Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health and Nutrition Examination Survey, 2001 to 2010
Gu Q , Burt VL , Dillon CF , Yoon S . Circulation 2012 126 (17) 2105-14 BACKGROUND: The monitoring of national trends in hypertension treatment and control can provide important insight into the effectiveness of primary prevention efforts for cardiovascular disease. The objective of this study was to examine recent trends in antihypertensive medication use and its impact on blood pressure control among US adults with hypertension. METHODS AND RESULTS: A total of 9320 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey 2001 to 2010 were included in this study. The prevalence of antihypertensive medication use increased from 63.5% in 2001 to 2002 to 77.3% in 2009 to 2010 (P(trend)<0.01). Most notably, there was a large increase in the use of multiple antihypertensive agents (from 36.8% to 47.7%, P(trend)<0.01). Overall, the use of thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers increased by 23%, 57%, 31%, and 100%, respectively. In comparison with monotherapy, single-pill combinations and multiple-pill combinations were associated with 55% and 26% increased likelihoods of blood pressure control, respectively. By the 2009 to 2010 time period, 47% of all hypertensive people and 60% of treated hypertensive people had blood pressure controlled. However, higher treated but uncontrolled hypertension rates continued to persist among older Americans, non-Hispanic blacks, diabetic people, and those with chronic kidney disease. Also, Mexican Americans with hypertension were still less likely to take antihypertensive medication than non-Hispanic whites with hypertension. CONCLUSIONS: Antihypertensive medication use and blood pressure control among US adults with hypertension significantly increased over the past 10 years. Combination therapy regimens can facilitate achievement of blood pressure goals. |
Impact of geographic density of eye care professionals on eye care among adults with diabetes
Chou CF , Zhang X , Crews JE , Barker LE , Lee PP , Saaddine JB . Ophthalmic Epidemiol 2012 19 (6) 340-9 OBJECTIVE: To examine the impact of the geographic density of eye care professionals (ECPs) on the receipt of annual dilated eye examinations among adults in the United States with diabetes. METHOD: Data from the 2006 Behavioral Risk Factor Surveillance System were linked to the 2007 Area Resource File to examine the association between the density of ECPs (ophthalmologists and optometrists) per 100,000 people and self-reports of having had a dilated eye examination in the last year. The sample included adults aged 18+ years with diabetes (N = 29,495). Multivariate logistic regression was conducted to estimate adjusted odds ratios of annual dilated eye examinations, while controlling for age, sex, marital status and education, and stratifying by health insurance. RESULTS: Approximately 10% of respondents with diabetes lived in counties with no ECPs. Prevalence of being uninsured was 7.4% and 15.5% in those with and without dilated eye exams, respectively. After controlling for covariates and stratifying by health insurance, diabetic adults with health insurance cover residing in areas with no ECPs were less likely to report having had a dilated eye examination in the past year than those with 20 or more ECPs/100,000 people (odds ratio 0.72, 95% confidence interval 0.58-0.91). CONCLUSION: Residence in a county with a low density of ECPs reduced the likelihood of receiving annual dilated eye examinations among insured adults with diabetes. Enhancing the ability of ECPs to reach and care for those in need might better protect vision in people with diabetes. More research is needed to determine the mix of services that produces the best patient outcome. |
C-reactive protein, fibrinogen, and cardiovascular disease prediction
Kaptoge S , Di Angelantonio E , Pennells L , Wood AM , White IR , Gao P , Walker M , Thompson A , Sarwar N , Caslake M , Butterworth AS , Amouyel P , Assmann G , Bakker SJ , Barr EL , Barrett-Connor E , Benjamin EJ , Bjorkelund C , Brenner H , Brunner E , Clarke R , Cooper JA , Cremer P , Cushman M , Dagenais GR , D'Agostino RB Sr , Dankner R , Davey-Smith G , Deeg D , Dekker JM , Engstrom G , Folsom AR , Fowkes FG , Gallacher J , Gaziano JM , Giampaoli S , Gillum RF , Hofman A , Howard BV , Ingelsson E , Iso H , Jorgensen T , Kiechl S , Kitamura A , Kiyohara Y , Koenig W , Kromhout D , Kuller LH , Lawlor DA , Meade TW , Nissinen A , Nordestgaard BG , Onat A , Panagiotakos DB , Psaty BM , Rodriguez B , Rosengren A , Salomaa V , Kauhanen J , Salonen JT , Shaffer JA , Shea S , Ford I , Stehouwer CD , Strandberg TE , Tipping RW , Tosetto A , Wassertheil-Smoller S , Wennberg P , Westendorp RG , Whincup PH , Wilhelmsen L , Woodward M , Lowe GD , Wareham NJ , Khaw KT , Sattar N , Packard CJ , Gudnason V , Ridker PM , Pepys MB , Thompson SG , Danesh J . N Engl J Med 2012 367 (14) 1310-20 BACKGROUND: There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. METHODS: We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. RESULTS: The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P<0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of "low" (<10%), "intermediate" (10% to <20%), and "high" (≥20%) (P<0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ≥20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. CONCLUSIONS: In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.). |
Cervical carcinoma rates among young females in the United States
Benard VB , Watson M , Castle PE , Saraiya M . Obstet Gynecol 2012 120 (5) 1117-23 OBJECTIVE: All national organizations now recommend that women be screened for cervical cancer beginning at age 21 years, regardless of age of sexual initiation; however, studies have shown that providers continue to screen much earlier than recommended. Two federal cancer surveillance systems were used to quantify the burden of invasive cervical carcinoma among women younger than 40 years of age. METHODS: We examined combined data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program covering 92% of the U.S. population. We calculated the age-adjusted incidence of cervical carcinoma among women younger than age 40 years by age, race, ethnicity, and histology for the time period of 1999-2008. RESULTS: For women younger than age 40 years, 78% of the cervical cancer cases were diagnosed in women aged 30-39, 21% were diagnosed in women 20-29 years of age, and 1% was diagnosed in women younger than age 20 years. There was an average of 3,063 cases of invasive cervical carcinomas annually from 1999 through 2008, with an average of 14 carcinomas per year (rate of 0.15 per 100,000 females) among those aged 15-19 years, and 125 carcinomas per year (rate of 1.4 per 100,000 females) among those aged 20-24 years. CONCLUSION: Cervical cancer is very rare in young women. Widespread implementation of Pap testing over the past four decades has detected very few cases of cervical cancer in women younger than 25 while potentially causing harm with unnecessary follow-up interventions. LEVEL OF EVIDENCE: III. |
Rotavirus mortality in India: estimates based on a nationally representative survey of diarrhoeal deaths
Morris SK , Awasthi S , Khera A , Bassani DG , Kang G , Parashar UD , Kumar R , Shet A , Glass RI , Jha P . Bull World Health Organ 2012 90 (10) 720-727 OBJECTIVE: To estimate the number of rotavirus-associated deaths among Indian children younger than five years. METHODS: We surveyed more than 23,000 child deaths from a nationally representative survey of 1.1 million Indian households during 2001-2003. Diarrhoeal deaths were characterized by region, age and sex and were combined with the proportion of deaths attributable to rotavirus, as determined by hospital microbiologic data collected by the Indian Rotavirus Strain Surveillance Network from December 2005 to November 2007. Rotavirus vaccine efficacy data from clinical trials in developing countries were used to estimate the number of deaths preventable by a national vaccination programme. Data were analysed using Stata SE version 10. FINDINGS: Rotavirus caused an estimated 113 000 deaths (99% confidence interval, CI: 86,000-155,000); 50% (54 700) and 75% (85 400) occurred before one and two years of age, respectively. One child in 242 died from rotavirus infection before five years of age. Rotavirus-associated mortality rates overall, among girls and among boys were 4.14 (99% CI: 3.14-5.68), 4.89 (99% CI: 3.75-6.79) and 3.45 (99% CI: 2.58-4.66) deaths per 1000 live births, respectively. Rates were highest in Bihar, Uttar Pradesh and Madhya Pradesh, which together accounted for > 50% of deaths (64,400) nationally. Rotavirus vaccine could prevent 41,000-48,000 deaths among children aged 3-59 months. CONCLUSION: The burden of rotavirus-associated mortality is high among Indian children, highlighting the potential benefits of rotavirus vaccination. |
Roundtable postherpetic neuralgia-what, why, how long, and what's next?
Harpaz R , Nagel MA , Schmader K , Tyring SK , Yawn BP . Popul Health Manag 2012 15 (6) 385-90 Dr. Barbara P. Yawn (BPY), Moderator: Welcome to our panel of distinguished experts who have broad clinical and research experience in the management and treatment of postherpetic neuralgia (PHN). The focus of this Roundtable Discussion will be on the challenges and advancements in the prevention and treatment of PHN. | As I have been working on the epidemiology of zoster for about the last seven years, I am particularly interested in what we do and do not know about viral latency and reactivation and about what promise the new vaccine may hold for PHN prevention. | My first question for the panel is, from each of your perspectives, what are the most important issues that we should be addressing in the medical community regarding PHN? Ken, will you start us off? | Dr. Kenneth Schmader (KS): From a geriatrician's perspective, it is the horrible effect that PHN has on quality of life and functional status for older adults. PHN affects all four domains of what we assess in geriatrics. Physically, people have a tremendous amount of fatigue. They may not eat well, and they may lose weight. Psychologically, it can impair cognition, and/or the drugs people are taking for the illness may cause depression. From a social standpoint, we all know those patients who are basically stuck in their own homes because the pain or the allodynia will not allow them to leave their own homes. Then, from a functional standpoint, it will interfere with basic and instrumental activities of daily living. | Dr. Rafael Harpaz (RH): I would like to add to Ken's comments, because I share the same concerns about the impact of PHN on the oldest, frailest, and most vulnerable population, especially those who are living independently. The oldest independent-living seniors are persons who have a difficult time accessing medical care to get their acute zoster treated with antivirals in a timely manner, and also to get their pain properly managed once PHN does develop. They also have a more difficult time tolerating many of the medications used to treat chronic pain, and they, of course, have less physical and social reserve to manage the pain. They are the people who are at the greatest risks of having their acute zoster become a game changer—life-shattering, severe, disabling, and very prolonged PHN. | Dr. Maria A. Nagel (MAN): I agree with both Ken and Rafael. A lot of my patients with PHN have a significant decline in all aspects of their way of life. In their day-to-day living they are more or less housebound because they do not know when they are going to have these unpredictable flare-ups overlying the intractable, constant pain. Many no longer go out or participate in social activities with their friends and families. They cannot wear certain types of clothing, depending on where their PHN is, or even get their hair brushed because it is so painful. For patients, the pain and the constant doctor visits become a central aspect of their life, and as a result, I see a lot of patients with depression. |
Transmission of hepatitis B virus associated with assisted monitoring of blood glucose at an assisted living facility in New York State
Schaffzin JK , Southwick KL , Clement EJ , Konings F , Ganova-Raeva L , Xia G , Khudyakov Y , Johnson GS . Am J Infect Control 2012 40 (8) 726-31 BACKGROUND: Hepatitis B virus (HBV) transmission has been reported after patient-to-patient blood exposure during assisted monitoring of blood glucose (AMBG). Three assisted-living facility (ALF) residents who underwent AMBG developed acute HBV infection (HBVI) within 10 days. We investigated HBV transmission and implemented preventive measures. METHODS: A retrospective cohort study was conducted. Infection control practices were assessed. HBVI screening was conducted for all staff and epidemiologically linked residents. Viral DNA sequences were compared for a subset of isolates. RESULTS: Lancing devices and glucometers were shared among residents without proper sanitization. Serologic testing of all 34 residents with diabetes and 12 epidemiologically linked residents present during the exposure period detected 6 residents with diabetes with current HBVI and 4 residents with diabetes and 1 epidemiologically linked resident with previous HBVI. A cohort study of 32 individuals with diabetes identified AMBG as a significant risk factor for HBVI (relative risk, 6.7; 95% confidence interval, 1.7-26.3). Viral DNA sequences for 5 AMBG-exposed residents' isolates were identical, suggesting a common source. CONCLUSIONS: AMBG was significantly associated with HBVI in ALF residents with diabetes. Despite clear preventive recommendations, bloodborne pathogen transmission continues to occur in the setting of AMBG. Strengthening direct care provider, infection preventionist, and health department partnerships with ALFs is crucial to ensure safe AMBG practices and prevent HBV transmission. |
A large, population-based study of 2009 pandemic influenza A virus subtype H1N1 infection diagnosis during pregnancy and outcomes for mothers and neonates
Hansen C , Desai S , Bredfeldt C , Cheetham C , Gallagher M , Li DK , Raebel MA , Riedlinger K , Shay DK , Thompson M , Davis RL . J Infect Dis 2012 206 (8) 1260-8 BACKGROUND: Pregnant women were at increased risk for serious outcomes of 2009 pandemic influenza A virus subtype H1N1 (influenza A[H1N1]pdm09) infection, but little is known about the overall impact of the pandemic on neonatal and maternal outcomes. METHODS: We identified live births that occurred from 1 July 2008 through 31 May 2010 in 5 Kaiser Permanente regions. Pregnant women were considered to have influenza if they had a positive result of a laboratory test for influenza virus or if they received a diagnosis of influenza during a period in which seasonal influenza virus or A(H1N1)pdm09 was the predominant circulating virus. RESULTS: There were 111,158 births from 109,015 pregnancies involving 107,889 mothers; 368 pregnant women (0.3%) received a diagnosis of influenza due to seasonal virus, and 959 (0.9%) received a diagnosis of influenza due to A(H1N1)pdm09; 107 688 did not receive an influenza diagnosis. Pregnant women with influenza due to A(H1N1)pdm09 were more likely than women with seasonal influenza infection to be hospitalized within 30 days of the diagnosis (27% vs 12%; odds ratio [OR], 2.84 [95% confidence interval {CI}, 2.01-4.02]). Pregnant women with A(H1N1)pdm09 who started antiviral treatment ≥2 days after the diagnosis were significantly more likely to be hospitalized than those who started antiviral treatment <2 days after diagnosis (OR, 3.43 [95% CI, 1.55-7.56]). Mothers with seasonal influenza virus infection had an increased risk for having a small-for-gestational-age infant (OR, 1.59 [95% CI, 1.15-2.20]). CONCLUSIONS: In this large, geographically diverse population, A(H1N1)pdm09 infection increased the risk for hospitalization during pregnancy. Late initiation of antiviral treatment was also associated with an increased risk for hospitalization. |
An online randomized controlled trial evaluating HIV prevention digital media interventions for men who have sex with men
Hirshfield S , Chiasson MA , Joseph H , Scheinmann R , Johnson WD , Remien RH , Shaw FS , Emmons R , Yu G , Margolis AD . PLoS One 2012 7 (10) e46252 BACKGROUND: As HIV infection continues unabated, there is a need for effective interventions targeting at-risk men who have sex with men (MSM). Engaging MSM online where they meet sexual partners is critical for HIV prevention efforts. METHODS: A randomized controlled trial (RCT) conducted online among U.S. MSM recruited from several gay sexual networking websites assessed the impact of 2 HIV prevention videos and an HIV prevention webpage compared to a control condition for the study outcomes HIV testing, serostatus disclosure, and unprotected anal intercourse (UAI) at 60-day follow-up. Video conditions were pooled due to reduced power from low retention (53%, n = 1,631). No participant incentives were provided. PRINCIPAL FINDINGS: Follow-up was completed by 1,631 (53%) of 3,092 eligible men. In the 60 days after the intervention, men in the pooled video condition were significantly more likely than men in the control to report full serostatus disclosure ('asked and told') with their last sexual partner (OR 1.32, 95% CI 1.01-1.74). Comparing baseline to follow-up, HIV-negative men in the pooled video (OR 0.70, 95% CI 0.54-0.91) and webpage condition (OR 0.43, 95% CI 0.25-0.72) significantly reduced UAI at follow-up. HIV-positive men in the pooled video condition significantly reduced UAI (OR 0.38, 95% CI 0.20-0.67) and serodiscordant UAI (OR 0.53, 95% CI 0.28-0.96) at follow-up. CONCLUSIONS/SIGNIFICANCE: Findings from this online RCT of MSM recruited from sexual networking websites suggest that a low cost, brief digital media intervention designed to engage critical thinking can increase HIV disclosure to sexual partners and decrease sexual risk. Effective, brief HIV prevention interventions featuring digital media that are made widely available may serve as a complementary part of an overall behavioral and biomedical strategy for reducing sexual risk by addressing the specific needs and circumstances of the target population, and by changing individual knowledge, motivations, and community norms. TRIAL REGISTRATION: ClinicalTrials.gov NCT00649701. |
Effectiveness of a school district closure for pandemic influenza A (H1N1) on acute respiratory illnesses in the community: a natural experiment
Copeland DL , Basurto-Davila R , Chung W , Kurian A , Fishbein DB , Szymanowski P , Zipprich J , Lipman H , Cetron MS , Meltzer MI , Averhoff F . Clin Infect Dis 2012 56 (4) 509-16 BACKGROUND: Following detection of pandemic influenza A H1N1 (pH1N1) in Dallas/Fort Worth, Texas, a school district (intervention community, [IC]) closed all public schools for eight days to reduce transmission. Nearby school districts (control community [CC]) mostly remained open. METHODS: We collected household data to measure self-reported acute respiratory illness (ARI), before, during, and after school closures. We also collected influenza-related visits to emergency departments (ED(flu)). RESULTS: In both communities, self-reported ARIs and ED(flu) visits increased from before to during the school closure, but the increase in ARI rates was 45% lower in the IC,0.6% before to 1.2% during, than in the CC, 0.4% before to 1.5% during (RR(During/Before)=0.55, p=0.001; aOR(During/Before)=0.49, p<.03). For households with school age children only (no children 0-5 years), IC had even lower increases in adjusted ARI than in the CC (aOR(During/Before)=0.28, p<.001). The relative increase of total ED(flu) visits in the IC was 27% lower (2.8% before to 4.4% during) compared to the CC (2.9% before to 6.2% during). Among children 6-18 years old, the percentage of ED(flu) in IC remained constant (5.1% before vs. 5.2% during), while in the CC it more than doubled (5.2% before vs. 10.9% during). After schools re-opened, ARI rates and ED(flu) visits decreased in both communities. CONCLUSIONS: Our study documents a reduction in ARI and ED(flu) visits in the intervention community. Our findings can be used to assess the potential benefit of school closures during pandemics. |
Estimated incidence of influenza-virus-associated severe pneumonia in children in El Salvador, 2008-2010
Clara W , Armero J , Rodriguez D , de Lozano C , Bonilla L , Minaya P , Chacon R , Jara J , Blanco N , Widdowson MA , Bresee J , Xu X , Klimov A , Azziz-Baumgartner E , Linares-Perez N . Bull World Health Organ 2012 90 (10) 756-763 OBJECTIVE: To estimate the incidence of influenza-virus-associated severe pneumonia among Salvadorian children aged < 5 years. METHODS: Data on children aged < 5 years admitted with severe pneumonia to a sentinel hospital in the western region were collected weekly. Nasal and oropharyngeal swab specimens were collected from a convenience sample of case patients for respiratory virus testing. A health-care utilization survey was conducted in the hospital catchment area to determine the proportion of residents who sought care at the hospital. The incidence of influenza-virus-associated severe pneumonia among all Salvadorian children aged < 5 years was estimated from surveillance and census data, with adjustment for health-care utilization. Influenza virus strains were characterized by the United States Centers for Disease Control and Prevention to determine their correspondence with northern and southern hemisphere influenza vaccine formulations. FINDINGS: Physicians identified 2554 cases of severe pneumonia. Samples from 608 cases were tested for respiratory viruses and 37 (6%) were positive for influenza virus. The estimated incidence of influenza-virus-associated severe pneumonia was 3.2 cases per 1000 person-years (95% confidence interval, CI: 2.8-3.7) overall, 1.5 cases per 1000 person-years (95% CI: 1.0-2.0) during 2008, 7.6 cases per 1000 person-years (95% CI: 6.5-8.9) during 2009 and 0.6 cases per 1000 person-years (95% CI: 0.3-1.0) during 2010. Northern and southern hemisphere vaccine formulations matched influenza virus strains isolated during 2008 and 2010. CONCLUSION: Influenza-virus-associated severe pneumonia occurred frequently among young Salvadorian children during 2008-2010. Antigens in northern and southern hemisphere influenza vaccine formulations corresponded to circulating strains. |
Factors associated with survival among adults with HIV-associated TB in Guangxi, China: a retrospective cohort study
Zhang Y , Sun K , Yu L , Tang Z , Huang S , Meng Z , Zheng Y , Wen Y , Zhu H , Chen RY , Varma JK , Zhang F . Future Virol 2012 7 (9) 933-942 AIM: Although China has the second highest burden of TB in the world and faces a burgeoning HIV epidemic, the epidemiology and 12-month clinical outcomes of HIV-infected TB patients have not previously been reported. METHODS: We reviewed records of all HIV-infected adults diagnosed with culture-confirmed TB from four HIV clinics in Guangxi, China from August 2006 to December 2008. Factors associated with patients survival within 12 months after TB diagnosis were evaluated in Cox proportional hazards models. RESULTS: Among the 201 patients included, 47 (23%) died within 12 months. Median CD4 count at TB diagnosis was 37 cells/mm(3) (interquartile range: 16-102). Receiving HAART (adjusted hazard ratio [AHR]: 4.2; 95% CI: 1.6-10.8), receiving TB treatment (AHR: 9.0; 95% CI: 1.5-53.5) and baseline BMI ≥ 18.5 (AHR: 8.4; 95% CI: 1.9-35.8) were independently associated with survival. Among 171 (85%) patients who received TB treatment, receiving HAART (HR: 5.1; 95% CI: 2.4-10.7) was the only factor significantly associated with survival. CONCLUSION: HIV-infected Chinese patients diagnosed with TB in Guangxi are at high risk of death within 12 months, a risk that is strongly mitigated by antiretroviral therapy. Improving survival from HIV-associated TB in China will require the integration of TB and HIV programs to improve access to treatment for both diseases. (2012 Future Medicine Ltd.) |
Brucellosis among hospitalized febrile patients in northern Tanzania
Bouley AJ , Biggs HM , Stoddard RA , Morrissey AB , Bartlett JA , Afwamba IA , Maro VP , Kinabo GD , Saganda W , Cleaveland S , Crump JA . Am J Trop Med Hyg 2012 87 (6) 1105-11 Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ≥ 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ≥ 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ≥ 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania. |
"Research participants want to feel they are better off than they were before research was introduced to them": engaging Cameroonian rural plantation populations in HIV research
Kiawi E , McLellan-Lemal E , Mosoko J , Chillag K , Raghunathan PL . BMC Int Health Hum Rights 2012 12 8 BACKGROUND: During a period of evolving international consensus on how to engage communities in research, facilitators and barriers to participation in HIV prevention research were explored in a rural plantation community in the coastal region of Cameroon. METHODS: A formative rapid assessment using structured observations, focus group discussions (FGD), and key informant interviews (KIIs) was conducted with a purposive non-probabilistic sample of plantation workers and their household members. Eligibility criteria included living or working >1 year within the plantation community and age >18 years. Both rapid and in-depth techniques were used to complete thematic analysis. RESULTS: Sixty-five persons participated in the study (6 FGDs and 12 KIIs). Participants viewed malaria and gastrointestinal conditions as more common health concerns than HIV. They identified three factors as contributing to HIV risk: concurrent sexual relationships, sex work, and infrequent condom use. Interviewees perceived that the community would participate in HIV research if it is designed to: (1) improve community welfare, (2) provide comprehensive health services and treatment for illnesses, (3) protect the personal information of participants, especially those who test positive for HIV, (4) provide participant incentives, (5) incorporate community input, and (6) minimize disruptions to "everyday life". Barriers to participation included: (1) fear of HIV testing, (2) mistrust of researchers given possible disrespect or intolerance of plantation community life and lack of concern for communication, (3) time commitment demands, (3) medical care and treatment that would be difficult or costly to access, and (4) life disruptions along with potential requirements for changes in behaviour (i.e., engage in or abstain from alcohol use and sex activities). CONCLUSIONS: Consistent with UNAIDS guidelines for good participatory practice in HIV prevention research, study participants placed a high premium on researchers' politeness, trust, respect, communication, tolerance and empathy towards their community. Plantation community members viewed provision of comprehensive health services as an important community benefit likely to enhance HIV research participation. |
Community health workers experiences and perspectives on mass drug administration for Schistosomiasis control in western Kenya: the SCORE project
Omedo MO , Matey EJ , Awiti A , Ogutu M , Alaii J , Karanja DM , Montgomery SP , Secor WE , Mwinzi PN . Am J Trop Med Hyg 2012 87 (6) 1065-72 The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) includes communitywide treatment in areas with ≥ 25% prevalence of schistosomiasis along the shores of Lake Victoria using community health workers (CHWs). The CHWs are key drivers in community-owned mass drug administration (MDA) intervention programs. We explored their experiences and perceptions after initial MDA participation. Unstructured open-ended group discussions were conducted after completion of MDA activities. Narratives were obtained from CHWs using a digital audio recorder during the group discussion, transcribed verbatim and translated into English where applicable. Thematic decomposition of data was done using ATLAS.t.i. software. From the perspective of the CHWs, factors influencing MDA compliance included drug side effects, food supply stability, and conspiracy theories about the "real" purpose of treatment. The interest of CHWs to serve as community drug distributors stemmed from both intrinsic and extrinsic factors. Feedback from CHWs can promote more effective MDA in rural Kenyan communities. |
Characterization of Culex pipiens complex (Diptera: Culicidae) populations in Colorado, USA using microsatellites
Kothera L , Godsey MS Jr , Doyle MS , Savage HM . PLoS One 2012 7 (10) e47602 Mosquitoes such as those in the Culex pipiens complex are important vectors of disease. This study was conducted to genetically characterize Cx. pipiens complex populations in the state of Colorado, USA, and to determine the number of genetic clusters represented by the data. Thirteen populations located among four major river basins were sampled (n = 597 individuals) using a panel of 14 microsatellites. The lowest-elevation sites had the highest Expected Heterozygosity (H(E)) values (range 0.54-0.65). AMOVA results indicated the presence of statistically significant amounts of variation within each level when populations were analyzed as one group or when they were grouped either by river basin or by their position on the east or west side of the Rocky Mountains. Most pairwise F(ST) values were significant via permutation test (range 0-0.10), with the highest values from comparisons with Lamar, in southeast CO. A neighbor joining tree based on Cavalli-Sforza and Edwards's chord distances was consistent with the geographic locations of populations, as well as with the AMOVA results. There was a significant isolation by distance effect, and the cluster analysis resolved five groups. Individuals were also assayed with an additional microsatellite marker, Cxpq78, proposed to be monomorphic in Cx. pipiens but polymorphic in the closely related but biologically distinct species Cx. quinquefasciatus. Low frequencies (≤3%) of Cx. quinquefasciatus alleles for this marker were noted, and mostly confined to populations along the Interstate 25 corridor. Pueblo was distinct in that it had 10% Cx. quinquefasciatus alleles, mostly of one allele size. The degree of population genetic structure observed in this study is in contrast with that of Cx. tarsalis, the other major vector of WNV in the western U.S., and likely reflects the two species' different dispersal strategies. |
Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: key questions and answers
McCaig LF , Burt CW . Ann Emerg Med 2012 60 (6) 716-721 e1 The National Hospital Ambulatory Medical Care Survey (NHAMCS) is widely used for medical research. Nearly 500 articles have been published based on this database, including 28 in Annals of Emergency Medicine. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments in nonfederal, general, and short-stay hospitals, conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics (http://www.cdc.gov/nchs/ahcd.htm). Strengths of the NHAMCS survey are its rigorous methodology, nationally representative nature, large size, wide array of variables, and capacity to examine long-term trends. Investigators can freely download the database and test locally developed hypotheses. Challenges with NHAMCS are that, given its logistic and statistical complexity, resulting research can be difficult for readers to interpret and for editors and reviewers to critique. There are important limitations and caveats to this survey that, if overlooked, could lead to misleading or inaccurate conclusions. In this article, we have a posed a series of questions to 2 NHAMCS statisticians, and we believe that their answers will be invaluable to both NHAMCS investigators and readers of its research. |
Epidemiologic and laboratory features of a large outbreak of pertussis-like illnesses associated with co-circulating Bordetella holmesii and Bordetella pertussis -- Ohio, 2010-2011
Rodgers L , Martin SW , Cohn A , Budd J , Marcon M , Terranella A , Mandal S , Salamon D , Leber A , Tondella ML , Tatti K , Spicer K , Emanuel A , Koch E , McGlone L , Pawloski L , Lemaile-Williams M , Tucker N , Iyer R , Clark TA , Diorio M . Clin Infect Dis 2012 56 (3) 322-31 BACKGROUND: During May 9 2010-May 7 2011, an outbreak of pertussis-like illness (incidence 80 cases/100,000 persons) occurred in Franklin County, Ohio. The majority of cases were identified by IS481-directed polymerase chain reaction (PCR), which does not differentiate among Bordetella species. We sought to determine outbreak etiology and epidemiologic characteristics. METHODS: We obtained demographic, clinical, and vaccination-related data from the Ohio Disease Reporting System and Impact Statewide Immunization Information System. We tested sera from 14 patients for anti-pertussis toxin (PT) antibodies and used species-specific PCR on 298 nasopharyngeal specimens. RESULTS: Reported cases totaled 918. IS481 results were available for 10 serologically tested patients; 5/10 had discordant anti-PT antibody and IS481 results, suggestive of Bordetella holmesii, which lacks PT and harbors IS481. We identified specific Bordetella species in 164 of 298 specimens tested with multitarget PCR; B. holmesii and Bordetella pertussis were exclusively detected among 48 (29%) and 112 (68%), respectively; both were detected in 4 (2%). Among 48 patients with B. holmesii infections, 63% were aged 11-18 years, compared with 35% of 112 patients with B. pertussis infections (P = .001). Symptoms were similar among B. holmesii and B. pertussis-infected patients. Adolescent pertussis ("Tdap") booster vaccinations were more effective against B. pertussis than B. holmesii (effectiveness: 67% and 36%, respectively; 95% confidence intervals: 38%-82% and -33%-69%, respectively). CONCLUSIONS: We report the first documented mixed outbreak of B. pertussis and B. holmesii infections. B. holmesii particularly affected adolescents. Although laboratory capacity limitations might inhibit routine use of multitarget PCRs for clinical diagnosis; focused testing and enhanced surveillance might improve understanding the burden of B. holmesii infection. |
The burden and severity of illness due to 2009 pandemic influenza A (H1N1) in a large US city during the late summer and early fall of 2009
Doshi SS , Stauffer KE , Fiebelkorn AP , Lafond KE , Davidson HA , Apostolou A , Taylor TH Jr , Smith W , Karcz AN , Watson JR , Openo KP , Brooks JG , Zheteyeva Y , Schrag SJ , Fry AM . Am J Epidemiol 2012 176 (6) 519-26 In estimates of illness severity from the spring wave of the 2009 influenza A (H1N1) pandemic, reported case fatality proportions were less than 0.05%. In prior pandemics, subsequent waves of illness were associated with higher mortality. The authors evaluated the burden of the pandemic H1N1 (pH1N1) outbreak in metropolitan Atlanta, Georgia, in the fall of 2009, when increased influenza activity heralded the second wave of the pandemic in the United States. Using data from a community survey, existing surveillance systems, public health laboratories, and local hospitals, they estimated numbers of pH1N1-associated illnesses, emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and deaths occurring in metropolitan Atlanta during the period August 16, 2009-September 26, 2009. The authors estimated 132,140 pediatric and 132,110 adult symptomatic cases of pH1N1 in metropolitan Atlanta during the investigation time frame. Among children, these cases were associated with 4,560 ED visits, 190 hospitalizations, 51 ICU admissions, and 4 deaths. Among adults, they were associated with 1,130 ED visits, 590 hospitalizations, 140 ICU admissions, and 63 deaths. The combined symptomatic case hospitalization proportion, case ICU admission proportion, and case fatality proportion were 0.281%, 0.069%, and 0.024%, respectively. Influenza burden can be estimated using existing data and local surveys. The increased severity reported for subsequent waves in past pandemics was not evident in this investigation. Nevertheless, the second pH1N1 pandemic wave led to substantial numbers of ED visits, hospitalizations, and deaths in metropolitan Atlanta. |
Developing a web-based HIV behavioral surveillance pilot project among men who have sex with men
Sanchez T , Smith A , Denson D , Dinenno E , Lansky A . Open AIDS J 2012 6 224-31 BACKGROUND: A web-based HIV behavioral surveillance system (WHBS) has potential to collect behavioral data from men who have sex with men (MSM) not reached through traditional sampling methods. Six U.S. cities conducted a WHBS pilot in 2005-2007 to determine the feasibility to conduct a behavioral surveillance project entirely on the internet. METHODS: Three sampling methods of adult MSM on the internet were explored: direct marketing (DM) using banner advertisements; respondent-driven sampling (RDS) using peer recruitment; and venue-based sampling (VBS) using internet venues. RESULTS: A total of 8,434 complete MSM surveys were obtained: 8,109 through DM, 130 through RDS, and 195 through VBS. By methods, enrollment rates ranged from 70-90%; completion rates ranged from 67-95%. DM obtained the largest proportions of racial/ethnic minority MSM (36%) and MSM 18-20 years (19%). CONCLUSIONS: Only the DM method achieved a substantial number of complete MSM surveys. Successful implementation of an internet-based systematic sampling method may be problematic, but a convenience sample of MSM using banner advertisements is feasible and may produce useful and timely behavioral information from a large number of MSM. |
National outbreak of type A foodborne botulism associated with a widely distributed commercially canned hot dog chili sauce
Juliao PC , Maslanka S , Dykes J , Gaul L , Bagdure S , Granzow-Kibiger L , Salehi E , Zink D , Neligan RP , Barton-Behravesh C , Luquez C , Biggerstaff M , Lynch M , Olson C , Williams I , Barzilay EJ . Clin Infect Dis 2012 56 (3) 376-82 BACKGROUND: On July 7 and 11, 2007, respectively, health officials in Texas and Indiana reported 4 possible cases of type A foodborne botulism to the US Centers for Disease Control and Prevention. Foodborne botulism is a rare and sometimes fatal illness caused by consuming foods containing botulinum neurotoxin. METHODS: Investigators reviewed patients' medical charts and food histories. Clinical specimens and food samples were tested for botulinum toxin and neurotoxin-producing Clostridium spp. Investigators conducted inspections of the cannery that produced the implicated product. RESULTS: Eight confirmed outbreak associated cases were identified from Indiana (2), Texas (3), and Ohio (3). Botulinum toxin type A was identified in leftover chili sauce consumed by the Indiana patients and one of the Ohio patients. Cannery inspectors found violations of federal canned-food regulations that could have led to survival of C. botulinum spores during sterilization. The company recalled 39 million cans of chili. Following the outbreak, the US Food and Drug Administration inspected other canneries with similar canning systems and issued warnings to the industry about the danger of C. botulinum and the importance of compliance with canned food manufacturing regulations. CONCLUSION: Commercially produced hot dog chili sauce caused these cases of type A botulism. This is the first US foodborne botulism outbreak involving a commercial cannery in more than 30 years. Sharing of epidemiologic and laboratory findings allowed for the rapid identification of implicated food items and swift removal of potentially deadly products from the market by US food regulatory authorities. |
High HIV incidence and prevalence and associated factors among young MSM in 21 USA cities, 2008
Balaji AB , Bowles KE , Le BC , Paz-Bailey G , Oster AM . AIDS 2012 27 (2) 269-78 OBJECTIVE: To estimate HIV prevalence, estimated annual HIV incidence density, and factors associated with HIV infection among young men who have sex with men (MSM) in the United States. DESIGN: The 2008 National HIV Behavioral Surveillance System (NHBS), a cross-sectional survey conducted in 21 US cities. METHODS: NHBS respondents included in the analysis were MSM aged 18-24 with a valid HIV test who reported ≥1 male sex partner in the past year. We calculated HIV prevalence and estimated annual incidence density (number of HIV infections/total number of person-years at risk). Generalized estimating equations were used to determine factors associated with testing positive for HIV. RESULTS: Of 1889 young MSM, 198 (10%) had a positive HIV test; of these, 136 (69%) did not report being HIV-positive when interviewed. Estimated annual HIV incidence density was 2.9%; incidence was highest for blacks. Among young MSM who did not report being HIV infected, factors associated with testing HIV-positive included: black race, < high school education, using both alcohol and drugs before or during last sex; having an HIV test >12 months ago or reporting a visit to a medical provider in the past year. CONCLUSIONS: We report a high HIV prevalence and estimated incidence density for young MSM. Individual risk behaviors did not fully explain HIV risk, emphasizing the need to address socio-demographic and structural-level factors in public health interventions targeted toward young MSM. |
Stand-alone mass media campaigns to increase physical activity: a Community Guide updated review
Brown DR , Soares J , Epping JM , Lankford TJ , Wallace JS , Hopkins D , Buchanan LR , Orleans CT , Community Preventive Services Task Force . Am J Prev Med 2012 43 (5) 551-61 CONTEXT: The goal of the systematic review described in this summary was to determine the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. This systematic review is an update of a Community Guide systematic review and Community Preventive Services Task Force recommendation completed in 2001. EVIDENCE ACQUISITION: Updated searches for literature published from 1980 to 2008 were conducted in 11 databases. Of 267 articles resulting from the literature search, 16 were selected for full abstraction, including the three studies from the original 2001 review. Standard Community Guide methods were used to conduct the systematic evidence review. EVIDENCE SYNTHESIS: Physical activity outcomes were assessed using a variety of self-report measures with duration intervals ranging from 6 weeks to 4 years. Ten studies using comparable outcome measures documented a median absolute increase of 3.4 percentage points (interquartile interval: 2.4 to 4.2 percentage points), and a median relative increase of 6.7% (interquartile interval: 3.0% to 14.1%), in self-reported physical activity levels. The remaining six studies used alternative outcome measures: three evaluated changes in self-reported time spent in physical activity (median relative change, 4.4%; range of values, 3.1%-18.2%); two studies used a single outcome measure and found that participants reported being more active after the campaign than before it; and one study found that a mass media weight-loss program led to a self-reported increase in physical activity. CONCLUSIONS: The findings of this updated systematic review show that intervention effects, based wholly on self-reported measures, were modest and inconsistent. These findings did not lead the Task Force to change its earlier conclusion of insufficient evidence to determine the effectiveness of stand-alone mass media campaigns to increase physical activity. This paper also discusses areas needing future research to strengthen the evidence base. Finally, studies published between 2009 and 2011, after the Task Force finding was reached, and briefly summarized here, are shown to support that finding. |
Text4baby: development and implementation of a national text messaging health information service
Whittaker R , Matoff-Stepp S , Meehan J , Kendrick J , Jordan E , Stange P , Cash A , Meyer P , Baitty J , Johnson P , Ratzan S , Rhee K . Am J Public Health 2012 102 (12) 2207-13 Text4baby is the first free national health text messaging service in the United States that aims to provide timely information to pregnant women and new mothers to help them improve their health and the health of their babies. Here we describe the development of the text messages and the large public-private partnership that led to the national launch of the service in 2010. Promotion at the local, state, and national levels produced rapid uptake across the United States. More than 320,000 people enrolled with text4baby between February 2010 and March 2012. Further evaluations of the effectiveness of the service are ongoing; however, important lessons can be learned from its development and uptake. (Am J Public Health. Published online ahead of print October 18, 2012: e1-e7. doi:10.2105/AJPH.2012.300736). |
Hospitalizations and mortality associated with norovirus outbreaks in nursing homes, 2009-2010
Trivedi TK , Desalvo T , Lee L , Palumbo A , Moll M , Curns A , Hall AJ , Patel M , Parashar UD , Lopman BA . JAMA 2012 308 (16) 1-8 CONTEXT: Norovirus outbreaks are common among vulnerable, elderly populations in US nursing homes. OBJECTIVES: To assess whether all-cause hospitalization and mortality rates are increased during norovirus outbreak vs nonoutbreak periods in nursing homes, and to identify factors associated with increased risk. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of Medicare-certified nursing homes in Oregon, Wisconsin, and Pennsylvania that reported at least 1 confirmed or suspected norovirus outbreak to the Centers for Disease Control and Prevention's National Outbreak Reporting System (NORS), January 2009 to December 2010. Deaths and hospitalizations occurring among residents of these nursing homes were identified through the Medicare Minimum Data Set (MDS). MAIN OUTCOME MEASURES: Rates of all-cause hospitalization and mortality during outbreak compared with nonoutbreak periods were estimated using a random-effects Poisson regression model controlling for background seasonality in both outcomes. RESULTS: The cohort consisted of 308 nursing homes that reported 407 norovirus outbreaks to NORS. Per MDS, 67 730 hospitalizations and 26 055 deaths occurred in these homes during the 2-year study. Hospitalization rates were 124.0 (95% CI, 119.4-129.1) vs 109.5 (95% CI, 108.6-110.3) hospitalizations per nursing home-year during outbreak vs nonoutbreak periods, yielding a seasonally adjusted rate ratio (RR) of 1.09 (95% CI, 1.05-1.14). Similarly, mortality rates were 53.7 (95% CI, 50.6-57.0) vs 41.9 (95% CI, 41.4-42.4) deaths per nursing home-year in outbreak vs nonoutbreak periods (seasonally adjusted RR, 1.11; 95% CI, 1.05-1.18). The increases in hospitalizations and mortality were concentrated in the first 2 weeks (week 0 and 1) and the initial week (week 0) of the outbreak, respectively. Homes with lower daily registered nurse (RN) hours per resident (<0.75) had increased mortality rates during norovirus outbreaks compared with baseline (RR, 1.26; 95% CI, 1.14-1.40), while no increased risk (RR, 1.03; 95% CI, 0.96-1.12) was observed in homes with higher daily RN hours per resident (P = .007 by likelihood ratio test); the increase in hospitalization rates did not show a similar pattern. CONCLUSION: Norovirus outbreaks were associated with significant concurrent increases in all-cause hospitalization and mortality in nursing homes. |
Symptomatic infection and detection of vaccine and vaccine-reassortant rotavirus strains in 5 children: a case series
Boom JA , Sahni LC , Payne DC , Gautam R , Lyde F , Mijatovic-Rustempasic S , Bowen MD , Tate JE , Rench MA , Gentsch JR , Parashar UD , Baker CJ . J Infect Dis 2012 206 (8) 1275-9 Vaccine or vaccine-reassortant rotavirus strains were detected in fecal specimens from 5 of 106 (4.7%) immunocompetent children who required treatment for rotavirus gastroenteritis at a large pediatric hospital in Texas in 2009-2010. Four strains were related to pentavalent rotavirus vaccine, whereas one was related to monovalent rotavirus vaccine. The contribution of these strains to each patient's illness was unclear given that 2 patients had prominent respiratory symptoms and 2 were concurrently infected with another pathogen (group F adenovirus and norovirus). Continued monitoring is necessary to assess the role of vaccine strains and vaccine-reassortant strains in pediatric rotavirus infections. |
Varicella vaccine uptake in Shandong Province, China
Xu A , Xu Q , Fang X , Bialek S , Wang C . Hum Vaccin Immunother 2012 8 (9) 1213-7 Varicella vaccine has been licensed in China for decade to be used as single dose in children aged ≥ 12 mo of age in private sector. Little data were available on varicella uptake to date in China yet. A cross-sectional study was conducted in Shandong Province in May 2011 to examine varicella vaccination coverage among children aged 16-40 mo and examine factors associated with varicella vaccine uptake. The overall coverage among children eligible for varicella vaccine was 62% (range 16.7-94.7% by county), much lower than the coverage of the eight vaccines included in the national immunization program (all above 97%). Though proximity to immunization services (< 5 km) was linked with higher vaccine uptake (62.6 vs. 37.4%, p = 0.02), county-level economic development (77.8, 61.0 and 47.1% for developed, sub-developed and developing regions, respectively, p < 0.001) played an even more important role in varicella vaccination. Moreover, there was little variation in coverage of vaccines included in the national immunization program along with county-level economic development. Even though varicella vaccine uptake is relatively high for use on a private basis, the vaccination coverage is not high enough to prevent epidemiology shift to adolescents and adults who are more prone to develop severe outcomes to varicella. Further enhancement on varicella vaccination coverage is necessary and inclusion to national immunization program seems to be a promising option for achieving and maintaining high coverage. |
Pneumococcal carriage and invasive disease in children before introduction of the 13-valent conjugate vaccine: comparison with the pre-7-valent conjugate vaccine era
Sharma D , Baughman W , Holst A , Thomas S , Jackson D , Carvalho MD , Beall B , Satola S , Jerris R , Jain S , Farley MM , Nuorti JP . Pediatr Infect Dis J 2012 32 (2) e45-53 BACKGROUND: Nasopharyngeal (NP) carriage and invasive pneumococcal disease (IPD) due to serotypes in the 7-valent pneumococcal conjugate vaccine (PCV7) declined dramatically after vaccine introduction, whereas non-PCV7 serotypes increased modestly. Characteristics of pneumococcal carriage and IPD among children in Atlanta were compared during two time periods: pre-PCV7 introduction and pre-PCV13 introduction. METHODS: NP swabs from 231 and 451 children aged 6 to 59 months receiving outpatient medical care were obtained in 1995 and 2009, respectively. A total of 202 and 47 IPD cases were identified in children < 5 years of age in 1995 and 2008-2009, respectively, through active, population-based surveillance in Atlanta. Isolates were serotyped, sequence typed (ST), and tested for antimicrobial susceptibility RESULTS: Forty percent (93/231) of children in 1995 and 31% (139/451) in 2009 were colonized with Streptococcus pneumoniae; 60% and 0.7% were PCV7 serotypes, respectively. In 1995, PCV7 serotypes accounted for 83% and 19A 5% of IPD compared with no PCV7 serotypes and 49% 19A among IPD in 2009 [P<0.001]. In 2009, PCV13 serotypes accounted for 22% of carriage (mostly 19A) and 60% of invasive isolates [P<0.001]. ST320 accounted for 66% and 52% of 19A carriage and IPD isolates in 2009, respectively; all ST320 isolates were multi-drug resistant. No ST320 NP or IPD isolates were identified pre-PCV7. CONCLUSIONS: Serotype distribution among NP and IPD isolates in Atlanta has shifted to non-PCV7 serotypes; 19A was the leading serotype for both. The multi-drug resistant ST320 strain was responsible for two-thirds of 19A carriage isolates and nearly half of IPD isolates. The predominance of serotype 19A in carriage and IPD among children in Atlanta highlights the potential direct and indirect benefits anticipated by implementation of PCV13 in the community. |
Decline in gastroenteritis-related triage calls after rotavirus vaccine licensure
Williams DJ , Edwards KM , Payne DC , Manning J , Parashar UD , Lopman BA . Pediatrics 2012 130 (4) e872-8 OBJECTIVE: We sought to determine the impact of rotavirus vaccine implementation on gastroenteritis (GE)-related calls to a large telephone triage service in Tennessee. METHODS: Total and GE-related calls received by the Vanderbilt Telephone Triage Program for children <5 years of age were examined from May 1, 2004 to April 30, 2010. Time series adapted Poisson regression models were used to compare weekly GE-related call proportions between the prevaccine (May 2004 to April 2007) and postlicensure (May 2007 to April 2010) periods. Separate models compared GE-related call proportions in the historical rotavirus (February to April) and nonrotavirus (May to January) seasons. Associations between call data and laboratory-confirmed rotavirus detections and regionally reported norovirus activity were also assessed. RESULTS: There were 156,362 total calls and 19,731 GE-related calls. Annual GE-related call proportions declined by 8% (95% confidence interval, 3%-12%) in the postlicensure period; declines ranging from 23% to 31% occurred during the historical rotavirus season in all 3 postlicensure years. No declines occurred in the nonrotavirus season. After vaccine licensure, reductions in laboratory-confirmed rotavirus activity were associated with declines in GE-related call proportions. Peak GE-related call proportions in the postlicensure period occurred earlier than in prevaccine years and were not strongly associated with laboratory-confirmed rotavirus but instead showed good correlation with norovirus outbreaks. CONCLUSIONS: A decline in GE-related call proportions among young children after rotavirus vaccine licensure was documented by using a novel surveillance platform that captures mild GE not detected in other surveillance systems. Since rotavirus vaccine licensure, peak call proportions correlate with regional norovirus activity, highlighting the role of that pathogen in community GE. |
Risky play and children's safety: balancing priorities for optimal child development
Brussoni M , Olsen LL , Pike I , Sleet DA . Int J Environ Res Public Health 2012 9 (9) 3134-3148 Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children's outdoor risky play hinders their development. We explore the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children's diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children "as safe as necessary," not "as safe as possible." This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children's safety. (2012 by the authors; licensee MDPI, Basel, Switzerland.) |
Parental characteristics associated with bullying perpetration in US children aged 10 to 17 years
Shetgiri R , Lin H , Avila RM , Flores G . Am J Public Health 2012 102 (12) 2280-6 OBJECTIVES: We identified factors associated with child bullying in the United States. METHODS: We used the 2007 National Survey of Children's Health to examine associations among child, parent, and community factors and bullying perpetration among children aged 10 to 17 years, using bivariate and stepwise multivariable analyses. RESULTS: African American and Latino children and children living in poverty and who had emotional, developmental, or behavioral (EDB) problems had higher odds of bullying, as did children of parents who felt angry with their child or who felt their child bothered them a lot or was hard to care for; suboptimal maternal mental health was associated with higher bullying odds. Children who always or usually completed homework and had parents who talked with them and met all or most of their friends had lower bullying odds. CONCLUSIONS: Assessing children's EDB problems, maternal mental health, and parental perceptions may identify children at risk for bullying. Parent-child communication, meeting children's friends, and encouraging children academically were associated with lower bullying odds; these protective factors may be useful in designing preventive interventions. (Am J Public Health. Published online ahead of print October 18, 2012: e1-e7. doi:10.2105/AJPH.2012.300725). |
Molecular surveillance of Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi by genotyping and subtyping parasites in wastewater.
Li N , Xiao L , Wang L , Zhao S , Zhao X , Duan L , Guo M , Liu L , Feng Y . PLoS Negl Trop Dis 2012 6 (9) e1809 BACKGROUND: Despite their wide occurrence, cryptosporidiosis and giardiasis are considered neglected diseases by the World Health Organization. The epidemiology of these diseases and microsporidiosis in humans in developing countries is poorly understood. The high concentration of pathogens in raw sewage makes the characterization of the transmission of these pathogens simple through the genotype and subtype analysis of a small number of samples. METHODOLOGY/PRINCIPAL FINDINGS: The distribution of genotypes and subtypes of Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi in 386 samples of combined sewer systems from Shanghai, Nanjing and Wuhan and the sewer system in Qingdao in China was determined using PCR-sequencing tools. Eimeria spp. were also genotyped to assess the contribution of domestic animals to Cryptosporidium spp., G. duodenalis, and E. bieneusi in wastewater. The high occurrence of Cryptosporidium spp. (56.2%), G. duodenalis (82.6%), E. bieneusi (87.6%), and Eimeria/Cyclospora (80.3%) made the source attribution possible. As expected, several human-pathogenic species/genotypes, including Cryptosporidium hominis, Cryptosporidium meleagridis, G. duodenalis sub-assemblage A-II, and E. bieneusi genotype D, were the dominant parasites in wastewater. In addition to humans, the common presence of Cryptosporidium spp. and Eimeria spp. from rodents indicated that rodents might have contributed to the occurrence of E. bieneusi genotype D in samples. Likewise, the finding of Eimeria spp. and Cryptosporidium baileyi from birds indicated that C. meleagridis might be of both human and bird origins. CONCLUSIONS/SIGNIFICANCE: The distribution of Cryptosporidium species, G. duodenalis genotypes and subtypes, and E. bieneusi genotypes in urban wastewater indicates that anthroponotic transmission appeared to be important in epidemiology of cryptosporidiosis, giardiasis, and microsporidiosis in the study areas. The finding of different distributions of subtypes between Shanghai and Wuhan was indicative of possible differences in the source of C. hominis among different areas in China. |
pSK41-like plasmid is necessary for Inc18-like vanA plasmid transfer from Enterococcus faecalis to Staphylococcus aureus in vitro
Zhu W , Clark N , Patel JB . Antimicrob Agents Chemother 2012 57 (1) 212-9 Vancomycin-resistant Staphylococcus aureus (VRSA) are thought to occur by in vivo conjugative transfer of a vanA plasmid from Enterococcus to S. aureus. We studied bacterial isolates from VRSA cases that occurred in the United States to identify microbiological factors which may contribute to this plasmid transfer. First, vancomycin-susceptible, methicillin-resistant S. aureus (MRSA) isolates from five VRSA cases were tested for their ability to accept foreign DNA by conjugation in mating experiments with E. faecalis JH2-2 containing pAM378, a pheromone-response conjugative plasmid. All of the MRSA isolates accepted the plasmid DNA with similar transfer efficiencies (approximately 10(-7)/donor CFU) except one isolate, MRSA8, for which conjugation was not successful. MRSA isolates were also tested as recipients in mating experiments between an E. faecalis isolate with an Inc18-like vanA plasmid that was isolated from a VRSA case patient. Conjugative transfer was successful for 3/5 MRSA isolates. Successful MRSA recipients carried a pSK41-like plasmid, a staphylococcal conjugative plasmid, whereas the two unsuccessful MRSA recipients did not carry pSK41. Transfer of a pSK41-like plasmid from a successful MRSA recipient to the two unsuccessful recipients resulted in conjugal transfer of the Inc18-like vanA plasmid from E. faecalis at a frequency of 10(-7)/recipient CFU. In addition, conjugal transfer could be achieved for pSK41-negative MRSA in the presence of a cell-free culture filtrate from S. aureus carrying a pSK41-like plasmid at a frequency of 10(-8)/recipient CFU. These results indicated that a pSK41-like plasmid can facilitate the transfer of an Inc18-like vanA plasmid from E. faecalis to S. aureus possibly via an extracellular factor produced by pSK41-carrying isolates. |
Genotoxicity and carcinogenicity of cobalt-, nickel- and copper-based nanoparticles
Magaye R , Zhao JS , Bowman L , Ding M . Exp Ther Med 2012 4 (4) 551-561 The nanotechnology industry has matured and expanded at a rapid pace in the last decade, leading to the research and development of nanomaterials with enormous potential. The largest source of these nanomaterials is the transitional metals. It has been revealed that numerous properties of these nano-sized elements are not present in their bulk states. The nano size of these particles means they are easily transported into biological systems, thus, raising the question of their effects on the susceptible systems. Although advances have been made and insights have been gained on the effect of transitional metals on susceptible biological systems, there still is much ground to be covered, particularly with respect to our knowledge on the genotoxic and carcinogenic effects. Therefore, this review intends to summarize the current knowledge on the genotoxic and carcinogenic potential of cobalt-, nickel- and copper-based nanoparticles indicated in in vitro and in vivo mammalian studies. In the present review, we briefly state the sources, use and exposure routes of these nanoparticles and summarize the current literature findings on their in vivo and in vitro genotoxic and carcinogenic effects. Due to the increasing evidence of their role in carcinogenicity, we have also included studies that have reported epigenetic factors, such as abnormal apoptosis, enhanced oxidative stress and pro-inflammatory effects involving these nanoparticles. |
A high-throughput diagnostic method for measuring human exposure to organophosphorus nerve agents
Knaack JS , Zhou Y , Abney CW , Jacob JT , Prezioso SM , Hardy K , Lemire SW , Thomas J , Johnson RC . Anal Chem 2012 84 (21) 9470-7 An automated high-throughput immunomagnetic separation (IMS) method for diagnosing exposure to the organophosphorus nerve agents (OPNAs) sarin (GB), cyclohexylsarin (GF), VX, and Russian VX (RVX) was developed to increase sample processing capacity for emergency response applications. Diagnosis of exposure to OPNAs was based on the formation of OPNA adducts to butyrylcholinesterase (BuChE). Data reported with this method represent a ratio of the agent-specific BuChE adduct concentration, relative to the total BuChE peptide concentration that provides a nonactivity measurement expressed as percent adducted. All magnetic bead transfer steps and washes were performed using instrumentation in a 96-well format allowing for simultaneous extraction of 86 clinical samples plus reference materials. Automating extractions increased sample throughput 50-fold, as compared to a previously reported manual method. The limits of detection, determined using synthetic peptides, were 1 ng/mL for unadducted BuChE and GB-, GF-, VX-, and RVX-adducted BuChE. The automated method was characterized using unexposed serum and serum pools exposed to GB, GF, VX, or RVX. Variation for the measurement of percent adducted was <12% for all characterized quality control serum pools. Twenty-six (26) serum samples from individuals asymptomatic for cholinesterase inhibitor exposure were analyzed using this method, and no background levels of OPNA exposure were observed. Unexposed BuChE serum concentrations measured using this method ranged from 2.8 mcg/mL to 10.6 mcg/mL, with an average concentration of 6.4 mcg/mL. |
Capturing the reaction pathway in near-atomic-resolution crystal structures of HIV-1 protease
Shen CH , Tie Y , Yu X , Wang YF , Kovalevsky AY , Harrison RW , Weber IT . Biochemistry 2012 51 (39) 7726-32 Snapshots of three consecutive steps in the proteolytic reaction of HIV-1 protease (PR) were obtained in crystal structures at resolutions of 1.2-1.4 A. Structures of wild-type protease and two mutants (PR(V32I) and PR(I47V)) with V32I and I47V substitutions, which are common in drug resistance, reveal the gem-diol tetrahedral intermediate, the separating N- and C-terminal products, and the C-terminal product of an autoproteolytic peptide. These structures represent three stages in the reaction pathway and shed light on the reaction mechanism. The near-atomic-resolution geometric details include a short hydrogen bond between the intermediate and the outer carboxylate oxygen of one catalytic Asp25 that is conserved in all three structures. The two products in the complex with mutant PR(I47V) have a 2.2 A separation of the amide and carboxyl carbon of the adjacent ends, suggesting partial cleavage prior to product release. The complex of mutant PR(V32I) with a single C-terminal product shows density for water molecules in the other half of the binding site, including a partial occupancy water molecule interacting with the product carboxylate end and the carbonyl oxygen of one conformation of Gly27, which suggests a potential role of Gly27 in recycling from the product complex to the ligand-free enzyme. These structural details at near-atomic resolution enhance our understanding of the reaction pathway and will assist in the design of mechanism-based inhibitors as antiviral agents. |
Development and validation of a PulseNet standardized protocol for subtyping isolates of Cronobacter species
Brengi SP , O'Brien SB , Pichel M , Iversen C , Arduino M , Binsztein N , Jensen B , Pagotto F , Ribot EM , Stephan R , Cernela N , Cooper K , Fanning S . Foodborne Pathog Dis 2012 9 (9) 861-7 Cronobacter (formerly known as Enterobacter sakazakii) is a genus comprising seven species regarded as opportunistic pathogens that can be found in a wide variety of environments and foods, including powdered infant formula (PIF). Cronobacter sakazakii, the major species of this genus, has been epidemiologically linked to cases of bacteremia, meningitis in neonates, and necrotizing enterocolitis, and contaminated PIF has been identified as an important source of infection. Robust and reproducible subtyping methods are required to aid in the detection and investigation, of foodborne outbreaks. In this study, a pulsed-field gel electrophoresis (PFGE) protocol was developed and validated for subtyping Cronobacter species. It was derived from an existing modified PulseNet protocol, wherein XbaI and SpeI were the primary and secondary restriction enzymes used, generating an average of 14.7 and 20.3 bands, respectively. The PFGE method developed was both reproducible and discriminatory for subtyping Cronobacter species. |
Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: a systematic review of the literature
Johnson CY , Honein MA , Dana Flanders W , Howards PP , Oakley GP Jr , Rasmussen SA . Birth Defects Res A Clin Mol Teratol 2012 94 (11) 857-63 BACKGROUND: In regions where prenatal screening for anencephaly and spina bifida is widespread, many cases of these defects are diagnosed prenatally. The purpose of this study was to estimate the frequency of termination of pregnancy (TOP) following prenatal diagnosis of anencephaly or spina bifida and to investigate factors associated with TOP that might lead to selection bias in epidemiologic studies. METHODS: We included articles indexed in Medline or Embase between 1990 and May 2012 reporting the frequency of TOP following prenatal diagnosis of anencephaly or spina bifida with English-language abstracts, 20 or more prenatally diagnosed cases, and at least half of the study years in 1990 or later. We summarized the frequency of TOP across studies using random-effects metaanalysis and stratified results by fetal and study characteristics. RESULTS: Among the 17 studies identified, 9 included anencephaly and 15 included spina bifida. Nine were from Europe, six were from North America, and one each was from South America and Asia. The overall frequency of TOP following prenatal diagnosis was 83% for anencephaly (range, 59-100%) and 63% for spina bifida (range, 31-97%). There were insufficient data to stratify the results for anencephaly; TOP for spina bifida was more common when the prenatal diagnosis occurred at less than 24 weeks' gestation, with defects of greater severity, and in Europe versus North America. CONCLUSIONS: Because underascertainment of birth defects might be more likely when the pregnancy ends in TOP and TOP is associated with fetal characteristics, selection bias is possible in epidemiologic studies of anencephaly or spina bifida. ((c) 2012 Wiley Periodicals, Inc.) |
Estimating the burden of maternal and neonatal deaths associated with jaundice in Bangladesh: possible role of hepatitis E infection
Gurley ES , Halder AK , Streatfield PK , Sazzad HM , Nurul Huda TM , Hossain MJ , Luby SP . Am J Public Health 2012 102 (12) 2248-54 OBJECTIVES: We estimated the population-based incidence of maternal and neonatal mortality associated with hepatitis E virus (HEV) in Bangladesh. METHODS: We analyzed verbal autopsy data from 4 population-based studies in Bangladesh to calculate the maternal and neonatal mortality ratios associated with jaundice during pregnancy. We then reviewed the published literature to estimate the proportion of maternal deaths associated with liver disease during pregnancy that were the result of HEV in hospitals. RESULTS: We found that 19% to 25% of all maternal deaths and 7% to 13% of all neonatal deaths in Bangladesh were associated with jaundice in pregnant women. In the published literature, 58% of deaths in pregnant women with acute liver disease in hospitals were associated with HEV. CONCLUSIONS: Jaundice is frequently associated with maternal and neonatal deaths in Bangladesh, and the published literature suggests that HEV may cause many of these deaths. HEV is preventable, and studies to estimate the burden of HEV in endemic countries are urgently needed. (Am J Public Health. Published online ahead of print October 18, 2012: e1-e7. doi:10.2105/AJPH.2012.300749). |
Assessment and management of inguinal hernia in infants
Wang KS , Papile LA , Baley JE , Benitz W , Cummings J , Carlo WA , Kumar P , Polin RA , Tan RC , Watterberg KL , Barfield WD , Macones G , Jefferies AL , Mainous RO , Raju TNK , Couto J , Brandt ML , Shamberger RC , Caty MG , Heiss KF , Holcomb Iii GW , Meyers RL , Moss RL , Rescorla FJ , Thorne V . Pediatrics 2012 130 (4) 768-773 Inguinal hernia repair in infants is a routine surgical procedure. However, numerous issues, including timing of the repair, the need to explore the contralateral groin, use of laparoscopy, and anesthetic approach, remain unsettled. Given the lack of compelling data, consideration should be given to large, prospective, randomized controlled trials to determine best practices for the management of inguinal hernias in infants. (Copyright 2012 by the American Academy of Pediatrics.) |
Leukemia among male construction workers in California, 1988-2007
Luckhaupt SE , Deapen D , Cress R , Schumacher P , Shen R , Calvert GM . Leuk Lymphoma 2012 53 (11) 2228-36 A total of 18,708 male cases of leukemia from the California Cancer Registry, including 1703 cases usually employed in construction, were each matched with up to five controls from the same source who were diagnosed with cancers not thought to be related to exposures common in construction. Compared to other workers, construction workers were found to have a significantly elevated risk for all leukemia combined (morbidity odds ratio [MOR] = 1.14, 95% confidence interval [CI] = 1.08, 1.20), acute lymphocytic leukemia (ALL) (MOR = 1.30, 95% CI = 1.07, 1.58), acute myeloid leukemia (AML) (MOR = 1.15, 95% CI = 1.03, 1.27) and chronic myeloid leukemia (CML) (MOR = 1.25, 95% CI = 1.09, 1.44). Among the different construction occupations, the highest MOR for all leukemia was among carpet installers (MOR = 1.99, 95% CI = 1.16, 3.44), followed by plumbers (MOR = 1.28, 95% CI = 1.03, 1.59) and laborers (MOR = 1.26, 95% CI = 1.12, 1.42). Other associations were limited to specific construction occupations, leukemia subtypes and/or racial/ethnic groups. These associations should be further studied with more in-depth exposure assessment. |
Acute Chagas disease in a returning traveler
Carter YL , Juliano JJ , Montgomery SP , Qvarnstrom Y . Am J Trop Med Hyg 2012 87 (6) 1038-40 Acute Chagas disease is rarely recognized, and the risk for acquiring the disease is undefined in travelers to Central America. We describe a case of acute Chagas disease in a traveler to Costa Rica and highlight the need for increased awareness of this infection in travelers to Chagas-endemic areas. |
Training of home health aides and nurse aides: findings from national data
Sengupta M , Ejaz FK , Harris-Kojetin LD . Gerontol Geriatr Educ 2012 33 (4) 383-401 Training and satisfaction with training were examined using data from nationally representative samples of 2,897 certified nursing assistants (CNAs) from the National Nursing Assistant Survey and 3,377 home health aides (HHAs) from the National Home Health Aide Survey conducted in 2004 and 2007, respectively. This article focuses on the commonalities and differences in the perceptions of CNAs and HHAs regarding the initial and continuing education they received to prepare them for their job. More than 80% of HHAs and all CNAs received some initial training. Of these, significantly more HHAs compared to CNAs felt that training had prepared them "very well" for their jobs. The two groups also differed in their assessments of the content of the initial training; for example, more CNAs believed that their training was "excellent" in helping them address patients' limitations in activities of daily living compared to HHAs. The vast majority of HHAs and CNAs received continuing education, and about three fourths in each group assessed this training as being "very useful." In light of the increasing demands for HHAs and CNAs with the aging of America, findings from these national studies could be used to inform educational and training initiatives for this critical workforce. |
Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality
Harper MA , Meyer RE , Berg CJ . Obstet Gynecol 2012 120 (5) 1013-9 OBJECTIVE: To estimate the birth prevalence and 7-year case-fatality rate of peripartum cardiomyopathy for a statewide population by applying the National Institutes of Health Workshop on Peripartum Cardiomyopathy definition, including echocardiographic criteria for left ventricular dysfunction. METHODS: This was an epidemiologic study of residents of North Carolina experiencing an obstetric delivery or a pregnancy-related death before delivery in 2002 through 2003 including 235,599 live births. Potential cases were identified from International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM), pregnancy and cardiovascular codes followed by medical record review, and from the state pregnancy-related mortality file. Only women meeting the established definition including echocardiographic criteria for left ventricular dysfunction and women with diagnoses at autopsy were included. The state death file and the U.S. Social Security Death Index were searched for the years 2002 through 2010 for all cases. RESULTS: A total of 740 potential cases from 70 hospitals were identified from discharge ICD-9-CM codes. The medical records for 698 (94.3%) were located and reviewed. Seventy-eight met inclusion criteria. An additional seven women had diagnoses only at autopsy. The birth prevalence was 1 case for every 2,772 live births or 3.61 cases per 10,000 live births (95% confidence interval 2.88-4.46). The 7-year case-fatality rate was 16.5% (95% confidence interval 10--25.9%). Black non-Hispanic women experienced an almost fourfold increased prevalence and fatality compared with white women. Women older than age 35 years had the highest prevalence. CONCLUSIONS: The racial disparity in both birth prevalence and case-fatality is striking; one in six women died within 7 years. LEVEL OF EVIDENCE: II. |
Effect of missed combined hormonal contraceptives on contraceptive effectiveness: a systematic review
Zapata LB , Steenland MW , Brahmi D , Marchbanks PA , Curtis KM . Contraception 2012 87 (5) 685-700 BACKGROUND: Combined hormonal contraceptives (CHCs) are popular methods of reversible contraception in the United States, but adherence remains an issue as reflected in their lower rates of typical use effectiveness. The objective of this systematic review was to evaluate evidence on the effect of missed CHCs on pregnancy rates as well as surrogate measures of contraceptive effectiveness (e.g., ovulation, follicular development, changes in hormone levels, cervical mucus quality). STUDY DESIGN: We searched the PubMed database for peer-reviewed articles published in any language from database inception through April 2012. We included studies that examined measures of contraceptive effectiveness during cycles with extended hormone-free intervals or nonadherence (e.g., omission of pills, delayed patch replacement) on days not adjacent to the hormone-free interval. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. RESULTS: The search strategy identified 1387 articles, of which 26 met our study selection criteria. There is wide variability in the amount of follicular development and risk of ovulation among women who extended the pill-free interval to 8-14 days; in general, the risk of ovulation was low, and among women who did ovulate, cycles were usually abnormal (i.e., low progesterone levels, small follicles and/or poor cervical mucus) (Level I, good, indirect to Level II-3, fair, indirect). Studies of women who missed one to four consecutive pills or 1-3 consecutive days of delay before patch replacement at times other than adjacent to the hormone-free interval reported little follicular activity and low risk of ovulation (Level I, fair, indirect to Level II-3, poor, indirect). Studies comparing 30 mcg versus 20 mcg mc ethinyl estradiol pills showed more follicular activity when 20 mcg ethinyl estradiol pills were missed (Level I, good, indirect). CONCLUSION: Most of the studies in this evidence base relied on surrogate measures of pregnancy risk and ranged in quality. For studies providing indirect evidence on the effects of missed CHCs, it is unclear how differences in surrogate measures correspond to pregnancy risk. Fewer studies examined the transdermal patch and vaginal ring than combined oral contraceptives. |
Evidence-based guidance on selected practice recommendations for contraceptive use: identification of research gaps
Folger SG , Jamieson DJ , Godfrey EM , Zapata LB , Curtis KM . Contraception 2012 87 (5) 517-23 The Centers for Disease Control and Prevention (CDC) is developing the US Selected Practice Recommendations (US SPR) for Contraceptive Use, an adaptation of the World Health Organization’s (WHO’s) evidence-based SPR guidance addressing contraceptive management issues that, while common, may also be complex or controversial [1]. | The recommendations in the US SPR will be based on the best available existing scientific evidence and expert guidance on such issues. The evidence was reviewed at an expert meeting held by the CDC in October 2011. In addition to informing development of recommendations for the US SPR, the meeting also served to identify research gaps for which additional evidence is needed to address or further clarify some common questions on contraceptive management and use. These research gaps are listed in Table 1, categorized by general area of interest. In this paper, we discuss three of the research gaps for purposes of illustration: (a) What are the most effective approaches to improve patient and provider understanding of and adherence to instructions for actions to take following dosing errors with oral contraceptive pills (OCPs) (missed pills), the transdermal contraceptive patch and the contraceptive ring? (b) What are the most effective and feasible approaches for prevention and management of bleeding irregularities among women using hormonal or intrauterine contraception? (c) What are the long-term effectiveness and safety of, and patient satisfaction with, hysteroscopic sterilization? For each of these questions, we discuss the significance of the issue, the type of evidence that is needed and the methodological challenges for conducting the needed research. |
Hormonal contraceptive use and female-to-male HIV transmission: a systematic review of the epidemiologic evidence
Polis CB , Phillips SJ , Curtis KM . AIDS 2012 27 (4) 493-505 OBJECTIVE: To systematically review epidemiologic evidence assessing whether hormonal contraception (HC) alters the risk of HIV transmission from an HIV-positive woman to an HIV-negative male partner. DESIGN: Systematic review. METHODS: We included articles published or in press through December 15, 2011. We assessed studies with direct evidence on HC use and HIV transmission, and summarized studies with indirect evidence related to genital or plasma viral load. RESULTS: One study provided direct evidence on oral contraceptive pills (OCPs) or injectable contraception and female-to-male HIV transmission; both injectables (Cox adjusted hazard ratio [adjHR] 1.95, 95% confidence interval [CI] 1.06-3.58; marginal structural model [MSM] adjusted odds ratio [adjOR] 3.01, 95% CI 1.47-6.16) and OCPs (Cox adjHR 2.09, 95% CI 0.75-5.84; MSM adjOR 2.35, 95% CI 0.79-6.95) generated elevated point estimates, but only estimates for injectables were significant. Findings from eleven indirect studies assessing various HC methods and viral genital shedding or setpoint were mixed, and seven of eight studies indicated no adverse effect of various HC methods on plasma viral load. CONCLUSION: The only direct study on OCPs or injectable contraception and female-to-male HIV transmission suggests increased risk with the use of injectables. Given the potential for confounding in observational data, the paucity of direct evidence on this subject, and mixed indirect evidence, additional evidence is needed. |
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