Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: reasons for geographic and racial differences in stroke study 2003-2007
Odewole OA , Williamson RS , Zakai NA , Berry RJ , Judd SE , Qi YP , Adedinsewo DA , Oakley GP Jr . Am J Clin Nutr 2013 98 (4) 1042-7 BACKGROUND: The United States implemented mandatory folic acid fortification of enriched cereal grains in 1998. Although several studies have documented the resulting decrease in anemia and folate deficiency, to our knowledge, no one has determined the prevalence of folate-deficiency anemia after fortification. OBJECTIVE: We determined the prevalence of folate deficiency and folate-deficiency anemia within a sample of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. DESIGN: The REGARDS cohort is a prospective cohort of 30,239 black and white participants living in the contiguous United States. We measured serum folate concentrations in a random sample of 1546 REGARDS participants aged ≥50 y with baseline hemoglobin and red blood cell mean corpuscular volume measurements. Folate deficiency was defined as a serum folate concentration <6.6 nmol/L (<3.0 ng/mL), and anemia was defined as a hemoglobin concentration <13 g/dL in men and <12 g/dL in nonpregnant women (WHO criteria). Folate-deficiency anemia was defined as the presence of both folate deficiency and anemia. RESULTS: The mean hemoglobin concentration was 13.6 g/dL, and 15.9% of subjects had anemia. The median serum folate concentration was 34.2 nmol/L (15.1 ng/mL), and only 2 of 1546 participants 0.1%) were folate deficient. Both subjects were African American women with markedly elevated C-reactive protein concentrations, macrocytosis, and normal serum cobalamin concentrations; only one subject was anemic. Overall, the prevalence of folate-deficiency anemia was <0.1% (1 of 1546 subjects). CONCLUSION: Our data suggest that, after mandatory folic acid fortification, the prevalence of folate-deficiency anemia is nearly nonexistent in a community-dwelling population in the United States. |
Patterns of multisite pain and associations with risk factors
Coggon D , Ntani G , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Masood Kadir M , Warnakulasuriya SSP , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Sarquis LM , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Salazar Vega EJ , Harris CE , Serra C , Martinez MJ , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Sirk T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe RA , Yoshimura N , Kelsall HL , Hoe VCW , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A . Pain 2013 154 (9) 1769-77 To explore definitions for multisite pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants vs 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites. |
AMIGAS: building a cervical cancer screening intervention for public health practice
Smith JL , Wilson KM , Orians CE , Byrd TL . J Womens Health (Larchmt) 2013 22 (9) 718-23 BACKGROUND: Many barriers to cervical cancer screening for Hispanic women have been documented, but few effective interventions exist. The Community Preventive Services Task Force recommends increasing cervical cancer screening through various methods. Building on this evidence, the Centers for Disease Control and Prevention funded the research and testing phases for an evidence-based and theoretically grounded intervention designed to increase cervical cancer screening among never and rarely screened Hispanic women of Mexican descent. In this article, we describe the development process of the AMIGAS (Ayudando a las Mujeres con Informacion, Guia, y Amor para su Salud) intervention, highlight the integration of scientific evidence and community-based participatory research principles, and identify opportunities for dissemination, adaptation, and implementation of this intervention. METHODS: The AMIGAS team was a collaboration among researchers, promotoras (community health workers), and program administrators. The multiyear, multiphase project was conducted in Houston, Texas; El Paso, Texas; and Yakima, Washington. The team completed several rounds of formative research, designed intervention materials and methodology, conducted a randomized controlled trial, created a guide for program administrators, and developed an intervention dissemination plan. RESULTS: Trial results demonstrated that AMIGAS was successful in increasing cervical cancer screening among Hispanic women. Adaptation of AMIGAS showed minimal reduction of outcomes. Dissemination efforts are underway to make AMIGAS available in a downloadable format via the Internet. CONCLUSIONS: Developing a community-based intervention that is evidence-based and theoretically grounded is challenging, time-intensive, and requires collaboration among multiple disciplines. Inclusion of key stakeholders-in particular program deliverers and administrators-and planning for dissemination and translation to practice are integral components of successful intervention design. By providing explicit directions for adaptation for program deliverers, relevant information for program administrators, and access to the intervention via the Internet, AMIGAS is available to help increase cervical cancer screening among Hispanic women and other women disproportionately affected by cervical cancer. |
Association of UV index and sunscreen use among white high school sudents in the United States
Everett Jones S , O'Malley Olsen E , Michael SL , Saraiya M . J Sch Health 2013 83 (10) 750-6 BACKGROUND: When used appropriately, sunscreen decreases the amount of ultraviolet (UV) radiation exposure to the skin and is recommended to prevent skin cancer. This study examined the association between annual average UV index and sunscreen use among White, non-Hispanic youth. METHODS: The 2007 and 2009 national Youth Risk Behavior Survey (YRBS) data were analyzed. The YRBS is a school-based, cross-sectional study that uses a 3-stage cluster sample design to obtain a nationally representative sample of public and private high school students in the United States. Overall response rates were 68% and 72% (N = 14,041 and 16,410, respectively). Logistic regression analyzes, controlling for grade, examined whether annual average (mean) UV index where students attend school, a proxy measure of potential sunlight exposure, was associated with sunscreen use. RESULTS: Among White male students, as the mean UV index increased, the adjusted odds of never wearing sunscreen increased (adjusted odds ratio, AOR = 1.15 [95% CI = 1.04, 1.27], p < .01) and the adjusted odds of most of the time or always wearing sunscreen decreased (AOR = 0.85 [0.78, 0.94], p < .01). There was no association between sunscreen use and mean UV index among White female students. CONCLUSION: These findings suggest a need for renewed public health efforts among school, clinical, and public health professionals to promote sunscreen use as part of a comprehensive approach to prevent skin cancer. School and community approaches that passively protect young people from the sun should be considered as a complement to efforts to increase sunscreen use. |
Associations between insulin and heart rate variability in police officers
Charles LE , Andrew ME , Sarkisian K , Shengqiao L , Mnatsakanova A , Violanti JM , Wilson M , Gu JK , Miller DB , Burchfiel CM . Am J Hum Biol 2013 26 (1) 56-63 OBJECTIVE: Low heart rate variability (HRV) has been linked to cardiovascular disease. Our objective was to examine the cross-sectional association between insulin and HRV. METHODS: Insulin levels were measured in 355 nondiabetic officers from the BCOPS study, following a 12 h fast. HRV was performed according to methods published by the task force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology for measurement and analysis of HRV. Mean values of high (HF) and low frequency (LF) HRV were compared across tertiles of insulin using ANOVA and ANCOVA; p-values were obtained from linear regression models. RESULTS: Higher mean levels of insulin were significantly associated with lower (i.e., worse) mean levels of HRV before and after risk-factor adjustment. The results for HF HRV (ms2 ) were as follows: 1st insulin (microU/ml) tertile (156.3; 95% confidence interval (CI) = 128.6-189.9); 2nd tertile (154.3; 95% CI = 124.3-191.5); 3rd tertile (127.9; 95% CI = 105.0-155.8), p for trend = 0.017. Results with LF HRV were similar to HF HRV. Insulin was also inversely and significantly associated with HRV among officers with BMI ≥25 kg/m2 , with ≥25.5% body fat, and among those who reported low (<median) physical activity scores. CONCLUSIONS: In this cohort, insulin levels were inversely and significantly associated with both HF and LF HRV, especially among those with higher levels of obesity and lower levels of physical activity, suggesting associations with autonomic nervous system function. Prospective studies of this association in other populations are warranted. Am. J. Hum. Biol., 2013. (c) 2013 Wiley Periodicals, Inc. |
Diabetes and risk of hospitalized fall injury among older adults
Yau RK , Strotmeyer ES , Resnick HE , Sellmeyer DE , Feingold KR , Cauley JA , Vittinghoff E , De Rekeneire N , Harris TB , Nevitt MC , Cummings SR , Shorr RI , Schwartz AV . Diabetes Care 2013 36 (12) 3985-91 OBJECTIVE: To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization. RESEARCH DESIGN AND METHODS: The longitudinal Health, Aging, and Body Composition Study included 3,075 adults aged 70-79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models. RESULTS: At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio [HR] 1.48 [95% CI 1.12-1.95]) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 [1.05-1.88]) and insulin-treated diabetes (2.24 [1.24-4.03]). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization. CONCLUSIONS: Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall. |
Development of a reverse genetics system to generate recombinant Marburg virus derived from a bat isolate.
Albarino CG , Uebelhoer LS , Vincent JP , Khristova ML , Chakrabarti AK , McElroy A , Nichol ST , Towner JS . Virology 2013 446 230-7 Recent investigations have shown the Egyptian fruit bat (Rousettus aegyptiacus) to be a natural reservoir for marburgviruses. To better understand the life cycle of these viruses in the natural host, a new reverse genetics system was developed for the reliable rescue of a Marburg virus (MARV) originally isolated directly from a R. aegyptiacus bat (371Bat). To develop this system, the exact terminal sequences were first determined by 5' and 3' RACE, followed by the cloning of viral proteins NP, VP35, VP30 and L into expression plasmids. Novel conditions were then developed to efficiently replicate virus mini-genomes followed by the construction of full-length genomic clones from which recombinant wild type and GFP-containing MARVs were rescued. Surprisingly, when these recombinant MARVs were propagated in primary human macrophages, a dramatic difference was found in their ability to grow and to elicit anti-viral cytokine responses. |
Seroprevalence of herpes simplex virus types 1 and 2--United States, 1999-2010
Bradley H , Markowitz LE , Gibson T , McQuillan GM . J Infect Dis 2013 209 (3) 325-33 BACKGROUND: Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common infections with serious sequelae. HSV-1 is an increasingly important cause of genital herpes in industrialized countries. METHODS: Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES), we examined HSV-1 and HSV-2 seroprevalence among 14- to 49-year-olds in the United States. We estimated seroprevalence in 1999-2004 and 2005-2010, stratified by sociodemographic characteristics and sexual behaviors. We also reviewed HSV-1 and HSV-2 seroprevalence from 1976-1980 to 2005-2010. RESULTS: In 2005-2010, the seroprevalence of HSV-1 was 53.9%, and the seroprevalence of HSV-2 was 15.7%. From 1999-2004 to 2005-2010, HSV-1 seroprevalence declined by nearly 7% (P < .01), but HSV-2 seroprevalence did not change significantly. The largest decline in HSV-1 seroprevalence from 1999-2004 to 2005-2010 was observed among adolescents aged 14-19 years, among whom seroprevalence declined by nearly 23%, from 39.0% to 30.1% (P < .01). In this age group, HSV-1 seroprevalence declined >29% from 1976-1980 to 2005-2010 (P < .01). CONCLUSIONS: An increasing number of adolescents lack HSV-1 antibodies at sexual debut. In the absence of declines in HSV-2 infections, the prevalence of genital herpes may increase. |
Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities
Sutton MY , Lanier YA , Willis LA , Castellanos T , Dominguez K , Fitzpatrick L , Miller KS . Am J Public Health 2013 103 (12) 2207-14 OBJECTIVES: We reviewed data for the Minority HIV/AIDS Research Initiative (MARI), which was established in 2003 to support underrepresented minority scientists performing HIV prevention research in highly affected communities. METHODS: MARI was established at the Centers for Disease Prevention and Control as a program of competitively awarded, mentored grants for early career researchers conducting HIV prevention research in highly affected racial/ethnic and sexual minority communities. We have described progress from 2003 to 2013. RESULTS: To date, MARI has mentored 27 scientist leaders using low-cost strategies to enhance the development of effective HIV prevention interventions. These scientists have (1) developed research programs in disproportionately affected communities of color, (2) produced first-authored peer-reviewed scientific and programmatic products (including articles and community-level interventions), and (3) obtained larger, subsequent funding awards for research and programmatic work related to HIV prevention and health disparities work. CONCLUSION: The MARI program demonstrates how to effectively engage minority scientists to conduct HIV prevention research and reduce racial/ethnic investigator disparities and serves as a model for programs to reduce disparities in other public health areas in which communities of color are disproportionately affected. |
"To share or not to share?" serosorting by hepatitis C status in the sharing of drug injection equipment among NHBS-IDU2 participants
Smith BD , Jewett A , Burt RD , Zibbell JE , Yartel AK , Dinenno E . J Infect Dis 2013 208 (12) 1934-42 BACKGROUND: Persons who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV) infection. CDC estimates there are 17,000 new infections per year, mainly among PWID. This study examines injection equipment serosorting - considering HCV serostatus when deciding whether and with whom to share injection equipment.OBJECTIVE: To examine whether injection equipment serosorting is occurring among PWID in selected cities. METHODS: Using data from the National HIV Behavioral Surveillance System-Injection Drug Users (NHBS-IDU2, 2009), we developed multivariate logistic regression models to examine the extent to which participants' self-reported HCV status is associated with their injection equipment serosorting behavior and knowledge of last injecting partner's HCV status.RESULTS:. Participants who knew their HCV status were more likely to know the HCV status of their last injecting partner, compared to those who did not know their status (HCV+: aOR 4.1, 95%CI 3.4-4.9; HCV-: aOR 2.5, 95%CI 2.0-3.0). Participants who reported being HCV+, relative to those of unknown HCV status, were five times more likely to share injection equipment with a partner of HCV-positive status (aOR 4.8, 95%CI 3.9-6.0). CONCLUSION: Our analysis suggests PWID are more likely to share injection equipment with persons of concordant HCV status. |
Validation of sputum smear results in the electronic TB Register for the management of tuberculosis, South Africa
Dilraj A , Bristow CC , Connolly C , Margot B , Dlamini S , Podewils LJ . Int J Tuberc Lung Dis 2013 17 (10) 1317-21 BACKGROUND: The accuracy of tuberculosis (TB) surveillance systems is paramount in TB control. In South Africa, information from the laboratory is not directly linked to the Electronic TB Register (ETR). OBJECTIVE: To validate smear results recorded in the ETR with those recorded in the laboratory. METHODS: A retrospective evaluation was conducted among all sputum smear-positive TB patients recorded in the ETR during the fourth quarter of 2009 in KwaZulu-Natal Province. RESULTS: Of 1036 smear-positive patients recorded in the ETR, 683 (65.9%) had positive results recorded in the laboratory register. Only 364 (53.2%) had their smear results recorded in the ETR at the end of the intensive phase of treatment; of 326 (89.6%) recorded as converted to smear-negative, 224 (61.5%) were confirmed as smear-negative in the laboratory. Of 331 patients with end-of-treatment results in the ETR, 302 (91.2%) were recorded as cured, but only 105 (34.8%) were confirmed in the laboratory. CONCLUSIONS: Over a third of TB patients registered as smear-positive in the ETR could not be confirmed based on laboratory results. Many patients did not have a laboratory record, lending to uncertainty as to the validity of the smear results and treatment outcomes recorded in the ETR. |
Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men
McCree DH , Millett G , Baytop C , Royal S , Ellen J , Halkitis PN , Kupprat SA , Gillen S . Am J Public Health 2013 103 (10) 1851-6 OBJECTIVES: We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). METHODS: The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. RESULTS:. Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. CONCLUSION: SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies. |
Multiplex microsphere immunoassays for the detection of IgM and IgG to arboviral diseases
Basile AJ , Horiuchi K , Panella AJ , Laven J , Kosoy O , Lanciotti RS , Venkateswaran N , Biggerstaff BJ . PLoS One 2013 8 (9) e75670 Serodiagnosis of arthropod-borne viruses (arboviruses) at the Division of Vector-Borne Diseases, CDC, employs a combination of individual enzyme-linked immunosorbent assays and microsphere immunoassays (MIAs) to test for IgM and IgG, followed by confirmatory plaque-reduction neutralization tests. Based upon the geographic origin of a sample, it may be tested concurrently for multiple arboviruses, which can be a cumbersome task. The advent of multiplexing represents an opportunity to streamline these types of assays; however, because serologic cross-reactivity of the arboviral antigens often confounds results, it is of interest to employ data analysis methods that address this issue. Here, we constructed 13-virus multiplexed IgM and IgG MIAs that included internal and external controls, based upon the Luminex platform. Results from samples tested using these methods were analyzed using 8 different statistical schemes to identify the best way to classify the data. Geographic batteries were also devised to serve as a more practical diagnostic format, and further samples were tested using the abbreviated multiplexes. Comparative error rates for the classification schemes identified a specific boosting method based on logistic regression "Logitboost" as the classification method of choice. When the data from all samples tested were combined into one set, error rates from the multiplex IgM and IgG MIAs were <5% for all geographic batteries. This work represents both the most comprehensive, validated multiplexing method for arboviruses to date, and also the most systematic attempt to determine the most useful classification method for use with these types of serologic tests. |
The economic burden of sixteen measles outbreaks on United States public health departments in 2011
Ortega-Sanchez IR , Vijayaraghavan M , Barskey AE , Wallace GS . Vaccine 2013 32 (11) 1311-7 BACKGROUND: Despite vaccination efforts and documentation of elimination of indigenous measles in 2000, the United States (US) experienced a marked increase in imported cases and outbreaks of measles in 2011. Due to the high infectiousness and potential severity of measles, these outbreaks require a vigorous response from public health institutions. The effort and resources required to respond to these outbreaks are likely to impose a significant economic burden on these institutions. OBJECTIVE: To estimate the economic burden of measles outbreaks (defined as ≥3 epidemiologically linked cases) on the local and state public health institutions in the US in 2011. METHODS: From the perspective of local and state public health institutions, we estimated personnel time and resources allocated to measles outbreak response in local and state public health departments, and estimated the corresponding costs associated with these outbreaks in the US in 2011. We used cost and resource utilization data from previous studies on measles outbreaks in the US and, relying on outbreak size classification based on a case-day index, we estimated costs incurred by local and state public health institutions. RESULTS: In 2011, the US experienced 16 outbreaks with 107 confirmed cases. The average duration of an outbreak was 22 days (range: 5-68). The total estimated number of identified contacts to measles cases ranged from 8936 to 17,450, requiring from 42,635 to 83,133 personnel hours. Overall, the total economic burden on local and state public health institutions that dealt with measles outbreaks during 2011 ranged from an estimated $2.7 million to $5.3 million US dollars. CONCLUSION: Investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts. |
Genomic analysis identifies targets of convergent positive selection in drug-resistant Mycobacterium tuberculosis
Farhat MR , Shapiro BJ , Kieser KJ , Sultana R , Jacobson KR , Victor TC , Warren RM , Streicher EM , Calver A , Sloutsky A , Kaur D , Posey JE , Plikaytis B , Oggioni MR , Gardy JL , Johnston JC , Rodrigues M , Tang PK , Kato-Maeda M , Borowsky ML , Muddukrishna B , Kreiswirth BN , Kurepina N , Galagan J , Gagneux S , Birren B , Rubin EJ , Lander ES , Sabeti PC , Murray M . Nat Genet 2013 45 (10) 1183-9 M. tuberculosis is evolving antibiotic resistance, threatening attempts at tuberculosis epidemic control. Mechanisms of resistance, including genetic changes favored by selection in resistant isolates, are incompletely understood. Using 116 newly sequenced and 7 previously sequenced M. tuberculosis whole genomes, we identified genome-wide signatures of positive selection specific to the 47 drug-resistant strains. By searching for convergent evolution-the independent fixation of mutations in the same nucleotide position or gene-we recovered 100% of a set of known resistance markers. We also found evidence of positive selection in an additional 39 genomic regions in resistant isolates. These regions encode components in cell wall biosynthesis, transcriptional regulation and DNA repair pathways. Mutations in these regions could directly confer resistance or compensate for fitness costs associated with resistance. Functional genetic analysis of mutations in one gene, ponA1, demonstrated an in vitro growth advantage in the presence of the drug rifampicin. |
HIV incidence among men with and those without sexually transmitted rectal infections: estimates from matching against an HIV case registry
Pathela P , Braunstein SL , Blank S , Schillinger JA . Clin Infect Dis 2013 57 (8) 1203-9 BACKGROUND: Sexually transmitted bacterial rectal infections are objective markers of HIV risk behavior. Quantifying HIV risk among men who have sex with men (MSM) who have had these infections can inform prevention efforts. We measured HIV risk among MSM who have and those who have not been diagnosed with rectal Chlamydia trachomatis (CT) and/or rectal Neisseria gonorrhoeae (GC). METHODS: HIV incidence among a cohort of 276 HIV-negative MSM diagnosed with rectal CT and/or GC in New York City sexually transmitted disease (STD) clinics was compared to HIV incidence among HIV-negative MSM without these infections. Matches against the citywide HIV/AIDS registry identified HIV diagnoses from STD clinics, and by other providers. Cox proportional hazards models were used to explore factors associated with HIV acquisition among MSM with rectal infections. RESULTS: HIV-negative MSM with rectal infections (>70% of which were asymptomatic) contributed 464.7 person-years of follow-up. Among them, 31 (11.2%) were diagnosed with HIV, of whom 14 (45%) were diagnosed by non-STD clinic providers. The annual HIV incidence was significantly higher among MSM with rectal infections (6.67%; 95% confidence interval [CI], 4.61%-9.35%) than among MSM without rectal infections (2.53%; 95% CI, 1.31%-4.42%). Black race (hazard ratio, 4.98; 95% CI, 1.75-14.17) was associated with incident HIV among MSM with rectal CT/GC. CONCLUSIONS: One in 15 MSM with rectal infections was diagnosed with HIV within a year, a higher risk than for MSM without rectal infections. Such data have implications for screening for rectal STD, and may be useful for targeting populations for risk-reduction counseling and other HIV prevention strategies, such as preexposure prophylaxis. |
Human antibodies that neutralize respiratory droplet transmissible H5N1 influenza viruses
Thornburg NJ , Nannemann DP , Blum DL , Belser JA , Tumpey TM , Deshpande S , Fritz GA , Sapparapu G , Krause JC , Lee JH , Ward AB , Lee DE , Li S , Winarski KL , Spiller BW , Meiler J , Crowe JE Jr . J Clin Invest 2013 123 (10) 4405-9 Recent studies described the experimental adaptation of influenza H5 HAs that confers respiratory droplet transmission (rdt) to influenza virus in ferrets. Acquisition of the ability to transmit via aerosol may lead to the development of a highly pathogenic pandemic H5 virus. Vaccines are predicted to play an important role in H5N1 control should the virus become readily transmissible between humans. We obtained PBMCs from patients who received an A/Vietnam/1203/2004 H5N1 subunit vaccine. Human hybridomas were then generated and characterized. We identified antibodies that bound the HA head domain and recognized both WT and rdt H5 HAs. We used a combination of structural techniques to define a mechanism of antibody recognition of an H5 HA receptor-binding site that neutralized H5N1 influenza viruses and pseudoviruses carrying the HA rdt variants that have mutations near the receptor-binding site. Incorporation or retention of this critical antigenic site should be considered in the design of novel H5 HA immunogens to protect against mammalian-adapted H5N1 mutants. |
Intravaginal ring eluting tenofovir disoproxil fumarate completely protects macaques from multiple vaginal simian-HIV challenges
Smith JM , Rastogi R , Teller RS , Srinivasan P , Mesquita PM , Nagaraja U , McNicholl JM , Hendry RM , Dinh CT , Martin A , Herold BC , Kiser PF . Proc Natl Acad Sci U S A 2013 110 (40) 16145-50 Topical preexposure prophylaxis interrupts HIV transmission at the site of mucosal exposure. Intermittently dosed vaginal gels containing the HIV-1 reverse transcriptase inhibitor tenofovir protected pigtailed macaques depending on the timing of viral challenge relative to gel application. However, modest or no protection was observed in clinical trials. Intravaginal rings (IVRs) may improve efficacy by providing long-term sustained drug delivery leading to constant mucosal antiretroviral concentrations and enhancing adherence. Although a few IVRs have entered the clinical pipeline, 100% efficacy in a repeated macaque vaginal challenge model has not been achieved. Here we describe a reservoir IVR technology that delivers the tenofovir prodrug tenofovir disoproxil fumarate (TDF) continuously over 28 d. With four monthly ring changes in this repeated challenge model, TDF IVRs generated reproducible and protective drug levels. All TDF IVR-treated macaques (n = 6) remained seronegative and simian-HIV RNA negative after 16 weekly vaginal exposures to 50 tissue culture infectious dose SHIV162p3. In contrast, 11/12 control macaques became infected, with a median of four exposures assuming an eclipse of 7 d from infection to virus RNA detection. Protection was associated with tenofovir levels in vaginal fluid [mean 1.8 x 10(5) ng/mL (range 1.1 x 10(4) to 6.6 x 10(5) ng/mL)] and ex vivo antiviral activity of cervicovaginal lavage samples. These observations support further advancement of TDF IVRs as well as the concept that extended duration drug delivery devices delivering topical antiretrovirals could be effective tools in preventing the sexual transmission of HIV in humans. |
An assessment of the performance of self-reported vaccination status for hepatitis B, National Health and Nutrition Examination Survey 1999-2008
Denniston Maxine M , Byrd Kathy K , Monina Klevens R , Drobeniuc Jan , Kamili Saleem , Jiles Ruth B . Am J Public Health 2013 103 (10) 1865-1873 OBJECTIVES: We sought to assess the performance of self-reported vaccination with hepatitis B vaccine (HepB) compared with serological status for hepatitis B markers in the general US civilian population. METHODS: Using 1999 through 2008 National Health and Nutrition Examination Survey data, we calculated 3 measures of agreement between self-reported HepB vaccination status and serological status: percent concordance, and positive (PPV) and negative predictive values (NPV) of self-report. Logistic regression was used to identify factors associated with agreement between self-report and serological status. RESULTS: Overall agreement was 83% (95% CI = 82.3, 83.7), NPV of self-report was high (0.95; 95% CI = 0.93, 0.95) and PPV was low (0.53; 95% CI = 0.51, 0.54). Birth year relative to the 1991 recommendation for universal infant HepB vaccination had a strong association with agreement, however, the association was positive for those who reported receiving at least 3 doses and negative for those who reported receiving no doses. CONCLUSIONS:. Although the low PPV in our study could be attributable in part to waning of vaccine-induced anti-HBs over time, national adult HepB vaccination coverage may be lower than previously estimated because national estimates usually depend on self-report of vaccine receipt. |
Factors associated with adverse mental health outcomes in locally recruited aid workers assisting Iraqi refugees in Jordan
Eriksson Cynthia B , Cardozo Barbara Lopes , Ghitis Frida , Sabin Miriam , Crawford Carol Gotway , Zhu Julia , Rijnen Bas , Kaiser Reinhard . J Aggress Maltreat Trauma 2013 22 (6) 660-680 Nongovernmental organizations (NGOs) serve Iraqis living in Jordan as "guests." In 2008, 258 Jordanian humanitarian staff and Iraqi volunteers working for NGOs completed a needs assessment survey. Work characteristics, stressors, and support variables were evaluated regarding their influence on depression, anxiety, post-traumatic stress disorder (PTSD), and burnout through multivariate logistic regressions. There was a significant difference in depression, anxiety, and burnout across nationality. Traumatic exposure increased the risk for anxiety, depression, and PTSD. Working longer in the humanitarian sector was associated with less risk of anxiety and depression, and lower social support was a risk for anxiety. Managers were at higher risk for burnout, and low team cohesion was a risk for burnout. Implications for aid organizations are discussed. |
Inhibition of glutathione biosynthesis alters compartmental redox status and the thiol proteome in organogenesis-stage rat conceptuses
Harris C , Shuster DZ , Roman Gomez R , Sant KE , Reed MS , Pohl J , Hansen JM . Free Radic Biol Med 2013 63 325-37 Developmental signals that control growth and differentiation are regulated by environmental factors that generate reactive oxygen species (ROS) and alter steady-state redox environments in tissues and fluids. Protein thiols are selectively oxidized and reduced in distinct spatial and temporal patterns in conjunction with changes in glutathione/glutathione disulfide (GSH/GSSG) and cysteine/cystine (Cys/CySS) redox potentials (E(h)) to regulate developmental signaling. The purpose of this study was to measure compartment-specific thiol redox status in cultured organogenesis-stage rat conceptuses and to evaluate the impact of thiol oxidation on the redox proteome. The visceral yolk sac (VYS) has the highest initial (0 h) total intracellular GSH (GSH+2GSSG) concentration (5.5 mM) and the lowest Eh (-223 mV) as determined by HPLC analysis. Total embryo (EMB) GSH concentrations ranged lower (3.2 mM) and were only slightly more oxidized than the VYS. Total GSH concentrations in yolk sac fluid (YSF) and amniotic fluid (AF) are >500-fold lower than in tissues and are highly oxidized (YSF E(h)=-121 mV and AF E(h)=-49 mV). Steady-state total Cys concentrations (Cys+2CySS) were significantly lower than GSH in tissues but were otherwise equal in VYS and EMB near 0.5 mM. On gestational day 11, total GSH and Cys concentrations in EMB and VYS increase significantly over the 6h time course while E(h) remains relatively constant. The Eh (GSH/GSSG) in YSF and AF become more reduced over time while E(h) (Cys/CySS) become more oxidized. Addition of L-buthionine-S,R-sulfoximine (BS0) to selectively inhibit GSH synthesis and mimic the effects of some GSH-depleting environmental chemicals significantly decreased VYS and EMB GSH and Cys concentrations and increased Eh over the 6h exposure period, showing a greater overall oxidation. In the YSF, BSO caused a significant increase in total Cys concentrations to 1.7 mM but did not significantly change the E(h) for Cys/CySS. A significant net oxidation was seen in the BSO-treated AF compartment after 6 h. Biotinylated iodoacetamide (BIAM) labeling of proteins revealed the significant thiol oxidation of many EMB proteins following BSO treatment. Quantitative changes in the thiol proteome, associated with developmentally relevant pathways, were detected using isotope coded affinity tag (ICAT) labeling and mass spectroscopy. Adaptive pathways were selectively enriched with increased concentrations of proteins involved in mRNA processing (splicesome) and mRNA stabilization (glycolysis, GAPDH), as well as protein synthesis (aminoacyl-tRNA) and protein folding (antigen processing, Hsp70, protein disulfide isomerase). These results show the ability of chemical and environmental modulators to selectively alter compartmental intracellular and extracellular GSH and Cys concentrations and change their corresponding E(h) within the intact viable conceptus. The altered E(h) were also of sufficient magnitude to alter the redox proteome and change relative protein concentrations, suggesting that the mechanistic links through which environmental factors inform and regulate developmental signaling pathways may be discovered using systems developmental biology techniques. |
Low-wind and other microclimatic factors in near-road black carbon variability: a case study and assessment implications
Liang MS , Keener TC , Birch ME , Baldauf R , Neal J , Yang YJ . Atmos Environ (1994) 2013 80 204-215 Airborne black carbon from urban traffic is a climate forcing agent and has been associated with health risks to near-road populations. In this paper, we describe a case study of black carbon concentration and compositional variability at and near a traffic-laden multi-lane highway in Cincinnati, Ohio, using an onsite aethalometer and filter-based NIOSH Method 5040 measurements; the former measured 1-min average black carbon concentrations and the latter determined the levels of organic and elemental carbon (OC and EC) averaged over an approximately 2-h time interval. The results show significant wind and temperature effects on black carbon concentration and composition in a way more complex than predicted by Gaussian dispersion models. Under oblique low winds, namely u x [ = u x sin ( θ )] ~ (0, -0.5 m s-1), which mostly occurred during morning hours, black carbon concentrations per unit traffic flow were highest and had large variation. The variability did not always follow Gaussian dispersion but was characteristic of a uniform distribution at a near-road distance. Under all other wind conditions, the near-road black carbon variation met Gaussian dispersion characteristics. Significant differences in roadside dispersion are observed between OC and EC fractions, between PM2.5 and PM10-2.5, and between the morning period and rest of the day. In a general case, the overall black carbon variability at the multi-lane highway can be stated as bimodal consisting of Gaussian dispersion and non-Gaussian uniform distribution. Transition between the two types depends on wind velocity and wind angle to the traffic flow. In the order of decreasing importance, the microclimatic controlling factors over the black carbon variability are: 1) wind velocity and the angle with traffic; 2) diurnal temperature variations due to thermal buoyancy; and 3) downwind Gaussian dispersion. Combinations of these factors may have created various traffic-microclimate interactions that have significant impact on near-road black carbon transport. |
Aerosol generation by modern flush toilets
Johnson D , Lynch R , Marshall C , Mead K , Hirst D . Aerosol Sci Technol 2013 47 (9) 1047-1057 A microbe-contaminated toilet will produce bioaerosols when flushed. We assessed toilet plume aerosol from high efficiency (HET), pressure-assisted high efficiency (PAT), and flushometer (FOM) toilets with similar bowl water and flush volumes. Total and droplet nuclei "bioaerosols" were assessed. Monodisperse 0.25-1.9-mm fluorescent microspheres served as microbe surrogates in separate trials in a mockup 5 m(3) water closet (WC). Bowl water seeding was approximately 10 (12) particles/mL. Droplet nuclei were sampled onto 0.2-mm pore size mixed cellulose ester filters beginning 15 min after the flush using open-face cassettes mounted on the WC walls. Pre- and postflush bowl water concentrations were measured. Filter particle counts were analyzed via fluorescent microscopy. Bowl headspace droplet count size distributions were bimodal and similar for all toilet types and flush conditions, with 95% of droplets <2 mm diameter and >99% <5 mm. Up to 145,000 droplets were produced per flush, with the high-energy flushometer producing over three times as many as the lower energy PAT and over 12 times as many as the lowest energy HET despite similar flush volumes. The mean numbers of fluorescent droplet nuclei particles aerosolized and remaining airborne also increased with flush energy. Fluorescent droplet nuclei per flush decreased with increasing particle size. These findings suggest two concurrent aerosolization mechanisms-splashing for large droplets and bubble bursting for the fine droplets that form droplet nuclei. |
Yersinia enterocolitica infections associated with improperly pasteurized milk products: southwest Pennsylvania, March-August, 2011
Longenberger AH , Gronostaj MP , Yee GY , Johnson LM , Lando JF , Voorhees RE , Waller K , Weltman AC , Moll M , Lyss SB , Cadwell BL , Gladney LM , Ostroff SM . Epidemiol Infect 2013 142 (8) 1-11 In July 2011, a cluster of Yersinia enterocolitica infections was detected in southwestern Pennsylvania, USA. We investigated the outbreak's source and scope in order to prevent further transmission. Twenty-two persons were diagnosed with yersiniosis; 16 of whom reported consuming pasteurized dairy products from dairy A. Pasteurized milk and food samples were collected from this dairy. Y. enterocolitica was isolated from two products. Isolates from both food samples and available clinical isolates from nine dairy A consumers were indistinguishable by pulsed-field gel electrophoresis. Environmental and microbiological investigations were performed at dairy A and pasteurization deficiencies were noted. Because consumption of pasteurized milk is common and outbreaks have the potential to become large, public health interventions such as consumer advisories or closure of the dairy must be implemented quickly to prevent additional cases if epidemiological or laboratory evidence implicates pasteurized milk as the outbreak source. |
Evaluation of the hypersensitivity potential of alternative butter flavorings
Anderson SE , Franko J , Wells JR , Lukomska E , Meade BJ . Food Chem Toxicol 2013 62C 373-381 Concern has been raised over the association of diacetyl with lung disease clinically resembling bronchiolitis obliterans in food manufacturing workers. This has resulted in the need for identification of alternative chemicals to be used in the manufacturing process. Structurally similar chemicals, 2,3-pentanedione, 2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione, used as constituents of synthetic flavoring agents have been suggested as potential alternatives for diacetyl, however, immunotoxicity data on these chemicals are limited. The present study evaluated the dermal irritation and sensitization potential of diacetyl alternatives using a murine model. None of the chemicals were identified as dermal irritants when tested at concentrations up to 50%. Similar to diacetyl (EC3=17.9%), concentration-dependent increases in lymphocyte proliferation were observed following exposure to all four chemicals, with calculated EC3 values of 15.4% (2,3-pentanedione), 18.2% (2,3-hexanedione), 15.5% (3,4-hexanedione) and 14.1% (2,3-heptanedione). No biologically significant elevations in local or total serum IgE were identified after exposure to 25-50% concentrations of these chemicals. These results demonstrate the potential for development of hypersensitivity responses to these proposed alternative butter flavorings and raise concern about the use of structurally similar replacement chemicals. Additionally, a contaminant with strong sensitization potential was found in varying concentrations in diacetyl obtained from different producers. |
Joint effects between five identified risk variants, allergy, and autoimmune conditions on glioma risk
Safaeian M , Rajaraman P , Hartge P , Yeager M , Linet M , Butler MA , Ruder AM , Purdue MP , Hsing A , Beane-Freeman L , Hoppin JA , Albanes D , Weinstein SJ , Inskip PD , Brenner A , Rothman N , Chatterjee N , Gillanders EM , Chanock SJ , Wang SS . Cancer Causes Control 2013 24 (10) 1885-91 Common variants in two of the five genetic regions recently identified from genome-wide association studies (GWAS) of risk of glioma were reported to interact with a history of allergic symptoms. In a pooled analysis of five epidemiologic studies, we evaluated the association between the five GWAS implicated gene variants and allergies and autoimmune conditions (AIC) on glioma risk (851 adult glioma cases and 3,977 controls). We further evaluated the joint effects between allergies and AIC and these gene variants on glioma risk. Risk estimates were calculated as odds ratios (OR) and 95 % confidence intervals (95 % CI), adjusted for age, gender, and study. Joint effects were evaluated by conducting stratified analyses whereby the risk associations (OR and 95 % CI) with the allergy or autoimmune conditions for glioma were evaluated by the presence or absence of the 'at-risk' variant, and estimated p interaction by fitting models with the main effects of allergy or autoimmune conditions and genotype and an interaction (product) term between them. Four of the five SNPs previously reported by others were statistically significantly associated with increased risk of glioma in our study (rs2736100, rs4295627, rs4977756, and rs6010620); rs498872 was not associated with glioma in our study. Reporting any allergies or AIC was associated with reduced risks of glioma (allergy: adjusted OR = 0.71, 95 % CI 0.55-0.91; AIC: adjusted OR = 0.65, 95 % CI 0.47-0.90). We did not observe differential association between allergic or autoimmune conditions and glioma by genotype, and there were no statistically significant p interactions. Stratified analysis by glioma grade (low and high grade) did not suggest risk differences by disease grade. Our results do not provide evidence that allergies or AIC modulate the association between the four GWAS-identified SNPs examined and risk of glioma. |
Trends in professional development for and collaboration by health education teachers-41 states, 2000-2010
Brener ND , McManus T , Wechsler H , Kann L . J Sch Health 2013 83 (10) 734-42 BACKGROUND: Professional development (PD) and collaboration help ensure the quality of school health education. The purpose of this study was to examine trends in the percentage of lead health education teachers (LHETs) receiving PD on health topics and collaborating with other school staff on health education activities. METHODS: This study analyzed representative data from 41 states participating in School Health Profiles surveys between 2000 and 2010. Logistic regression examined linear trends in the percentage of LHETs who received PD on 12 topics and who collaborated on health education activities. RESULTS: Significant increases in the percentage of LHETs receiving PD on nutrition and physical activity and significant decreases in the percentage of LHETs receiving PD on alcohol- and other drug-use prevention and human immunodeficiency virus prevention were seen. Significant increases in the percentage of LHETs who collaborated with physical education staff and nutrition services staff were seen in 29 and 39 states, respectively. CONCLUSIONS: Although 10-year increases in PD and collaboration in the areas of nutrition and physical activity are encouraging, PD and collaboration in other topic areas still need improvement. These results will help states target more resources toward PD and collaboration in areas where they have been decreasing. |
How school healthy is your state? A state-by-state comparison of school health practices related to a healthy school environment and health education
Brener ND , Wechsler H , McManus T . J Sch Health 2013 83 (10) 743-9 BACKGROUND: School Health Profiles (Profiles) results help states understand how they compare to each other on specific school health policies and practices. The purpose of this study was to develop composite measures of critical Profiles results and use them to rate each state on their overall performance. METHODS: Using data from state Profiles surveys conducted in 2010, the authors examined 12 key practices: 6 related to a healthy school environment and 6 related to health education. States were divided into quartiles based on the percentage of schools in the state that engaged in the practice, and then rank-ordered based on the sum of their quartile scores. RESULTS: Whereas some states have low ranks or high ranks in both sets of practices, others have a relatively low rank in one set but a high rank in the other. States with the lowest overall sums tend to be in the west and midwest, whereas states with the highest sums tend to be in the east. CONCLUSIONS: This study identifies states whose school health policies and practices should be emulated and other states whose policies and practices are in urgent need of improvement. |
Complex interventions and their implications for systematic reviews: a pragmatic approach
Petticrew M , Anderson L , Elder R , Grimshaw J , Hopkins D , Hahn R , Krause L , Kristjansson E , Mercer S , Sipe T , Tugwell P , Ueffing E , Waters E , Welch V . J Clin Epidemiol 2013 66 (11) 1209-14 Complex interventions present unique challenges for systematic reviews. Current debates tend to center around describing complexity, rather than providing guidance on what to do about it. At a series of meetings during 2009-2012, we met to review the challenges and practical steps reviewer could take to incorporate a complexity perspective into systematic reviews. Based on this, we outline a pragmatic approach to dealing with complexity, beginning, as for any review, with clearly defining the research question(s). We argue that reviews of complex interventions can themselves be simple or complex, depending on the question to be answered. In systematic reviews and evaluations of complex interventions, it will be helpful to start by identifying the sources of complexity, then mapping aspects of complexity in the intervention onto the appropriate sources of evidence (such as specific types of quantitative or qualitative study). Although we focus on systematic reviews, the general approach is also applicable to primary research that is aimed at evaluating complex interventions. Although the examples are drawn from health care, the approach may also be applied to other sectors (e.g., social policy or international development). We end by concluding that systematic reviews should follow the principle of Occam's razor: explanations should be as complex as they need to be and no more. |
Healthcare-associated infections studies project: an American Journal of Infection Control and National Healthcare Safety Network data quality collaboration-LabID Clostridium Difficile event 2013
Hebden JN , Anttila A , Allen-Bridson K , Morrell GC , Wright MO , Horan T . Am J Infect Control 2013 41 (10) 916-7 This is the first in a series of case studies that will be published in American Journal of Infection Control following the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) surveillance definition update of 2013. These cases reflect some of the complex patient scenarios infection professionals encounter during daily surveillance of health care-associated infections using NHSN definitions. Answers to the questions posed and immediate feedback in the form of answers and explanations are available at: http://www.surveymonkey.com/s/AJIC-NHSN-LbId2013. All individual participant answers will remain confidential, although it is the authors' hope to share a summary of the findings at a later date. Cases, answers, and explanations have been reviewed and approved by NHSN staff. Active participation is encouraged and recommended. Review/reference Chapter 12-Multidrug-resistant organism &C difficile infection module protocol, of the NHSN Patient Safety Component Manual (http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf), for information you may need to answer the case study questions. |
The role of attitudes about vaccine safety, efficacy, and value in explaining parents reported vaccination behavior
LaVail Katherine Hart , Kennedy Allison Michelle . Health Educ Behav 2013 40 (5) 544-551 OBJECTIVES: To explain vaccine confidence as it related to parents' decisions to vaccinate their children with recommended vaccines, and to develop a confidence measure to efficiently and effectively predict parents' self-reported vaccine behaviors. METHOD: A sample of parents with at least one child younger than 6 years (n = 376) was analyzed using data from the HealthStyles 2010 survey. Questions were grouped into block variables to create three confidence constructs: value, safety, and efficacy. Regression equations controlling for demographic characteristics were used to identify the confidence construct(s) that best predicted parents' self-reported vaccination decisions (accept all, some, or none of the recommended childhood vaccines). RESULTS: Among the three constructs evaluated, confidence in the value of vaccines, that is the belief that vaccines are important and vaccinating one's children is the right thing to do, was the best predictor of parents' vaccine decisions, F(2, 351) = 119.199, p < .001. When combined into a block variable for analysis, two survey items measuring confidence in the value of vaccines accounted for 40% of the variance in parents' self-reported vaccine decisions. Confidence in the safety or efficacy of vaccines failed to account for additional significant variance in parent-reported vaccination behavior. CONCLUSIONS: Confidence in the value of vaccines is a helpful predictor of parent-reported vaccination behavior. Attitudinal constructs of confidence in the safety and efficacy of vaccines failed to account for additional significant variance in parents' vaccination behaviors. Future research should assess the role of vaccine knowledge and tangible barriers, such as access and cost, to further explain parents' vaccination behaviors. |
Vaccination coverage levels among children enrolled in the Vaccine Safety Datalink
McCarthy NL , Irving S , Donahue JG , Weintraub E , Gee J , Belongia E , Baggs J . Vaccine 2013 31 (49) 5822-6 INTRODUCTION: The Vaccine Safety Datalink (VSD) is a collaborative project whose infrastructure provides comprehensive medical and immunization histories for more than 9 million adults and children annually, a predominantly insured population. This study provides the coverage rates of recommended vaccines among children 19-35 months in the VSD from 2005 through 2010. We examine the consistency in vaccine coverage levels, detect possible trends, and evaluate any effect of vaccine shortages on coverage in the VSD. METHODS: We included data from all 10 VSD sites, and examined each year independently. Coverage rates were defined as the percentage of children in the VSD aged 19, 24, or 35 months in a given study year who had received the specified Advisory Committee on Immunization Practices (ACIP) recommended vaccine(s). RESULTS: We assessed coverage on 658,154 children. The overall coverage rate for children receiving all of the specified ACIP recommended vaccines was 73%, 80%, and 78% at ages 19, 24, and 35 months respectively. The range of coverage across all ages and years was 95-97% for polio vaccine, 91-97%, for MMR vaccine, 94-97% for HepB vaccine, 81-95% for DTaP vaccine, 90-95% for varicella vaccine, 66-91% for PCV, and 93-98% for Hib vaccine. Coverage rates of 4 or more doses of PCV were relatively low in 2005 possibly due to a vaccine shortage, and increased sharply in 2007. Hib vaccine coverage was relatively stable among all ages until 2009 when rates declined among children aged 19 and 24 months also during a vaccine shortage. CONCLUSIONS: Vaccine coverage in the VSD is high, but there is a decline from 2005 to 2010. The results of this study provide benchmark data for future studies, and describe how vaccine supply shortages and resulting changes in ACIP recommendations may have affected vaccine coverage rates in the VSD. |
Impact of varicella vaccination on varicella-related hospitalizations among American Indian/Alaska Native people
Singleton RJ , Holman RC , Person MK , Steiner CA , Redd JT , Hennessy TW , Groom A , Holve S , Seward JF . Pediatr Infect Dis J 2013 33 (3) 276-9 BACKGROUND: Routine childhood varicella vaccination, implemented in 1995, has resulted in significant declines in varicella-related hospitalizations in the United States. Varicella hospitalization rates among the American Indian and Alaska Native (AI/AN) population have not been previously documented. METHODS: We selected varicella-related hospitalizations, based on a published definition, from the Indian Health Service inpatient database for AI/ANs in the Alaska, Southwest and Northern Plains regions (1995-2010) and from the Nationwide Inpatient Sample for the general US population (2007-2010). We analyzed average annual hospitalization rates pre-vaccine (1995-1998) and post-vaccine (2007-2010) for the AI/AN population, and post-vaccine for the general US population. RESULTS: From 1995-1998 to 2007-2010, the average annual varicella-related hospitalization rate for AI/ANs in the three regions decreased 95% (0.66 to 0.03/10,000 persons); the post-vaccine rate appears lower than the general US rate (0.06, 95% CI 0.05-0.06). The rate declined in all AI/AN pediatric age groups. Infants experienced the highest pre-vaccine (14.07) and post-vaccine (0.83) hospitalization rates. Adults experienced low rates in both time periods. Varicella vaccination rates in 19-35 month old AI/AN children during fiscal years 2008-2010 were 88.1% to 91.0%. CONCLUSIONS: Widespread use of varicella vaccine in AI/AN children was accompanied by substantial declines in varicella-related hospitalizations consistent with high varicella vaccine effectiveness in preventing severe varicella outcomes. |
Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis
Schofield TJ , Lee RD , Merrick MT . J Adolesc Health 2013 53 S32-8 PURPOSE: The present paper summarizes findings of the special issue papers on the intergenerational continuity of child maltreatment and through meta-analysis explores the potential moderating effects of safe, stable, nurturing relationships (SSNRs). METHODS: Studies were selected for inclusion in this meta-analysis if they (1) were published in peer-reviewed journals; (2) tested for intergenerational continuity in any form of child maltreatment, using prospective, longitudinal data; and (3) tested for moderating effects of any variable of SSNRs on intergenerational continuity of child maltreatment. The search revealed only one additional study beyond the four reports written for this special issue that met inclusion criteria for the meta-analysis. RESULTS: Estimates of intergenerational stability of child maltreatment from the studies included in this special issue are consistent with several other studies, which find that child maltreatment in one generation is positively related to child maltreatment in the next generation. Furthermore, meta-analytic results from the five studies that met the inclusion criteria suggest a protective, moderating effect of SSNRs on intergenerational continuity of child maltreatment. The calculated fail-safe index indicated that 49 unpublished intergenerational studies with an average null effect would be required to render nonsignificant the overall moderation effect of SSNRs on child maltreatment. CONCLUSIONS: This special issue expanded the examination of SSNRs beyond the caregiver-child dyad. That is, these studies considered SSNRs in adult relationships as well as parent-child relationships. Results suggest that certain types of SSNRs between parents and other adults (e.g., romantic partner, co-parent, or adult social support resource) may decrease maltreatment continuity. |
Safe, stable, nurturing relationships break the intergenerational cycle of abuse: a prospective nationally representative cohort of children in the United kingdom
Jaffee SR , Bowes L , Ouellet-Morin I , Fisher HL , Moffitt TE , Merrick MT , Arseneault L . J Adolesc Health 2013 53 S4-S10 PURPOSE: To identify contextual and interpersonal factors that distinguish families in which the intergenerational transmission of maltreatment is maintained from families in which the cycle is broken. METHODS: The sample was composed of 1,116 families in the United Kingdom who participated in the Environmental Risk (E-Risk) Longitudinal Twin Study. We assessed mother's childhood history of maltreatment retrospectively with a validated and reliable interview. Prospective reports of children's physical maltreatment were collected repeatedly up to 12 years. We compared families in which mothers but not children had experienced maltreatment with families in which both mothers and children had experienced maltreatment, and with families without maltreatment, on a range of contextual and interpersonal factors known to affect child development. RESULTS: In multivariate analyses, supportive and trusting relationships with intimate partners, high levels of maternal warmth toward children, and low levels of partner violence between adults distinguished families in which mothers but not children experienced maltreatment from families in which mothers and children experienced maltreatment. Families in which only mothers experienced maltreatment were largely similar to families in which neither generation experienced maltreatment, except that mothers belonging to the former group were more likely to have a lifetime history of depression and low levels of social support. CONCLUSIONS: Safe, stable, nurturing relationships between intimate partners and between mothers and children are associated with breaking the cycle of abuse in families. Additional research is needed to determine whether these factors have a causal role in preventing the transmission of maltreatment from one generation to the next. |
Tests of the mitigating effects of caring and supportive relationships in the study of abusive disciplining over two generations
Herrenkohl TI , Klika JB , Brown EC , Herrenkohl RC , Leeb RT . J Adolesc Health 2013 53 S18-24 PURPOSE: To examine evidence of the continuity in abusive discipline across two generations (G1 and G2) and the role of safe, stable, and nurturing relationships (SSNRs) as protective factors. METHODS: Data are from the Lehigh Longitudinal Study, a prospective investigation of the causes and consequences child maltreatment that began in the 1970s with a sample of 457 children and their parents. Data were most recently collected in 2008-2010 from 80% of the original child sample (N = 357) when they were adults age 36 years on average. Of those assessed as adults, 268 participants (G2s) were parenting children and thus comprise the analysis sample. Analyses examined the association between harsh physical discipline practices by G1 parents and G2's reports of similarly severe discipline practices used in parenting their own children. Analyses also investigated the direct and interactive (protective) effects of SSNR variables that pertain to the care, warmth, and support children received from their mothers, fathers, and siblings over their lifetimes. A measure of an adult partner's warmth and support was also included. A case-level examination of G2 harsh discipliners was included to investigate other forms of past and more recent forms of abuse exposure. RESULTS: Results show a significant predictive association between physical discipline by G1 and G2 parents (beta = .30; p < .05; odds ratio, 1.14; confidence interval, 1.04-1.26), after accounting for childhood socioeconomic status and gender. Whereas being harshly disciplined as a child was inversely related to reports of having had a caring relationship with one's mother (r = -.25; p < .01), only care and support from one's father predicted a lower risk of harsh physical discipline by G2s (beta = -.24; p < .05; odds ratio, .74; confidence interval, .59-.92). None of the SSNR variables moderated the effect of G1 discipline on G2 discipline. A case-level examination of the abusive histories of G2 harsh discipliners found they had in some instances been exposed to physical and emotional abuse by multiple caregivers and by adult partners. CONCLUSIONS: There is continuity in physical disciplining over two generations. SSNRs measured in this study did not mediate or moderate the effect of G1 on G2 harsh physical discipline, although care and support from fathers was inversely related to the likelihood of G2 harsh physical discipline. This relationship is independent of abuse in childhood. Research is needed to identify factors that interrupt the intergenerational continuity of harsh physical (abusive) disciplining so that promising interventions can be developed and implemented. |
Examining the role of safe, stable, and nurturing relationships in the intergenerational continuity of child maltreatment-introduction to the special issue
Merrick MT , Leeb RT , Lee RD . J Adolesc Health 2013 53 S1-3 This special issue is the result of a successful collaboration between the Centers for Disease Control and Prevention (CDC) and researchers leading four important longitudinal studies on intergenerational patterns of violence: The Environmental Risk Longitudinal Twin Study (E-Risk) [1]; the Family Transitions Project (FTP) [2]; the Lehigh Longitudinal Study [3]; and the Rochester Youth Development Study [4]. The papers that follow investigate the role of safe, stable, and nurturing relationships and social contexts in the lives of children and their caregivers, provide insight into complex relationship factors that influence the intergenerational continuity of child maltreatment, and point to a number of important avenues to improve the lives of children and families by preventing violence and promoting health and well-being. | Child maltreatment is a significant public health problem that requires a multifaceted approach to prevention. It is estimated that one out of every ten children in the United States experiences one or more forms of physical, sexual, or emotional abuse or neglect by a parent or other caregiver at some point during their lifetime [5], [6], [7]. In 2011, social service workers identified 681,000 children1 in the United States as substantiated victims of maltreatment. This equates to an overall victimization rate of 9.1 per 1,000 children in the U.S. population [8]. It is well-established that experiencing child maltreatment is associated with a variety of negative physical, emotional, and psychological outcomes, including subsequent harsh and/or neglectful parenting in adulthood [9], [10], [11], [12], [13]. Yet, it is also clear that not all maltreated children grow up to become maltreating parents [14], [15]. Thus, identifying factors that distinguish families in which the cycle of violence is maintained from families in which it is interrupted is critical for violence prevention and optimal child development. |
"Above all things, be glad and young": Advancing research on violence in adolescence
McDonald Renee , Merrick Melissa T . Psychol Violence 2013 3 (4) 289-296 Adolescence is a unique developmental period in which youth are at heightened risk for violence perpetration and victimization, both of which can adversely affect the course of normal psychosocial development and health across the life course. The possible range of violent experiences during adolescence is broad, including physical and relational peer violence, bullying, sexual violence, cyber-aggression, child maltreatment, exposure to parental intimate partner violence, exposure to aggressive media, and more. The 8 articles in this special issue span this wide range of violence experiences. In helping to fill gaps in knowledge about the nature and processes by which violence develops, and how violence experiences affect adolescents, these articles as a group also offer direction for future research. They illustrate the need for research that cuts across the separate bodies of research on violence involving youth, that tackles thorny questions about the conceptualization of violence in its myriad forms, and that considers the ways in which the various forms and dimensions of violence operate together, across levels of the social ecology, to influence outcomes. The findings in this collection of studies also have implications for the development of prevention and intervention programs to address the problem of violence in adolescence. |
Breaking the cycle of maltreatment: the role of safe, stable, and nurturing relationships
Thornberry TP , Henry KL , Smith CA , Ireland TO , Greenman SJ , Lee RD . J Adolesc Health 2013 53 S25-31 PURPOSE: We examine two research questions. First, does a history of child maltreatment victimization significantly increase the likelihood of maltreatment perpetration during adulthood? Second, do safe, stable, and nurturing relationships (SSNRs) during early adulthood serve as direct protective factors, buffering protective factors, or both to interrupt intergenerational continuity in maltreating behaviors? METHODS: Data come from the Rochester Youth Development Study that followed a community sample from age 14 to 31 with 14 assessments. Maltreatment victimization records covering birth through age 17 were collected from Child Protective Services records as were maltreatment perpetration records from age 21 to 30. Data on five SSNRs were measured during three interviews from ages 21 to 23. RESULTS: There is a significant relationship between maltreatment victimization and maltreatment perpetration (odds ratio = 2.57; 95% confidence interval = 1.47-4.50). Three of the five SSNRs investigated-relationship satisfaction, parental satisfaction, and attachment to child-served as direct protective factors, significantly reducing risk for those who had been maltreated. However, none of the interaction terms-between maltreatment victimization and the SSNR-was statistically significant, indicating that the SSNRs did not serve as buffering protective factors CONCLUSIONS: Although a history of maltreatment significantly increases the risk of subsequent perpetration of maltreatment, enhancing SSNRs with intimate partners and with children during early adulthood can decrease the odds that a victim of maltreatment will become a perpetrator. Mandated reporters and service providers should be aware of the risk posed by earlier maltreatment and be prepared to ameliorate that risk, in part by strengthening supportive social relationships. |
Two-stage experimental design for dose-response modeling in toxicology studies
Wang K , Yang F , Porter DW , Wu NQ . ACS Sustain Chem Eng 2013 1 (9) 1119-1128 The efficient design of experiments (i.e., selection of experimental doses and allocation of animals) is important to establishing dose response relationships in toxicology studies. The proposed procedure for design of experiments is distinct from those in the literature because it is able to adequately accommodate the special features of the dose response data, which include non-normality, variance heterogeneity, possibly nonlinearity of the dose response curve, and data scarcity. The design procedure is built in a sequential two-stage paradigm that allows for a learning process. In the first stage, preliminary experiments are performed to gain information regarding the underlying dose response curve and variance structure. In the second stage, the prior information obtained from the previous stage is utilized to guide the second-stage experiments. An optimization algorithm is developed to search for the design of experiments that will lead to dose response models of the highest quality. To evaluate model quality (or uncertainty), which is the basis of design optimization, a bootstrapping method is employed; unlike standard statistical methods, bootstrapping is not subject to restrictive assumptions such as normality or large sample sizes. The design procedure in this paper will help to reduce the experimental cost/time in toxicology studies and alleviate the sustainability concerns regarding the tremendous new materials and chemicals. |
A new approach to design safe CNTs with an understanding of redox potential
Tsuruoka S , Cassee FR , Castranova V . Part Fibre Toxicol 2013 10 (1) 44 BACKGROUND: Carbon nanotubes (CNTs) are being increasingly industrialized and applied for various products. As of today, although several toxicological evaluations of CNTs have been conducted, designing safer CNTs is not practiced because reaction kinetics of CNTs with bioactive species is not fully understood. RESULTS: The authors propose a kinetic mechanism to establish designing safe CNTs as a new goal. According to a literature search on the behavior of CNTs and the effects of impurities, it is found that chemical reactions on CNT surface are attributed to redox reactions involving metal impurities and carbon structures at the CNT surface. CONCLUSION: A new goal is proposed to design safer CNTs using the redox potential hypothesis. The value of this hypothesis must be practically investigated and proven through the further experiments. |
Evaluation of pump pulsation in respirable size-selective sampling: Part I. pulsation measurements
Lee EG , Lee L , Mohlmann C , Flemmer MM , Kashon M , Harper M . Ann Occup Hyg 2013 58 (1) 60-73 Pulsations generated by personal sampling pumps modulate the airflow through the sampling trains, thereby varying sampling efficiencies, and possibly invalidating collection or monitoring. The purpose of this study was to characterize pulsations generated by personal sampling pumps relative to a nominal flow rate at the inlet of different respirable cyclones. Experiments were conducted using a factorial combination of 13 widely used sampling pumps (11 medium and 2 high volumetric flow rate pumps having a diaphragm mechanism) and 7 cyclones [10-mm nylon also known as Dorr-Oliver (DO), Higgins-Dewell (HD), GS-1, GS-3, Aluminum, GK2.69, and FSP-10]. A hot-wire anemometer probe cemented to the inlet of each cyclone type was used to obtain pulsation readings. The three medium flow rate pump models showing the highest, a midrange, and the lowest pulsations and two high flow rate pump models for each cyclone type were tested with dust-loaded filters (0.05, 0.21, and 1.25mg) to determine the effects of filter loading on pulsations. The effects of different tubing materials and lengths on pulsations were also investigated. The fundamental frequency range was 22-110 Hz and the magnitude of pulsation as a proportion of the mean flow rate ranged from 4.4 to 73.1%. Most pump/cyclone combinations generated pulse magnitudes ≥10% (48 out of 59 combinations), while pulse shapes varied considerably. Pulsation magnitudes were not considerably different for the clean and dust-loaded filters for the DO, HD, and Aluminum cyclones, but no consistent pattern was observed for the other cyclone types. Tubing material had less effect on pulsations than tubing length; when the tubing length was 183cm, pronounced damping was observed for a pump with high pulsation (>60%) for all tested tubing materials except for the Tygon Inert tubing. The findings in this study prompted a further study to determine the possibility of shifts in cyclone sampling efficiency due to sampling pump pulsations, and those results are reported subsequently. |
The influence of laser pulse duration and energy on ICP-MS signal intensity, elemental fractionation, and particle size distribution in NIR fs-LA-ICP-MS
Diwakar PK , Harilal SS , LaHaye NL , Hassanein A , Kulkarni P . J Anal At Spectrom 2013 28 (9) 1420-1429 Laser parameters, typically wavelength, pulse width, irradiance, repetition rate, and pulse energy, are critical parameters which influence the laser ablation process and thereby influence the LA-ICP-MS signal. In recent times, femtosecond laser ablation has gained popularity owing to the reduction in fractionation related issues and improved analytical performance which can provide matrix-independent sampling. The advantage offered by fs-LA is due to shorter pulse duration of the laser as compared to the phonon relaxation time and heat diffusion time. Hence the thermal effects are minimized in fs-LA. Recently, fs-LA-ICP-MS demonstrated improved analytical performance as compared to ns-LA-ICP-MS, but detailed mechanisms and processes are still not clearly understood. Improvement of fs-LA-ICP-MS over ns-LA-ICP-MS elucidates the importance of laser pulse duration and related effects on the ablation process. In this study, we have investigated the influence of laser pulse width (40 fs to 0.3 ns) and energy on LA-ICP-MS signal intensity and repeatability using a brass sample. Experiments were performed in single spot ablation mode as well as rastering ablation mode to monitor the Cu/Zn ratio. The recorded ICP-MS signal was correlated with total particle counts generated during laser ablation as well as particle size distribution. Our results show the importance of pulse width effects in the fs regime that becomes more pronounced when moving from femtosecond to picosecond and nanosecond regimes. |
Investigation of terpinolene + ozone or terpinolene + nitrate radical reaction products using denuder/filter apparatus
Harrison JC , Wells JR . Atmos Environ (1994) 2013 80 524-532 Terpinolene's (1-methyl-4-(propan-2-ylidene)cyclohexene) reaction with ozone or the nitrate radical was investigated using a denuder/filter apparatus in order to characterize gas-phase and particulate reaction products. Identification of the reaction products (i.e., aldehydes, ketones, dicarbonyls and carboxylic acids) was made using two derivatization methods; O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine (PFBHA) to derivatize the carbonyl products or 3-Ethyl-1-[3-(dimethylamino)propyl]carbodiimide hydrochloride (EDC) and 2,2,2-trifluoroethylamine hydrochloride (TFEA) to derivatize the carboxylic acid products. Proposed carbonyl products for ozonolysis of terpinolene are: 4-methylcyclohex-3-en-1-one, 2-hydroxy-4-methylcyclohex-3-en-1-one, glyoxal, methyl glyoxal, 3-oxobutanal, and 6-oxo-3-(propan-2-ylidene)heptanal. Proposed carbonyl products for nitrate radical reaction of terpinolene are: 2-hydroxy-4-methylcyclohex-3-en-1-one, glyoxal, methyl glyoxal, and 4-oxopentanal. No carboxylic acid products were detected with either oxidizing reactant. |
Biodegradation of single-walled carbon nanotubes by eosinophil peroxidase
Andon FT , Kapralov AA , Yanamala N , Feng W , Baygan A , Chambers BJ , Hultenby K , Ye F , Toprak MS , Brandner BD , Fornara A , Klein-Seetharaman J , Kotchey GP , Star A , Shvedova AA , Fadeel B , Kagan VE . Small 2013 9 (16) 2721-9 Eosinophil peroxidase (EPO) is one of the major oxidant-producing enzymes during inflammatory states in the human lung. The degradation of single-walled carbon nanotubes (SWCNTs) upon incubation with human EPO and H2 O2 is reported. Biodegradation of SWCNTs is higher in the presence of NaBr, but neither EPO alone nor H2 O2 alone caused the degradation of nanotubes. Molecular modeling reveals two binding sites for SWCNTs on EPO, one located at the proximal side (same side as the catalytic site) and the other on the distal side of EPO. The oxidized groups on SWCNTs in both cases are stabilized by electrostatic interactions with positively charged residues. Biodegradation of SWCNTs can also be executed in an ex vivo culture system using primary murine eosinophils stimulated to undergo degranulation. Biodegradation is proven by a range of methods including transmission electron microscopy, UV-visible-NIR spectroscopy, Raman spectroscopy, and confocal Raman imaging. Thus, human EPO (in vitro) and ex vivo activated eosinophils mediate biodegradation of SWCNTs: an observation that is relevant to pulmonary responses to these materials. |
Prenatal exposure to environmental phenols: concentrations in amniotic fluid and variability in urinary concentrations during pregnancy
Philippat C , Wolff MS , Calafat AM , Ye X , Bausell R , Meadows M , Stone J , Slama R , Engel SM . Environ Health Perspect 2013 121 (10) 1225-31 BACKGROUND: Maternal urinary biomarkers are often used to assess fetal exposure to phenols and their precursors. Their effectiveness as a measure of exposure in epidemiological studies depends on their variability during pregnancy and their ability to accurately predict fetal exposure.OBJECTIVES: We assessed the relationship between urinary and amniotic fluid concentrations of nine environmental phenols, and the reproducibility of urinary concentrations, among pregnant women.METHODS: Seventy-one women referred for amniocentesis were included. Maternal urine was collected at the time of the amniocentesis appointment and on two subsequent occasions. Urine and amniotic fluid were analyzed for 2,4- and 2,5-dichlorophenols, bisphenol A, benzophenone-3, triclosan, and methyl-, ethyl-, propyl-, and butylparabens using online solid phase extraction-high performance liquid chromatography-isotope dilution tandem mass spectrometry.RESULTS: Only benzophenone-3 and propylparaben were detectable in more than half of the amniotic fluid samples; for these phenols, concentrations in amniotic fluid and maternal urine collected on the same day were positively correlated (rho = 0.53 and 0.32, respectively). Other phenols were detected infrequently in amniotic fluid (e.g., bisphenol A was detected in only two samples). The intraclass correlation coefficients (ICCs) of urinary concentrations in samples from individual women ranged from 0.48 and 0.62 for all phenols except bisphenol A (ICC = 0.11).CONCLUSION: Amniotic fluid detection frequencies for most phenols were low. The reproducibility of urine measures was poor for bisphenol A, but good for the other phenols. Although a single sample may provide a reasonable estimate of exposure for some phenols, collecting multiple urine samples during pregnancy is an option to reduce exposure measurement error in studies regarding the effects of phenol prenatal exposure on health.Citation: Philippat C, Wolff MS, Calafat AM, Ye X, Bausell R, Meadows M, Stone J, Slama R, Engel SM. 2013. Prenatal exposure to environmental phenols: concentrations in amniotic fluid and variability in urinary concentrations during pregnancy. |
Dietary predictors of maternal prenatal blood mercury levels in the ALSPAC Birth Cohort Study
Golding Jean , Steer Colin D , Hibbeln Joseph R , Emmett Pauline M , Lowery Tony , Jones Robert . Environ Health Perspect 2013 121 (10) 1214-1218 BACKGROUND: Very high levels of prenatal maternal mercury have adverse effects on the developing fetal brain. It has been suggested that all possible sources of mercury should be avoided. However, although seafood is a known source of mercury, little is known about other dietary components that contribute to the overall levels of blood mercury. OBJECTIVE: Our goal was to quantify the contribution of components of maternal diet to prenatal blood mercury level. Methods: Whole blood samples and information on diet and sociodemographic factors were colÂlected from pregnant women (n = 4,484) enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). The blood samples were assayed for total mercury using inductively coupled plasma dynamic reaction cell mass spectrometry. Linear regression was used to estimate the relative contributions of 103 dietary variables and 6 sociodemographic characteristics to whole blood total mercury levels (TBM; untransformed and log-transformed) based on R2 values. RESULTS: We estimated that maternal diet accounted for 19.8% of the total variation in ln-TBM, with 44% of diet-associated variability (8.75% of the total variation) associated with seafood consumption (white fish, oily fish, and shellfish). Other dietary components positively associated with TBM included wine and herbal teas, and components with significant negative associations included white bread, meat pies or pasties, and french fries. CONCLUSIONS: Although seafood is a source of dietary mercury, seafood appeared to explain a relaÂtively small proportion of the variation in TBM in our UK study population. Our findings require confirmation, but suggest that limiting seafood intake during pregnancy may have a limited impact on prenatal blood mercury levels. |
Measurements and modeling of through-the-earth communications for coal mines
Yan L , Waynert JA , Sunderman C . IEEE Trans Ind Appl 2013 49 (5) 1979-1983 This paper presents modeling results from the National Institute for Occupational Safety and Health research into through-the-earth (TTE) communications technology for underground coal mines. Research focuses on the factors controlling the propagation and coupling of radio signals between transmit and receive antennas separated by earth or coal. Most TTE systems use single or multiturn loops of conductor for the transmit antenna. We compare the magnetic field distribution predicted from analytical formulas to the predictions of a method of moments computational electromagnetic (CEM) code. The predictions are compared in free space, in a homogeneous earth, and with the effect of the presence of the surface of the earth. The evaluations are done with the transmit loop buried in the earth and with the loop above the surface. The analytic results are shown to agree reasonably well with the more detailed CEM predictions for the situations considered, reducing the need for expensive and complicated CEM codes in analyzing simple TTE configurations. The predictive methods are applied to TTE measurements made in 94 different coal mines by the Bureau of Mines in the 1970s, and the implications for the apparent conductivity of the earth are discussed. |
Measurements of medium-frequency propagation characteristics of a transmission line in an underground coal mine
Li J , Whisner B , Waynert JA . IEEE Trans Ind Appl 2013 49 (5) 1984-91 In underground coal mines, medium frequency (MF) communication systems couple their signals to metal infrastructures such as ac power cables and wire-based telephone lines, which guide the signals to propagate for a long distance. To better understand the propagation characteristics of MF signals, an easy-to-use measurement method was recently developed at the National Institute for Occupational Safety and Health. The method will be introduced along with an equivalent transmission line model for a long metallic infrastructure in underground coal mines. The model serves as the fundamental driver for the method development. Propagation measurements on a twisted pair of telephone lines in an underground mine were made using this method. The measurements confirmed the low MF signal attenuation rate and the dependence of the propagation characteristics of the line on the electrical properties of surrounding coal and rock as theoretical studies predicted. |
Evaluation of visual performance when using incandescent, fluorescent, and led machine lights in mesopic conditions
Reyes MA , Gallagher S , Sammarco JJ . IEEE Trans Ind Appl 2013 49 (5) 1992-1999 This experiment investigated the effects of different machine-mounted area lighting technologies on visual performance in a simulated underground mine environment. The primary objective was to conduct a comparative evaluation of the lighting technologies based on the visual performance of 36 human subjects in a simulated underground mine environment. Incandescent (Incand), fluorescent (Fluor), and light-emitting diode (LED) technologies were used to create four lighting combinations. Visual performance was quantified for the detection of movement in the peripheral field of view and the identification of ground hazards. Measurements were made of the speed (response time measured in milliseconds), the accuracy (the number of targets and objects missed), and the subjective discomfort rating of the glare experienced for each lighting combination. A secondary objective explored the effects of aging on visual performance. The results indicate that lighting combinations which consisted of LED area lights significantly improved visual performance for the detection of hazards found in the peripheral field of view, as well as those found on the ground. They furthermore indicate that age plays a significant role in visual performance. |
Attenuation constants of radio waves in lossy-walled rectangular waveguides
Zhou C , Waynert J , Plass T , Jacksha R . Prog Electromagn Res 2013 142 75-105 At the ultra-high frequencies (UHF) common to portable radios, the mine tunnel acts as a dielectric waveguide, directing and absorbing energy as a radio signal propagates. Understanding radio propagation behavior in a dielectric waveguide is critical for designing reliable, optimized communication systems in an underground mine. One of the major parameters used to predict the power attenuation in lossy waveguides is the attenuation constant. In this paper, we theoretically and experimentally investigate the attenuation constants for a rectangular waveguide with dielectric walls. We provide a new derivation of the attenuation constant based on the classic Fresnel reflection coefficients. The new derivation takes advantage of ray representation of plane waves and provides more insight into understanding radio attenuation in tunnels. We also investigate the impact of different parameters on the attenuation constant, including the tunnel transverse dimensions, permittivity, conductivity, frequency, and polarization, with an aim to find their theoretical optimal values that result in the minimum power loss. Additionally, measurements of the attenuation constants of the dominant mode at different frequencies (455, 915, 2450, and 5800 MHz) for a straight concrete tunnel are presented and compared to theoretical predictions. It is shown that the analytical results match the measured results very well at all four frequencies. |
Renewable energy and occupational health and safety research directions: a white paper from the Energy Summit, Denver Colorado, April 11-13, 2011
Mulloy KB , Sumner SA , Rose C , Conway GA , Reynolds SJ , Davidson ME , Heidel DS , Layde PM . Am J Ind Med 2013 56 (11) 1359-70 Renewable energy production may offer advantages to human health by way of less pollution and fewer climate-change associated ill-health effects. Limited data suggests that renewable energy will also offer benefits to workers in the form of reduced occupational injury, illness and deaths. However, studies of worker safety and health in the industry are limited. The Mountain and Plains Education and Research Center (MAP ERC) Energy Summit held in April 2011 explored issues concerning worker health and safety in the renewable energy industry. The limited information on hazards of working in the renewable energy industry emphasizes the need for further research. Two basic approaches to guiding both prevention and future research should include: (1) applying lessons learned from other fields of occupational safety and health, particularly the extractive energy industry; and (2) utilizing knowledge of occupational hazards of specific materials and processes used in the renewable energy industry. |
Lung tumor promotion by chromium-containing welding particulate matter in a mouse model
Zeidler-Erdely PC , Meighan TG , Erdely A , Battelli LA , Kashon ML , Keane M , Antonini JM . Part Fibre Toxicol 2013 10 (1) 45 BACKGROUND: Epidemiology suggests that occupational exposure to welding particulate matter (PM) may increase lung cancer risk. However, animal studies are lacking to conclusively link welding with an increased risk. PM derived from stainless steel (SS) welding contains carcinogenic metals such as hexavalent chromium and nickel. We hypothesized that welding PM may act as a tumor promoter and increase lung tumor multiplicity in vivo. Therefore, the capacity of chromium-containing gas metal arc (GMA)-SS welding PM to promote lung tumors was evaluated using a two-stage (initiation-promotion) model in lung tumor susceptible A/J mice. METHODS: Male mice (n = 28-30/group) were treated either with the initiator 3-methylcholanthrene (MCA;10 microg/g; IP) or vehicle (corn oil) followed by 5 weekly pharyngeal aspirations of GMA-SS (340 or 680 microg/exposure) or PBS. Lung tumors were enumerated at 30 weeks post-initiation. RESULTS: MCA initiation followed by GMA-SS welding PM exposure promoted tumor multiplicity in both the low (12.1 = 1.5 tumors/mouse) and high (14.0 +/- 1.8 tumors/mouse) exposure groups significantly above MCA/sham (4.77 +/- 0.7 tumors/mouse; p = 0.0001). Multiplicity was also highly significant (p < 0.004) across all individual lung regions of GMA-SS-exposed mice. No exposure effects were found in the corn oil groups at 30 weeks. Histopathology confirmed the gross findings and revealed increased inflammation and a greater number of malignant lesions in the MCA/welding PM-exposed groups. CONCLUSIONS: GMA-SS welding PM acts as a lung tumor promoter in vivo. Thus, this study provides animal evidence to support the epidemiological data that show welders have an increased lung cancer risk. |
The musculoskeletal loading profile of the thumb during pipetting based on tendon displacement
Wu JZ , Sinsel EW , Shroyer JF , Welcome DE , Zhao KD , An KN , Buczek FL . Med Eng Phys 2013 35 (12) 1801-10 Strong evidence indicates that highly repetitive manual work is associated with the development of upper extremity musculoskeletal disorders (MSDs). One of the occupational activities that involves highly repetitive and forceful hand work is manual pipetting in chemical or biological laboratories. In the current study, we quantified tendon displacement as a parameter to assess the cumulative loading exposure of the musculoskeletal system in the thumb during pipetting. The maximal tendon displacement was found in the flexor pollicis longus (FPL) tendon. Assuming that subjects' pipetting rates were maintained constant during a period of 1h, the average accumulated tendon displacement in the FPL reached 29m, which is in the lower range of those observed in other occupational activities, such as typing and nail gun operations. Our results showed that tendon displacement data contain relatively small standard deviations, despite high variances in thumb kinematics, suggesting that the tendon displacements may be useful in evaluating the musculoskeletal loading profile. |
Evaluating an entertainment-education telenovela to promote workplace safety
Castaneda DE , Organista KC , Rodriguez L , Check P . SAGE Open 2013 3 (3) Occupational safety and health professionals worked with health communication experts to collaborate with a major Spanish language television network to develop and implement a construction workplace safety media intervention targeting Latino/Hispanic audiences. An Entertainment–Education (EE) health communication strategy was used to create a worksite safety storyline weaved into the main plot of a nationally televised Telenovela (Spanish language soap opera). A secondary analysis of audience survey data in a pre/posttest cross-sectional equivalent group design was performed to evaluate the effectiveness of this EE media intervention to change knowledge, attitudes, and intention outcomes related to the prevention of fatal falls at construction worksites. Results indicate that using culturally relevant mediums can be an effective way of reaching and educating audiences about specific fall prevention information. This is aligned with recommendations by the Institute of Medicine (IOM) to increase interventions and evaluations of culturally relevant and competent health communication. |
Evaluation of pump pulsation in respirable size-selective sampling: Part II. changes in sampling efficiency
Lee EG , Lee T , Kim SW , Lee L , Flemmer MM , Harper M . Ann Occup Hyg 2013 58 (1) 74-84 This second, and concluding, part of this study evaluated changes in sampling efficiency of respirable size-selective samplers due to air pulsations generated by the selected personal sampling pumps characterized in Part I (Lee E, Lee L, Mohlmann C et al. Evaluation of pump pulsation in respirable size-selective sampling: Part I. Pulsation measurements. Ann Occup Hyg 2013). Nine particle sizes of monodisperse ammonium fluorescein (from 1 to 9 mum mass median aerodynamic diameter) were generated individually by a vibrating orifice aerosol generator from dilute solutions of fluorescein in aqueous ammonia and then injected into an environmental chamber. To collect these particles, 10-mm nylon cyclones, also known as Dorr-Oliver (DO) cyclones, were used with five medium volumetric flow rate pumps. Those were the Apex IS, HFS513, GilAir5, Elite5, and Basic5 pumps, which were found in Part I to generate pulsations of 5% (the lowest), 25%, 30%, 56%, and 70% (the highest), respectively. GK2.69 cyclones were used with the Legacy [pump pulsation (PP) = 15%] and Elite12 (PP = 41%) pumps for collection at high flows. The DO cyclone was also used to evaluate changes in sampling efficiency due to pulse shape. The HFS513 pump, which generates a more complex pulse shape, was compared to a single sine wave fluctuation generated by a piston. The luminescent intensity of the fluorescein extracted from each sample was measured with a luminescence spectrometer. Sampling efficiencies were obtained by dividing the intensity of the fluorescein extracted from the filter placed in a cyclone with the intensity obtained from the filter used with a sharp-edged reference sampler. Then, sampling efficiency curves were generated using a sigmoid function with three parameters and each sampling efficiency curve was compared to that of the reference cyclone by constructing bias maps. In general, no change in sampling efficiency (bias under +/-10%) was observed until pulsations exceeded 25% for the DO cyclone. However, for three models of pumps producing 30%, 56%, and 70% pulsations, substantial changes were confirmed. The GK2.69 cyclone showed a similar pattern to that of the DO cyclone, i.e. no change in sampling efficiency for the Legacy producing 15% pulsation and a substantial change for the Elite12 producing 41% pulsation. Pulse shape did not cause any change in sampling efficiency when compared to the single sine wave. The findings suggest that 25% pulsation at the inlet of the cyclone as measured by this test can be acceptable for the respirable particle collection. If this test is used in place of that currently in European standards (EN 1232-1997 and EN 12919-1999) or is used in any International Organization for Standardization standard, then a 25% pulsation criterion could be adopted. This work suggests that a 10% criterion as currently specified in the European standards for testing may be overly restrictive and not able to be met by many pumps on the market. Further work is recommended to determine which criterion would be applicable to this test if it is to be retained in its current form. |
Filter performance degradation of electrostatic N95 and P100 filtering facepiece respirators by dioctyl phthalate aerosol loading
Rengasamy S , Miller A , Vo E , Eimer BC . J Eng Fiber Fabr 2013 8 (3) 62-69 Polydisperse dioctyl phthalate (DOP) aerosols are employed for testing filter penetration with loading of R- and P-series particulate filters for National Institute for Occupational Safety and Health (NIOSH) certification. Penetration for filters must not exceed NIOSH allowed maximum levels during the entire loading of 200 mg DOP indicating no filter degradation. Degradation of respirators loaded with DOP by other aerosols as well as respirators exposed to both oil and non-oil aerosols found in some workplaces is not well studied. To better understand the degradation of respirators with electrostatic filter media, two models of N95 and P100 filtering facepiece respirators (FFRs) were loaded with polydisperse DOP aerosols up to 200 mg as employed for NIOSH certification testing with simultaneous measurement of filter penetration. In parallel experiments, both N95 and P100 FFRs were loaded with 10 to 200 mg DOP and challenged with polydisperse NaCl aerosol employed for NIOSH certification testing as well as monodisperse NaCl aerosol, and filter penetration was measured. Results showed that filter penetration for both N95 models increased with increasing amounts of DOP loading and exceeded NIOSH allowed maximum penetration (5%) by both DOP and NaCl aerosols indicating filter degradation. Monodisperse NaCl aerosols (20-400 nm) gradually increased the penetration and shifted the most penetrating particle size from ~40 nm to larger sizes. In the case of P100 FFRs, DOP aerosol penetration was below 0.03% for up to 200 mg DOP loading as required for NIOSH certification. Interestingly, one of the two P100 FFR models loaded with 10-50 mg DOP showed greater than 0.03% penetration with polydisperse, as well as monodisperse, NaCl aerosol testing. Overall, the results obtained in the study indicate that some P100 models loaded with DOP at lower amounts may show higher penetration with other aerosols such as NaCl. Further studies are needed to better understand the filter degradation of DOP loaded respirators. |
Carbon nanotubes among diesel exhaust particles: real samples or contaminants?
Jung HS , Miller A , Park K , Kittelson DB . J Air Waste Manag Assoc 2013 63 (10) 1199-1204 During three separate studies involving characterization of diesel particulate matter, carbon nanotubes (CNTs) were found among diesel exhaust particles sampled onto transmission electron microscopy (TEM) grids. During these studies, samples were collected from three different diesel engines at normal operating conditions with or without an iron catalyst (introduced as ferrocene) in the fuel. This paper is to report the authors' observation of CNTs among diesel exhaust particles, with the intent to stimulate awareness and further discussion regarding the formation mechanisms of CNTs during diesel combustion. IMPLICATIONS: Increased attention is being given to CNTs and other nanomaterials and a recent review paper showed that CNTs are capable of inflammation in the lung when inhaled. For this reason and because diesel engines are so common, it is important to acknowledge the existence of CNTs among diesel particles and possible regulation and online measurement method development. |
Diseases attributable to asbestos exposure: years of potential life lost, United States, 1999-2010
Bang KM , Mazurek JM , Wood JM , Hendricks SA . Am J Ind Med 2013 57 (1) 38-48 BACKGROUND: Although asbestos use has been restricted in recent decades, asbestos-associated deaths continue to occur in the United States. OBJECTIVES: We evaluated premature mortality and loss of potentially productive years of life attributable to asbestos-associated diseases. METHODS: Using 1999-2010 National Center for Health Statistics mortality data, we identified decedents aged ≥25 years whose death certificate listed asbestosis and malignant mesothelioma as the underlying cause of death. We computed years of potential life lost to life expectancy (YPLL) and to age 65 (YPLL65 ). RESULTS: During 1999-2010, a total of 427,005 YPLL and 55,184 YPLL65 were attributed to asbestosis (56,907 YPLL and 2,167 YPLL65 ), malignant mesothelioma (370,098 YPPL and 53,017 YPLL65 ). Overall and disease-specific asbestos-attributable total YPLL and YPLL65 and median YPLL and YPLL65 per decedent did not change significantly from 1999 to 2010. CONCLUSIONS: The continuing occurrence of asbestos-associated diseases and their substantial premature mortality burden underscore the need for maintaining prevention efforts and for ongoing surveillance to monitor temporal trends in these diseases. |
Intake belt air safety by the numbers
Martikainen A , Dougherty H . Saf Sci 2014 62 130-135 Due to prior major accidents in the United States underground coal mines, regulations concerning use of intake belt air were changed in 2008. Several safety requirements were introduced to combat the most acknowledged risk of using belt air; conveyor belt flammability. However, use of belt air increases airflow at the face area, which results in improved methane control. A definitive connection between belt air use and accident occurrence has not been established. Also, the frequency of belt air ventilation violations and their relation to other ventilation violations is not known, so reliable weighing of the benefits and risks is difficult. Based on data from 98 reports on underground belt entry fires the relationship among belt fires, ignitions, explosions, fatalities, and injury information was analyzed. Ignitions and explosions due to lack of ventilating air are much more common than belt fires. The number of injuries and fatalities resulting from these incidents far outnumbers those related to belt fires. Belt air related issues were further studied by researching an MSHA violations database. The number of belt air standard violations was expected to be significant enough to show the need to restrict its use. However, this was not found. It was concluded that because methane explosions and ignitions result in a much larger number of accidents, injuries, and fatalities, the benefit of additional air supplied to the face surpasses the risk of belt fires. Also, data showed that mines using belt air were not at greater risk than mines not using belt air. |
Use of reservoir simulation and in-mine ventilation measurements to estimate coal seam properties
Erdogan SS , Karacan CO , Okandan E . Int J Rock Mech Min Sci 2013 63 148-158 Methane is a safety concern in underground coal mines. In its explosive range of 5%–15% in air, methane can be easily ignited in the presence of an ignition source to create a violent methane explosion. Ventilation is the main control mechanism to keep methane levels below the explosive limit. However, effectiveness of a ventilation system is dependent on multiple factors such as geological conditions, mine design, and reservoir properties of the coal seam. Without good knowledge of these factors, methane emissions can still create a localized zone of high methane concentrations in areas of low air velocities and quantities, and can render the ventilation system ineffective. Among those factors controlling methane emissions, reservoir properties of the coal seam are particularly important, especially if the mined seam is the main source of methane, with the properties of the coal controlling methane storage and emission potential during mining operations. | If not diluted by ventilation air, methane in coal seams is not only a hazard to mining safety, but an important concern from an environmental point of view as a greenhouse gas. Capturing and utilizing methane from active mines will both improve mining safety and decrease greenhouse gas emissions, and will provide an additional energy source that otherwise will be lost. A similar concept is also true for sealed workings and abandoned mines, as methane accumulating in these areas can be detrimental for active mines operating nearby in the event of gas migration between the workings. Methane accumulations can also be used for energy production if captured. Methane capture and utilization technologies have been demonstrated and are being successfully used mainly in the US and in Australia, and in other countries around the world [1]. |
Experimental study on CO and CO2 emissions from spontaneous heating of coals at varying temperatures and O2 concentrations
Yuan L , Smith AC . J Loss Prev Process Ind 2013 26 (6) 1321-1327 Laboratory experiments were conducted to investigate carbon monoxide (CO) and carbon dioxide (CO2) emissions from spontaneous heating of three U.S. coal samples in an isothermal oven at temperatures between 50 and 110 °C. The oxygen (O2) concentration of an oxygen/nitrogen (N2) mixture flowing through the coal sample was 3, 5, 10, 15, and 21%, respectively. The temperature at the center of the coal sample was continuously monitored, while the CO, CO2, and O2 concentrations of the exit gas were continuously measured. The results indicate that the CO and CO2 concentrations and the CO/CO2 ratio increased when the initial temperature was increased. As the inlet O2 concentration increased, the CO and CO2 concentrations increased, while the CO/CO2 ratios tended to converge to the same value. The ratio of CO/CO2 was found to be independent of coal properties, approaching a constant value of 0.2. The maximum CO production rate correlated well with the maximum coal temperature rise. The apparent order of reaction for coal oxidation was estimated to be between 0.52 and 0.72. The experimental results in this study could be used for early detection and evaluation of a spontaneous heating in underground coal mines. |
Trends and outcomes for donor oocyte cycles in the United States, 2000-2010
Kawwass JF , Monsour M , Crawford S , Kissin DM , Session DR , Kulkarni AD , Jamieson DJ . JAMA 2013 310 (22) 2426-34 IMPORTANCE: The prevalence of oocyte donation for in vitro fertilization (IVF) has increased in the United States, but little information is available regarding maternal or infant outcomes to improve counseling and clinical decision making. OBJECTIVES To quantify trends in donor oocyte cycles in the United States and to determine predictors of a good perinatal outcome among IVF cycles using fresh (noncryopreserved) embryos derived from donor oocytes. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data from the Centers for Disease Control and Prevention's National ART Surveillance System, to which fertility centers are mandated to report and which includes data on more than 95% of all IVF cycles performed in the United States. Data from 2000 to 2010 described trends. Data from 2010 determined predictors. MAIN OUTCOMES AND MEASURES: Good perinatal outcome, defined as a singleton live-born infant delivered at 37 weeks or later and weighing 2500 g or more. RESULTS From 2000 to 2010, data from 443 clinics (93% of all US fertility centers) were included. The annual number of donor oocyte cycles significantly increased, from 10 801 to 18 306. Among all donor oocyte cycles, an increasing trend was observed from 2000 to 2010 in the proportion of cycles using frozen (vs fresh) embryos (26.7% [95% CI, 25.8%-27.5%] to 40.3% [95% CI, 39.6%-41.1%]) and elective single-embryo transfers (vs transfer of multiple embryos) (0.8% [95% CI, 0.7%-1.0%] to 14.5% [95% CI, 14.0%-15.1%]). Good perinatal outcomes increased from 18.5% (95% CI, 17.7%-19.3%) to 24.4% (95% CI, 23.8%-25.1%) (P < .001 for all listed trends). Mean donor and recipient ages remained stable at 28 (SD, 2.8) years and 41 (SD, 5.3) years, respectively. In 2010, 396 clinics contributed data. For donor oocyte cycles using fresh embryos (n = 9865), 27.5% (95% CI, 26.6%-28.4%) resulted in good perinatal outcome. Transfer of an embryo at day 5 (adjusted odds ratio [OR], 1.17 [95% CI, 1.04-1.32]) and elective single-embryo transfers (adjusted OR, 2.32 [95% CI, 1.92-2.80]) were positively associated with good perinatal outcome; tubal (adjusted OR, 0.72 [95% CI, 0.60-0.86]) or uterine (adjusted OR, 0.74 [95% CI, 0.58-0.94]) factor infertility and non-Hispanic black recipient race/ethnicity (adjusted OR, 0.48 [95% CI, 0.35-0.67]) were associated with decreased odds of good outcome. Recipient age was not associated with likelihood of good perinatal outcome. CONCLUSIONS AND RELEVANCE: In the United States from 2000 to 2010, there was an increase in number of donor oocyte cycles, accompanied by an increase in good outcomes. Further studies are needed to understand the mechanisms underlying the factors associated with less successful outcomes. |
Attitudes toward mental illness in adults by mental illness-related factors and chronic disease status: 2007 and 2009 Behavioral Risk Factor Surveillance System
Kobau R , Zack MM . Am J Public Health 2013 103 (11) 2078-89 Objectives. We examined how attitudes toward mental illness treatment and its course differ by serious psychological distress, mental illness treatment, chronic disease, and sociodemographic factors using representative state-based data. Methods. Using data from jurisdictions supporting the Behavioral Risk Factor Surveillance System's Mental Illness and Stigma Module (35 states, the District of Columbia, and Puerto Rico), we compared adjusted proportions of adults agreeing that "Treatment can help people with mental illness lead normal lives" (treatment effectiveness) and that "People are generally caring and sympathetic to people with mental illness" (supportive environment), by demographic characteristics, serious psychological distress, chronic disease status, and mental illness treatment. Results. Attitudes regarding treatment effectiveness and a supportive environment for people with mental illness varied within and between groups. Most adults receiving mental illness treatment agreed that treatment is effective. Fewer adults with serious psychological distress than those without such distress agreed that treatment is effective. Fewer of those receiving treatment, those with psychological distress, and those with chronic disease perceived the environment as supportive. Conclusions. These data can be used to target interventions for population subgroups with less favorable attitudes and for surveillance. |
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