 months-8 years to 38% (95% CI, -16% to 67%) in adults aged ≥65 years. CONCLUSIONS: The US 2010-2011 influenza vaccines were moderately effective in preventing medically attended influenza during a season when all 3 vaccine strains were antigenically similar to circulating viruses. Continued monitoring of influenza vaccines in all age groups is important, particularly as new vaccines are introduced. |
Anthrax vaccine-induced antibodies provide cross-species prediction of survival to aerosol challenge
Fay MP , Follmann DA , Lynn F , Schiffer JM , Stark GV , Kohberger R , Quinn CP , Nuzum EO . Sci Transl Med 2012 4 (151) 151ra126 Because clinical trials to assess the efficacy of vaccines against anthrax are not ethical or feasible, licensure for new anthrax vaccines will likely involve the Food and Drug Administration's "Animal Rule," a set of regulations that allow approval of products based on efficacy data only in animals combined with immunogenicity and safety data in animals and humans. U.S. government-sponsored animal studies have shown anthrax vaccine efficacy in a variety of settings. We examined data from 21 of those studies to determine whether an immunological bridge based on lethal toxin neutralization activity assay (TNA) can predict survival against an inhalation anthrax challenge within and across species and genera. The 21 studies were classified into 11 different settings, each of which had the same animal species, vaccine type and formulation, vaccination schedule, time of TNA measurement, and challenge time. Logistic regression models determined the contribution of vaccine dilution dose and TNA on prediction of survival. For most settings, logistic models using only TNA explained more than 75% of the survival effect of the models with dose additionally included. Cross-species survival predictions using TNA were compared to the actual survival and shown to have good agreement (Cohen's kappa ranged from 0.55 to 0.78). In one study design, cynomolgus macaque data predicted 78.6% survival in rhesus macaques (actual survival, 83.0%) and 72.6% in rabbits (actual survival, 64.6%). These data add support for the use of TNA as an immunological bridge between species to extrapolate data in animals to predict anthrax vaccine effectiveness in humans. |
Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: A laboratory medicine best practices systematic review and meta-analysis
Liebow EB , Derzon JH , Fontanesi J , Favoretto AM , Baetz RA , Shaw C , Thompson P , Mass D , Christenson R , Epner P , Snyder SR . Clin Biochem 2012 45 979-87 OBJECTIVE: To conduct a systematic review of the evidence available in support of automated notification methods and call centers and to acknowledge other considerations in making evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting. DESIGN AND METHODS: This review followed the Laboratory Medicine Best Practices (LMBP) review methods (Christenson, et al. 2011). A broad literature search and call for unpublished submissions returned 196 bibliographic records which were screened for eligibility. 41 studies were retrieved. Of these, 4 contained credible evidence for the timeliness and accuracy of automatic notification systems and 5 provided credible evidence for call centers for communicating critical value information in in-patient care settings. RESULTS: Studies reporting improvement from implementing automated notification findings report mean differences and were standardized using the standard difference in means (d=0.42; 95% CI=0.2-0.62) while studies reporting improvement from implementing call centers generally reported criterion referenced findings and were standardized using odds ratios (OR=22.1; 95% CI=17.1-28.6). CONCLUSIONS: The evidence, although suggestive, is not sufficient to make an LMBP recommendation for or against using automated notification systems as a best practice to improve the timeliness of critical value reporting in an in-patient care setting. Call centers, however, are effective in improving the timeliness of critical value reporting in an in-patient care setting, and meet LMBP criteria to be recommended as an "evidence-based best practice." |
Improvement of disease prediction and modeling through the use of meteorological ensembles: human plague in Uganda
Moore SM , Monaghan A , Griffith KS , Apangu T , Mead PS , Eisen RJ . PLoS One 2012 7 (9) e44431 Climate and weather influence the occurrence, distribution, and incidence of infectious diseases, particularly those caused by vector-borne or zoonotic pathogens. Thus, models based on meteorological data have helped predict when and where human cases are most likely to occur. Such knowledge aids in targeting limited prevention and control resources and may ultimately reduce the burden of diseases. Paradoxically, localities where such models could yield the greatest benefits, such as tropical regions where morbidity and mortality caused by vector-borne diseases is greatest, often lack high-quality in situ local meteorological data. Satellite- and model-based gridded climate datasets can be used to approximate local meteorological conditions in data-sparse regions, however their accuracy varies. Here we investigate how the selection of a particular dataset can influence the outcomes of disease forecasting models. Our model system focuses on plague (Yersinia pestis infection) in the West Nile region of Uganda. The majority of recent human cases have been reported from East Africa and Madagascar, where meteorological observations are sparse and topography yields complex weather patterns. Using an ensemble of meteorological datasets and model-averaging techniques we find that the number of suspected cases in the West Nile region was negatively associated with dry season rainfall (December-February) and positively with rainfall prior to the plague season. We demonstrate that ensembles of available meteorological datasets can be used to quantify climatic uncertainty and minimize its impacts on infectious disease models. These methods are particularly valuable in regions with sparse observational networks and high morbidity and mortality from vector-borne diseases. |
Top 20 violence and injury practice innovations since 1992
Kress HC , Noonan R , Freire K , Marr A , Olson A . J Safety Res 2012 43 (4) 257-63 This article presents what the authors consider to be among the top 20 practice innovations since the inception of the National Center for Injury Prevention and Control in 1992. The innovations embody various characteristics of successful public health programs and have contributed to declines in violence, motor vehicle, residential fire, and other injury rates over the past 20 years. Taken together, these innovations have reduced the burden of violence and injury and have influenced current practice and practitioners in the United States and worldwide. |
Trends in traumatic brain injury in the U.S. and the public health response: 1995–2009
Coronado VG , McGuire LC , Sarmiento K , Bell J , Lionbarger MR , Jones CD , Geller AI , Khoury N , Xu L . J Safety Res 2012 43 (4) 299-307 Problem Traumatic Brain Injury (TBI) is a public health problem in the United States. In 2009, approximately 3.5 million patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N = 300,667) or were treated and released from emergency departments (EDs; N = 2,077,350), outpatient departments (ODs; N = 83,857), and office-based physicians (OB-P; N = 1,079,338). In addition, 52,695 died with one or more TBI-related diagnoses. Methods Federal TBI-related laws that have guided CDC since 1996 were reviewed. Trends in TBI were obtained by analyzing data from nationally representative surveys conducted by the National Center for Health Statistics (NCHS). Findings CDC has developed and is implementing a strategy to reduce the burden of TBI in the United States. Currently, 20 states have TBI surveillance and prevention systems. From 1995–2009, the TBI rates per 100,000 population increased in EDs (434.1 vs. 686.0) and OB-Ps (234.6 vs. 352.3); and decreased in ODs (42.6 vs. 28.1) and in TBI-related deaths (19.9 vs. 16.6). TBI Hospitalizations decreased from 95.5 in 1995 to 77.9 in 2000 and increased to 95.7 in 2009. Conclusions The rates of TBI have increased since 1995 for ED and PO visits. To reduce of the burden and mitigate the impact of TBI in the United States, an improved state- and territory-specific TBI surveillance system that accurately measures burden and includes information on the acute and long-term outcomes of TBI is needed. |
Twenty years of scientific progress in injury and violence research and the next public health frontier
Greenspan AI , Noonan RK . J Safety Res 2012 43 (4) 249-55 The establishment of the National Center for Injury Prevention and Control (NCIPC or Injury Center) in 1992 as part of the Centers for Disease Control and Prevention (CDC) firmly established the Injury Center as the lead federal agency for non-occupational injury prevention and control (Sleet et al., 2012). Since then, it has provided leadership and a strong scientific base for intramural and extramural-investigator funded injury research. The Injury Center's scientific mission encompasses efforts from primary prevention to treatment and rehabilitation. Early CDC efforts were primarily focused on describing the extent of the problem, identifying risk and protective factors that affect the extent of violence and injury in our society, and gaining visibility for violence and injury as a major public health problem. Efforts such as the development of injury-based surveillance systems provided population-based surveillance data regarding the extent and distribution of fatal and non-fatal injuries, helped to identify demographic characteristics for those who were most at risk, and identified risk and protective factors that influence that risk. Celebrating the Injury Center's 20th anniversary presents an opportunity not only to reflect on past accomplishments but also to look ahead at what still needs to be done. |
The National Center for Injury Prevention and Control on its 20th anniversary: a safe future and the importance of 20
Mack KA , Freire K , Marr A . J Safety Res 2012 43 (4) 229-30 In recognition of NCIPC's role in creating a safer world, we brought together 20 contributions for this Journal of Safety Research Anniversary Supplement that represents the breadth of our work while acknowledging that we cannot truly represent the depth of the work over the past two decades. The Center's current focal and cross-cutting areas are highlighted in the articles of this Supplement and cover a range of activities from violence prevention, unintentional injury, to acute care and rehabilitation. The Supplement also contains contributions from partners and highlights the resources of the Center. |
NCIPC's contribution to global injury and violence prevention: past, present, and future
Mahendra RR , Roehler DR , Degutis LC . J Safety Res 2012 43 (4) 271-7 Injuries and violence impact millions across the globe each year. For the past 20 years, the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC) has assembled the largest cadre of injury and violence prevention experts in the world to reduce the burden of injuries and violence domestically and to inform global injury and violence prevention efforts. This article focuses on NCIPC's global injury and violence prevention work that involves: increasing awareness of the preventability of injury and violence, partnerships to promote injury research and best practices; establishing standards and guidance for data collection; building capacity through training and mentoring; and supporting evidence-based strategies. To decrease the global burden, the authors propose priority setting to maximize the development and sustainability of financial and human resources for injury and violence prevention. Impact on Industry: The authors call for increased capacity and resources for global injury and violence prevention. |
Preventing violence against children and youth
Tharp AT , Simon TR , Saul J . J Safety Res 2012 43 (4) 291-8 The National Center for Injury Prevention and Control (NCIPC) has a focus on preventing interpersonal violence against children and youth. Prevention of violence against children and youth involves fostering healthy relationships and building healthy environments in which young people can flourish. We review NCIPC's work over the past 20 years that has contributed to this goal by highlighting surveillance systems that identify the magnitude of violence, etiological research that identifies risk and protective factors that are associated with violence, evaluation research that has expanded the evidence base of what works to prevent violence, and comprehensive, broad-based programs that engage and empower communities to prevent violence. NCIPC's work demonstrates that violence is preventable and the Center is working to move the promise of effective prevention into practice. These efforts all work toward protecting the health and well-being of children and youth and set the stage for NCIPC's future work. |
Evaluation of the North Carolina Violent Death Reporting System, 2009
Dailey NJ , Norwood T , Moore ZS , Fleischauer AT , Proescholdbell S . N C Med J 2012 73 (4) 257-62 BACKGROUND: Violence is a leading cause of death in North Carolina. The North Carolina Violent Death Reporting System (NC-VDRS) is part of the National Violent Death Reporting System (NVDRS), which monitors violent deaths and collects information about injuries and psychosocial contributors. Our objective was to describe and evaluate the quality, timeliness, and usefulness of the system. METHODS: We used the Centers for Disease Control and Prevention's guidelines for evaluating public health surveillance systems to assess the system. We performed subjective assessment of system attributes by reviewing system documents and interviewing stakeholders. We estimated NC-VDRS's reporting completeness using a capture-recapture method. RESULTS: Stakeholders considered data provided by NC-VDRS to be of high quality. Reporting to the national system has taken place before the specified 6-month and 18-month deadlines, but local stakeholder reports have been delayed up to 36 months. Stakeholders reported using NC-VDRS data for program planning and community education. The system is estimated to capture all NVDRS-defined cases, but law enforcement officers report only 61% of suicides. LIMITATIONS: The law enforcement agencies we interviewed may not be representative of all participating agencies in the state. Data sources used to assess completeness were not independent. CONCLUSION: NC-VDRS is useful and well-accepted. However, completeness of suicide reporting is limited, and reporting to local stakeholders has been delayed. Improving these limitations might improve the usefulness of the system for planning and appropriately targeting violence prevention interventions. |
From modest beginnings to a winnable battle: road safety efforts at CDC's Injury Center
Dellinger AM , Sleet DA . J Safety Res 2012 43 (4) 279-82 There are now more than 200 million licensed drivers, who drive an average of 13,000 miles per year on 4 million miles of roads. In 2010 crashes resulted in nearly 33,000 deaths and millions of nonfatal injuries. This article describes the Injury Center's response to this public health threat from our beginnings as a small Center in 1992, current motor vehicle injury prevention priorities, and emerging road safety issues that will need attention in the future. |
The future of injury and violence prevention: Where are we going?
Degutis LC . J Safety Res 2012 43 (4) 231-2 As we are celebrating the 20th anniversary of the National Center for Injury Prevention (NCIPC) and Control at the Centers for Disease Control and Prevention (CDC), we are looking at the possibilities for progress in the next decade and beyond. We face many challenges, but through collaboration, innovation and creativity, we can meet the challenges ahead and ensure that the field of injury and violence prevention continues to work toward the goal of allowing people to live their lives injury and violence free. |
A history of injury and violence prevention in public health and evolution of the National Center for Injury Prevention and Control at CDC
Sleet DA , Baldwin G , Marr A , Spivak H , Patterson S , Morrison C , Holmes W , Peeples AB , Degutis LC . J Safety Res 2012 43 (4) 233-47 Injuries and violence are among the oldest health problems facing humans. And yet, only within the past 50 years has the problem being addressed with scientific rigor using public health methods. The field of injury and violence prevention began as early as 1913, but wasn't approached systematically or epidemiologically until the 1940s and 1950s. It accelerated rapidly between 1960 and 1985. Coupled with active federal and state interest in reducing injuries and violence, this period was marked by important medical, scientific, and public health advances. The National Center for Injury Prevention and Control (NCIPC) was an outgrowth of this progress and in 2012 celebrated its 20th anniversary. NCIPC was created in 1992 after a series of government reports identified injury as one of the most important public health problems facing the nation. Congressional action provided the impetus for the creation of NCIPC as the lead federal agency for non-occupational injury and violence prevention. In subsequent years, NCIPC and its partners fostered many advances and built even greater capacity. Because of the tragically high burden and cost of injuries and violence in the United States and across the globe, researchers, practitioners, and decision makers can improve progress by redoubling prevention efforts in the next 20 years. This article traces the history of injury and violence prevention as a public health priority – including the evolution and current structure of the CDC's National Center for Injury Prevention and Control. |
Injury and violence prevention policy: Celebrating our successes, protecting our future
Koné RG , Zurick E , Patterson S , Peeples A . J Safety Res 2012 43 (4) 265-70 Policy strategies for injury and violence prevention influence systems development, organizational change, social norms, and individual behavior to improve the health and safety of a population. Injury and violence prevention professionals should consider how their issues resonate with various audiences, including policy makers, the public, and other decision makers. As the cost of healthcare continues to rise and greater demands are placed on the healthcare system, the use of public health policy becomes increasingly critical to protect the public's health and prevent injury and violence and its related morbidities and disabilities (Degutis, 2011). This article highlights some impactful policy successes from the field, allows us to reflect on the Injury Center's 20th anniversary, and describes steps to address injuries and violence into the future. The purpose of this paper is to discuss policy as a public health strategy and the critical role it plays in injury and violence prevention. |
CDC Foundation
Stokes C . J Safety Res 2012 43 (4) 315 On behalf of the CDC Foundation, it is my pleasure to congratulate the staff of CDC's National Center for Injury Prevention and Control on 20 years of life-saving injury prevention work! We appreciate the opportunity to collaborate with CDC on addressing one of the leading causes of death and disability in this country. | The CDC Foundation is proud to build partnerships that support CDC's injury prevention activities. Since 2004, the CDC Foundation has raised more than $15 million to help CDC reduce injuries and violence through prevention. These partnerships have helped CDC protect Americans from motor-vehicle injuries and death, sports-related injuries, and intimate partner violence. Recently, private-sector partners have signed-on to support CDC's injury prevention work globally - supporting a fleet safety program in India and an initiative to evaluate the impact of sexual violence against girls and young women in countries around the world. | A few of these programs are highlighted below. Each program has expanded CDC's capacity to work with local, state, national, and international partners to save lives. Over the next 20 years, as CDC continues to build our knowledge and understanding of what works to prevent injuries and violence, the CDC Foundation looks forward to new opportunities to advance CDC's work to protect our families, our communities, and our workforce, and to share the science of what works with partners around the world. |
Rotavirus VP8*: phylogeny, host range, and interaction with histo-blood group antigens
Liu Y , Huang P , Tan M , Liu Y , Biesiada J , Meller J , Castello AA , Jiang B , Jiang X . J Virol 2012 86 (18) 9899-910 The distal portion of rotavirus (RV) VP4 spike protein (VP8*) is implicated in binding to cellular receptors, thereby facilitating viral attachment and entry. While VP8* of some animal RVs engage sialic acid, human RVs often attach to and enter cells in a sialic acid-independent manner. A recent study demonstrated that the major human RVs (P[4], P[6], and P[8]) recognize human histo-blood group antigens (HBGAs). In this study, we performed a phylogenetic analysis of RVs and showed further variations of RV interaction with HBGAs. On the basis of the VP8* sequences, RVs are grouped into five P genogroups (P[I] to P[V]), of which P[I], P[IV], and P[V] mainly infect animals, P[II] infects humans, and P[III] infects both animals and humans. The sialic acid-dependent RVs (P[1], P[2], P[3], and P[7]) form a subcluster within P[I], while all three major P genotypes of human RVs (P[4], P[6], and P[8]) are clustered in P[II]. We then characterized three human RVs (P[9], P[14], and P[25]) in P[III] and observed a new pattern of binding to the type A antigen which is distinct from that of the P[II] RVs. The binding was demonstrated by hemagglutination and saliva binding assay using recombinant VP8* and native RVs. Homology modeling and mutagenesis study showed that the locations of the carbohydrate binding interfaces are shared with the sialic acid-dependent RVs, although different amino acids are involved. The P[III] VP8* proteins also bind the A antigens of the porcine and bovine mucins, suggesting the A antigen as a possible factor for cross-species transmission of RVs. Our study suggests that HBGAs play an important role in RV infection and evolution. |
Within-subject interlaboratory variability of QuantiFERON-TB Gold In-Tube tests
Whitworth WC , Hamilton LR , Goodwin DJ , Barrera C , West KB , Racster L , Daniels LJ , Chuke SO , Campbell BH , Bohanon J , Jaffar AT , Drane W , Maserang D , Mazurek GH . PLoS One 2012 7 (9) e43790 BACKGROUND: The QuantiFERON(R)-TB Gold In-Tube test (QFT-GIT) is a viable alternative to the tuberculin skin test (TST) for detecting Mycobacterium tuberculosis infection. However, within-subject variability may limit test utility. To assess variability, we compared results from the same subjects when QFT-GIT enzyme-linked immunosorbent assays (ELISAs) were performed in different laboratories. METHODS: Subjects were recruited at two sites and blood was tested in three labs. Two labs used the same type of automated ELISA workstation, 8-point calibration curves, and electronic data transfer. The third lab used a different automated ELISA workstation, 4-point calibration curves, and manual data entry. Variability was assessed by interpretation agreement and comparison of interferon-gamma (IFN-gamma) measurements. Data for subjects with discordant interpretations or discrepancies in TB Response >0.05 IU/mL were verified or corrected, and variability was reassessed using a reconciled dataset. RESULTS: Ninety-seven subjects had results from three labs. Eleven (11.3%) had discordant interpretations and 72 (74.2%) had discrepancies >0.05 IU/mL using unreconciled results. After correction of manual data entry errors for 9 subjects, and exclusion of 6 subjects due to methodological errors, 7 (7.7%) subjects were discordant. Of these, 6 (85.7%) had all TB Responses within 0.25 IU/mL of the manufacturer's recommended cutoff. Non-uniform error of measurement was observed, with greater variation in higher IFN-gamma measurements. Within-subject standard deviation for TB Response was as high as 0.16 IU/mL, and limits of agreement ranged from -0.46 to 0.43 IU/mL for subjects with mean TB Response within 0.25 IU/mL of the cutoff. CONCLUSION: Greater interlaboratory variability was associated with manual data entry and higher IFN-gamma measurements. Manual data entry should be avoided. Because variability in measuring TB Response may affect interpretation, especially near the cutoff, consideration should be given to developing a range of values near the cutoff to be interpreted as "borderline," rather than negative or positive. |
Multi-walled carbon nanotubes: sampling criteria and aerosol characterization
Chen BT , Schwegler-Berry D , McKinney W , Stone S , Cumpston JL , Friend S , Porter DW , Castranova V , Frazer DG . Inhal Toxicol 2012 24 (12) 798-820 This study intends to develop protocols for sampling and characterizing multi-walled carbon nanotube (MWCNT) aerosols in workplaces or during inhalation studies. Manufactured dry powder containing MWCNT's, combined with soot and metal catalysts, form complex morphologies and diverse shapes. The aerosols, examined in this study, were produced using an acoustical generator. Representative samples were collected from an exposure chamber using filters and a cascade impactor for microscopic and gravimetric analyses. Results from filters showed that a density of 0.008-0.10 particles per microm(2) filter surface provided adequate samples for particle counting and sizing. Microscopic counting indicated that MWCNT's, resuspended at a concentration of 10 mg/m(3), contained 2.7 x 10(4) particles/cm(3). Each particle structure contained an average of 18 nanotubes, resulting in a total of 4.9 x 10(5) nanotubes/cm(3). In addition, fibrous particles within the aerosol had a count median length of 3.04 microm and a width of 100.3 nm, while the isometric particles had a count median diameter of 0.90 microm. A combination of impactor and microscopic measurements established that the mass median aerodynamic diameter of the mixture was 1.5 microm. It was also determined that the mean effective density of well-defined isometric particles was between 0.71 and 0.88 g/cm(3), and the mean shape factor of individual nanotubes was between 1.94 and 2.71. The information obtained from this study can be used for designing animal inhalation exposure studies and adopted as guidance for sampling and characterizing MWCNT aerosols in workplaces. The measurement scheme should be relevant for any carbon nanotube aerosol. |
Effect of calibration and environmental condition on the performance of direct-reading organic vapor monitors
Coffey C , Lebouf R , Lee L , Slaven J , Martin S . J Occup Environ Hyg 2012 9 (11) 670-80 The performance of three MIRAN SapphIRe Portable Infrared Ambient Air Analyzers and three Century Portable Toxic Vapor Analyzers equipped with photoionization (PID) and flame ionization (FID) detectors was compared with charcoal tube sampling. Relationships were investigated using two different calibration methods at four cyclohexane concentrations, three temperatures, and four relative humidities. For the first method, the TVA monitors were calibrated with a single concentration of methane for the FID, and isobutylene for the PID. The SapphIRe monitors were zeroed and the monitor's manufacturer-supplied library was used. For the second method, a five-point cyclohexane calibration curve was created for each monitor. Comparison of the monitor results of each calibration method (pooled data) indicated a significant difference between methods (t-test, p < 0.001), The SapphIRe group had results closer to the charcoal tubes with the second calibration method, while the PID and FID monitor groups performed better using the first calibration method. The PID monitor group's performance was affected only at the 90% relative humidity (RH) condition. Using the first method, the monitor readings were compared with the charcoal tube average using mixed linear model analyses of variance (ANOVAs) and regression. The ANOVA results showed there was a statistically significant difference among readings from all monitor types (p <0.0001). The regression results demonstrated that the SapphIRe (r(2) = 0.97) and FID (r(2) = 0.92) monitor groups correlated well with the charcoal tubes. The PID monitor group had a similar correlation when 90% RH was excluded (r(2) = 0.94) but had a weaker correlation when it was included (r(2) = 0.58). The operator should take care when using these monitors at high concentrations and the PID monitors at high humidities, consider the variability between units of the same monitor, and conduct performance verification of the monitor being used. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a program listing, schematic diagrams, and other design details for the test automation system.]. |
Effectiveness of barcoding for reducing patient specimen and laboratory testing identification errors: a Laboratory Medicine Best Practices systematic review and meta-analysis
Snyder SR , Favoretto AM , Derzon JH , Christenson RH , Kahn SE , Shaw CS , Baetz RA , Mass D , Fantz CR , Raab SS , Tanasijevic MJ , Liebow EB . Clin Biochem 2012 45 988-98 OBJECTIVES: This is the first systematic review of the effectiveness of barcoding practices for reducing patient specimen and laboratory testing identification errors. DESIGN AND METHODS: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. RESULTS: A total of 17 observational studies reporting on barcoding systems are included in the body of evidence; 10 for patient specimens and 7 for point-of-care testing. All 17 studies favored barcoding, with meta-analysis mean odds ratios for barcoding systems of 4.39 (95% CI: 3.05-6.32) and for point-of-care testing of 5.93 (95% CI: 5.28-6.67). CONCLUSIONS: Barcoding is effective for reducing patient specimen and laboratory testing identification errors in diverse hospital settings and is recommended as an evidence-based "best practice." The overall strength of evidence rating is high and the effect size rating is substantial. Unpublished studies made an important contribution comprising almost half of the body of evidence. |
Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis
Snyder SR , Favoretto AM , Baetz RA , Derzon JH , Madison BM , Mass D , Shaw CS , Layfield CD , Christenson RH , Liebow EB . Clin Biochem 2012 45 999-1011 OBJECTIVES: This article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits. DESIGN AND METHODS: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. RESULTS: Studies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12). CONCLUSIONS: Venipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based "best practices" with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement. |
Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis
Heyer NJ , Derzon JH , Winges L , Shaw C , Mass D , Snyder SR , Epner P , Nichols JH , Gayken JA , Ernst D , Liebow EB . Clin Biochem 2012 45 1012-32 OBJECTIVE: To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. RESULTS: A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35-0.57]. CONCLUSIONS: Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site. |
Effects of covered solid sorbent tube sample holders on organic vapor measurements
Marpoe BS , Groves WA , Lee EG , Slaven JE , Harper M . J Occup Environ Hyg 2012 9 (10) 572-9 A study was conducted to examine whether there are significant differences between organic vapor concentrations measured using charcoal tubes with three different configurations: uncovered sample holder (open tube), SKC, and Buck brand covered sample holders. A fractional factorial experimental design was used with the following factors and levels: vapor (n-hexane vs. m-xylene), pump type (pulsating vs. continuous), exposure profile (variable vs. constant), flow rate (30 mL/min vs. 200 mL/min), duration (30 min vs. 80 min), and sample placement (mannequin vs. free hanging). Two of each sampler configuration (six total) were placed in an exposure chamber, and a dynamic test-atmosphere generation system was used to prepare atmospheres containing approximately 12-15 ppm n-hexane or m-xylene with exposure profiles and sampling conducted according to a run sheet generated for the experimental design. A total of 24 runs were completed with six samplers per run, yielding 144 samples that were analyzed by gas chromatography/flame ionization detector. Concentration results for each pair of SKC and Buck covered sample holders were averaged and normalized by dividing by the average result for the open tube sampler from the same run to eliminate the effect of daily variation in chamber concentrations. The resulting ratio of covered sample tube holder and open tube concentrations was used as the response variable. Results of analysis of variance using the general linear model (MINITAB 16) identified statistically significant main effects and/or interactions for pump type, exposure profile, flow rate, and sample holder. However, the magnitude of the effects was generally less than 10%, and overall mean concentration ratios were 0.989 and 1.02 for the Buck and SKC sample holders, respectively. These results show good agreement between covered sample holder results and open tube measurements and demonstrate that exposure assessment errors resulting from the use of covered sorbent tube sample holders for organic vapor monitoring are relatively small (<10%) and not likely to be of practical importance. |
In vivo bioluminescence imaging of Escherichia coli O104:H4 and role of aerobactin during colonization of a mouse model of infection
Torres AG , Cieza RJ , Rojas-Lopez M , Blumentritt CA , Souza CS , Johnston RK , Strockbine N , Kaper JB , Sbrana E , Popov VL . BMC Microbiol 2012 12 112 BACKGROUND: A major outbreak of bloody diarrhea associated with Shiga toxin-producing Escherichia coli O104:H4 occurred early in 2011, to which an unusual number of hemolytic uremic syndrome cases were linked. Due to limited information regarding pathogenesis and/or virulence properties of this particular serotype, we investigated the contribution of the aerobactin iron transport system during in vitro and in vivo conditions. RESULTS: A bioluminescent reporter construct was used to perform real-time monitoring of E. coli O104:H4 in a mouse model of infection. We verified that our reporter strain maintained characteristics and growth kinetics that were similar to those of the wild-type E. coli strain. We found that the intestinal cecum of ICR (CD-1) mice was colonized by O104:H4, with bacteria persisting for up to 7 days after intragastric inoculation. MALDI-TOF analysis of heat-extracted proteins was performed to identify putative surface-exposed virulence determinants. A protein with a high similarity to the aerobactin iron receptor was identified and further demonstrated to be up-regulated in E. coli O104:H4 when grown on MacConkey agar or during iron-depleted conditions. Because the aerobactin iron acquisition system is a key virulence factor in Enterobacteriaceae, an isogenic aerobactin receptor (iutA) mutant was created and its intestinal fitness assessed in the murine model. We demonstrated that the aerobactin mutant was out-competed by the wild-type E. coli O104:H4 during in vivo competition experiments, and the mutant was unable to persist in the cecum. CONCLUSION: Our findings demonstrate that bioluminescent imaging is a useful tool to monitor E. coli O104:H4 colonization properties, and the murine model can become a rapid way to evaluate bacterial factors associated with fitness and/or colonization during E. coli O104:H4 infections. |
Detailed mechanistic investigation into the S-nitrosation of cysteamine
Morakinyo MK , Chipinda I , Hettick J , Siegel PD , Abramson J , Strongin R , Martincigh BS , Simoyi RH . Can J Chem 2012 90 (9) 724-738 The nitrosation of cysteamine (H2NCH2CH2SH) to produce cysteamine-S-nitrosothiol (CANO) was studied in slightly acidic medium by using nitrous acid prepared in situ. The stoichiometry of the reaction was H2NCH2CH2SH + HNO2 → H2NCH2CH2SNO + H2O. On prolonged standing, the nitrosothiol decomposed quantitatively to yield the disulfide, cystamine: 2H2NCH2CH2SNO → H2NCH2CH2S–SCH2CH2NH2 + 2NO. NO2 and N2O3 are not the primary nitrosating agents, since their precursor (NO) was not detected during the nitrosation process. The reaction is first order in nitrous acid, thus implicating it as the major nitrosating agent in mildly acidic pH conditions. Acid catalyzes nitrosation after nitrous acid has saturated, implicating the protonated nitrous acid species, the nitrosonium cation (NO+) as a contributing nitrosating species in highly acidic environments. The acid catalysis at constant nitrous acid concentrations suggests that the nitrosonium cation nitrosates at a much higher rate than nitrous acid. Bimolecular rate constants for the nitrosation of cysteamine by nitrous acid and by the nitrosonium cation were deduced to be 17.9 ± 1.5 (mol/L)–1 s–1 and 6.7 × 104 (mol/L)–1 s–1, respectively. Both Cu(I) and Cu(II) ions were effective catalysts for the formation and decomposition of the cysteamine nitrosothiol. Cu(II) ions could catalyze the nitrosation of cysteamine in neutral conditions, whereas Cu(I) could only catalyze in acidic conditions. Transnitrosation kinetics of CANO with glutathione showed the formation of cystamine and the mixed disulfide with no formation of oxidized glutathione (GSSG). The nitrosation reaction was satisfactorily simulated by a simple reaction scheme involving eight reactions. |
NIOSH-sponsored research in through-the-earth communications for mines: a status report
Yenchek MR , Homce GT , Damiano NW , Srednicki JR . IEEE Trans Ind Appl 2012 48 (5) 1700-1707 This paper presents the results of recent contractual research sponsored by the National Institute for Occupational Safety and Health that aimed at demonstrating the feasibility of through-the-earth (TTE) wireless communication in mining. TTE systems, developed by five different contractors, are discussed with a focus on technical approach, prototype hardware, and field test results. System features include both magnetic and electric field sensing, loop and line antennas, digital and analog processing, noise filtering and cancelation, and direction finding. The systems were demonstrated at commercial mine sites. The results of these tests are characterized by transmission range and power levels. This paper concludes with a discussion of issues that remain to be resolved as TTE communications are implemented. These include text versus voice format, acceptable time delays, portability, ease of deployment, an interface with existing communications systems, permissibility, and the effect of geological variations. |
Using the associative imagery technique in qualitative health research: the experiences of homecare workers and consumers
Gong F , Castaneda D , Zhang X , Stock L , Ayala L , Baron S . Qual Health Res 2012 22 (10) 1414-24 The associative imagery technique is a qualitative tool with which researchers use carefully selected photographs or images to trigger participants' responses to explain difficult behavioral and social concepts. In this article, we describe the development and implementation of the associative imagery method in focus groups to understand the complex relationships between homecare workers and their clients as part of a larger health and safety intervention project conducted by the National Institute for Occupational Safety and Health. A total of 116 homecare workers and clients were recruited for the study. We found that participants used images mainly in two ways. First, the images served to remind participants of specific persons, events, and/or objects. Second, the images facilitated recollections and reflections that allowed participants to metaphorically describe their experiences, feelings, and emotions. Both usages of imagery generated comments that answered the research question in a more relevant, descriptive, and vivid way. |
Job insecurity, work-family imbalance, and hostile work environment: prevalence data from the 2010 national health interview survey
Alterman T , Luckhaupt SE , Dahlhamer JM , Ward BW , Calvert GM . Am J Ind Med 2012 56 (6) 660-9 BACKGROUND: Little nationally representative information on job insecurity, work-family imbalance, and hostile work environments experienced by workers in the US is available. METHODS: Prevalence rates from the 2010 National Health Interview Survey (NHIS) were calculated for three workplace psychosocial factors (job insecurity, work-family imbalance, bullying/harassment) using SUDAAN to account for the complex NHIS sample design. RESULTS: Data were available for 17,524 adults who worked in the 12 months that preceded the interview. Overall prevalence rates were 31.7% for job insecurity, 16.3% for work-family imbalance, and 7.8% for hostile work environment (being bullied or harassed). The highest prevalence rate of job insecurity was found for construction and extraction occupations. Workers in legal occupations had the highest prevalence rate of work-family imbalance. Workers in protective service occupations had the highest prevalence rate of hostile work environment. CONCLUSIONS: We identified demographic characteristics along with industries and occupations with the highest prevalence rates for three adverse workplace psychosocial factors. These data can be used for benchmarking and identification of targets for investigation and intervention activities. |
Dispersion and exposure to a cough-generated aerosol in a simulated medical examination room
Lindsley WG , King WP , Thewlis RE , Reynolds JS , Panday K , Cao G , Szalajda JV . J Occup Environ Hyg 2012 9 (12) 681-90 Few studies have quantified the dispersion of potentially infectious bioaerosols produced by patients in the health care environment and the exposure of health care workers to these particles. Controlled studies are needed to assess the spread of bioaerosols and the efficacy of different types of respiratory personal protective equipment (PPE) in preventing airborne disease transmission. An environmental chamber was equipped to simulate a patient coughing aerosol particles into a medical examination room, and a health care worker breathing while exposed to these particles. The system has three main parts: (1) a coughing simulator that expels an aerosol-laden cough through a head form; (2) a breathing simulator with a second head form that can be fitted with respiratory PPE; and (3) aerosol particle counters to measure concentrations inside and outside the PPE and at locations throughout the room. Dispersion of aerosol particles with optical diameters from 0.3 to 7.5 mum was evaluated along with the influence of breathing rate, room ventilation, and the locations of the coughing and breathing simulators. Penetration of cough aerosol particles through nine models of surgical masks and respirators placed on the breathing simulator was measured at 32 and 85 L/min flow rates and compared with the results from a standard filter tester. Results show that cough-generated aerosol particles spread rapidly throughout the room, and that within 5 min, a worker anywhere in the room would be exposed to potentially hazardous aerosols. Aerosol exposure is highest with no personal protective equipment, followed by surgical masks, and the least exposure is seen with N95 FFRs. These differences are seen regardless of breathing rate and relative position of the coughing and breathing simulators. These results provide a better understanding of the exposure of workers to cough aerosols from patients and of the relative efficacy of different types of respiratory PPE, and they will assist investigators in providing research-based recommendations for effective respiratory protection strategies in health care settings. |
Coal workers’ pneumoconiosis prevalence disparity between Australia and the United States
Joy GL , Colinet JF , Landen DD . Min Eng 2012 64 (7) 65-71 Although rates of pneumoconiosis in coal miners have declined substantially in the United States since the passage of the Federal Coal Mine Health and Safety Act of 1969, new cases continue to occur, including cases of rapidly progressive disease. In contrast, Australia’s underground coal mining industry has reported few new cases of pneumoconiosis for more than 20 years. Mortality from coal workers’ pneumoconiosis in official health statistics and the prevalence of pneumoconiosis among miners screened in X-ray surveillance programs are also lower in Australia. The U.S. National Institute for Occupational Safety and Health (NIOSH) was requested by both industry and labor stakeholders to examine this issue, with the ultimate aim of reducing the rate of pneumoconiosis among U.S. coal miners. A number of factors, including coal dust exposure, silica exposure and coal rank were examined as potential contributors to the above noted differences. Comparison of coal rank data from each country did not illuminate the issue. Air sample data from the coal mining industries in both countries show that coal dust levels in Australian mines are somewhat higher than those reported in similar U.S. mines; however, quartz exposure for Australian miners is lower than for many U.S. miners. If quartz is contributing to the greater number of cases of pneumoconiosis in the United States, more effective dust control measures, as well as an independent exposure standard for respirable quartz in coal mining, should be implemented to reduce this potentially disabling condition. |
Elimination of Onchocerca volvulus transmission in the Huehuetenango focus of Guatemala
Cruz-Ortiz N , Gonzalez RJ , Lindblade KA , Richards FO Jr , Sauerbrey M , Zea-Flores G , Dominguez A , Oliva O , Catu E , Rizzo N . J Parasitol Res 2012 2012 638429 In Latin America, onchocerciasis is targeted for elimination by 2012 through twice-yearly mass treatment of the eligible population with ivermectin. In Guatemala, two of the four historical endemic foci have demonstrated elimination of transmission, following World Health Organization guidelines. Using established guidelines ophthalmological, serological, and entomological evaluations were conducted in 2007-8 to determine the transmission status of onchocerciasis in the Huehuetenango focus. The prevalence of Onchocerca volvulus microfilariae in the anterior segment of the eye in 365 residents was 0% (95% confidence interval [CI] 0-0.8%), the prevalence of infection of O. volvulus in Simulium ochraceum among 8252 flies collected between November 2007 and April 2008 was 0% (95% CI 0-0.02%), and the prevalence of antibodies to a recombinant O. volvulus antigen in 3118 school age children was 0% (95% CI 0-0.1%). These results showed transmission interruption; thus, in 2009 mass treatment was halted and posttreatment surveillance began. To verify for potential recrudescence an entomological evaluation (from December 2010 to April 2011) was conducted during the 2nd and 3rd year of posttreatment surveillance. A total of 4587 S. ochraceum were collected, and the prevalence of infection of O. volvulus was 0% (95% CI 0-0.04%). Transmission of onchocerciasis in the Huehuetenango focus has been eliminated. |
A comprehensive approach to identifying intervention targets for patient-safety improvement in a hospital setting
Cunningham TR , Geller ES . J Organ Behav Manage 2012 32 (3) 194-220 Despite differences in approaches to organizational problem solving, healthcare managers and organizational behavior management (OBM) practitioners share a number of practices, and connecting healthcare management with OBM may lead to improvements in patient safety. A broad needs-assessment methodology was applied to identify patient-safety intervention targets in a large rural medical center. This included a content analysis of descriptions of managers' follow-up actions to error reports for nine types of the most frequently occurring errors. Follow-up actions were coded according to the taxonomy of behavioral intervention components developed by Geller et al. (1990). Two error types were identified as targets for intervention, and the outcome of this assessment process indicated a clear need to apply OBM interventions at the management level and thus have a hospital-wide benefit to patient safety. Future implications for using a system-wide approach to identifying and classifying responses to medical error are discussed. |
News from the CDC: integrating behavioral health into the patient-centered medical home
Chowdhury F , Kulcsar M , Gilchrist S , Hawkins N . Transl Behav Med 2012 2 (3) 257-259 Persons with mental illness are at higher risk of developing life-threatening physical conditions or dying prematurely [1], and several studies have reported improvements in health status when patients received integrated services. By integrating behavioral health services with primary care services, we can improve health care quality, preventive care practices, and health outcomes and reduce fragmented health care delivery for people who have mental illness or addictions and physical health problems [2, 3]. An emerging model for improving health care quality in the USA is the patient-centered medical home (PCMH). This model may provide an ideal way to integrate behavioral health and primary care services [4], particularly for persons with chronic conditions such as diabetes [5, 6] and hypertension [7, 8]. Already, some federal programs and state policies are supporting this approach as a way to integrate and improve health care services for persons with behavioral and physical health problems. |
Methods to improve international comparability of census and survey measures of disability
Madans JH , Loeb M . Disabil Rehabil 2012 35 (13) 1070-3 PURPOSE: To describe the methods used by the Washington Group on Disability Statistics (WG) to develop internationally comparable questions on disability that can be used worldwide. METHOD: The WG approach to developing disability measures included careful consideration of the theoretical and conceptual issues associated with disability, translating disability concepts into measurement tools, and mixed-method evaluations of the proposed questions using both cognitive and field interviewing methodologies. RESULTS: Disability is a complex construct the measurement of which presents considerable challenges for survey methodologists. The Washington Group on Disability Statistics (WG), a UN Statistical Commission sponsored city group, was established to address the methodological and measurement challenges that have characterized disability statistics and to develop questions for use worldwide that will provide comparable, valid and reliable disability statistics. The WG used a variety of methods to meet these objectives and has finalized a short set disability measure for use in censuses worldwide. CONCLUSIONS: The methodologies adopted by the WG have resulted in question sets that greatly improve the international comparability of disability statistics and will advance our understanding of disability worldwide. |
Tobacco use, cessation, and home smoking rules in a Hispanic community
O'Hegarty M , Pederson LL , Asman K , Thorne SL , Caraballo RS . Am J Health Behav 2013 37 (2) 248-56 OBJECTIVE: To determine prevalence of smoking, quit ratios, and home smoking rules among Hispanics residing in colonias in El Paso, Texas. METHODS: Face-to-face interviews with 1485 Hispanic adults. GeoFrame field enumeration methods were used to develop a sampling frame from households in randomly selected colonias. RESULTS: The overall percent of current cigarette smoking was 14.6% (95% CI 12.4 to 16.8); Over 55% of smokers reported a serious quit attempt. Participants overwhelmingly reported that smoking was not allowed in their homes. CONCLUSIONS: Prevalence estimates for current smoking and restriction in the home were similar to those reported for recent national surveys. |
Prescription drug overdoses: A review
Paulozzi LJ . J Safety Res 2012 43 (4) 283-9 PROBLEM: Overdoses involving prescription drugs in the United States have reached epidemic proportions over the past 20 years. METHODS: This review categorizes and summarizes literature on the topic dating from the first published reports through 2011 using a traditional epidemiologic model of host, agent, and environment. RESULTS: Host factors include male sex, middle age, non-Hispanic white race, low income, and mental health problems. Agent risk factors include use of opioid analgesics and benzodiazepines, high prescribed dosage for opioid analgesics, multiple prescriptions, and multiple prescribers. Environmental factors include rural residence and high community prescribing rates. DISCUSSION: The epidemiology of prescription drug overdoses differs from the epidemiology of illicit drug overdoses. Incomplete understanding of prescription overdoses impedes prevention efforts. SUMMARY: This epidemic demands additional attention from injury professionals. |
A cross-country comparison of secondhand smoke exposure among adults: findings from the Global Adult Tobacco Survey (GATS)
King BA , Mirza SA , Babb SD . Tob Control 2012 22 (4) e5 OBJECTIVE: Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature death among non-smoking adults and children. The objective of this study was to determine the nature, extent and demographic correlates of SHS exposure among adults in low- and middle-income countries with a high burden of tobacco use. METHODS: Data were obtained from the Global Adult Tobacco Survey (GATS), a nationally representative household survey of individuals 15 years of age or older. Interviews were conducted during 2008-2010 in Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Descriptive statistics were used to determine the prevalence and correlates of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and healthcare facilities. RESULTS: Exposure to SHS in the home ranged from 17.3% (Mexico) to 73.1% (Vietnam). Among those who work in an indoor area outside the home, SHS exposure in the workplace ranged from 16.5% (Uruguay) to 63.3% (China). Exposure to SHS ranged from 6.9% (Uruguay) to 72.7% (Egypt) in government buildings, 4.4% (Uruguay) to 88.5% (China) in restaurants, 5.4% (Uruguay) to 79.6% (Egypt) on public transportation, and 3.8% (Uruguay) to 49.2% (Egypt) in healthcare facilities. CONCLUSIONS: A large proportion of adults living in low- and middle-income countries are exposed to SHS in their homes, workplaces, and other public places. Countries can enact and enforce legislation requiring 100% smoke-free public places and workplaces, and can also conduct educational initiatives to reduce SHS exposure in homes. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Genetics and Genomics
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Mining
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Program Evaluation
- Social and Behavioral Sciences
- Statistics as Topic
- Substance Use and Abuse
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