Oral contraceptives and family history of breast cancer
Gaffield ME , Culwell KR , Ravi A . Contraception 2009 80 (4) 372-80 BACKGROUND: Questions remain regarding whether oral contraceptive (OC) use among women with a family history of breast cancer increases disease risk. STUDY DESIGN: We conducted a systematic review by searching MEDLINE and CENTRAL databases for evidence (in all languages) published in peer-reviewed journals from 1966 to July 2008 that provided estimates of breast cancer risk according to family history. Twelve articles were identified and the quality of each study was assessed using the United States Preventive Services Task Force grading system. RESULTS: Results from 10 studies and one pooled analysis of 54 studies suggest that the use of OCs does not significantly modify the risk of breast cancer among women with a familial history of breast cancer; however, evidence from four studies shows that some women may be at a greater risk, particularly women who took OCs prior to 1975. CONCLUSIONS: Current evidence shows that women with a family history of breast cancer do not increase their disease risk by using OCs. |
Stability of the factor structure of the metabolic syndrome across pubertal development: confirmatory factor analyses of three alternative models
Goodman E , Li C , Tu YK , Ford E , Sun SS , Huang TT . J Pediatr 2009 155 (3) S5 e1-8 OBJECTIVE: To test the fit and stability of 3 alternative models of the metabolic syndrome's factor structure across 3 developmental stages. STUDY DESIGN: With data from the Fels Longitudinal Study, confirmatory factor analyses tested 3 alternative models of the factor structure underlying relationships among 8 metabolic syndrome-associated risks. Models tested were a 1-factor model (A), a 4-factor model (B), and a second-order latent factor model (C). Developmental stages assessed were prepuberty (ages 8-10), puberty (ages 11-15), and postpuberty (ages 16-20). RESULTS: Convergence was achieved for all developmental stages for model A, but the fit was poor throughout (root mean square error of approximation > 0.1). Standardized factor loadings for waist circumference and body mass index were much stronger than those for fasting insulin at all 3 time points. Although prepuberty and postpuberty models converged for models B and C, each model had problems with Heywood cases. The puberty model did not converge for either model B or C. CONCLUSIONS: The hypothetical structures commonly used to support the metabolic syndrome concept do not provide adequate fit in a pediatric sample and may be variable by maturation stage. A components-based approach to cardiovascular risk reduction, with emphasis on obesity prevention and control, may be a more appropriate clinical strategy for children and youth than a syndromic approach. |
Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review
Culwell KR , Curtis KM . Contraception 2009 80 (4) 337-45 BACKGROUND: As nearly all women with venous thromboembolism (VTE) will be treated with anticoagulant therapy, it is important to consider how anticoagulation affects the safety of contraceptive use. STUDY DESIGN: We conducted a systematic review of the literature regarding use of contraceptive methods in women with current VTE on anticoagulant therapy. Due to the limited direct evidence that was identified, we expanded our search to include women on anticoagulant therapy for indications other than VTE and women with bleeding disorders. RESULTS: Six articles met our inclusion criteria. Three observational studies found the levonorgestrel-releasing IUD (LNG-IUD) was an effective treatment for menorrhagia for women on anticoagulation therapy or with bleeding disorders. Prevention of recurrent hemorrhagic ovarian cysts was seen in women on chronic anticoagulation treated with depot-medroxyprogesterone acetate (DMPA) in one small observational study. Among women with bleeding disorders, no complications were seen in 16 women with placement of the LNG-IUD. One pharmacokinetic study found no statistically significant interaction between combined oral contraceptives and warfarin. Other than one case report, no evidence was found regarding the risk of recurrent thrombosis in women on anticoagulation therapy using a contraceptive method. CONCLUSION: The majority of studies in this review examined treatment effects of the LNG-IUD or DMPA on complications of anticoagulation and found overall beneficial effects of their use in these circumstances. Minimal evidence in women with inherited bleeding disorders suggests that insertion of the LNG-IUD does not pose major bleeding risks in these women with appropriate management. |
Associations of serum concentrations of 25-hydroxyvitamin D and parathyroid hormone with surrogate markers of insulin resistance among U.S. adults without physician-diagnosed diabetes: National Health and Nutrition Examination Survey, 2003-2006
Zhao G , Ford ES , Li C . Diabetes Care 2009 33 (2) 344-7 OBJECTIVE: To examine whether concentrations of serum 25-hydroxyvitamin D (25[OH]D) and parathyroid hormone (PTH) are associated with surrogate markers of insulin resistance (IR) in U.S. adults without physician-diagnosed diabetes. RESEARCH DESIGN AND METHODS: Cross-sectional data (n=3,206) from the 2003-2006 National Health and Nutrition Examination Survey were analyzed. RESULTS: The age-adjusted prevalence of hyperinsulinemia, high homeostatic model assessment-IR, high glycohemoglobin, and fasting and 2-hour hyperglycemia decreased linearly across quintiles of 25(OH)D but increased linearly across quintiles of PTH (except for a quadratic trend for fasting hyperglycemia). After extensive adjustment for potential confounders, the relationships between 25(OH)D and the markers of IR and 2-hour hyperglycemia persisted. Only hyperinsulinemia was positively associated with PTH (P<0.05). CONCLUSIONS: Among U.S. adults without physician-diagnosed diabetes, low concentrations of serum 25(OH)D were associated with markers of IR. The role of PTH in IR deserves further investigation. |
Asthma and serious psychological distress: prevalence and risk factors among U.S. adults, 2001-2007
Oraka E , King ME , Callahan DB . Chest 2009 137 (3) 609-16 BACKGROUND: For millions of adults, effective control of asthma requires a regimen of care that may be compromised by psychological factors such as anxiety and depression. This study estimated the prevalence and risk factors for serious psychological distress (SPD) and explored their relationship to health-related quality of life (HRQOL) among adults with asthma in the United States. METHODS: We analyzed data from 186,738 adult respondents from the 2001-2007 U.S. National Health Interview Survey. We calculated weighted average prevalence estimates of current asthma and SPD by demographic characteristics and health-related factors. We used logistic regression analysis to calculate odds ratios for factors that may have predicted asthma, SPD, and HRQOL. RESULTS: From 2001 to 2007, the average annual prevalence of current asthma was 7.0% and the average prevalence of SPD was 3.0%. Among adults with asthma, the prevalence of SPD was 7.5% (95% CI, 7.0-8.1%). A negative association between HRQOL and SPD was found for all adults, independent of asthma status. A similar pattern of risk factors predicted SPD and the co-occurrence of SPD and asthma, although adults with asthma who reported lower socioeconomic status, a history of smoking or alcohol use, and more comorbid chronic conditions had significantly higher odds of SPD. CONCLUSION: This research suggests the importance of mental health screening for persons with asthma and the need for clinical and community-based interventions to target modifiable lifestyle factors that contribute to psychological distress and make asthma worse. |
The effects of hormonal contraceptive use among women with viral hepatitis or cirrhosis of the liver: a systematic review
Kapp N , Tilley IB , Curtis KM . Contraception 2009 80 (4) 381-6 BACKGROUND: This report evaluates the effects of hormonal contraceptive use among women with viral hepatitis or cirrhosis of the liver. METHODS: PubMed and Cochrane databases were searched from inception to June 2008 for publications that examined the use of hormonal contraceptives among women with viral hepatitis or cirrhosis of the liver. RESULTS: Six studies met the inclusion criteria. In one study of acute hepatitis, combined oral contraceptive (COC) use did not affect duration of hospitalization or successful disease resolution. The remainder of the studies examined chronic hepatitis or its sequelae. Women recovered from hepatitis experienced transaminase elevation with COC use which resolved after 4 weeks in one study or increased slightly over 6 months in another study. Hepatitis B virus carriers using COCs had similar transaminase levels as nonusing carriers over 6 months. Studies of chronic hepatitis C infection demonstrated no influence of COC use on progression or severity of liver fibrosis or development of hepatocellular carcinoma. CONCLUSION: Data from one study suggest that COCs do not affect the course of acute hepatitis. Limited data from studies on chronic hepatitis or its sequelae suggest that COC use does not affect the rate of progression or severity of cirrhotic fibrosis, the risk of hepatocellular carcinoma in women with chronic hepatitis, or the risk of liver dysfunction in hepatitis B virus carriers. |
Hormonal contraceptive use among women with liver tumors: a systematic review
Kapp N , Curtis KM . Contraception 2009 80 (4) 387-90 BACKGROUND: The review was conducted to evaluate from the literature the safety of hormonal methods of contraception in women with liver tumors, specifically in benign and malignant disease. STUDY DESIGN: We searched PubMed and Cochrane databases to find all articles published from database inception through July 2008 that were relevant to hormonal contraception use and liver tumors. RESULTS: Of 148 articles, three publications of two studies met the criteria for inclusion in this review; both investigated the use of hormonal contraception in women with the benign liver tumor focal nodular hyperplasia (FNH). In one small, retrospective case series, use of combined oral contraceptives (COCs) over a 4-year average follow-up was not associated with a change in either the number or size of hepatic lesions. In another case series, use of either COCs or progestogen-only contraceptives (POCs) after FNH diagnosis had no influence on disease progression or resolution. CONCLUSIONS: The studies identified examined oral contraceptive use among women with FNH. We did not identify any studies of hormonal contraceptive use among women with hepatocellular adenoma or with malignant liver tumors. Limited, poor-quality evidence suggests that for women with FNH, use of low-dose COCs or POCs does not appear to influence either liver lesion resolution or progression. |
Multidrug-resistant TB and HIV in Thailand: overlapping, but not independently associated, risk factors
Akksilp S , Wattanaamornkiat W , Kittikraisak W , Nateniyom S , Rienthong S , Sirinak C , Ngamlert K , Mankatittham W , Sattayawuthipong W , Sumnapun S , Yamada N , Monkongdee P , Anuwatnonthakate A , Burapat C , Wells CD , Tappero JW , Varma JK . Southeast Asian J Trop Med Public Health 2009 40 (5) 1000-14 The HIV and multi-drug resistant tuberculosis (MDR-TB) epidemics are closely linked. In Thailand as part of a sentinel surveillance system, we collected data prospectively about pulmonary TB cases treated in public clinics. A subset of HIV-infected TB patients identified through this system had additional data collected for a research study. We conducted multivariate analysis to identify factors associated with MDR-TB. Of 10,428 TB patients, 2,376 (23%) were HIV-infected; 145 (1%) had MDR-TB. Of the MDR-TB cases, 52 (37%) were HIV-infected. Independent risk factors for MDR-TB included age 18-29 years old, male sex, and previous TB treatment, but not HIV infection. Among new patients, having an injection drug use history was a risk factor for MDR-TB. Of 539 HIV-infected TB patients in the research study, MDR-TB was diagnosed in 19 (4%); the only significant risk factors were previous TB treatment and previous hepatitis. In Thailand, HIV is common among MDR-TB patients, but is not an independent risk factor for MDR-TB. Populations at high risk for HIV-young adults, men, injection drug users - should be prioritized for drug susceptibility testing. |
Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006
Campsmith ML , Rhodes PH , Hall HI , Green TA . J Acquir Immune Defic Syndr 2009 53 (5) 619-24 OBJECTIVES: To describe adults/adolescents (age 13 years and older) living with undiagnosed HIV infection in the United States at the end of 2006. METHODS: HIV prevalence and percentage undiagnosed were estimated from cumulative HIV incidence using an extended back-calculation model (using both HIV and AIDS data, the time of first diagnosis with HIV, and disease severity at diagnosis) and estimated cumulative deaths. RESULTS: An estimated 1,106,400 adults/adolescents (95% confidence interval = 1,056,400-1,156,400) were living with HIV in the United States at the end of 2006; overall, 21.0% (232,700; 95% confidence interval = 221,200-244,200) were undiagnosed. Whites had the lowest percentage undiagnosed (18.8%) compared with Hispanics/Latinos (21.6%), blacks/African Americans (22.2%), American Indians/Alaska Natives (25.8%), and Asians/Pacific Islanders (29.5%; all P < 0.001). Persons with a behavioral risk of injection drug use (IDU) had the lowest percentage undiagnosed (female IDU: 13.7% and male IDU: 14.5%); men exposed through heterosexual contact had the highest (26.7%) followed by men who have sex with men (23.5%). CONCLUSIONS: Differences in undiagnosed HIV were evident across demographic and behavior groups. Effective testing programs and early access to treatment and prevention services are necessary to reduce undiagnosed HIV infections and HIV prevalence. |
Blood and seminal plasma HIV-1 RNA levels among HIV-1-infected injecting drug users participating in the AIDSVAX B/E efficacy trial in Bangkok, Thailand
Kittikraisak W , van Griensven F , Martin M , McNicholl J , Gilbert PB , Chuachoowong R , Vanichseni S , Sutthent R , Tappero JW , Mastro TD , Hu DJ , Gurwith M , Kitayaporn D , Sangkum U , Choopanya K . J Acquir Immune Defic Syndr 2009 51 (5) 601-8 BACKGROUND: We investigated effects of vaccination with AIDSVAX B/E HIV-1 candidate vaccine on blood and seminal plasma HIV-1 RNA viral loads (BVL and SVL, respectively) in vaccine recipients (VRs) and placebo recipients (PRs) who acquired infection. METHODS: Linear mixed models were fitted for repeated measurements of BVL. Generalized estimating equations were used to assess the difference in SVL detectability between VRs and PRs. RESULTS: A total of 196 participants became HIV-1 infected during the trial. Thirty-two (16%) became infected with HIV-1 subtype B and 164 (84%) with HIV-1 subtype CRF01_AE. Per protocol-specified analysis, there were no differences in BVL levels between VRs and PRs. When stratified by HIV-1-infecting subtype, vaccination with AIDSVAX B/E was initially associated with higher BVL among HIV-1 CRF01_AE-infected VRs compared with HIV-1 CRF01_AE-infected PRs; however, this difference did not persist over time. HIV-1 subtype B-infected VRs had slightly higher BVL levels and were more likely to have detectable SVL during the follow-up period than HIV-1 subtype B-infected PRs. CONCLUSIONS: Subtle differences in BVL and SVL were detected between VRs and PRs. These results may help to further understand the dynamics between HIV-1 vaccination, HIV-1-infecting subtypes, and subsequent viral expression in different body compartments. |
Changes in the use of HIV antiretroviral resistance testing in a large cohort of U.S. patients, 1999 to 2006
Buchacz K , Baker RK , Young B , Brooks JT , HIVOutpatient Study Investigators . J Acquir Immune Defic Syndr 2009 53 (5) 625-32 INTRODUCTION: Monitoring antiretroviral (ARV) drug resistance is of growing importance in the management of persons infected with HIV, but few reports document how genotypic and phenotypic resistance testing (GPT) has been used among patients receiving routine outpatient care. METHODS: We studied data from participants in the HIV Outpatient Study seen at 10 HIV clinics in the United States during 1999 to 2006. We restricted analyses to patients whom we considered eligible for GPT (i.e., had a documented HIV viral load >1000 copies/mL). We used multivariable general modeling to evaluate temporal trends in use of GPT among eligible patients and to identify factors associated with being tested during 1999 to 2002 and 2003 to 2006. RESULTS: Of 5594 active patients, 3995 (71%) were considered eligible for GPT in at least one year during 1999 to 2006 (declining from 50.2% in 1999 to 31.2% in 2006). The fraction of eligible patients receiving GPT increased from 11.2% in 1999 to 31.0% in 2003 (P < 0.001 for trend) and then stabilized at approximately 30% through 2006. Among persons tested, the annual percentage receiving only genotype testing declined over time (90% to 56%), whereas the percentage receiving genotype and phenotype testing increased (5.4% to 39.1%). The annual use of GPT for ARV-naive patients increased over time and after 2003 exceeded the corresponding rates for ARV-experienced patients. In multivariable analyses, low CD4 count and high HIV viral load were consistently associated with GPT. Compared with other ARV-experienced patients, those who were triple ARV-class experienced were consistently more likely to be tested, whereas ARV-naive were less likely to be tested during 1999 to 2002 and more likely during 2003 to 2006. In addition, women and heterosexual men (vs. men who have sex with men) and black patients (vs. white) were less likely to be tested during 1999 to 2002, whereas older patients were less likely to be tested during 2003 to 2006. DISCUSSION: The annual frequency of GPT use has increased almost threefold since 1999. GPT use among ARV-naive patients has increased coincident with dissemination of recommendations. Although earlier sex and racial/ethnic disparities in testing have waned, older patients were significantly less likely to be tested in recent years. |
Dilemmas in the management of syphilis: a survey of infectious diseases experts
Dowell D , Polgreen PM , Beekmann SE , Workowski KA , Berman SM , Peterman TA . Clin Infect Dis 2009 49 (10) 1526-9 We surveyed infectious diseases consultants to determine how they manage syphilis when there are insufficient data to guide management or when guidelines cannot be followed because of a lack of available definitive diagnostic tests. Most providers did not have access to dark-field microscopy. We found variation in management of syphilis, especially for patients with human immunodeficiency virus infection. |
Factors associated with death among HIV-uninfected TB patients in Thailand, 2004-2006
Amnuaiphon W , Anuwatnonthakate A , Nuyongphak P , Sinthuwatanawibool C , Rujiwongsakorn S , Nakara P , Komsakorn S , Wattanaamornkiet W , Moolphate S , Chiengsorn N , Kaewsaard S , Nateniyom S , Varma JK . Trop Med Int Health 2009 14 (11) 1338-46 OBJECTIVES: In countries with both TB and human immunodeficiency virus (HIV) epidemics, HIV is known to be the most powerful risk factor for death during tuberculosis (TB) treatment. Few recent studies have evaluated risk factors for death among HIV-uninfected TB patients in these countries. We analysed data from a multi-province demonstration project in Thailand to answer this question. METHOD: We prospectively collected data from HIV-uninfected TB patients treated for TB in four provinces and the national infectious diseases hospital in Thailand from 2004-2006. Standard WHO definitions were used to classify treatment outcomes. We used log-binomial multivariate regression to calculate adjusted relative risk (aRR) and 95% confidence intervals (CI) for factors associated with death. RESULTS: Of 5318 cases, 441 (8%) died during TB treatment. The mean age was 47 years (range 8 months-97 years). Multidrug-resistant (MDR)-TB was diagnosed in 62 (1%). In multivariate analysis, patients older than 44 years were significantly more likely to die than patients aged 15-44 years [age 45-64, aRR 2.9 (CI 2.2-3.8)] [age > 64 years, aRR 5.0 (CI 3.9-6.6)]. Other independent risk factors for death included Thai nationality [aRR 3.9 (CI 1.6-9.5)], MDR-TB [aRR 2.8 (CI 1.7-4.8)], not being married [aRR 1.4 (CI 1.2-1.7)], and living in Chiang Rai province [aRR 2.7 (CI 1.7-4.4)]. CONCLUSIONS: The death rate was high among HIV-uninfected TB patients in Thailand. Efforts to improve TB diagnosis and treatment in the elderly and to improve MDR-TB treatment may help reduce mortality. |
HAART during pregnancy and during breastfeeding among HIV-infected women in the developing world: has the time come?
Bulterys M , Wilfert CM . AIDS 2009 23 (18) 2473-7 There are as yet no definitive data from randomized controlled trials with clinical end points to inform when to optimally start HAART in asymptomatic HIV-infected patients [1,2]. However, the advent of more potent and better-tolerated antiretroviral drugs has led to a strong push toward earlier initiation of HAART. This trend has been driven primarily by findings from large prospective cohort studies [3–5] in the United States and elsewhere showing lower mortality and fewer adverse events associated with initiation of HAART at higher CD4 cell counts. During pregnancy, healthcare providers in high-income countries recommend initiation of HAART for all HIV-infected women in order to reduce viral load, improve maternal health, and prevent perinatal HIV transmission [1,6]. In resource-poor settings, initiating HAART has been recommended only for pregnant women with more advanced HIV disease [i.e., CD4 cell count < 200 cells/μl (<250 cells/μl in some countries such as Malawi) or HIV-related symptoms and CD4 cell count < 350 cells/μl] [7]. | In this issue of AIDS, Ouyang et al. [8] challenge the notion that one commonly used antiretroviral drug – nevirapine (NVP) – is uniquely associated with hepatotoxicity during pregnancy [9]. The authors analyzed data from three large prospective cohort studies and found that pregnancy itself was significantly associated with increased hepatotoxicity in HIV-infected women. Contrary to previous reports [10–12], the investigators did not find an increase in hepatotoxicity among pregnant women exposed to NVP, including NVP-naive women with CD4 cell counts above 250 cells/μl. Pregnancy may provide a unique physiology that predisposes women to drug-induced hepatotoxicity [6,8]. Consequently, whenever feasible, liver enzymes should be monitored among pregnant HIV-infected women receiving antiretroviral drugs. The above findings are highly relevant for developing countries where NVP remains a common component of first-line HAART, including during pregnancy. For the reasons mentioned by Ouyang et al. [8], the risk and determinants of hepatotoxicity may differ for pregnant women in resource-poor settings. However, the strong association of hepatic abnormality with pregnancy and not with NVP in this large prospective study, and the fact that hepatic dysfunction was not demonstrably worse with higher CD4 cell count, could be of major consequence for pregnant HIV-infected women, especially in resource-poor settings. It is also important to emphasize that the hepatotoxicity previously noted in patients taking continuous NVP has not been seen when NVP is used as a single, intrapartum dose [13]. |
Norovirus distribution within an estuarine environment
Gentry J , Vinje J , Guadagnoli D , Lipp EK . Appl Environ Microbiol 2009 75 (17) 5474-80 Human norovirus (NoV) has been studied extensively as an important cause of gastroenteritis outbreaks worldwide. While oysters are a primary vehicle for infection, few studies have examined the wider distribution of NoV in the estuarine environment. Active shellfish-harvesting areas in Georgia were examined for the prevalence, genotype diversity, and concentrations of NoV in a variety of estuarine sample types over the course of 1 year. Of the 225 samples (9 oyster, 72 water, 72 63- to 200-microm plankton, and 72 >200-microm plankton) collected from 12 stations across two estuaries, 21 samples (9.3%) tested positive for NoV. By sample type, 55.0% (5/9) of oysters, 8.3% (6/72) of water samples, 11.1% (8/72) of 63- to 200-microm plankton samples, and 2.8% (2/72) of >200-microm plankton samples were positive for human NoV. The two NoV-positive >200-microm plankton samples, which contained mainly zooplankton, had the greatest quantity of NoV genomes (3.5 x 10(13) and 1.7 x 10(15) genomes g(-1)) of any sample tested. The majority, 90.5% (19/21), of the samples tested positive for genogroup I NoV, and only 9.5% (2/21) of the samples tested positive for genogroup II. The high concentrations of NoV in plankton samples compared to water and oyster samples were unexpected and provide new insights into the presence and distribution of human NoV in the water environment. |
Secondhand tobacco smoke exposure among children and adolescents: United States, 2003-2006
Marano C , Schober SE , Brody DJ , Zhang C . Pediatrics 2009 124 (5) 1299-305 OBJECTIVE: The implementation of policies that prohibit tobacco smoking in public places has resulted in a significant reduction in secondhand smoke (SHS) exposure in the US population; however, such policies do not extend to private homes, where children continue to be exposed. Our objective was to assess SHS exposure among US children and adolescents by using serum cotinine measures to compare those who were exposed to SHS in the home and those without home exposure. METHODS: We analyzed serum cotinine data from the 2003-2006 National Health and Nutrition Examination Survey for 5518 children (3-11 years) and nonsmoking adolescents (12-19 years). We calculated geometric mean serum cotinine levels by sociodemographic and household characteristics according to self-reported home SHS exposure. Multiple regression analysis was conducted to evaluate independent predictors of serum cotinine levels. RESULTS: Geometric mean serum cotinine levels were 1.05 ng/mL among those with home SHS exposure and 0.05 ng/mL among those without home exposure. Among children who were exposed to SHS at home, serum cotinine levels were inversely associated with age and were similar for non-Hispanic black and non-Hispanic white children. Conversely, among children without SHS exposure at home, serum cotinine levels were higher among non-Hispanic black compared with non-Hispanic white children, and there was no relationship with age. Mexican American children had the lowest level of SHS exposure. CONCLUSIONS: Serum cotinine levels were an order of magnitude higher among children with reported SHS exposure at home compared with those with no exposure in the home. |
Population-based lupus registries: advancing our epidemiologic understanding
Sam Lim S , Drenkard C , McCune WJ , Helmick CG , Gordon C , Deguire P , Bayakly R , Somers EC . Arthritis Rheum 2009 61 (10) 1462-6 Without a new medication approved for systemic lupus erythematosus (SLE) by the Food and Drug Administration in more than 40 years, there has been a recent flurry of research activity and clinical trials. However, a basic epidemiologic understanding of SLE, which is necessary to understand the full clinical spectrum and population burden, lags behind. Estimates of the incidence and prevalence of SLE in the US have varied widely and are outdated (Table 1). This is likely due to the use of different case definitions, limited sources for case ascertainment, small source populations, and different demographic groups targeted, as well as the protean characteristics of the disease, poor reliability of self-report, lack of reliability in diagnosis and coding in health system databases, and issues related to access to health care by high-risk populations. Estimates for other types of lupus (e.g., primary discoid lupus) are even less well defined. |
Adverse childhood experiences and the risk of premature mortality
Brown DW , Anda RF , Tiemeier H , Felitti VJ , Edwards VJ , Croft JB , Giles WH . Am J Prev Med 2009 37 (5) 389-96 BACKGROUND: Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood. PURPOSE: This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood. METHODS: Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009. RESULTS: Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years. CONCLUSIONS: ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death. |
The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008
Yoder JS , Eddy BA , Visvesvara GS , Capewell L , Beach MJ . Epidemiol Infect 2009 138 (7) 968-75 Naegleria fowleri, a free-living, thermophilic amoeba ubiquitous in the environment, causes primary amoebic meningoencephalitis (PAM), a rare but nearly always fatal disease of the central nervous system. While case reports of PAM have been documented worldwide, very few individuals have been diagnosed with PAM despite the vast number of people who have contact with fresh water where N. fowleri may be present. In the USA, 111 PAM case-patients have been prospectively diagnosed, reported, and verified by state health officials since 1962. Consistent with the literature, case reports reveal that N. fowleri infections occur primarily in previously healthy young males exposed to warm recreational waters, especially lakes and ponds, in warm-weather locations during summer months. The annual number of PAM case reports varied, but does not appear to be increasing over time. Because PAM is a rare disease, it is challenging to understand the environmental and host-specific factors associated with infection in order to develop science-based, risk reduction messages for swimmers. |
Foodborne disease trends and reports
Gerner-Smidt P , Whichard JM . Foodborne Pathog Dis 2009 6 (7) 749-51 Noroviruses are a group of genetically diverseRNAviruses that can cause acute gastroenteritis. They can beclassified into five genogroups (GI–V) of which viruses fromGI, GII, and GIV infect humans and GII.4 viruses are mostprevalent. Most infections are acquired through direct contactwith an ill person or contaminated environment, but trans-mission through contaminated food is also common. Becausethe virus cannot be culturedin vitro, detection of the virus inclinical material and on contaminated food is based on reversetranscriptase polymerase chain reaction. Norovirus is resis-tant to desiccation, extremes of temperatures, and a number ofdisinfectants. In addition, ill patients excrete large numbers ofinfectious viral particles and the infectious dose is low. Foodmay be easily contaminated at its source; e.g., sewage-contaminated oyster beds, sewage-irrigated produce fields, ora symptomatic or an asymptomatic food worker (Patelet al.,2009).With improved diagnostic methods, norovirus has emergedas one of the most common etiologies in foodborne outbreaks.In the latest foodborne disease outbreak summary from theUnited States (CDC, 2006), norovirus caused 33% of 2167 out-breaks with confirmed etiology reported during the period1998–2002, and the proportion of norovirus outbreaks has in-creased over time. In Europe, norovirus caused 9% of 5609outbreaks reported to the European Food Safety Authority and4% of 2025 outbreaks in which the vehicle was identified(Anonymous, 2009). Although norovirus is an important causeof foodborne outbreaks, the virus has been detected in only arelatively small proportion of all norovirus outbreaks (Patelet al., 2009). From 2002 to 2004, norovirus sequences for 1254outbreaks were reported to the European Foodborne Virusdatabase. Of these, 224 outbreaks were foodborne, 654 weretransmitted from person to person, and 376 had an unknownmode of transmission (Verhoefet al., 2009). It is important toinvestigate foodborne outbreaks in order to learn from them toimprove food safety. Norovirus outbreaks that are spread fromperson to person can be associated with very different pre-vention and control measures and are often investigated in adifferent manner than foodborne outbreaks |
Maternal attitudes toward DNA collection for gene-environment studies: a qualitative research study
Jenkins MM , Reed-Gross E , Rasmussen SA , Barfield WD , Prue CE , Gallagher ML , Honein MA . Am J Med Genet A 2009 149A (11) 2378-86 To assess attitudes toward DNA collection in an epidemiological study, focus groups were assembled in September 2007 with mothers who had participated in a case-control study of birth defects. Each recruited mother previously had completed an interview and had received a mailed kit containing cytobrushes to collect buccal cells for DNA from herself, her infant, and her infant's father during the period July 2004 through July 2007. A total of 38 mothers attended six focus groups comprising: (1) non-Hispanic Black mothers of case infants who participated or (2) did not participate in DNA collection, (3) mothers of any race or ethnicity who had case infants of low birth weight who participated or (4) did not participate in DNA collection, and (5) non-Hispanic Black mothers of control infants who participated or (6) did not participate in DNA collection. Moderator-led discussions probed maternal attitudes toward providing specimens, factors that influenced decision making, and collection method preferences. Biologics participants reported that they provided DNA for altruistic reasons. Biologics nonparticipants voiced concerns about government involvement and how their DNA will be used. Information provided (or not provided) on DNA use, storage, and disposal influenced decision making. Biologics participants and nonparticipants reported that paternal skepticism was a barrier to participation. All mothers were asked to rank DNA collection methods in terms of preference (cytobrushes, saliva, mouthwash, newborn blood spots, and blood collection). Preferred methods were convenient and noninvasive. Better understanding attitudes toward DNA collection and preferred collection methods might allow more inclusive participation and benefit future studies. (c) 2009 Wiley-Liss, Inc. |
Global mortality associated with rotavirus disease among children in 2004
Parashar UD , Burton A , Lanata C , Boschi-Pinto C , Shibuya K , Steele D , Birmingham M , Glass RI . J Infect Dis 2009 200 S9-S15 BACKGROUND: As new rotavirus vaccines are being introduced in immunization programs, global and national estimates of disease burden, especially rotavirus-associated mortality, are needed to assess the potential health benefits of vaccination and to monitor vaccine impact. METHODS: We identified 76 studies that were initiated after 1990, lasted at least 1 full year, and examined rotavirus among >100 children hospitalized with diarrhea. The studies were assigned to 5 groups (A-E) with use of World Health Organization classification of countries by child mortality and geography. For each group, the mean rotavirus detection rate was multiplied by diarrhea-related mortality figures from 2004 for countries in that group to yield estimates of rotavirus-associated mortality. RESULTS: Overall, rotavirus accounted for 527,000 deaths (95% confidence interval, 475,000-580,000 deaths) annually or 29% of all deaths due to diarrhea among children <5 years of age. Twenty-three percent of deaths due to rotavirus disease occurred in India, and 6 countries (India, Nigeria, Congo, Ethiopia, China, and Pakistan) accounted for more than one-half of deaths due to rotavirus disease. CONCLUSIONS: The high mortality associated with rotavirus disease underscores the need for targeted interventions, such as vaccines. To realize the full life-saving potential of vaccines, it will be vital to ensure that they reach children in countries with high mortality. These baseline figures will allow future assessment of vaccine impact on rotavirus-associated mortality. |
Understanding differences in HIV sexual transmission among Latino and black men who have sex with men: the Brothers y Hermanos Study
Marks G , Millett GA , Bingham T , Bond L , Lauby J , Liau A , Murrill CS , Stueve A . AIDS Behav 2009 13 (4) 682-90 HIV sexual transmission risk behaviors were examined among 1,065 Latino and 1,140 black men who have sex with men (MSM). Participants completed a computer-administered questionnaire and were tested for HIV infection. Of men who reported that their last HIV test was negative or that they had never been tested or did not get the result of their last test, 17% of black and 5% of Latino MSM tested HIV-positive in our study. In both ethnic groups, the three-month prevalence of unprotected anal intercourse (UAI) with HIV-negative or unknown serostatus partners was twice as high among men unaware of their HIV infection than men who knew they were HIV seropositive at the time of enrollment. UAI exclusively with HIV-positive partners was more prevalent among HIV-positive/aware than HIV-positive/unaware men. The findings advance understanding of the high incidence of HIV infection among black MSM in the U.S. |
The power of Mom in communicating health
Daniel KL . Am J Public Health 2009 99 (12) 2119 As a Mom, I make or influence health decisions and actions for my children, my spouse, my friends, my parents, and even my pets. I schedule my husband's colonoscopy appointment, get my kids immunized, buy the car safety seats, convince my Dad to use his hearing aids, and keep the family medical records. Sometimes I even care for my own health! Before seeing the pediatrician, I check my kid's developmental milestones, and a Web site or two. My Mom checked with our pediatrician, Doctor Dennis; I've got “Doctor Google” (www.google.com). Multiply my behaviors by every Mom in the country, and we're a pretty powerful segment that influences the public's health. | Yet, although I play this critical role, public health doesn't seem to recognize my potential. If it did, it would work with me instead of at me. Instead, public health preaches to me, scares me, doles out bits of information, and doesn't really acknowledge my influence. Public health bemoans, but mainly ignores, the powerful pull that mass media has on my attention. Public health knows that advertising works, but rarely uses counter-marketing to increase its own impact. |
A recommendation to improve employee weight status through worksite health promotion programs targeting nutrition, physical activity, or both
Task Force on Community Preventive Services , Anderson LM . Am J Prev Med 2009 37 (4) 358-9 Obesity is now recognized as a major health problem with substantial direct and indirect costs to individuals and the U.S. healthcare system. In workplaces over the past century, economic and industrial innovations have reduced the number of workers in primary industries (e.g., agriculture, fishing, mining, or forestry); increased automation and labor-saving devices in production industries; and produced large increases in the proportion of people engaged in sedentary industries. Many workers are sedentary, with easy access to energy-dense (i.e., “empty-calorie”) foods and beverages. Epidemiologic studies of characteristics of working conditions and worker overweight or obesity have shown associations between long work hours, shift work, and job stress and increases in BMI.1 The association between excess body weight and risk for a range of occupational conditions—including injury, asthma, musculoskeletal disorders, immune response, neurotoxicity, stress, cardiovascular disease, and cancer—has been described elsewhere.1 | More than 30% of the U.S. adult population is obese, and a link has been established between obesity and cardiovascular disease, hypertension, dyslipidemia, type 2 diabetes, stroke, osteoarthritis, and some cancers.2, 3 Estimates of aggregate overweight- and obesity-attributable medical spending in the U.S. in 1998 were as high as $78.5 billion ($92.6 billion in 2002 dollars) or 9.1% of the total annual medical expenditure.4 Given the tremendous costs, policymakers, health administrators, and employee wellness program directors need to take action by supporting evidence-based physical activity and nutrition programs that can help reduce the burden of obesity on the U.S. healthcare system. In the workplace, obesity affects costs associated with absenteeism, sick leave, disability, injuries, and healthcare claims.5 Programs and policies that improve worker health and ultimately reduce healthcare costs are of great importance to employers.6 Although extant reviews, both qualitative7, 8, 9, 10 and quantitative,11, 12, 13 have yielded mixed results on the effectiveness of worksite programs in reducing overweight and obesity among workers, these reviews investigated multiple health risk outcomes and did not attempt to quantify program impacts on weight as a summary measure of effect across the bodies of evidence reviewed. |
Social marketing and health communication: from people to places
Daniel KL , Bernhardt JM , Eroglu D . Am J Public Health 2009 99 (12) 2120-2 Many of the significant challenges we face in public health require that individuals change their behavior as part of the solution. Barriers to behavior change, whether known or unidentified, compound these challenges even more. As guest editors of this issue, we propose that the complementary use of social ecological theory and robust social marketing practice offers significant promise to overcome these impediments to improving the public's health. | We know that people make decisions—healthy or not—within the context of the social and cultural environment in which they live. If people cannot find a safe environment in which to exercise, they probably won't. If they cannot afford fresh fruits and vegetables, they can't eat them. If condoms are socially unacceptable, they won't be used. Social ecological theory is one important framework that offers insight into how and why these behaviors occur. The theory identifies multiple levels of influence (intrapersonal, interpersonal, social, environmental, and institutional)1 and employs a variety of disciplines and perspectives in an effort to understand and address complex public health problems. | Social marketing is an applied approach that fits well within this theoretical perspective. The approach uses strategies from commercial marketing, but focuses on how consumers interact with services and products that promote health. The fundamental axiom in social marketing is the notion of voluntary exchange: that individuals adopt products, ideas and behaviors from which they expect to benefit.2 The combined approaches of social marketing and social ecological theory focusing on people and places can result in stronger and more permanent behavior changes. |
Healthcare non-adherence decisions and internet health information
Weaver JB , Thompson NJ , Weaver SS , Hopkins GL . Comput Human Behav 2009 25 (6) 1373-1380 While the internet is emerging as an important transforming mechanism for health care and public health, questions remain about its limitations. Growing evidence indicates that a significant proportion of internet health information consumers is engaging treatment strategies inconsistent with professional recommendations. This study aimed to distinguish internet users who report non-adherence behavior from their counterparts based on several personal and environmental determinants. Using information obtained via the internet to refuse or discontinue treatment recommended by a doctor or dentist proved to be a widespread (11.2%) behavior. Internet health information bolstered non-adherence appears strongly linked with personal determinants such as anxiety, diminishing health, and gender--a pattern consistent with prior adherence research--and with environmental determinants including the perceived importance of both internet health information and internet-facilitated interpersonal interactions as well as using the internet as a social support vehicle. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract). |
Nosocomial outbreak of novel arenavirus infection, Southern Africa
Paweska JT , Sewlall NH , Ksiazek TG , Blumberg LH , Hale MJ , Lipkin WI , Weyer J , Nichol ST , Rollin PE , McMullan LK , Paddock CD , Briese T , Mnyaluza J , Dinh TH , Mukonka V , Ching P , Duse A , Richards G , de Jong G , Cohen C , Ikalafeng B , Mugero C , Asomugha C , Malotle MM , Nteo DM , Misiani E , Swanepoel R , Zaki SR , Outbreak Control Team . Emerg Infect Dis 2009 15 (10) 1598-1602 A nosocomial outbreak of disease involving 5 patients, 4 of whom died, occurred in South Africa during September-October 2008. The first patient had been transferred from Zambia to South Africa for medical management. Three cases involved secondary spread of infection from the first patient, and 1 was a tertiary infection. A novel arenavirus was identified. The source of the first patient's infection remains undetermined. |
Health care transmission of a newly emergent adenovirus serotype in health care personnel at a military hospital in Texas, 2007
Lessa FC , Gould PL , Pascoe N , Erdman DD , Lu X , Bunning ML , Marconi VC , Lott L , Widdowson MA , Anderson LJ , Srinivasan A . J Infect Dis 2009 200 (11) 1759-65 BACKGROUND: Adenoviruses can cause outbreaks of febrile respiratory illness in military trainees, but until 2007, adenovirus serotype 14 (Ad14) was never associated with such outbreaks. From April through June 2007, 15 trainees at one base were hospitalized for pneumonia due to Ad14. Subsequent reports of febrile respiratory illness among health care personnel suggested nosocomial transmission. METHODS: Health care personnel participants completed a questionnaire and provided blood and nasal wash specimens for Ad14 diagnostic testing. We defined a confirmed case of Ad14 infection as one with titers 1:80 or nasal wash specimens positive for Ad14 by polymerase chain reaction, whereas a possible case was defined by titers of 1:20 or 1:40. We also collected environmental samples. RESULTS: Among 218 tested health care personnel, 35 (16%) had titers 1:20; of these, 7 had possible cases and 28 had confirmed cases of infection. Confirmed case patients were more likely to report febrile respiratory illness (57% vs 11%; [Formula: see text]) and to have had direct contact with patients with Ad14 infection (82% vs 62%; [Formula: see text]). Of the 23 confirmed case patients with direct contact with Ad14-infected patients, 52% reported that patients were not in contact and droplet precautions at the time of exposure. Ad14 was recovered from several hospital surfaces. CONCLUSIONS: Our findings of possible nosocomial transmission of Ad14 highlight the need to reinforce infection control guidelines. |
Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand
Rerks-Ngarm S , Pitisuttithum P , Nitayaphan S , Kaewkungwal J , Chiu J , Paris R , Premsri N , Namwat C , de Souza M , Adams E , Benenson M , Gurunathan S , Tartaglia J , McNeil JG , Francis DP , Stablein D , Birx DL , Chunsuttiwat S , Khamboonruang C , Thongcharoen P , Robb ML , Michael NL , Kunasol P , Kim JH , MOPH-TAVEG Investigators . N Engl J Med 2009 361 (23) 2209-20 BACKGROUND: The development of a safe and effective vaccine against the human immunodeficiency virus type 1 (HIV-1) is critical to pandemic control. METHODS: In a community-based, randomized, multicenter, double-blind, placebo-controlled efficacy trial, we evaluated four priming injections of a recombinant canarypox vector vaccine (ALVAC-HIV [vCP1521]) plus two booster injections of a recombinant glycoprotein 120 subunit vaccine (AIDSVAX B/E). The vaccine and placebo injections were administered to 16,402 healthy men and women between the ages of 18 and 30 years in Rayong and Chon Buri provinces in Thailand. The volunteers, primarily at heterosexual risk for HIV infection, were monitored for the coprimary end points: HIV-1 infection and early HIV-1 viremia, at the end of the 6-month vaccination series and every 6 months thereafter for 3 years. RESULTS: In the intention-to-treat analysis involving 16,402 subjects, there was a trend toward the prevention of HIV-1 infection among the vaccine recipients, with a vaccine efficacy of 26.4% (95% confidence interval [CI], -4.0 to 47.9; P=0.08). In the per-protocol analysis involving 12,452 subjects, the vaccine efficacy was 26.2% (95% CI, -13.3 to 51.9; P=0.16). In the modified intention-to-treat analysis involving 16,395 subjects (with the exclusion of 7 subjects who were found to have had HIV-1 infection at baseline), the vaccine efficacy was 31.2% (95% CI, 1.1 to 51.2; P=0.04). Vaccination did not affect the degree of viremia or the CD4+ T-cell count in subjects in whom HIV-1 infection was subsequently diagnosed. CONCLUSIONS: This ALVAC-HIV and AIDSVAX B/E vaccine regimen may reduce the risk of HIV infection in a community-based population with largely heterosexual risk. Vaccination did not affect the viral load or CD4+ count in subjects with HIV infection. Although the results show only a modest benefit, they offer insight for future research. (ClinicalTrials.gov number, NCT00223080.) Copyright 2009 Massachusetts Medical Society. |
The yin and yang of paracetamol and paediatric immunisations
Chen RT , Clark TA , Halperin SA . Lancet 2009 374 (9698) 1305-6 Although highly effective, whole-cell pertussis vaccines are associated with high rates of injection-site reactions, fever, and less commonly febrile seizures. Two trials in the 1980s showed that rates of postimmunisation fever could be reduced through the prophylactic administration of paracetamol (acetaminophen),1, 2 which led the US Advisory Committee on Immunization Practice to recommend “it is reasonable to consider administering antipyretics (such as acetaminophen) at age-appropriate doses at the time of vaccination and every 4–6 h for 48–72 h to children at higher risk for seizures than the general population”.3 In practice, the administration of paracetamol to all children receiving whole-cell pertussis vaccine became widespread. In Canada, the National Advisory Committee on Immunization advised “because of the lower incidence of fever associated with [acellular pertussis] vaccines, there may be less justification for routine use of prophylactic acetaminophen, as had been recommended with the whole-cell pertussis vaccines”.4 Lewis and colleagues2 had cautioned about the possible effects of anti-inflammatory agents on a diminished immune response. But, because no effect on immunogenicity was noted with paracetamol and whole-cell pertussis vaccine,5, 6 the extensive prelicensure trials with acellular pertussis studied the effect of paracetamol on reactogenicity, not immunogenicity.7, 8 | In The Lancet today, Roman Prymula and colleagues are the first to examine this issue carefully with a current paediatric vaccine regimen.9 Unexpectedly, they found reduced immunogenicity of common paediatric vaccines with use of paracetamol in open-label randomised trials for both primary and booster doses. The investigators discuss several potential mechanisms for the observed effect on the antibody response. Prevention of inflammation and fever is unlikely because the immune responses (and the effect of paracetamol) in children with and without fever were similar. The authors propose that the most attractive mechanism is interference with the early interactions of dendritic cells, T cells, and B cells of the primary immune response through a reduction of inflammatory signals at the injection site, which would also explain the decreased effect of paracetamol on immunogenicity of the booster dose. However, despite being an inhibitor of cyclo-oxygenase 2 (COX-2), paracetamol's anti-inflammatory activity is contested, perhaps related to inhibition of activity in high-peroxide environments that are common at sites of inflammation.10 Paracetamol's COX-2 inhibiting activity might be restricted to the CNS, where oxidative stresses are more tightly controlled. An anti-inflammatory mechanism would be of particular concern with ibuprofen for the prevention and treatment of adverse events after immunisation. Ibuprofen is a more potent COX-2 inhibitor with greater anti-inflammatory activity than paracetamol, particularly at peripheral sites of tissue inflammation. The effect of ibuprofen on the antibody response postimmunisation (and postinfection) is not known. |
Availability of human papillomavirus vaccine at medical practices in an area with elevated rates of cervical cancer
Gottlieb SL , Brewer NT , Smith JS , Keating KM , Markowitz LE . J Adolesc Health 2009 45 (5) 438-44 PURPOSE: To assess availability of human papillomavirus (HPV) vaccine at medical practices in an area with elevated cervical cancer rates. METHODS: During July-November 2007, we conducted a telephone survey of staff at medical practices providing outpatient care to 9- to 26-year-old females in four North Carolina counties with elevated cervical cancer rates. We assessed availability of HPV vaccine and concerns about its provision. RESULTS: Staff from 71 of 96 eligible practices completed a full interview. Overall, 62% of these practices had HPV vaccine available to patients (family practice, 74%; pediatrics, 75%; obstetrics-gynecology, 64%; internal medicine, 15%). In multivariate analysis, practice characteristics that independently predicted a lower likelihood of carrying HPV vaccine were having at least 50% African-American patient population (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.06-0.63) and providing only privately purchased (and no state-supplied) vaccines (OR 0.19, 95% CI 0.06-0.63). HPV vaccine nonproviders were significantly more likely than HPV vaccine providers to report "large" concerns about the up-front costs of purchasing HPV vaccine (52% vs. 27%, p < .05) and late reimbursement (33% vs. 14%, p < .05). CONCLUSIONS: Approximately 1 year after its introduction, HPV vaccine was available at three-quarters of family practice and pediatrics practices, two-thirds of obstetrics-gynecology practices, and few internal medicine practices in an area with elevated cervical cancer rates. Practices' concerns about cost and reimbursement have implications for accessibility of HPV vaccine to those who need it most. |
Human papillomavirus vaccine initiation in an area with elevated rates of cervical cancer
Gottlieb SL , Brewer NT , Sternberg MR , Smith JS , Ziarnowski K , Liddon N , Markowitz LE . J Adolesc Health 2009 45 (5) 430-7 PURPOSE: We assessed human papillomavirus (HPV) vaccination of adolescent girls living in communities with elevated cervical cancer rates. METHODS: During July to October 2007, we conducted interviews with a probability sample of parents (or guardians) of 10- to 18-year-old girls in five North Carolina counties with cervical cancer rates substantially higher than the national average. Estimates are weighted. RESULTS: We interviewed 889 (73%) of 1220 eligible parents; 38% were black. Overall, 10.3% (95% confidence interval [CI] 7.7%-13.5%) of daughters had received at least 1 dose of HPV vaccine. Only 6.4% of 10- to 12-year-olds had initiated vaccination, versus 17.5% of 16- to 18-year-olds (odds ratio [OR] 3.1, 95% CI 1.4-6.9). Older age of daughters and doctor's recommendation were the only factors independently associated with vaccine initiation. Main reasons reported for not initiating HPV vaccine were: needing more information (22%) or never having heard of the vaccine (14%), believing daughter is too young (16%) or not yet sexually active (13%), and not having gone to the doctor yet (13%). Only 0.5% of parents cited concern about HPV vaccine making a teenage girl more likely to have sex as a main reason for not vaccinating. Of 780 parents with unvaccinated daughters, 62% reported their daughters "probably" or "definitely" will, and 10% reported their daughters "definitely won't" get HPV vaccine in the next year. CONCLUSIONS: Approximately 1 year after its introduction, HPV vaccine had been initiated by only 10% of adolescent girls in an area with elevated cervical cancer rates; however, most parents intended for their daughters to be vaccinated. Additional efforts are needed to ensure that parents' intentions to vaccinate are realized. |
Impact of routine hepatitis B immunization on the prevalence of chronic hepatitis B virus infection in the Marshall Islands and the Federated States of Micronesia
Bialek SR , Helgenberger L , Fischer GE , Bower WA , Konelios M , Chaine JP , Armstrong G , Williams IT , Bell BP . Pediatr Infect Dis J 2009 29 (1) 18-22 BACKGROUND: To evaluate the impact of routine hepatitis B (HB) vaccination on the prevalence of chronic hepatitis B virus (HBV) infection among children in Pacific Island countries where HBV infection was highly endemic, we conducted HB serosurveys during 2000 to 2007 among women of childbearing age born before implementation of HB vaccination and among children born after its implementation. METHODS: Serum specimens were collected from children aged 2 to 6 years and their mothers in Chuuk, Federated States of Micronesia in 2000, children aged 2 to 9 years and their mothers in Pohnpei, Federated States of Micronesia in 2005, and 5- to 9-year-old children and prenatal clinic patients in 2007 in Republic of the Marshall Islands (RMI). Specimens were tested for HB surface antigen (HBsAg) and antibodies to HB core antigen (total anti-HBc). HB vaccination coverage was determined from health department vaccination registries. We defined chronic HBV infection as the presence of HBsAg. RESULTS: Birthdose and 3 dose HB vaccination coverage was 48% and 87%, respectively, in Chuuk, 87% and 90% in Pohnpei, and 49% and 93% in RMI. Chronic HBV infection prevalence among children was 2.5% (9/362) in Chuuk, 1.5% (7/478) in Pohnpei and 1.8% (6/331) in RMI. Chronic HBV infection prevalence among women was 9.2% (21/229) in Chuuk, 4.4% (10/229) in Pohnpei, and 9.5% (11/116) in RMI. CONCLUSIONS: Hepatitis B vaccination has resulted in a substantial decline in chronic infection in children in the Pacific Islands. HB vaccine effectiveness is high in this region, despite challenges in providing HB vaccine at birth and completing vaccination series on schedule. |
Unintentional fall injuries associated with walkers and canes in older adults treated in U.S. emergency departments
Stevens JA , Thomas K , Teh L , Greenspan AI . J Am Geriatr Soc 2009 57 (8) 1464-9 OBJECTIVES: To characterize nonfatal, unintentional, fall-related injuries associated with walkers and canes in older adults. DESIGN: Surveillance data of injuries treated in hospital emergency departments (EDs), January 1, 2001, to December 31, 2006. SETTING: The National Electronic Injury Surveillance System All Injury Program, which collects data from a nationally representative stratified probability sample of 66 U.S. hospital EDs. PARTICIPANTS: People aged 65 and older treated in EDs for 3,932 nonfatal unintentional fall injuries and whose records indicated that a cane or a walker was involved in the fall. MEASUREMENTS: Sex, age, whether the fall involved a cane or walker, primary diagnosis, part of the body injured, disposition, and location and circumstances of the fall. RESULTS: An estimated 47,312 older adult fall injuries associated with walking aids were treated annually in U.S. EDs: 87.3% with walkers, 12.3% with canes, and 0.4% with both. Walkers were associated with seven times as many injuries as canes. Women's injury rates exceeded those for men (rate ratios=2.6 for walkers, 1.4 for canes.) The most prevalent injuries were fractures and contusions or abrasions. Approximately one-third of subjects were hospitalized for their injuries. CONCLUSION: Injuries and hospital admissions for falls associated with walking aids were frequent in this highly vulnerable population. The results suggest that more research is needed to improve the design of walking aids. More information also is needed about the circumstances preceding falls, both to better understand the contributing fall risk factors and to develop specific and effective fall prevention strategies. |
Method for measurement of the quaternary amine compounds paraquat and diquat in human urine using high-performance liquid chromatography-tandem mass spectrometry
Whitehead RD Jr , Montesano MA , Jayatilaka NK , Buckley B , Winnik B , Needham LL , Barr DB . J Chromatogr B Analyt Technol Biomed Life Sci 2009 878 (27) 2548-53 We have developed a highly selective and sensitive analytical method to quantify paraquat and diquat by use of high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The sample preparation includes solid phase extraction that uses weak cation exchange cartridges. These highly charged dual quaternary amines were not retained by standard reversed phase columns, but they could be adequately separated through HPLC with a HILIC column. The detection was carried out with a triple quadrupole mass spectrometer with an electrospray ionization probe in positive ion mode in multiple reaction monitoring. Repeated analysis in human urine samples spiked with low (5ng/ml), medium (15ng/ml), and high (30ng/ml) concentrations of the analytes yielded relative standard deviations of less than 9%. The extraction efficiencies ranged from 77.7% to 94.2%. The limits of detection were in the range of 1ng/ml. |
A multi-center comparison of two norovirus ORF2-based genotyping protocols
Mattison K , Grudeski E , Auk B , Charest H , Drews SJ , Fritzinger A , Gregoricus N , Hayward S , Houde A , Lee BE , Pang XL , Wong J , Booth TF , Vinje J . J Clin Microbiol 2009 47 (12) 3927-32 Norovirus outbreaks can be difficult to track due to the high frequency of environmental norovirus detection and the limited strain variation in some genotyping regions. However, rapid and accurate source identification can limit the spread of a foodborne outbreak and reduce the number of cases. Harmonization of genotyping assays is critical for enabling the rapid exchange of sequence data nationally and internationally. Several regions of the genome have been proposed for this purpose, but no consensus has been reached. In the present study, two standardized genotyping protocols (region C and region D) were evaluated by 9 laboratories in Canada and the United States using a coded panel of 96 fecal specimens representing 22 different norovirus genotypes. Overall, region C typing had a success rate of 78% compared to 52% for region D, however region D provides greater nucleotide sequence diversity for identifying new GII.4 variant strains. Significant differences in successful genotyping were observed between the 9 participating laboratories (10% to 100%) and between the different genotypes (6% to 100%). For several genogroup II strains, the reduced region D amplification correlated directly with mismatches between primer sequences and template. Based on overall performance, we recommended the region C protocol for routine genotyping of noroviruses while the region D protocol may be useful for identifying new GII.4 variants. Standardized genotyping will enable the rapid exchange of outbreak and sequence data through electronic norovirus surveillance networks. |
Negative immune regulator Tim-3 is overexpressed on T cells in hepatitis C virus infection and its blockade rescues dysfunctional CD4+ and CD8+ T cells
Golden-Mason L , Palmer BE , Kassam N , Townshend-Bulson L , Livingston S , McMahon BJ , Castelblanco N , Kuchroo V , Gretch DR , Rosen HR . J Virol 2009 83 (18) 9122-30 A number of emerging molecules and pathways have been implicated in mediating the T-cell exhaustion characteristic of chronic viral infection. Not all dysfunctional T cells express PD-1, nor are they all rescued by blockade of the PD-1/PD-1 ligand pathway. In this study, we characterize the expression of T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) in chronic hepatitis C infection. For the first time, we found that Tim-3 expression is increased on CD4(+) and CD8(+) T cells in chronic hepatitis C virus (HCV) infection. The proportion of dually PD-1/Tim-3-expressing cells is greatest in liver-resident T cells, significantly more so in HCV-specific than in cytomegalovirus-specific cytotoxic T lymphocytes. Tim-3 expression correlates with a dysfunctional and senescent phenotype (CD127(low) CD57(high)), a central rather than effector memory profile (CD45RA(negative) CCR7(high)), and reduced Th1/Tc1 cytokine production. We also demonstrate the ability to enhance T-cell proliferation and gamma interferon production in response to HCV-specific antigens by blocking the Tim-3-Tim-3 ligand interaction. These findings have implications for the development of novel immunotherapeutic approaches to this common viral infection. |
New Centers for Disease Control and Prevention publication on good laboratory practices for molecular genetics testing
Chen B . Beijing Da Xue Xue Bao Yi Xue Ban 2009 41 (4) 395-6 The Centers for Disease Control and Prevention (CDC) is publishing a document titled "Good Laboratory PRactices for Molecular Genetic Testing for Heritable Diseases and Conditions" in the recommendations and reports series of the Morbidity and Mortality Weekly Report (MMWR) in spring 2009. This document will provide the recommendations of the Clinical Laboratory Improvement Advisory Committee (CLIAC) for good labortoary practices in the areas of molecular genetic testing that have been recognized as needing specific guidance for complying with applicable requirements in the Clinical Laboratory Improvement Amendments (CLIA) regulations, or as needing quality assurance measures in addition to the general CLIA requirements. The MMWR document is intended to be used by the following laboratories or individuals for the purpose of improving the quality and utilization of genetic laboratory services: 1) Laboratories performing molecular genetic testing for heritable diseases and conditions; 2) Users of the labortaory services, including (but not limited to) healthcare professionals, patients, referring or referral laboratories, and payers of laboratory services; 3) Medical and public health professionals who evaluate laboratory practices and policies. |
A paired comparison between human skin and hairless guinea pig skin in vitro permeability and lag time measurements for 6 industrial chemicals
Frasch HF , Barbero AM . Cutan Ocul Toxicol 2009 28 (3) 107-13 The purpose of the present study was to measure and compare permeability coefficients (k(p)) and lag times (tau) in human skin and hairless guinea pig (HGP) skin. Paired experiments employed heat-separated epidermal membranes from human and HGP sources mounted on static in vitro diffusion cells. Infinite-dose, saturated aqueous solutions of 6 industrial chemicals were used as donors: aniline, benzene, 1,2- dichloroethane, diethyl phthalate, naphthalene, and tetrachloroethylene. No significant differences were found between human and HGP skin for either k(p) or tau for any of these chemicals (p ≥ .24). HGP vs. human k(p) measurements, and HGP vs. human tau measurements, were highly correlated. For k(p), the slope of the linear correlation was close to unity (1.080 +/- 0.182) and the intercept close to 0 (0.015 +/- 0. 029 cm/h), with a correlation coefficient (r(2)) = 0.898. For tau, the slope was also close to unity (0.818 +/- 0.030) and the intercept close to 0 (-0.014 +/- 0.023 h), with r(2) = 0.994. These results suggest that HGP skin may serve as an excellent surrogate for human skin in in vitro dermal penetration studies. |
Rapid detection of the CYP2A6*12 hybrid allele by Pyrosequencing technology
Koontz DA , Huckins JJ , Spencer A , Gallagher ML . BMC Med Genet 2009 10 80 BACKGROUND: Identification of CYP2A6 alleles associated with reduced enzyme activity is important in the study of inter-individual differences in drug metabolism. CYP2A6*12 is a hybrid allele that results from unequal crossover between CYP2A6 and CYP2A7 genes. The 5' regulatory region and exons 1-2 are derived from CYP2A7, and exons 3-9 are derived from CYP2A6. Conventional methods for detection of CYP2A6*12 consist of two-step PCR protocols that are laborious and unsuitable for high-throughput genotyping. We developed a rapid and accurate method to detect the CYP2A6*12 allele by Pyrosequencing technology. METHODS: A single set of PCR primers was designed to specifically amplify both the CYP2A6*1 wild-type allele and the CYP2A6*12 hybrid allele. An internal Pyrosequencing primer was used to generate allele-specific sequence information, which detected homozygous wild-type, heterozygous hybrid, and homozygous hybrid alleles. We first validated the assay on 104 DNA samples that were also genotyped by conventional two-step PCR and by cycle sequencing. CYP2A6*12 allele frequencies were then determined using the Pyrosequencing assay on 181 multi-ethnic DNA samples from subjects of African American, European Caucasian, Pacific Rim, and Hispanic descent. Finally, we streamlined the Pyrosequencing assay by integrating liquid handling robotics into the workflow. RESULTS: Pyrosequencing results demonstrated 100% concordance with conventional two-step PCR and cycle sequencing methods. Allele frequency data showed slightly higher prevalence of the CYP2A6*12 allele in European Caucasians and Hispanics. CONCLUSION: This Pyrosequencing assay proved to be a simple, rapid, and accurate alternative to conventional methods, which can be easily adapted to the needs of higher-throughput studies. |
Evaluation of automated and manual commercial DNA extraction methods for the recovery of Brucella spp. DNA from suspensions and spiked swabs
Dauphin LA , Hutchins RJ , Bost LA , Bowen MD . J Clin Microbiol 2009 47 (12) 3920-6 This study evaluated automated and manual commercial DNA extraction methods for their ability to recover DNA from Brucella species in PBS suspension and from spiked swab specimens. Six extraction methods, representing several of the methodologies which are commercially available for DNA extraction, as well as representing varying throughput capacities, were evaluated: the MagNA Pure Compact and the MagNA Pure LC instruments, the IT 1-2-3 DNA Sample Purification Kit, the MasterPure Complete DNA and RNA Purification Kit, the QIAamp DNA Blood Mini Kit, and the UltraClean Microbial DNA Isolation Kit. These six extraction methods were performed upon three pathogenic Brucella species: B. abortus, B. melitensis, and B. suis. Viability testing of the DNA extracts indicated that all six extraction methods were efficient at inactivating virulent Brucella spp. Real-time PCR analysis using Brucella genus- and species-specific TaqMan assays revealed that use of the MasterPure kit resulted in superior levels of detection from bacterial suspensions, while the MasterPure and the MagNA Pure Compact kits performed equally well for extraction of spiked swab samples. This study demonstrated that DNA extraction methodologies differ in their ability to recover Brucella DNA from PBS bacterial suspensions and from swab specimens and thus that the extraction method used for a given type of sample matrix can influence the sensitivity of real-time PCR assays for Brucella. |
Postnatal HIV-1 transmission after cessation of infant extended antiretroviral prophylaxis and effect of maternal highly active antiretroviral therapy
Taha TE , Kumwenda J , Cole SR , Hoover DR , Kafulafula G , Fowler MG , Thigpen MC , Li Q , Kumwenda NI , Mofenson L . J Infect Dis 2009 200 (10) 1490-7 BACKGROUND: The association between postnatal human immunodeficiency virus type 1 (HIV-1) transmission and maternal highly active antiretroviral therapy (HAART) after infant extended antiretroviral prophylaxis was assessed. METHODS: A follow-up study was conducted for the Post-Exposure Prophylaxis of Infants trial in Blantyre, Malawi (PEPI-Malawi). In PEPI-Malawi, breast-feeding infants of HIV-infected women were randomized at birth to receive a either control regimen (single-dose nevirapine plus 1 week of zidovudine); the control regimen plus nevirapine to age 14 weeks; or the control regimen plus nevirapine and zidovudine to age 14 weeks. Infant HIV infection, maternal CD4 cell count, and HAART use were determined. Maternal HAART use was categorized as HAART eligible but untreated (CD4 cell count of <250 cells/muL, no HAART received), HAART eligible and treated (CD4 cell count of <250 cells/muL, HAART received), and HAART ineligible (CD4 cell count of 250 cells/muL). The incidence of HIV infection and the association between postnatal HIV transmission and maternal HAART were calculated among infants who were HIV negative at 14 weeks. RESULTS: Of 2318 infants, 130 (5.6%) acquired HIV infection, and 310 mothers (13.4%) received HAART. The rates of HIV transmission (in cases per 100 person-years) were as follows: for the HAART-eligible/untreated category, 10.56 (95% confidence interval [CI], 7.91-13.82); for the HAART-eligible/treated category, 1.79 (95% CI, 0.58-4.18); and for the HAART-ineligible category, 3.66 (95% CI, 2.86-4.61). The HIV transmission rate ratio for the HAART-eligible/treated category versus the HAART-eligible/untreated category, adjusted for infant prophylaxis, was 0.18 (95% CI, 0.07-0.44). CONCLUSIONS: Postnatal HIV transmission continues after cessation of infant prophylaxis. HAART-eligible women should start treatment early for their own health and to reduce postnatal HIV transmission to their infants. |
Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease
Gaffield ME , Kapp N , Curtis KM . Contraception 2009 80 (4) 363-71 BACKGROUND: Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy. STUDY DESIGN: We searched MEDLINE and The Cochrane Library for articles in any language on use of combined oral contraceptives (COC), copper-bearing or levonorgestrel-releasing IUDs among women with benign or malignant GTD, from database inception through November 2008. One review and nine articles were identified and evaluated. RESULTS: Incidence of postmolar trophoblastic disease was lower among COC users compared with nonusers in six studies, but higher among COC users in three studies. Five studies reported shorter human chorionic gonadotropin (hCG) regression duration among COC users compared with other methods. Development of postmolar trophoblastic disease did not differ significantly among IUD users compared with COC users or nonusers in three studies. CONCLUSIONS: Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method. |
Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-infected women in Malawi
Kafulafula G , Hoover DR , Taha TE , Thigpen M , Li Q , Fowler MG , Kumwenda NI , Nkanaunena K , Mipando L , Mofenson LM . J Acquir Immune Defic Syndr 2009 53 (1) 6-13 BACKGROUND: We assessed gastroenteritis (GE) burden in 2 randomized trials conducted in Malawi to reduce postnatal HIV transmission before and after World Health Organization recommendations regarding exclusive breastfeeding for HIV-exposed infants were adopted. The 2 trials were the nevirapine/AZT (NVAZ, 2000-2003 with prolonged breastfeeding) and the Postexposure Prophylaxis to the Infant (PEPI, 2004-2007 with breastfeeding cessation by 6 months). METHODS: From NVAZ and PEPI trials data, GE frequency through age 12 months among HIV-negative exposed infants was evaluated. Overall and GE-related cumulative mortality rates were estimated using Kaplan-Meier curves. RESULTS: The frequency of at least one GE-related hospitalization was greater in PEPI vs. NVAZ after age 6 months (respectively, 2.9% vs. 0.1%, at 7-9 months and 1.6% vs. 0.2% at 10-12 months, P < 0.001). Cumulative GE-related mortality was significantly higher in PEPI than in NVAZ after age 6 months; at ages 9 and 12 months GE-related mortality was 19 and 24 per 1000 infants in PEPI vs. 7 and 12 per 1000 infants in NVAZ (P = 0.0002). CONCLUSIONS: Early weaning was associated with increased risk of severe GE and GE-related mortality among HIV-exposed infants. Strategies are urgently needed which allow longer breastfeeding while reducing the risk of HIV breast milk transmission in resource-limited settings. |
Intrauterine device insertion during the postpartum period: a systematic review
Kapp N , Curtis KM . Contraception 2009 80 (4) 327-36 BACKGROUND: Insertion of an intrauterine device (IUD) at different times or by different routes during the postpartum period may increase the risk of complications. METHODS: We searched Medline, Lilacs and Cochrane Collaboration databases for articles in any language, between database inception until December 2008, which compared outcomes of postpartum IUD insertion time intervals. Search terms included postpartum, puerperium, postcesarean delivery, cesarean section, IUD(s), IUCD(s), intrauterine device(s) and insertion. RESULTS: From 297 articles, we identified 15 for inclusion in this review: all studies examined the outcomes from copper IUD insertions within the postpartum time period compared to other time intervals or compared routes (vaginal or via hysterotomy) of postpartum insertion. No studies of levonorgestrel IUDs were identified. Immediate IUD insertion (within 10 min of placental delivery) was safe when compared with later postpartum time periods and interval insertion. Immediate postpartum IUD insertion demonstrated lower expulsion rates when compared with delayed postpartum insertion but with higher rates than interval insertion. Immediate insertion following cesarean delivery demonstrated lower expulsion rates than immediate insertion following vaginal delivery. CONCLUSION: Poor to fair quality evidence from 15 articles demonstrated no increase in risk of complications among women who had an IUD inserted during the postpartum period; however, some increase in expulsion rates occurred with delayed postpartum insertion when compared to immediate insertion and with immediate insertion when compared to interval insertion. Postplacental placements during cesarean delivery are associated with lower expulsion rates than postplacental vaginal insertions, without increasing rates of postoperative complications. |
Long-term stability of a backfilled room-and-pillar test section at the Buick Mine, Missouri, USA
Tesarik DR , Seymour JB , Yanske TR . Int J Rock Mech Min Sci 2009 46 (7) 1182-1196 Rock mechanics instruments have been providing data in a backfilled room-and-pillar test section of the Buick Mine near Boss, Missouri, USA, for nearly 16 years. Host rock instruments include borehole extensometers installed in the mine roof and pillars, and biaxial stressmeters used in pillars and abutments. Embedment strain gauges, extensometers, and earth pressure cells were installed in the cemented backfill. The instruments monitored stability of the test section for two years while the pillars were extracted, and 14 years after pillar extraction to monitor long-term stability. Of the transducers that were not mined out when the pillars were extracted, 68% still function. Data from these instruments demonstrate that backfill improves long-term underground safety by supporting the mine roof and maintaining the strength of support pillars. For example, backfill significantly limited the dilation of a remaining support pillar by providing confinement on one side of the pillar. Post-mining stress and strain in the backfill account for 35% and 28% of the total stress and strain that was measured, respectively. Earth pressure cell stress measurements confirmed visual observations that the backfill remained stable. Post-mining stress measurements from the earth pressure cells fit natural log equations as a function of time with r-squared values ranging from 0.76 to 0.98. Natural log equations also described post-mining strain behavior of the backfill with r-squared values ranging from 0.30 to 0.99. Stresses calculated for the backfill by a three-dimensional numerical model of the test area were consistent with those that were measured by earth pressure cells. Published by Elsevier Ltd. |
National nanotechnology partnership to protect workers
Howard J , Murashov V . J Nanopart Res 2009 11 (7) 1673-1683 Nanotechnology is predicted to improve many aspects of human life. By 2015, it is estimated to represent $3.1 trillion in manufactured goods. Data is emerging that exposure to nanomaterials may pose a health risk to workers. If the economic promise of nanotechnology is to be achieved, ways need to be found to protect nanotechnology workers now. The Occupational Safety and Health Act of 1970 (OSHAct) gave the responsibility to protect workers to the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) through research, standards adoption, and standards enforcement. Since 1980, adopting new occupational health standards has grown more complex. The increased complexity has greatly slowed efforts to adopt protective standards for toxic agents that are well-known to pose significant risks. The likelihood of rapidly adopting standards to protect workers from nanomaterials, whose risks are just emerging, seems even more unlikely. Use of the OSHAct's general duty clause to protect workers also seems uncertain at this time. In the interim, a national partnership led by NIOSH involving nanotech manufacturers and downstream users, workers, academic researchers, safety, and health practitioners is proposed. A National Nanotechnology Partnership would generate knowledge about the nature and the extent of worker risk, utilize that knowledge to develop risk control strategies to protect nanotechnology workers now, and provide an evidence base for NIOSH recommendations to OSHA for a nanotechnology program standard at a future date. |
Exposure to atrazine and selected non-persistent pesticides among corn farmers during a growing season
Bakke B , De Roos AJ , Barr DB , Stewart PA , Blair A , Freeman LB , Lynch CF , Allen RH , Alavanja MC , Vermeulen R . J Expo Sci Environ Epidemiol 2009 19 (6) 544-54 The aim was to develop quantitative estimates of farmers' pesticide exposure to atrazine and to provide an overview of background levels of selected non-persistent pesticides among corn farmers in a longitudinal molecular epidemiologic study. The study population consisted of 30 Agricultural Health Study farmers from Iowa and 10 non-farming controls. Farmers completed daily and weekly diaries from March to November in 2002 and 2003 on pesticide use and other exposure determinants. Urine samples were collected at 10 time points relative to atrazine application and other farming activities. Pesticide exposure was assessed using urinary metabolites and diaries. The analytical limit of detection (LOD) ranged between 0.1 and 0.2 microg/l for all pesticide analytes except for isazaphos (1.5 microg/l) and diazinon (0.7 microg/l). Farmers had higher geometric mean urinary atrazine mercapturate (AZM) values than controls during planting (1.1 vs <LOD microg/g creatinine; P<0.05). AZM levels among farmers were significantly related to the amount of atrazine applied (P=0.015). Interestingly, farmers had a larger proportion of samples above the LOD than controls even after exclusion of observations with an atrazine application within 7 days before urine collection (38% vs 6%, P<0.0001). A similar pattern was observed for 2,4-D and acetochlor (92% vs 47%, P<0.0001 and 45% vs 4%, P<0.0001, respectively). Urinary AZM levels in farmers were largely driven by recent application of atrazine. Therefore, the amount of atrazine applied is likely to provide valid surrogates of atrazine exposure in epidemiologic studies. Elevated background levels of non-persistent pesticides, especially 2,4-D, indicate importance in epidemiologic studies of capturing pesticide exposures that might not be directly related to the actual application. |
Two-dimensional biomechanical model for estimating strength of youth and adolescents for manual material handling tasks
Waters TR , Garg A . Appl Ergon 2010 41 (1) 1-7 Youth and adolescents are routinely engaged in manual material handling (MMH) tasks that may exceed their strength capability to perform the task and may place them at excessive risk for musculoskeletal disorders. This paper reports on a two-dimensional biomechanical model that was developed to assess MMH tasks performed by youth 3-21 years of age. The model uses age, gender, posture of the youth performing the MMH activity, and weight of the load handled as input, and provides an estimate of the strength demands of the task and spinal disc compression and shear force resulting from the activity as output. The model can be used to assess whether a specific MMH task exceeds the strength demands for youth of certain ages or genders, which of the internal muscle strengths are most affected, and provides information about the estimated spinal disc compression and shear forces on the spine as a result of the specified MMH task. These results would be helpful in deciding whether a task is appropriate for a youth to perform or whether a certain task modification may be sufficient in reducing the physical demands to a level acceptable for a youth of certain age and gender. |
Use of combined oral contraceptives post abortion
Gaffield ME , Kapp N , Ravi A . Contraception 2009 80 (4) 355-62 BACKGROUND: Providing combined oral contraceptives (COCs) following surgical or medical induced abortion offers women an opportune moment to initiate a reliable contraceptive method. STUDY DESIGN: We conducted a systematic review, searching MEDLINE and The Cochrane Library for articles in any language concerning COC use following spontaneous, induced (medical or surgical) or septic abortion, from 1966 through June 2008. Seven articles were identified and evaluated using the United States Preventive Services Task Force system. RESULTS: Immediate COC initiation after first-trimester medical or surgical induced abortion did not increase side effects or prolong vaginal bleeding compared with use of a placebo, copper-bearing intrauterine device (IUD), nonhormonal contraceptive method or COC initiation at a later time. Initiating COCs after first-trimester surgical abortion produced small increases in coagulation parameters compared with IUD use; although they are statistically significant, their clinical relevance is unlikely. No study examined second-trimester induced or spontaneous abortion, or septic abortion. CONCLUSIONS: Evidence shows that COCs can be safely initiated immediately following surgical and medical abortion in the first-trimester of pregnancy. |
Keeping evidence-based recommendations up to date: the World Health Organization's global guidance for family planning
Curtis KM , Peterson HB , d'Arcangues C . Contraception 2009 80 (4) 323-4 Since the mid 1990s, the World Health Organization's (WHO) Department of Reproductive Health and Research, in collaboration with international partners, has been creating and updating global guidance for family planning, based on the best scientific evidence. In April 2008, WHO held its most recent expert meeting to update this guidance and create the fourth edition of the Medical Eligibility Criteria for Contraceptive Use[1] and the third edition of the Selected Practice Recommendations for Contraceptive Use[2]. The Medical Eligibility Criteria for Contraceptive Use gives recommendations regarding whether women with specific characteristics and medical conditions can use various methods of contraception. The Selected Practice Recommendations for Contraceptive Use addresses 33 contraceptive management issues, including contraceptive method initiation and continuation, management of side effects, and screening tests needed prior to contraceptive initiation. WHO has also created two companion documents that incorporate all of the guidance of the Medical Eligibility Criteria for Contraceptive Use and the Selected Practice Recommendations for Contraceptive Use into tools for family planning providers. The first is the Decision Making Tool for Family Planning Clients and Providers[3], which is a flip chart used to facilitate provider–client interaction in choosing a method of contraception. The second is Family Planning: A Global Handbook for Providers[4], created in collaboration with major family planning organizations around the world. These WHO Four Cornerstones for Evidence-based Guidance for Family Planning have had an impact on family planning practice globally. For example, the third edition of the Medical Eligibility Criteria for Contraceptive Use has been incorporated into guidelines in over 50 countries and is available in 13 languages. |
25 years of HBSC: challenges and successes
McQueen DV . Int J Public Health 2009 54 123-4 In today’s world there are many surveys and many of those | are surveys of children, but none possess the three salient | characteristics that have defined the HBSC: 1. it has been | sustained over a long period of time, more than a quarter | century; 2. it has built survey research capacity over that time | in many and varied countries; and 3. it is driven by an underlying theoretical approach that is informative, innovative | and sensitive to the leading issues of the time. Each of these | characteristics is a considerable challenge to any collective | knowledge seeking endeavor. Sustainability is difficult in any | scientific undertaking. Funding sources often suffer from the | political whims of decision makers in governments that vary | over time. Maintaining funding may not be as problematic | for large scale projects in the physical or biological sciences | because they are less likely to be seen as bound to societal | prejudices. However, a subject area such as health related | behaviour in school children is potentially much more sensitive to trends and views of current policies, because of the | age of respondents as well as content, such as sexual activity | and risk behaviours. Even where friendly policies do last over | many years, resources may vary in the same time period. Thus | for a funding body to consistently rate this survey as worthy of | continued support, the result is highly valued. Although each | participating country can tell its own story of sustainability, | some with more success than others, the point is that the whole | endeavor has been sustained and that is to be admired |
Brazilian young adults and noise: attitudes, habits, and audiological characteristics
Zocoli AM , Morata TC , Marques JM , Corteletti LJ . Int J Audiol 2009 48 (10) 692-699 The objective of this study was to examine behaviors and attitudes of Brazilian teenagers towards noise, and determine their audiological characteristics. Participants were 245 young persons (14 to 18 years old) who attended private school. Behaviors and attitudes were measured using the validated Portuguese version of the Youth Attitude to Noise Scale (YANS). Pure-tone audiometry was used to evaluate the hearing of a sub-sample of 24 participants. Music played through personal media players was the most common exposure reported. A substantial percentage of participants reported temporary tinnitus (69%) after attending discos, music concerts, and listening to music through headphones. Tinnitus complaints were more frequent among females (41%) than males (27%). Four participants (1.6%) reported use of a hearing protector. Among a subsample of 24 participants, two (8%) young women had bilateral audiometric notches. YANS scores in the present study were slightly lower than those obtained in Sweden and the US, indicating a more negative attitude towards noise. Gender, age, country, and/or region are variables that will influence exposure to noise or music and possibly hearing outcomes. |
Gender and race/ethnic differences in inaccurate weight perceptions among U.S. adolescents
Martin MA , Frisco ML , May AL . Womens Health Issues 2009 19 (5) 292-9 PURPOSE: Inaccurate weight perceptions may lead to unhealthy weight control practices among normal weight adolescents and to a greater risk of adult obesity and related morbidities for overweight adolescents. To examine which U.S. adolescents are at risk of these outcomes, we examine gender and racial/ethnic differences in weight perception inaccuracy. This is the first study of weight perception inaccuracy to include Latino/a and Asian American adolescents. METHODS: Among the 12,789 Wave II participants of the National Longitudinal Study of Adolescent Health, we estimate multivariate models that reveal how gender, race/ethnicity, and clinical weight categories predict weight perception inaccuracy. RESULTS: Relative to boys, girls have lower odds of underestimating their weight and greater odds of overestimating their weight. In particular, among overweight and obese adolescents, girls are more accurate than boys, but among normal weight adolescents, boys are more accurate. Compared with Whites, African Americans are more likely to underestimate their weight, particularly among overweight girls and obese boys. Overall and particularly among girls and normal weight adolescents, African Americans are less likely to overestimate their weight than their White counterparts. Finally, Asian American girls are more likely to underestimate their weight than White girls. CONCLUSION: These findings have important implications for identifying and intervening with adolescents at the greatest risk of long-term weight problems, weight-related morbidity, and unhealthy weight control practices. |
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