Trends in diabetes treatment patterns among primary care providers
Decker SL , Burt CW , Sisk JE . J Ambul Care Manage 2009 32 (4) 333-341 Using data from the National Ambulatory Medical Care Survey, logit models tested for trends in the probability that visits by adult diabetes patients to their primary care providers included recommended treatment measures, such as a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-II receptor blocker (ARB), blood pressure measurement, and diet/nutrition or exercise counseling. Results indicated that the probability that visits included prescription of an ACE or ARB and blood pressure measurement increased significantly over the 1997-2005 period, while the probability that visits documented provision of exercise counseling rose since 2001. |
Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome
Decker MJ , Eyal S , Shinar Z , Fuxman Y , Cahan C , Reeves WC , Baharav A . Sleep Breath 2009 14 (3) 233-9 PURPOSE: Newly developed algorithms putatively derive measures of sleep, wakefulness, and respiratory disturbance index (RDI) through detailed analysis of heart rate variability (HRV). Here, we establish levels of agreement for one such algorithm through comparative analysis of HRV-derived values of sleep-wake architecture and RDI with those calculated from manually scored polysomnographic (PSG) recordings. METHODS: Archived PSG data collected from 234 subjects who participated in a 3-day, 2-night study characterizing polysomnographic traits of chronic fatigue syndrome were scored manually. The electrocardiogram and pulse oximetry channels were scored separately with a novel scoring algorithm to derive values for wakefulness, sleep architecture, and RDI. RESULTS: Four hundred fifty-four whole-night PSG recordings were acquired, of which, 410 were technically acceptable. Comparative analyses demonstrated no difference for total minutes of sleep, wake, NREM, REM, nor sleep efficiency generated through manual scoring with those derived through HRV analyses. When NREM sleep was further partitioned into slow-wave sleep (stages 3-4) and light sleep (stages 1-2), values calculated through manual scoring differed significantly from those derived through HRV analyses. Levels of agreement between RDIs derived through the two methods revealed an R = 0.89. The Bland-Altman approach for determining levels of agreement between RDIs generated through manual scoring with those derived through HRV analysis revealed a mean difference of -0.7 +/- 8.8 (mean +/- two standard deviations). CONCLUSION: We found no difference between values of wakefulness, sleep, NREM, REM sleep, and RDI calculated from manually scored PSG recordings with those derived through analyses of HRV. |
Highly variable population-based prevalence rates of unilateral hearing loss after the application of common case definitions
Ross DS , Visser SN , Holstrum WJ , Qin T , Kenneson A . Ear Hear 2009 31 (1) 126-33 OBJECTIVES: This study shows how population-based estimates of the prevalence of unilateral hearing loss (UHL) in children aged 6 to 19 yrs can differ considerably with various applications of commonly accepted case definitions. It also examines demographic variables and risk factors related to UHL. DESIGN: The Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994, is a national population-based, cross-sectional survey. This study examined results of audiometric testing at 0.5 to 8 kHz and demographic data from in-person examination interviews. Three definitions of UHL were used: (1) 0.5, 1, and 2 kHz ≥15 dB pure-tone average (PTA); (2) 0.5, 1, 2, and 4 kHz ≥15 dB PTA; and (3) 0.5, 1, and 2 kHz ≥20 dB or PTA >25 dB at two or more frequencies above 2 kHz (3, 4, 6, and 8 kHz). Case definitions 2 and 3 are not merely subsets of case definition 1. Some overlap exists between the groups, but each case definition classifies a proportion of children who fall uniquely under that case definition. Inclusion of participants based on tympanometry results (test of middle ear function) was also examined as were demographic characteristics and risk factors associated with UHL. RESULTS: Overall, the weighted proportion of children with UHL using case definition 1 was 6.3% (approximately 3,213,000 children nationally); using case definition 2, it was 5.8% (approximately 2,958,000 nationally); using case definition 3, it was 3.0% (approximately 1,530,000 nationally). For all three case definitions, children who failed tympanometry were at higher risk for UHL than children who passed. For case definition 2, children from rural areas were at higher risk for UHL than were children from urban areas. CONCLUSIONS: This study demonstrates that different applications of well-accepted case definitions of UHL can influence population-based prevalence estimates, in this study by as much as a factor of 2. These findings highlight the importance of controlling for tympanometry status as a risk factor in such estimates. Which demographic characteristics and risk factors are significantly associated with hearing loss seem to vary depending on the case definition. These findings have implications for the interpretation of prevalence rates and risk factors in the literature on hearing loss in general. Prevalence rate estimates require careful consideration of the case definition of hearing loss, tympanometry status, and demographic characteristics. |
Mumps resurgences in the United States: a historical perspective on unexpected elements
Barskey AE , Glasser JW , LeBaron CW . Vaccine 2009 27 (44) 6186-95 In 2006 the United States experienced the largest nationwide mumps epidemic in 20 years, primarily affecting college dormitory residents. Unexpected elements of the outbreak included very abrupt time course (75% of cases occurred within 90 days), geographic focality (85% of cases occurred in eight rural Midwestern states), rapid upward and downward shift in peak age-specific attack rate (5-9-year olds to 18-24-year olds, then back), and two-dose vaccine failure (63% of case-patients had received two doses). To construct a historical context in which to understand the recent outbreak, we reviewed US mumps surveillance data, vaccination coverage estimates, and relevant peer-reviewed literature for the period 1917-2008. Many of the unexpected features of the 2006 mumps outbreak had been reported several times previously in the US, e.g., the 1986-1987 mumps resurgence had extremely abrupt onset, rural geographic focality, and an upward-then-downward age shift. Evidence suggested recurrent mumps outbreak patterns were attributable to accumulation of susceptibles in dispersed situations where the risk of endemic disease exposure was low and were triggered when this susceptible population was brought together in crowded living conditions. The 2006 epidemic followed this pattern, with two unique variations: it was preceded by a period of very high vaccination rates and very low disease incidence and was characterized by two-dose failure rates among adults vaccinated in childhood. Data from the past 80 years suggest that preventing future mumps epidemics will depend on innovative measures to detect and eliminate build-up of susceptibles among highly vaccinated populations. |
Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV Medicine Association of the Infectious Diseases Society of America
Aberg JA , Kaplan JE , Libman H , Emmanuel P , Anderson JR , Stone VE , Oleske JM , Currier JS , Gallant JE , HIV Medicine Association of the Infectious Diseases Society of America . Clin Infect Dis 2009 49 (5) 651-81 Evidence-based guidelines for the management of persons infected with human immunodeficiency virus (HIV) were prepared by an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America. These updated guidelines replace those published in 2004. The guidelines are intended for use by health care providers who care for HIV-infected patients or patients who may be at risk for acquiring HIV infection. Since 2004, new antiretroviral drugs and classes have become available, and the prognosis of persons with HIV infection continues to improve. However, with fewer complications and increased survival, HIV-infected persons are increasingly developing common health problems that also affect the general population. Some of these conditions may be related to HIV infection itself and its treatment. HIV-infected persons should be managed and monitored for all relevant age- and gender-specific health problems. New information based on publications from the period 2003-2008 has been incorporated into this document. |
A road map to control malaria, tuberculosis, and human immunodeficiency virus/AIDS
Frieden TR , Teklehaimanot A , Chideya S , Farmer P , Kim JY , Raviglione MC . Arch Intern Med 2009 169 (18) 1650-2 Although preventable and treatable, malaria, tuberculosis (TB), and human immunodeficiency virus (HIV) together kill more than 5 million people annually. The burden of these diseases can be reduced—but only with increased governmental and nongovernmental resources, effective public-private partnerships, and strengthened disease-specific and general health systems. |
Seroprevalence of Q fever in the United States, 2003-2004
Anderson AD , Kruszon-Moran D , Loftis AD , McQuillan G , Nicholson WL , Priestley RA , Candee AJ , Patterson NE , Massung RF . Am J Trop Med Hyg 2009 81 (4) 691-4 We performed serum testing for IgG antibodies against Coxiella burnetii (phase I and phase II) and analyzed questionnaire data from 4,437 adults > or = 20 years of age who participated in the National Health and Nutrition Examination Survey 2003-2004 survey cycle. National Q fever seroprevalence was determined by enzyme-linked immunosorbent assay and confirmed by using immunofluorescent antibody testing. Overall seroprevalence for Coxiella burnetii was 3.1% (95% confidence interval [CI] = 2.1-4.3%) among 4,437 adults > or = 20 years of age. Coxiella burnetii age-adjusted antibody prevalence was higher for men than for women (3.8%, 95% CI = 2.7-5.2% versus 2.5%, 95% CI = 1.5-3.7%, respectively, P < 0.05). Mexican Americans had a significantly higher antibody prevalence (7.4%, 95% CI = 6.6-8.3%) than either non-Hispanic whites (2.8%, 95% CI = 1.7-4.3%) or non-Hispanic blacks (1.3%, 95% CI = 0.6-2.5%) (P < 0.001). Multivariate analysis showed that the risk for Q fever antibody positivity increased with age and was higher among persons who were foreign-born, male, and living in poverty. These findings indicate that the national seroprevalence of Q fever in the United States is higher than expected on the basis of case numbers reported to the Centers for Disease Control and Prevention from state health departments. Potential differences in risk for exposure by race/ethnicity warrant further study. |
Hemolytic uremic syndrome and death in persons with escherichia coli O157:H7 infection, Foodborne Diseases Active Surveillance Network Sites, 2000-2006
Gould LH , Demma L , Jones TF , Hurd S , Vugia DJ , Smith K , Shiferaw B , Segler S , Palmer A , Zansky S , Griffin PM . Clin Infect Dis 2009 49 (10) 1480-5 BACKGROUND: Hemolytic uremic syndrome (HUS) is a life-threatening illness usually caused by infection with Shiga toxin-producing Escherichia coli O157 (STEC O157). We evaluated the age-specific rate of HUS and death among persons with STEC O157 infection and the risk factors associated with developing HUS. MEHTODS: STEC O157 infections and HUS cases were reported from 8 sites participating in the Foodborne Diseases Active Surveillance Network during 2000-2006. For each case of STEC O157 infection and HUS, demographic and clinical outcomes were reported. The proportion of STEC O157 infections resulting in HUS was determined. RESULTS:. A total of 3464 STEC O157 infections were ascertained; 218 persons (6.3%) developed HUS. The highest proportion of HUS cases (15.3%) occurred among children aged <5 years. Death occurred in 0.6% of all patients with STEC O157 infection and in 4.6% of those with HUS. With or without HUS, persons aged 60 years had the highest rate of death due to STEC O157 infection. Twelve (3.1%) of 390 persons aged 60 years died, including 5 (33.3%) of 15 persons with HUS and 7 (1.9%) of 375 without. Among children aged <5 years, death occurred in 4 (3.0%) of those with HUS and 2 (0.3%) of those without. CONCLUSION: Young children and females had an increased risk of HUS after STEC O157 infection. With or without HUS, elderly persons had the highest proportion of deaths associated with STEC O157 infection. These data support recommendations for aggressive supportive care of young children and the elderly early during illness due to STEC O157. |
Keep It Up: development of a community-based health screening and HIV prevention strategy for reaching young African American men
O'Donnell L , Bonaparte B , Joseph H , Agronick G , Leow DM , Myint UA , Stueve A . AIDS Educ Prev 2009 21 (4) 299-313 This article addresses the challenge of developing HIV prevention interventions that not only prove to be efficacious but also are designed from the outset to overcome obstacles to reaching priority populations. We describe how community input has informed development of Keep It Up (KIU), a community health screening and behavioral prevention program for young Black men. KIU embeds HIV prevention in a broader health promotion campaign, with the goal of reducing stigma and reaching a population that bears a disproportionate burden of HIV/AIDS and other health problems-hypertension, high cholesterol, diabetes, asthma, and obesity. Information from community partners, expert advisers, and focus groups was collected at key junctures and incorporated into four core components: social marketing, a computerized behavioral learning module, biological testing for HIV and other conditions, and a personalized health profile and risk reduction plan. A pilot with 116 participants provided evidence that the KIU model of integrating HIV prevention with other health screening is acceptable and has the potential to reach Black men at risk for HIV as well as other chronic health conditions. |
A U.S. partnership with India and Poland to track acute chemical releases to serve public health
Ruckart PZ , Orr M , Palaszewska-Tkacz A , Dewan A , Kapil V . Int J Environ Res Public Health 2009 6 (9) 2375-86 We describe a collaborative effort between the U.S., India, and Poland to track acute chemical releases during 2005-2007. In all three countries, fixed facility events were more common than transportation-related events; manufacturing and transportation/warehousing were the most frequently involved industries; and equipment failure and human error were the primary contributing factors. The most commonly released nonpetroleum substances were ammonia (India), carbon monoxide (U.S.) and mercury (Poland). More events in India (54%) resulted in victims compared with Poland (15%) and the U.S. (9%). The pilot program showed it is possible to successfully conduct international surveillance of acute hazardous substances releases with careful interpretation of the findings. |
The costs of respiratory illnesses arising from Florida gulf coast Karenia brevis blooms
Hoagland P , Jin D , Polansky LY , Kirkpatrick B , Kirkpatrick G , Fleming LE , Reich A , Watkins SM , Ullmann SG , Backer LC . Environ Health Perspect 2009 117 (8) 1239-43 BACKGROUND: Algal blooms of Karenia brevis, a harmful marine algae, occur almost annually off the west coast of Florida. At high concentrations, K. brevis blooms can cause harm through the release of potent toxins, known as brevetoxins, to the atmosphere. Epidemiologic studies suggest that aerosolized brevetoxins are linked to respiratory illnesses in humans. OBJECTIVES: We hypothesized a relationship between K. brevis blooms and respiratory illness visits to hospital emergency departments (EDs) while controlling for environmental factors, disease, and tourism. We sought to use this relationship to estimate the costs of illness associated with aerosolized brevetoxins. METHODS: We developed a statistical exposure-response model to express hypotheses about the relationship between respiratory illnesses and bloom events. We estimated the model with data on ED visits, K. brevis cell densities, and measures of pollen, pollutants, respiratory disease, and intra-annual population changes. RESULTS: We found that lagged K. brevis cell counts, low air temperatures, influenza outbreaks, high pollen counts, and tourist visits helped explain the number of respiratory-specific ED diagnoses. The capitalized estimated marginal costs of illness for ED respiratory illnesses associated with K. brevis blooms in Sarasota County, Florida, alone ranged from $0.5 to $4 million, depending on bloom severity. CONCLUSIONS: Blooms of K. brevis lead to significant economic impacts. The costs of illness of ED visits are a conservative estimate of the total economic impacts. It will become increasingly necessary to understand the scale of the economic losses associated with K. brevis blooms to make rational choices about appropriate mitigation. |
Enhancing the public health perspective on onsite wastewater systems
Zarate-Bermudez MA . J Environ Health 2009 72 (3) 59-61 In 2007, approximately 20% of U.S. | households—60 to 65 million Americans— | were served by some type of onsite | wastewater (OWW) system (American | Housing Survey, 2008). We expect these | systems to safely disperse treated household | wastewater into the soil and help to recharge | aquifers. But these systems have been associated with groundwater contamination and | are possibly a threat to public health. Our | knowledge of the performance of OWW | systems remains inadequate. Thus, we need | to enhance the public health perspective | on OWW systems by better understanding | their performance through | developing monitoring methodologies, | and | conducting epidemiologic studies to determine their impact on human health. | Most OWW systems in the United States | are conventional systems (see Figure 1). | Data on performance of these systems and | their components are limited. Hoover, Rubin, & Humenik (1998) reported that OWW | systems result in desirable levels of treatment. Only a few researchers, however, have | reported on the quality of wastewater entering or leaving septic tanks without assessing | performance of these systems (Valiela et al., | 1992; Viraraghavan & Hashem, 1986). Levels of solids, organic matter, nutrients, microorganisms, and other constituents of raw | wastewaters and effluents are unknown for | conventional and alternative OWW systems, | making it difficult to determine the overall | performance of these systems. |
Prediction model to maximize impact of syphilis partner notification-San Francisco, 2004-2008
Marcus JL , Katz MH , Katz KA , Bernstein KT , Wolf W , Klausner JD . Sex Transm Dis 2009 37 (2) 109-14 BACKGROUND: Syphilis cases increased 55% in San Francisco from 2007 (n = 354) to 2008 (n = 548). The San Francisco Department of Public Health interviews syphilis patients to identify sex partners needing treatment, but interviewing resources are limited. We developed and validated a model to prioritize interviews likely to result in treated partners. METHODS: We included data from interviews conducted from July 2004 through June 2008. We used multivariate analysis to model the number of treated partners per interview in a random half of the data set. We applied the model to the other half, calculating predicted and observed proportions of partners successfully treated and interviews conducted if limiting interviews by syphilis patient characteristics. RESULTS: In 1340 patient interviews, 1665 partners were named; of those, 827 (49.7%) were treated. Ratios of treated partners were significantly higher among patients aged <50 years, compared with ≥50 years (ratio 1.4; 95% confidence interval [CI], 1.0-1.9); patients with primary/secondary syphilis, compared with early latent (ratio 1.4; 95% CI: 1.1-1.8); and patients diagnosed at the municipal sexually transmitted disease clinic, compared with elsewhere (ratio 1.7; 95% CI: 1.4-2.1). Limiting interviews to patients aged <50 years would reduce interviews by 14% and identify 92% of partners needing treatment. Limiting interviews to primary/secondary syphilis patients would reduce interviews by 35% and identify 68% of partners needing treatment. CONCLUSIONS: Our model can provide modest efficiencies in allocating resources for syphilis partner notification. Health departments should consider developing tools to maximize impact of syphilis prevention and control activities. |
Validation of self-reported data on assisted conception in the Danish National Birth Cohort
Hvidtjorn D , Grove J , Schendel D , Schieve LA , Ernst E , Olsen J , Thorsen P . Hum Reprod 2009 24 (9) 2332-40 BACKGROUND: An increasing number of children are born after assisted conception and in surveillance programmes information on mode of conception is often achieved via maternal self-report. We assessed the validity of self-reported assisted conception in The Danish National Birth Cohort (DNBC), a prospective pregnancy cohort. Here, the term assisted conception refers to IVF, ICSI, ovulation induction and insemination. METHODS: We compared self-reported assisted conception in the DNBC to corresponding data from Danish national registers; the IVF Register and Danish Drug Prescription Register, providing method of conception in the entire population. In the DNBC, 101,042 women accepted the invitation in early pregnancy from 1996 to 2002. Our final study population comprised 88,151 DNBC women aged 20 years and older who participated in the first DNBC interview with a pregnancy resulting in a live born child. RESULTS: In the DNBC, assisted conception was reported with a sensitivity of 83% and positive predictive value of 88%. Misclassification was largely explained by ambiguous phrasing of the DNBC interview question and interview skip patterns. Women with false negative reporting were more often multipara (P < 0.001) and older (P = 0.027 for IVF/ICSI and P = 0.002 for ovulation induction). The risk ratio (RR) for being born preterm in IVF/ICSI children was lower for children identified via the DNBC, RR 3.61 (95% confidence interval (CI) 3.31-3.94), than the IVF Register, RR 4.36 (95% CI 4.02-4.74). CONCLUSIONS: There was a high positive predictive value of self-reported assisted conception in the DNBC, but the structure of the DNBC interview represented a problem and misclassification could introduce bias. |
Youth Attitude to Noise Scale (YANS) questionnaire adaptation into Brazilian Portuguese
Zocoli AM , Morata TC , Marques JM . Braz J Otorhinolaryngol 2009 75 (4) 485-92 The growing exposure of teenagers to environmental noise and music has generated interest in studies about the impact of such exposure, as well as the measures taken in these situations. Therefore, it is fundamental to use a valid and reliable instrument. AIM: to validate a Brazilian Portuguese version of the Youth Attitude to Noise Scale questionnaire. STUDY DESIGN: cross-sectional, repeated measures. MATERIALS AND METHODS: Translation from English into Portuguese, pre-test, linguistic adaptation, review of grammar and idiomatic equivalence, and translation from Portuguese back to English. Instrument application. Retesting within 30 to 90 days. Measurement of the questions used following Likert's scale. Through factorial analysis, explanation for the connections among a set of variables. RESULTS: there was a match between translation and counter-translation. The questions were satisfactorily understood. The factorial analysis was well defined with the use of four factors. The instrument's reproducibility was proven by the 0.75 Cronback Alpha general index. CONCLUSIONS: Significant correlations, indicating the construction and content validity for its use, serving as a tool to assess the attitudes of the youth facing exposure to environmental noise or music. |
Personal utility and genomic information: look before you leap.
Grosse SD , McBride CM , Evans JP , Khoury MJ . Genet Med 2009 11 (8) 575-6 In this issue, Foster et al.1 argue that the utility of personal genomic information and the level of evidence that is required to document utility depend on the context and audience. Similarly, others have suggested that the utility of genomic information be considered from three perspectives: the public health perspective, which emphasizes health improvements on a population level; the clinical perspective, which emphasizes the use of genomic information in diagnostic thinking and therapeutic choice; and the personal perspective, which may consider genomic information as having potential value per se, positive or negative, regardless of its clinical use or health outcomes.2 | Foster et al.1 suggest that personal utility can be measured and used to identify which individuals are most likely to benefit from or be harmed by personal genomic information. In the clinical setting, patient decision aids provide individuals and clinicians with tools for assessing potential benefits and harms of clinical treatment options. For example, a number of decision aids have been developed to help individuals considering genetic testing for hereditary breast cancer assess the probabilities and importance of medical and nonmedical consequences.3 No one doubts that there will be challenges to developing decision aids to help consumers assess the potential benefits and risks of genomic information associated with slight elevations in risk of disease. |
Development of genomic DNA reference materials for genetic testing of disorders common in people of Ashkenazi Jewish descent
Kalman L , Wilson JA , Buller A , Dixon J , Edelmann L , Geller L , Highsmith WE , Holtegaard L , Kornreich R , Rohlfs EM , Payeur TL , Sellers T , Toji L , Muralidharan K . J Mol Diagn 2009 11 (6) 530-6 Many recessive genetic disorders are found at a higher incidence in people of Ashkenazi Jewish (AJ) descent than in the general population. The American College of Medical Genetics and the American College of Obstetricians and Gynecologists have recommended that individuals of AJ descent undergo carrier screening for Tay Sachs disease, Canavan disease, familial dysautonomia, mucolipidosis IV, Niemann-Pick disease type A, Fanconi anemia type C, Bloom syndrome, and Gaucher disease. Although these recommendations have led to increased test volumes and number of laboratories offering AJ screening, well-characterized genomic reference materials are not publicly available. The Centers for Disease Control and Prevention-based Genetic Testing Reference Materials Coordination Program, in collaboration with members of the genetic testing community and Coriell Cell Repositories, have developed a panel of characterized genomic reference materials for AJ genetic testing. DNA from 31 cell lines, representing many of the common alleles for Tay Sachs disease, Canavan disease, familial dysautonomia, mucolipidosis IV, Niemann-Pick disease type A, Fanconi anemia type C, Bloom syndrome, Gaucher disease, and glycogen storage disease, was prepared by the Repository and tested in six clinical laboratories using three different PCR-based assay platforms. A total of 33 disease alleles was assayed and 25 different alleles were identified. These characterized materials are publicly available from Coriell and may be used for quality control, proficiency testing, test development, and research. |
Rapid assessment of HIV risk behavior in drug using sex workers in three cities in South Africa
Parry CD , Dewing S , Petersen P , Carney T , Needle R , Kroeger K , Treger L . AIDS Behav 2009 13 (5) 849-59 A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered. |
Concurrency, sex partner risk, and high-risk human papillomavirus infection among African American, Asian, and Hispanic women
Javanbakht M , Gorbach PM , Amani B , Walker S , Cranston RD , Datta SD , Kerndt PR . Sex Transm Dis 2009 37 (2) 68-74 BACKGROUND: Although the role of concurrent sexual partnerships (i.e., having sexual activity with another partner after a current partnership has been established) has been most strongly associated with the transmission of bacterial sexually transmitted infections, its role in the transmission of viral sexually transmitted infections, specifically human papillomavirus (HPV) is less clear. METHODS: Analysis of risk behavior data collected from 812 women screened for HPV as part of a sentinel surveillance project conducted in a family planning clinic, a primary care clinic, and 2 sexually transmitted disease clinics in Los Angeles, CA. RESULTS: The mean age of participants was 34.2 years (range: 18-65), with 31.8% identifying as African American 32.8% as Asian, and 28.4% as Hispanic. The overall prevalence of high-risk HPV (HR-HPV) was 21.7% and was higher among women who reported a concurrent partnership (25.7%) as compared to those who reported no concurrency (17.1%; P = 0.004). In multivariate analysis, concurrency was associated with HR-HPV and this relationship varied by race/ethnicity. Among Hispanic women those reporting a concurrent partnership were nearly twice as likely to have HR-HPV as compared to those who did not report concurrency (adjusted odds ration [AOR] = 1.71; 95% confidence interval [CI]: 1.13-2.58). However, among African American women those who reported a concurrent partnership were less likely to be diagnosed with HR-HPV (AOR = 0.60; 95% CI: 0.37-0.98). CONCLUSIONS: This study demonstrates that concurrency is associated with HR-HPV and that there may be differences by race/ethnicity in the individual or partnership characteristics of those who report concurrency. |
Correlates of forced sex among populations of men who have sex with men in Thailand
Guadamuz TE , Wimonsate W , Varangrat A , Phanuphak P , Jommaroeng R , Mock PA , Tappero JW , van Griensven F . Arch Sex Behav 2009 40 (2) 259-66 Although forced sex is a correlate of HIV infection, its prevalence and associated risks are not well described among men who have sex with men (MSM) in developing-country settings. Between March and October 2005, we assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Participants were enrolled from venues around Bangkok, Chiangmai, and Phuket using venue day-time sampling. Handheld computer-assisted self-interviewing was used to collect demographic and behavioral data and logistic regression evaluated factors associated with forced sex, defined as ever being forced to have sexual intercourse against one's will. Of the 2,049 participants (M age, 24.8 years), a history of forced sex was reported by 376 (18.4%) men and, of these, most were forced by someone they knew (83.8%), forced more than once (67.3%), and had first occurrence during adolescence (55.1%). In multivariate analysis, having a history of forced sex was significantly associated with being recruited in Phuket, classification as general MSM or transgender (versus classification as male sex worker), drug use, increased number of male sexual partners, and buying sex. The findings in our assessment were consistent with assessments from Western countries. Longitudinal studies are needed to understand the mechanisms of the relationships between forced sex correlates found in our assessment and HIV acquisition and transmission risks. |
Multistate outbreak of Serratia marcescens bloodstream infections caused by contamination of prefilled heparin and isotonic sodium chloride solution syringes
Blossom D , Noble-Wang J , Su J , Pur S , Chemaly R , Shams A , Jensen B , Pascoe N , Gullion J , Casey E , Hayden M , Arduino M , Budnitz DS , Raad I , Trenholme G , Srinivasan A , Serratia in Prefilled Syringes Investigation Team . Arch Intern Med 2009 169 (18) 1705-11 BACKGROUND: To investigate clusters of Serratia marcescens (SM) bloodstream infections (BSIs) at health care facilities in several states and determine whether contaminated prefilled heparin and isotonic sodium chloride solution (hereinafter, saline) syringes from a single manufacturer (company X) were the likely cause, we performed an outbreak investigation of inpatient and outpatient health care facilities from October 2007 through February 2008. METHODS: Active case finding for clusters of SM BSIs. Information on SM BSIs was obtained, and SM blood isolates were sent to the Centers for Disease Control and Prevention (CDC). Culture specimens were taken from various lots of prefilled heparin and saline syringes by health care facilities and the CDC to test for the presence of SM. The SM isolates from syringes and blood were compared by pulsed-field gel electrophoresis. RESULTS: A total of 162 SM BSIs in 9 states were reported among patients at facilities using prefilled heparin and/or saline syringes made by company X. Cultures of unopened prefilled heparin and saline syringes manufactured by company X grew SM. Of 83 SM blood isolates submitted to the CDC from 7 states, 70 (84%) were genetically related to the SM strain isolated from prefilled syringes. A US Food and Drug Administration inspection revealed that company X was not in compliance with quality system regulations. CONCLUSIONS: A multistate outbreak of SM BSIs was associated with intrinsic contamination of prefilled syringes. Our investigation highlights important issues in medication safety, including (1) the importance of pursuing possible product-associated outbreaks suggested by strong epidemiologic data even when initial cultures of the suspected product show no contamination and (2) the challenges of medical product recalls when production has been outsourced from one company to another. |
Mycobacterium abscessus post-injection abscesses from extrinsic contamination of multiple-dose bottles of normal saline in a rural clinic
Yuan J , Liu Y , Yang Z , Cai Y , Deng Z , Qin P , Li T , Dong Z , Yan Z , Zhou D , Luo H , Ma H , Pang X , Fontaine RE . Int J Infect Dis 2009 13 (5) 537-42 BACKGROUND: We investigated an outbreak of gluteal abscesses following intramuscular (IM) injections given at a clinic in rural China to identify the causative agent, source, and method of exposure. METHODS: We defined a case as an abscess that appeared at the site of an injection given since June 1, 2006. We compared case rates by injection route, medication, and diluents. We reviewed injection practices, and cultured abscesses and environmental sites for mycobacteria. RESULTS: From October through December 2006, 5.8% (n=35) of 604 persons who had received injections at the clinic developed a case. All 35 cases occurred in 184 patients (attack rate=19.0%) who had received IM injections with various drugs that had been mixed with normal saline (NS); risk ratio=infinity; p<0.0001. No cases occurred in the absence of NS exposure. We identified Mycobacterium abscessus from eight abscesses and from the clinic water supply, and observed the inappropriate reuse of a 16-gauge needle left in the rubber septum of 100 ml multiple-dose bottles of NS in the clinic. Fourteen percent (n=527) of the 3887 registered residents of this village had been treated with IM drugs over a three-month period, often for minor illnesses. CONCLUSIONS: This outbreak of M. abscessus occurred from exposure to extrinsically contaminated NS through improper injection practices. Frequent treatment of minor illnesses with IM injections of antibiotics was likely an important contributing factor to the size of this outbreak. |
Nontuberculous mycobacteria infections in immunocompromised patients: single institution experience
Wei MC , Banaei N , Yakrus MA , Stoll T , Gutierrez KM , Agarwal R . J Pediatr Hematol Oncol 2009 31 (8) 556-60 Disseminated infection due to nontuberculous Mycobacterium (NTM) species is rare in pediatrics. Here we report 6 infections affecting 5 patients at a single institution in an immunocompromised population of pediatric oncology and stem cell transplant recipients. The patients presented within a 1-year period with catheter-associated bacteremia. New pulmonary nodules were noted in 4 of the 5 patients. All of the infections were due to rapidly growing NTM. Patients were successfully treated with removal of the infected catheter and combination antibiotic therapy. There are currently no consensus guidelines for treatment of NTM infections in this population, and a therapeutic approach is presented here. |
Provider chart audits and outreach to parents: impact in improving childhood immunization coverage and immunization information system completeness
Kolasa MS , Lutz JP , Cofsky A , Jones T . J Public Health Manag Pract 2009 15 (6) 459-63 OBJECTIVE: Examine impact of provider chart audits and parental outreach in improving immunization coverage among children not up-to-date (NUTD) for immunizations in Philadelphia's immunization information system (IIS). METHODS: We identified 10-month-old children NUTD for age-appropriate immunizations using Philadelphia's IIS. Immunization rates at 10, 13, and 19 months were compared before and after contact with providers and parents. RESULTS: Of 5 610 children NUTD in the IIS at 10 months and living in areas with populations at risk for underimmunization, provider chart audits indicated that 3 612 (64%) were actually up-to-date (UTD); the majority of these (2 203) received additional age-appropriate immunizations and were also UTD at 19 months. Of 1 998 children truly NUTD at 10 months, half received overdue immunizations by 13 months following contact with parents via telephone, postcards, and home visits, but only 23 percent were UTD for age-appropriate vaccines at 19 months. CONCLUSIONS: Provider chart audits improved IIS data completeness, indicating that providers need to submit more complete and timely data to the IIS. Outreach to parents likely contributed to half of the children NUTD at 10 months receiving overdue immunizations by 13 months. However, most were again NUTD at 19 months, indicating that outreach efforts should be continued through 19 months or until children are brought UTD. Furthermore, in spite of outreach, about half of the NUTD children were not brought UTD by 13 or 19 months. New strategies should be developed to ensure that these children receive recommended vaccinations. |
Adult clinical and immunologic outcomes of the national antiretroviral treatment program in Rwanda during 2004-2005
Lowrance DW , Ndamage F , Kayirangwa E , Ndagije F , Lo W , Hoover DR , Hanson J , Elul B , Ayaba A , Ellerbrock T , Rukundo A , Shumbusho F , Nash D , Mugabo J , Assimwe A . J Acquir Immune Defic Syndr 2009 52 (1) 49-55 BACKGROUND: By December 2007, over 48,000 persons had initiated antiretroviral treatment (ART) at 171 clinics in Rwanda. Assessing national ART program outcomes is essential to determine whether programs have the desired impact. METHODS: We conducted a retrospective cohort study to assess key 6- and 12-month outcomes among a nationally representative, stratified, random sample of 3194 adults (> or =15 years) who initiated ART from January 1, 2004, through December 31, 2005. FINDINGS: At ART initiation, the median patient age was 37 years and 65% were female. Overall, the baseline median CD4 cell count was 141 cells per microliter. At 6 and 12 months after ART initiation, 92% and 86% of patients, respectively, remained on ART at their original site. By 6 months, 3.6% were dead and 3.4% were lost to follow-up; by 12 months, 4.6% were dead and 4.9% were lost to follow-up. Among patients with available follow-up CD4 cell count data, median CD4 cell counts increased by 98 cells per microliter and 119 cells per microliter at 6 and 12 months after ART initiation, respectively. CONCLUSIONS: Rwanda's national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality. |
Profiling characteristics of internet medical information users
Weaver JB 3rd , Mays D , Lindner G , Eroglu D , Fridinger F , Bernhardt JM . J Am Med Inform Assoc 2009 16 (5) 714-22 OBJECTIVE: The Internet's potential to bolster health promotion and disease prevention efforts has attracted considerable attention. Existing research leaves two things unclear, however: the prevalence of online health and medical information seeking and the distinguishing characteristics of individuals who seek that information. DESIGN: This study seeks to clarify and extend the knowledge base concerning health and medical information use online by profiling adults using Internet medical information (IMI). Secondary analysis of survey data from a large sample (n = 6,119) representative of the Atlanta, GA, area informed this investigation. MEASUREMENTS: Five survey questions were used to assess IMI use and general computer and Internet use during the 30 days before the survey was administered. Five questions were also used to assess respondents' health care system use. Several demographic characteristics were measured. RESULTS: Contrary to most prior research, this study found relatively low prevalence of IMI-seeking behavior. Specifically, IMI use was reported by 13.2% of all respondents (n = 6,119) and by 21.1% of respondents with Internet access (n = 3,829). Logistic regression models conducted among respondents accessing the Internet in the previous 30 days revealed that, when controlling for several sociodemographic characteristics, home computer ownership, online time per week, and health care system use are all positively linked with IMI-seeking behavior. CONCLUSIONS: The data suggest it may be premature to embrace unilaterally the Internet as an effective asset for health promotion and disease prevention efforts that target the public. |
Robbery and violence prevention in small retail businesses
Chronister T , Oxnard PD , Casteel C , Peek Asa C , Amandus H , Hartley D . Police Chief 2009 LXXVI (10) 1-5 Police departments work with small businesses to seek methodologies to thwart crimes. In Oxnard, California, it was found that the most effective strategies to mitigate robberies and the resulting violence might be surprising because they are low in cost; easy to implement and sustain; do not require any special technological know-how to use; and, for the most part, are also good for the business. After arriving at this conclusion, the Oxnard Police Department joined forces with the occupational safety research community to find the answers. |
Modern uses of electron microscopy for detection of viruses
Goldsmith CS , Miller SE . Clin Microbiol Rev 2009 22 (4) 552-63 Electron microscopy, considered by some to be an old technique, is still on the forefront of both clinical viral diagnoses and viral ultrastructure and pathogenesis studies. In the diagnostic setting, it is particularly valuable in the surveillance of emerging diseases and potential bioterrorism viruses. In the research arena, modalities such as immunoelectron microscopy, cryo-electron microscopy, and electron tomography have demonstrated how viral structural components fit together, attach to cells, assimilate during replication, and associate with the cellular machinery during replication and egression. These studies provide information for treatment and vaccine strategies. |
Overlapping signature genes between hepatocellular carcinoma and intrahepatic cholangiocarcinoma
Chen F , Li S , Castranova V . Eur J Gastroenterol Hepatol 2009 21 (11) 1320-1 There has been a long-standing interest in the discovery of signature genes for hepatocellular carcinoma (HCC). Concern has been expressed about the inconsistency of the identified signature genes reported by different laboratories. The discrepancy in HCC signature genes could stem from the differences in pathological features of the HCC samples used in gene profiling and the algorithms for data analysis. Benefiting from the improvement and standardization of the DNA microarray technology, several groups in recent years reported reproducible HCC signature gene sets that are able to predict tumor cell originating, intrahepatic recurrence, metastasis, and patient survival possibility. | Our research group and Nishino et al. [2] recently reported signature genes for HCC with high c-Jun N-terminal kinase 1 (JNK1) activation and intrahepatic cholangiocarcinoma (ICC) [1], respectively. In this study, we first determined changes of gene expression between HCC tissues and the matched distal nontumor liver tissues using Affymetrix HG-U133 plus 2 microarray (Affymetrix, Inc., Santa Clara, California, USA) followed by false discovery rate correction. The gene expression pattern associated with the status of JNK1 activation was then examined by comparing the genes in HCC samples with high JNK1 activation to the HCC samples with low JNK1 activation. The signature genes for ICC were identified through a serial analysis of gene expression using cDNA libraries from ICC and HCC by Nishino et al. [2]. They found that genes for KRT7, KRT19, S100A6, IGFBP5, SPP1, CD24, and BGN, etc. are upregulated in ICC relative to HCC [2]. By comparing the data from Nishino et al. [2] and our high JNK1 HCC gene profiling [1], a significant agreement between those ICC signature genes and the genes associated with the JNK1 activation status in HCC was noted. For the genes that were upregulated in ICC, including CLDN4, IGFBP5, and 19 genes listed in Table 3 of Nishino's report [2], 17 out of 21 genes are commonly presented among the increased expressed genes in the HCC with high JNK1 activation (Fig. 1). Only four out of 21 genes, including IGFBP5, CITED4, SCGN, and COL4A1, were downregulated in the HCC with high JNK1 activation. Intriguingly, 18 genes that showed the greatest degree of downregulation in ICC [2] were also significantly downregulated in the HCC samples with high JNK1 activation, except GSTA1 (Fig. 1). |
Bacteriophage cocktail for the prevention of biofilm formation by Pseudomonas aeruginosa on catheters in an in vitro model system
Fu W , Forster T , Mayer O , Curtin JJ , Lehman SM , Donlan RM . Antimicrob Agents Chemother 2009 54 (1) 397-404 Microorganisms develop biofilms on indwelling medical devices and are associated with device-related infections, resulting in substantial morbidity and mortality. This study investigated the effect of pretreating hydrogel-coated catheters with Pseudomonas aeruginosa bacteriophages on biofilm formation by P. aeruginosa in an in vitro model. Hydrogel-coated catheters were exposed to a 10 log10 PFU ml(-1) lysate of P. aeruginosa phage M4 for 2 hours at 37 degrees C prior to bacterial inoculation. The mean viable biofilm count on untreated catheters was 6.87 log10 CFU cm(-2) after 24 h. Pretreatment of catheters with phage reduced this value to 4.03 log10 CFU cm(-2) (p<0.001). Phage treatment immediately following bacterial inoculation also reduced biofilm viable counts (4.37 log10 CFU cm(-2) reduction, p<0.001). Regrowth of biofilms on phage-treated catheters occurred between 24 and 48 h, but supplemental treatment with phage at 24 h significantly reduced biofilm regrowth (p<0.001). Biofilm isolates resistant to phage M4 were recovered from phage-pretreated catheters. Phage susceptibility profiles of these isolates were used to guide the development of a five-phage cocktail from a larger library of P. aeruginosa phages. Pretreatment of catheters with this cocktail reduced the 48 h mean biofilm cell density by 99.9% (from 7.13 log10 CFU cm(-2) to 4.13 log10 CFU cm(-2), p<0.001), but fewer biofilm isolates were resistant to these phages. These results suggest the potential of applying phages, especially phage cocktails to the surfaces of indwelling medical devices for mitigating biofilm formation by clinically relevant bacteria. |
Characterization of the highly regulated antigen BBA05 in the enzootic cycle of Borrelia burgdorferi
Xu H , He M , Pang X , Xu ZC , Piesman J , Yang XF . Infect Immun 2009 78 (1) 100-7 Dramatic alteration of surface lipoprotein profiles is a key strategy that Borrelia burgdorferi, the Lyme disease pathogen, has evolved for adapting to the diverse environments of arthropod and mammalian hosts. Several of these differentially expressed lipoproteins have been shown to play important roles in the enzootic cycle of B. burgdorferi. BBA05 is a previously identified putative lipoprotein (P55 or S1 antigen) that elicits antibody responses in mammals. Recent microarray analyses indicate that bba05 is differentially expressed by many environmental factors including temperature. However, the role of BBA05 in the life cycle of B. burgdorferi has not been elucidated. Herein, we show that expression of bba05 was exclusively induced in feeding nymphal ticks during the spirochetal transmission from ticks to mammals. Upon generating a bba05 mutant in an infectious strain of B. burgdorferi, we showed that the bba05 mutant remained capable of establishing infection in mice, being acquired by ticks, persisting through tick molting, and re-infecting new mammalian hosts. These results indicate that, despite being a highly conserved and regulated antigen, BBA05 has a nonessential role in the transmission cycle of B. burgdorferi, at least in the animal model. |
Cryo-electron tomography elucidates the molecular architecture of Treponema pallidum, the syphilis spirochete
Izard J , Renken C , Hsieh CE , Desrosiers DC , Dunham-Ems S , La Vake C , Gebhardt LL , Limberger RJ , Cox DL , Marko M , Radolf JD . J Bacteriol 2009 191 (24) 7566-80 Cryo-electron tomography (CET) was used to examine the native cellular organization of Treponema pallidum, the syphilis spirochete. T. pallidum cells appeared to form flat waves, did not contain an outer coat, and, except for bulges over the basal bodies and widening in the vicinity of flagellar filaments, displayed a uniform periplasmic space. Although the outer membrane (OM) generally was smooth in contour, OM extrusions and blebs frequently were observed, highlighting the structure's fluidity and lack of attachment to underlying periplasmic constituents. Cytoplasmic filaments converged from their attachment points opposite the basal bodies to form arrays that run roughly parallel to the flagellar filaments along the inner surface of the cytoplasmic membrane (CM). Motile treponemes stably attached to rabbit epithelial cells predominantly via their tips. CET revealed that T. pallidum cell ends have a complex morphology and assume at least four distinct morphotypes. Images of dividing treponemes and organisms shedding cell envelope-derived blebs provided evidence for the spirochete's complex membrane biology. In the regions without flagellar filaments, PG was visualized as a thin layer that divided the periplasmic space into zones of higher and lower electron density adjacent to the CM and OM, respectively. Flagellar filaments were observed overlying the PG layer, while image modeling placed the PG-basal body contact site in the vicinity of the stator-P-collar junction. Bioinformatics and homology modeling indicated that the MotB proteins of T. pallidum, T. denticola, and B. burgdorferi have membrane topologies and PG binding sites highly similar to those of their well characterized E. coli and H. pylori orthologs. Collectively, our results help to clarify fundamental differences in cell envelope ultrastructure between spirochetes and Gram-negatives. They also confirm that PG stabilizes the flagellar motor and enable us to propose that in most spirochetes motility results from rotation of the flagellar filaments against the PG. |
Genotyping of Mycoplasma pneumoniae isolates using real-time PCR and high-resolution melt analysis
Schwartz SB , Thurman KA , Mitchell SL , Wolff BJ , Winchell JM . Clin Microbiol Infect 2009 15 (8) 756-62 Mycoplasma pneumoniae is an important respiratory pathogen, accounting for up to 25% of community-acquired pneumonia, and is a common cause of hospitalized pneumonia in otherwise healthy adults and children. Mycoplasma pneumoniae isolates can be classified into two main genomic groups (type 1 and type 2) based on sequence variation within the gene encoding the major adhesion molecule P1. Although numerous publications have described real-time PCR assays for the detection of M. pneumoniae, none has been able to discriminate the two genomic types. Here, a real-time PCR assay that can distinguish each type of M. pneumoniae utilizing high-resolution melt-curve analysis is reported. Using this method, 102 isolates obtained from patients from 1965 to the present, including those from recent outbreaks, were typed along with reference strains M129 (type 1) and FH (type 2). The results show that 55 isolates (54%) can be classified as type 1 and 47 isolates (46%) as type 2, and 100% correlation was demonstrated when compared with a standard PCR-restriction fragment length polymorphism typing procedure. Typing of isolates obtained from recent outbreaks in the USA has revealed the presence of both types. This assay provides a rapid, reliable and convenient method for typing M. pneumoniae isolates and may be useful for surveillance purposes and epidemiological investigations, and may provide insight into the biology of M. pneumoniae distribution within populations. |
Identification of P1 variants of Mycoplasma pneumoniae using High Resolution Melt Analysis
Schwartz SB , Mitchell SL , Thurman KA , Wolff BJ , Winchell JM . J Clin Microbiol 2009 47 (12) 4117-20 Mycoplasma pneumoniae is a leading cause of community-acquired pneumonia. Although two genetically distinct types of M. pneumoniae are known, variants of each also exist. We used a real-time PCR HRM genotyping assay to identify clinical variants which may provide greater insight into the genetic distribution of M. pneumoniae strains. |
Molecular epidemiology and risk factors for nasal carriage of Staphylococcus aureus and methicillin-resistant S. aureus in infants attending day-care centers in Brazil
Lamaro-Cardoso J , de Lencastre H , Kipnis A , Pimenta FC , Oliveira LS , Oliveira RM , Nouer S , Aires-de-Sousa M , Milheirico C , Andrade AL . J Clin Microbiol 2009 47 (12) 3991-7 Investigations regarding Staphylococcus aureus carriage among Brazilian children are scarce. We evaluated the determinants of S. aureus and methicillin-resistant S. aureus (MRSA) nasal carriage in infants attending day-care centers (DCCs) and the molecular features of the MRSA strains. A total of 1,192 children aged 2 months to 5 years attending 62 DCCs were screened for S. aureus and MRSA nasal carriage. MRSA isolates were characterized by pulsed-field gel electrophoresis, multilocus sequence typing, spa typing, staphylococcal cassette chromosome (SCC) mec typing and the presence of the Panton-Valentine leukocidin gene. Logistic regression was performed to determine risk factors associated with S. aureus and MRSA colonization. S. aureus and MRSA carriage were detected in 371 (31.1%) and 14 (1.2%) children, respectively. Variables found to be independently associated with an increased risk for S. aureus carriage included being older than 24 months (OR=1.8; 95%CI 1.3-2.6) and previous DCC attendance (OR=1.5; 95%CI 1.0-2.2). Having a mother with a high degree of education was a protective factor for nasal colonization (OR=0.4; 95%CI 0.2-0.8). Moreover, we observed that more children carrying MRSA had younger siblings compared to children not colonized by MRSA. Among the 14 MRSA strains, three SCCmec types (IIIA, IV and V) were detected, together with a multidrug resistant dominant MRSA lineage sharing 82.7% genetic similarity with the Brazilian clone (ST239-MRSA-IIIA). Although SCCmec type V was recovered from one healthy child who had been exposed to known risk factors for hospital associated MRSA, its genetic background was compatible with community-related MRSA. Our data suggest that DCC attendees could be contributing to MRSA cross-transmission between healthcare and community settings. |
Progress in protecting, promoting, and supporting breastfeeding: 1984-2009
Grummer-Strawn LM , Shealy KR . Breastfeed Med 2009 4 S31-S39 The 1984 Surgeon General's Workshop on Breastfeeding delineated six priority areas for action to protect, promote, and support breastfeeding. In this article, we examine trends in breastfeeding behaviors and recall key events and actions that shaped these behaviors over the past 25 years. We examine progress in breastfeeding support through workplaces, public education, professional education, health system changes, support services, and research. Rates of initiation of breastfeeding more than doubled from a nadir of only 26.5% in 1970 to 61.9% in 1982. Initiation fell to 51.5% in 1990, but has risen almost monotonically since then to 74.2% in 2005. Trends in breastfeeding at 6 months have paralleled initiation trends. Black-white disparities have narrowed for breastfeeding initiation but not for continuation to 6 months. Considerable progress in breastfeeding support has been seen over the past 25 years, with more employers allowing women time and space to express milk at work, more states enacting legislation to ensure that accommodations are made for employed women and protect the right to breastfeed in public, more opportunities for physician education on breastfeeding, expansion of professional lactation services, and substantial increases in the amount of research on breastfeeding. However, only 21.4% of babies are breastfed for a year, and only 11.9% exclusively breastfeed for 6 months. Only 2% of babies are born in facilities that meet international standards of care, and 74% of employers do not offer lactation rooms or accommodations for breastfeeding. Thus, in spite of considerable progress, significant gaps remain in protecting, promoting, and supporting breastfeeding. |
Use of traditional and complementary health practices in prenatal, delivery and postnatal care in the context of HIV transmission from mother to child (PMTCT) in the Eastern Cape, South Africa
Peltzer K , Phaswana-Mafuya N , Treger L . Afr J Tradit Complement Altern Med 2009 6 (2) 155-162 The aim of this study was as part of a baseline assessment in PMTCT in the traditional health sector: a) to determine the views of women who have used the services of traditional practitioners before, during and/ or after pregnancy, and b) to conduct formative research with traditional health practitioners (THPs), i.e. herbalists, diviners and traditional birth attendants (TBAs) on HIV, pregnancy care, delivery and infant care. The sample included a) 181 postnatal care clients with a child less than 12 months interviewed at postnatal clinic visits from 20 primary care clinics in the Kouga Local Service Area (LSA), Cacadu district, Eastern Cape, and b) 54 traditional birth attendants (TBAs) and 47 herbalists and/or diviners were interviewed from Kouga LSA. Results showed that THP (in particular TBAs and to a certain extend herbalists/diviners) play a significant role in pregnancy and postnatal care, and also with the assistance of delivery. Certain HIV risk practices were reported on the practice of TBAs. THPs also seem to have some role in infant feeding and family planning. THPs should be trained in optimising their services in pregnancy and postnatal care, and preparation for health facility delivery. In addition, they should be trained on HIV risk practices, HIV/AIDS, HIV prevention including PMTCT, infant feeding and family planning. |
Cluster of necrotizing enterocolitis in a neonatal intensive care unit: New Mexico, 2007
Wendelboe AM , Smelser C , Lucero CA , McDonald LC . Am J Infect Control 2009 38 (2) 144-8 BACKGROUND: Although the cause of necrotizing enterocolitis (NEC) is unknown, infection control practices have been shown to play an important role in containing many outbreaks. We investigated the etiology of a cluster of NEC in a level 3 neonatal intensive care unit and monitored for new cases following the implementation of enhanced infection control measures. METHODS: Investigators performed a chart and laboratory review for neonates with a diagnosis of NEC during January 1, 2007, to February 13, 2007, to identify risk factors. Enhanced environmental cleaning, cohorting of infants and nurses, and increased attention to hand hygiene were instituted. Commercial feeding products in the unit were tested for bacterial contamination. Close monitoring for new cases continued for 2 months following the identification of the cluster. RESULTS: Eleven cases of NEC were identified during the study period. Patients had a median of 5 disease risk factors (range, 3-8). Four distinct pathogens were detected in blood or stool specimens from 4 different patients. One sample of human milk fortifier (HMF) tested contained a colony count of Bacillus cereus at the US Food and Drug Administration's upper microbiologic limit for contamination. Seven (65%) patients received HMF before symptom onset, and 9 (82%) patients received 1 or more types of liquid formula. Only 1 new case was identified during the period of close monitoring. CONCLUSION: A microbiologic cause was not identified, and, although the cluster might have resolved spontaneously, enhanced infection control and changing batches of HMF might have played a role in controlling this outbreak. |
Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Yang Q , Cogswell ME , Hamner HC , Carriquiry A , Bailey LB , Pfeiffer CM , Berry RJ . Am J Clin Nutr 2009 91 (1) 64-72 BACKGROUND: US adults have access to multiple sources of folic acid. The contribution of these sources to usual intakes above the tolerable upper level (UL) (1000 mug/d) and to folate and vitamin B-12 status is unknown. OBJECTIVE: The objective was to estimate usual folic acid intake above the UL and adjusted serum and red blood cell folate, vitamin B-12, methylmalonic acid, and homocysteine concentrations among US adults by 3 major folic acid intake sources-enriched cereal-grain products (ECGP), ready-to-eat cereals (RTE), and supplements (SUP)-categorized into 4 mutually exclusive consumption groups. DESIGN: We used data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (n = 8258). RESULTS: Overall, 2.7% (95% CI: 1.9%, 3.5%) of adults consumed more than the UL of folic acid. The proportions of those who consumed folic acid from ECGP only, ECGP+RTE, ECGP+SUP, and ECGP+RTE+SUP were 42%, 18%, 25%, and 15%, respectively. Of 60% of adults who did not consume supplements containing folic acid (ECGP only and ECGP+RTE), 0% had intakes that exceeded the UL. Of 34% and 6% of adults who consumed supplements with an average of ≤400 and >400 mug folic acid/d, <1% and 47.8% (95% CI: 39.6%, 56.0%), respectively, had intakes that exceeded the UL. Consumption of RTE and/or supplements with folic acid was associated with higher folate and vitamin B-12 and lower homocysteine concentrations, and consumption of supplements with vitamin B-12 was associated with lower methylmalonic acid concentrations (P < 0.001). CONCLUSION: At current fortification levels, US adults who do not consume supplements or who consume an average of ≤400 mug folic acid/d from supplements are unlikely to exceed the UL in intake for folic acid. |
Respiratory protection against airborne nanoparticles: a review
Shaffer RE , Rengasamy S . J Nanopart Res 2009 11 (7) 1661-1672 As a precautionary measure, it is often recommended that workers take steps to reduce their exposure to airborne nanoparticles through the use of respiratory protective devices. The purpose of this study was to provide a review and analysis of the research literature and current recommendations on respirators used for protection against nanoparticles. Key research findings were that studies with particles as small as 4 nm have shown that conventional single-fiber filtration theory can be used to describe the filtration performance of respirators and that the most penetrating particle size for respirators equipped with commonly used electrostatic filter media is in the range of 30-100 nm. Future research needs include human laboratory and workplace protection factor studies to measure the respirator total inward leakage of nanoparticles. Industrial hygienists and safety professionals should continue to use traditional respirator selection guidance for workers exposed to nanoparticles. |
Vibration disrupts vascular function in a model of metabolic syndrome
Krajnak K , Waugh S , Johnson C , Miller R , Kiedrowski M . Ind Health 2009 47 (5) 533-542 Vibration-induced white finger (VWF) is a disorder seen in workers exposed to hand-transmitted vibration, and is characterized by cold-induced vasospasms and ringer blanching. Because overweight people with metabolic syndrome are pre-disposed to developing peripheral vascular disorders, it has been suggested that they also may be at greater risk of developing VWF if exposed to occupational vibration. We used an animal model of metabolic syndrome, the obese Zucker rat, to determine if metabolic syndrome alters vascular responses to vibration. Tails of lean and obese Zucker rats were exposed to vibration (125 Hz, 49 m/s(2) r.m.s.) or control conditions for 4 h/d for 10 d. Ventral tail arteries were collected and assessed for changes in gene expression, levels of reactive oxygen species (ROS) and for responsiveness to vasomodulating factors. Vibration exposure generally reduced the sensitivity of arteries to acetylcholine (ACh)-induced vasodilation. This decrease in sensitivity was most apparent in obese rats. Vibration also induced reductions in vascular nitric oxide concentrations and increases in vascular concentrations of ROS in obese rats. These results indicate that vibration interferes with endothelial-mediated vasodilation, and that metabolic syndrome exacerbates these effects. These findings are consistent with idea that workers with metabolic syndrome have an increased risk of developing VWF. |
Current perception threshold and the HAVS Stockholm sensorineural scale
House R , Krajnak K , Manno M , Lander L . Occup Med (Lond) 2009 59 (7) 476-82 BACKGROUND: It is important to determine which tests of sensorineural dysfunction identify the neurological damage from hand-arm vibration exposure. AIMS: To examine the association between the hand-arm vibration syndrome (HAVS) Stockholm sensorineural scale stages and tests of peripheral neurological function including measurement of current perception threshold (CPT) and nerve conduction. METHODS: All the subjects were men who were assessed for HAVS with a medical and occupational history and physical examination to determine the Stockholm stage, CPT testing at frequencies of 5, 250 and 2000 Hz for the median and ulnar nerves and measurement of nerve conduction carried out in a blinded fashion. RESULTS: A total of 155 of the 157 recruited subjects agreed to take part in the study, a 99% participation rate. CPT was statistically significantly increased (P < 0.001) in both Stockholm sensorineural Stages 1 and > or =2 in comparison to Stage 0 for every frequency and nerve combination. However, CPT could not discriminate well between Stages 1 and > or =2. There was no association between median or ulnar neuropathy measured by nerve conduction and the Stockholm stages. Polychotomous multinomial logistic regression indicated that the CPT measurements at 2000 Hz, corresponding to damage to large myelinated nerve fibres, were most predictive of both Stockholm Stages 1 and > or =2 in comparison to Stage 0. CONCLUSIONS: Neuropathy measured by nerve conduction was unrelated to the Stockholm scale stages. CPT was increased above Stage 0 but did not distinguish well between the higher stages of the Stockholm scale. |
Harness sizing and strap length configurations
Hsiao H , Whitestone J , Taylor S , Godby M , Guan J . Hum Factors 2009 51 (4) 497-518 OBJECTIVE: This article describes the derivation of strap lengths and adjustments to fall-arrest harnesses and the development of harness size configurations. BACKGROUND: Updated harness sizing configurations are needed to accommodate diverse populations in the current workforce. Method: Three-dimensional torso anthropometric data from 243 women and 258 men were incorporated into eight validated equations to develop a cost-effective harness sizing plan and to define strap lengths. RESULTS: To met strap adjustable range goals and to accommodate 95% to 98% of the estimated population, two sizing options were identified. CONCLUSION: Study outcomes suggest system improvement with three to four sizes for women and three to four sizes for men, on which the adjustment ranges of the torso straps were within 15 to 17 cm and within 20 to 23 cm on thigh and hip straps. APPLICATION: This research provided harness sizing and cut-length information for harness design to reduce the risk of worker injury that results from poor fit or improper size selection. |
Chemical-related injuries and illnesses in U.S. mining
Scott DF , Merritt EM , Miller AL , Drake PL . Min Eng 2009 61 (7) 41-46 The purpose of this study was to determine if miners were at risk from exposures to chemicals used in the mining industry and determine the nature and sources of the illnesses and injuries. The U.S. Mine Safety and Health Administration’s (MSHA) employment and accident, injury and illness database was reviewed. There were 2,705 cases of chemical-related injuries and illnesses reported from 1999 through 2006, involving 66 different chemicals. The main source (cause) of chemical-related cases was acids/alkalis (about 39%). The primary nature (effect) of chemical-related cases was chemical burns (about 57%). The job classifi cation where workers incurred the most chemical-related injuries and illnesses was cleaning plant operator/media operator/boney preparation plant operator/crusher worker (cleaning plant operators are responsible for maintenance of plants, media operators are responsible for handling reagents, boney preparation plant operators oversee removal of "bone" from coal, and crusher workers use large crushers to break mined material). From 1999 through 2006, the rate of "nonfatal days lost" and "no days lost" (resulting from injuries) did not change signifi cantly; however, the rate of illnesses decreased signifi cantly. Chemical burns accounted for a large number of injuries; mining companies should carefully examine their personal protective equipment (PPE) requirements, training methods and safety culture to ensure that their workers are protected. |
Impact of spina bifida on parental caregivers: findings from a survey of Arkansas families
Grosse SD , Flores AL , Ouyang L , Robbins JM , Tilford JM . J Child Fam Stud 2009 18 (5) 574-581 The well-being of caregivers of children with spina bifida and other conditions is an important topic. We interviewed the primary caregivers of 98 children aged 0-17 years with spina bifida sampled from a population-based birth defects registry in Arkansas and the caregivers of 49 unaffected children. Measures of caregiver well-being were compared between the groups and by level of lesion (sacral, lower lumbar, and upper lumbar/thoracic). We performed linear and logistic regression analysis to test the associations controlling for other characteristics. Among caregivers of children with spina bifida, the average number of hours of sleep was significantly less than reported by other caregivers and was associated with lesion level among children less than 7 years of age. Significant associations, often varying by child age, were also found for the caregiver's reports of lower Quality of Well-Being (QWB) score, often feeling blue, rarely feeling happy, fair or poor health, lack of leisure days, and not hosting friends, but no significant association was found with not visiting friends. The intensive long-term care required by children with spina bifida, particularly by those with higher lesions, can negatively impact caregiver health and well-being. Support for these caregivers is needed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract). |
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