Racial/ethnicity disparities in invasive breast cancer among younger and older women: An analysis using multiple measures of population health
Hung MC , Ekwueme DU , Rim SH , White A . Cancer Epidemiol 2016 45 112-118 INTRODUCTION: Few studies have examined age and racial/ethnic disparities in invasive breast cancer among younger (age 15-44 years) vs. older (age 45-64 years) women. This study estimates disparities in breast cancer among younger compared with older women by race/ethnicity using five measures of population health: life expectancy (LE), expected years of life lost (EYLL), cumulative incidence rate (CIR), and incidence and mortality rate ratios (IRR and MRR). METHODS: Using Surveillance, Epidemiology, and End Results data, LE and EYLL were estimated from a cohort of 15-44 and 45-64 years, non-Hispanic black (NHB), non-Hispanic white (NHW), and Hispanic women diagnosed with breast cancer, 2000-2013. Survival function was obtained from the study years and then extrapolated to lifetime using the Monte Carlo method. The CIR, IRR and MRR were calculated using 2009-2013 breast cancer incidence and mortality rates from the Centers for Disease Control and Prevention's National Program of Cancer Registries. RESULTS: The estimated LE ranged from 32.12 to 7.42 years for localized to distant stages among younger NHB women compared to 33.05 to 9.95 years for younger NHW women. The estimated EYLL was 12.78 years for younger women, and 4.99 for older women. By race/ethnicity, it was 15.53 years for NHB, 14.23 years for Hispanic and 11.87 years for NHW (P<0.00025). The CIR for age-group 15-44 years (CIR15-44) indicated a 1 in 86 probability for NHB compared to a 1 in 87 probability for NHW being diagnosed with breast cancer by age 45. The estimated age-adjusted incidence rate for NHB-to-NHW women was IRR=1.10 (95%, CI=1.08-1.11) and the corresponding mortality rate was MRR=2.02 (95%, CI=1.94-2.11). CONCLUSIONS: The breast cancer disparities between younger NHB compared to NHW women highlight the need for expanded efforts to address these disparities through primary prevention and to improve access to quality healthcare to minority women with breast cancer. |
Refining the patient navigation role in a colorectal cancer screening program: results from an intervention study
Rohan EA , Slotman B , DeGroff A , Morrissey KG , Murillo J , Schroy P . J Natl Compr Canc Netw 2016 14 (11) 1371-1378 BACKGROUND: Oncology patient navigators help individuals overcome barriers to increase access to cancer screening, diagnosis, and timely treatment. This study, part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, examined navigators' activities to ameliorate barriers to colonoscopy screening in a medically disadvantaged population. METHODS: This study was conducted from 2012 through 2014 at Boston Medical Center. We analyzed navigator service delivery and survey data collected on 420 participants who were navigated for colonoscopy screening after randomization to this intervention. Key variables under investigation included barriers to colonoscopy, activities navigators undertook to reduce barriers, time navigators spent on each activity and per contact, and patient satisfaction with navigation services. Descriptive analysis assessed how navigators spent their time and examined what aspects of patient navigation were most valued by patients. RESULTS: Navigators spent the most time assessing patient barriers/needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation. Navigators spent an average of 44 minutes per patient. Patients valued the navigators, especially for providing emotional/peer support and explaining screening procedures and bowel preparation clearly. CONCLUSIONS: Our findings help clarify the role of the navigator in colonoscopy screening within a medically disadvantaged community. These findings may help further refine the navigator role in cancer screening and treatment programs as facilities strive to effectively and efficiently integrate navigation into their services. |
Secular trends for skinfolds differ from those for BMI and waist circumference among adults examined in NHANES from 1988-1994 through 2009-2010
Freedman DS , Zemel BS , Ogden CL . Am J Clin Nutr 2016 105 (1) 169-176 BACKGROUND: Although the prevalence of a body mass index [BMI (in kg/m2)] ≥30 has tripled among US adults since the 1960s, BMI is only moderately correlated with body fatness. Because skinfolds can more accurately estimate body fatness than can BMI, it is possible that skinfolds could be useful in monitoring secular trends in body fatness. OBJECTIVE: We examined whether there were similar secular trends for skinfolds (triceps and subscapular), BMI, and waist circumference between US adults. DESIGN: This study was an analysis of 45,754 adults who participated in the NHANES from 1988-1994 through 2009-2010. Approximately 19% of the subjects were missing ≥1 skinfold-thickness measurement. These missing values were imputed from other characteristics. RESULTS: Trends in mean levels and in the prevalence of high levels of the 4 body size measures were fairly similar between men, with mean levels increasing by ≥5% from 1988-1994 through 2009-2010. Slightly larger increases were seen in women for BMI and waist circumference (7-8%), but trends in skinfolds were markedly different. The mean triceps skinfold, for example, increased by 2 mm through 2003-2004, but subsequently decreased so that the mean in 2009-2010 did not differ from that in 1988-1994. Compared with obese women in 1988-1994, the mean BMI of obese women in 2009-2010 was 1 higher, but mean levels of both skinfolds were 5-10% lower. CONCLUSIONS: Although there were fairly similar trends in levels of BMI, waist circumference, and skinfold thicknesses in men in the United States from 1988-1994 through 2009-2010, there were substantial differences in women. Our results indicate that it is unlikely that skinfold thicknesses could be used to monitor trends in obesity. |
Mental health differences between men and women caregivers, BRFSS 2009
Edwards VJ , Anderson LA , Thompson WW , Deokar AJ . J Women Aging 2016 29 (5) 1-7 This study uses data from the 2009 Behavioral Risk Factors Surveillance System (BRFSS) to examine differences between male and female caregivers by demographics, health-related quality of life (HRQOL), and the effect of social support on HRQOL. Roughly two-thirds of caregivers were women, and demographic characteristics differed among men and women caregivers. Women caregivers reported significantly more mentally and physically unhealthy days than men, but there were no differences between men and women in general health or life satisfaction. Men were significantly more likely to report that they rarely or never received social support. Despite this, the effect of social support on HRQOL was stronger in men than in women. Implications of these findings for caregiver support programs are discussed. |
Genotype-Specific Concordance of Chlamydia trachomatis Genital Infection Within Heterosexual Partnerships.
Schillinger JA , Katz BP , Markowitz LE , Braslins PG , Shrier LA , Madico G , van der Pol B , Orr DP , Rice PA , Batteiger BE . Sex Transm Dis 2016 43 (12) 741-749 BACKGROUND: Sexual transmission rates of Chlamydia trachomatis (Ct) cannot be measured directly; however, the study of concordance of Ct infection in sexual partnerships (dyads) can help to illuminate factors influencing Ct transmission. METHODS: Heterosexual men and women with Ct infection and their sex partners were enrolled and partner-specific coital and behavioral data collected for the prior 30 days. Microbiological data included Ct culture, and nucleic acid amplification testing (NAAT), quantitative Ct polymerase chain reaction, and ompA genotyping. We measured Ct concordance in dyads and factors (correlates) associated with concordance. RESULTS: One hundred twenty-one women and 125 men formed 128 dyads. Overall, 72.9% of male partners of NAAT-positive women and 68.6% of female partners of NAAT-positive men were Ct-infected. Concordance was more common in dyads with culture-positive members (78.6% of male partners, 77% of female partners). Partners of women and men who were NAAT-positive only had lower concordance (33.3%, 46.4%, respectively). Women in concordant dyads had significantly higher median endocervical quantitative Ct polymerase chain reaction values (3,032) compared with CT-infected women in discordant dyads (1013 inclusion forming units DNA equivalents per mL; P < 0.01). Among 54 Ct-concordant dyads with ompA genotype data for both members, 96.2% had identical genotypes. CONCLUSIONS: Higher organism load appears associated with concordance among women. Same-genotype chlamydial concordance was high in sexual partnerships. No behavioral factors were sufficiently discriminating to guide partner services activities. Findings may help model coitus-specific transmission probabilities. © Copyright 2016 American Sexually Transmitted Diseases Association |
Reactive school closure during increased influenza-like illness (ILI) activity in western Kentucky, 2013: a field evaluation of effect on ILI incidence and economic and social consequences for families
Russell ES , Zheteyeva Y , Gao H , Shi J , Rainey JJ , Thoroughman D , Uzicanin A . Open Forum Infect Dis 2016 3 (3) ofw113 Background. School closures are an important mitigation strategy during influenza pandemic: if implemented early in a local outbreak, they can slow the disease spread in the surrounding community. During seasonal influenza epidemics, school closures may occur reactively, after the disease is already widespread in the community. Such reactive closures are often too late to reduce influenza transmission. However, they can provide data to determine under which circumstances they might be effective in reducing influenza-like illness (ILI) transmission. Methods. We conducted a household survey in a school district in Kentucky. District A closed after high student absenteeism due to influenza-like illness (ILI), whereas adjacent Districts B and C remained open. We collected data on self-reported ILI among household members in these 3 districts 2 weeks before the District A closure, during closure, and 2 weeks after reopening, and we evaluated economic and social consequences of school closure on student households in District A. The difference-in-differences method was applied to compare changes in ILI rates from before to after closure between districts. Results. Estimated average daily ILI rate decreased less in District A than in District B or C for the entire sample and when stratified by age groups (0-5 years old, 6-18 years old, and above 18 years old). Twenty-five percent of District A households reported ≥1 closure-related economic or social difficulty. Conclusions. Closing schools after a widespread ILI activity in District A did not reduce ILI transmission but caused difficulties for some households. |
The unrecognized burden of typhoid fever
Obaro SK , Iroh Tam PY , Mintz ED . Expert Rev Vaccines 2016 16 (3) 249-260 INTRODUCTION: Typhoid fever (TF), caused by Salmonella enterica serovar Typhi, is the most common cause of enteric fever, responsible for an estimated 129,000 deaths and more than 11 million cases annually. Although several reviews have provided global and regional TF disease burden estimates, major gaps in our understanding of TF epidemiology remain. Areas covered: We provide an overview of the gaps in current estimates of TF disease burden and offer suggestions for addressing them, so that affected communities can receive the full potential of disease prevention offered by vaccination and water, sanitation, and hygiene interventions. Expert commentary: Current disease burden estimates for TF do not capture cases from certain host populations, nor those with atypical presentations of TF, which may lead to substantial underestimation of TF cases and deaths. These knowledge gaps pose major obstacles to the informed use of current and new generation typhoid vaccines. |
Pharmacists' knowledge and practices surrounding expedited partner therapy for Chlamydia trachomatis, New York City, 2012 and 2014
Reid A , Rogers ME , Arya V , Edelstein ZR , Schillinger JA . Sex Transm Dis 2016 43 (11) 679-684 Background Health care providers in New York City can prescribe treatment for Chlamydia trachomatis (Ct) for a patient's partner without the partner having a medical evaluation ("prescription-expedited partner therapy" [EPT]), and use of prescription-EPT is common. However, there is little known about pharmacists' knowledge and practices surrounding EPT. Methods Two cross-sectional surveys, in 2012 and 2014, were conducted with representative samples of supervising pharmacists in NYC neighborhoods with high rates of Ct infection. Results In both survey years, the majority of pharmacists who agreed to participate returned a survey (2012: 81% [83/103], 2014: 61% [106/173]), and pharmacist and pharmacy characteristics were similar across the 2 surveys. Pharmacists' EPT-related knowledge and practice was generally low, with little change between 2012 and 2014. In both years, fewer than half of pharmacists knew EPT was legal (2012, 46%; 2014, 42%). There were even decreases in specific content knowledge; in 2014, significantly fewer of the pharmacists who knew EPT was legal, knew that the initials "EPT" must be written in the body of the prescription (2012: 58%; 2014: 36%, P < 0.05). Most pharmacists in both survey years reported they had never received an EPT prescription, and those who had reported only infrequent receipt. Conclusions NYC pharmacists had low levels of knowledge and familiarity with EPT law and reported infrequent receipt of EPT prescriptions. Pharmacists and providers should be further educated about EPT laws and regulations so that prescription-EPT use can be accurately monitored, and to assure the success of this partner treatment strategy. Copyright © 2016 American Sexually Transmitted Diseases Association All rights reserved. |
Possibility and challenges of conversion of current virus species names to Linnaean binomials
Postler TS , Clawson AN , Amarasinghe GK , Basler CF , Bavari S , Benko M , Blasdell KR , Briese T , Buchmeier MJ , Bukreyev A , Calisher CH , Chandran K , Charrel R , Clegg CS , Collins PL , de la Torre JC , DeRisi JL , Dietzgen RG , Dolnik O , Durrwald R , Dye JM , Easton AJ , Emonet S , Formenty P , Fouchier RA , Ghedin E , Gonzalez JP , Harrach B , Hewson R , Horie M , Jiang D , Kobinger G , Kondo H , Kropinski AM , Krupovic M , Kurath G , Lamb RA , Leroy EM , Lukashevich IS , Maisner A , Mushegian AR , Netesov SV , Nowotny N , Patterson JL , Payne SL , Paweska JT , Peters CJ , Radoshitzky SR , Rima BK , Romanowski V , Rubbenstroth D , Sabanadzovic S , Sanfacon H , Salvato MS , Schwemmle M , Smither SJ , Stenglein MD , Stone DM , Takada A , Tesh RB , Tomonaga K , Tordo N , Towner JS , Vasilakis N , Volchkov VE , Wahl-Jensen V , Walker PJ , Wang LF , Varsani A , Whitfield AE , Zerbini FM , Kuhn JH . Syst Biol 2016 66 (3) 463-473 Botanical, mycological, zoological, and prokaryotic species names follow the Linnaean format, consisting of an italicized Latinized binomen with a capitalized genus name and a lower-case species epithet (e.g., Homo sapiens). Virus species names, however, do not follow a uniform format, and even when binomial, are not Linnaean in style. In this thought exercise, we attempted to convert all currently official names of species included in the virus family Arenaviridae and the virus order Mononegavirales to Linnaean binomials, and to identify and address associated challenges and concerns. Surprisingly, this endeavor was not as complicated or time-consuming as even the authors of this article expected when conceiving the experiment. |
Potential sources of bias in the use of Escherichia coli to measure waterborne diarrhea risk in low-income settings
Ercumen A , Arnold BF , Naser AM , Unicomb L , Colford JM Jr , Luby SP . Trop Med Int Health 2016 22 (1) 2-11 OBJECTIVES: Escherichia coli is the standard water quality indicator for diarrhea risk. Yet the association between E. coli and diarrhea is inconsistent across studies without a systematic assessment of methodological differences behind this variation. Most studies measure water quality cross-sectionally with diarrhea, risking exposure misclassification and reverse causation. Studies use different recall windows for self-reported diarrhea; longer periods increase potential outcome misclassification through misrecall. Control of confounding is inconsistent across studies. Additionally, diarrhea measured in unblinded intervention trials can present courtesy bias. We utilized measurements from a randomized trial of water interventions in Bangladesh to assess how these factors affect the E. coli-diarrhea association. METHODS: We compared cross-sectional versus prospective measurements of water quality and diarrhea, two- versus seven-day symptom recall periods, estimates with and without controlling for confounding and using measurements from control versus intervention arms of the trial. RESULTS: In the control arm, two-day diarrhea prevalence, measured prospectively one month after water quality, significantly increased with log10 E. coli (PR=1.50, 1.02-2.20). This association weakened when we used seven-day recall (PR=1.18, 0.88-1.57), cross-sectional measurements of E. coli and diarrhea (PR=1.11, 0.79-1.56) or did not control for confounding (PR=1.20, 0.88-1.62). Including data from intervention arms led to less interpretable associations, potentially due to courtesy bias, effect modification and/or reverse causation. CONCLUSIONS: By systematically addressing potential sources of bias, our analysis demonstrates a clear relationship between E. coli in drinking water and diarrhea, suggesting that the continued use of E. coli as an indicator of waterborne diarrhea risk is justified. |
Prevalence and correlates of genital infections among newly diagnosed human immunodeficiency virus-infected adults entering human immunodeficiency virus care in Windhoek, Namibia
Djomand G , Schlefer M , Gutreuter S , Tobias S , Patel R , Deluca N , Hood J , Sawadogo S , Chen C , Muadinohamba A , Lowrance DW , Bock N . Sex Transm Dis 2016 43 (11) 698-705 Background Identifying and treating genital infections, including sexually transmitted infections (STI), among newly diagnosed human immunodeficiency virus (HIV)-infected individuals may benefit both public and individual health. We assessed prevalence of genital infections and their correlates among newly diagnosed HIV-infected individuals enrolling in HIV care services in Namibia. Methods Newly diagnosed HIV-infected adults entering HIV care at 2 health facilities in Windhoek, Namibia, were recruited from December 2012 to March 2014. Participants provided behavioral and clinical data including CD4+ T lymphocyte counts. Genital and blood specimens were tested for gonorrhea, Chlamydia, trichomoniasis, Mycoplasma genitalium, syphilis, bacterial vaginosis, and vulvovaginal candidiasis. Results Among 599 adults, 56% were women and 15% reported consistent use of condoms in the past 6 months. The most common infections were bacterial vaginosis (37.2%), trichomoniasis (34.6%) and Chlamydia (14.6%) in women and M. genitalium (11.4%) in men. Correlates for trichomoniasis included being female (adjusted relative risk, [aRR], 7.18; 95% confidence interval [CI], 4.07-12.65), higher education (aRR, 0.58; 95% CI, 0.38-0.89), and lower CD4 cell count (aRR, 1.61; 95% CI, 1.08-2.40). Being female (aRR, 2.39; 95% CI, 1.27-4.50), nonmarried (aRR, 2.30; (95% CI, 1.28-4.14), and having condomless sex (aRR, 2.72; 95% CI, 1.06-7.00) were independently associated with chlamydial infection. Across all infections, female (aRR, 2.31; 95% CI, 1.79-2.98), nonmarried participants (aRR, 1.29; 95% CI, 1.06-1.59), had higher risk to present with any STI, whereas pregnant women (aRR, 1.16, 95% CI 1.03-1.31) were at increased risk of any STI or reproductive tract infection. |
Epidemiological and molecular investigation of a rubella outbreak, Romania, 2011 to 2012
Lazar M , Abernathy E , Chen M , Icenogle J , Janta D , Stanescu A , Pistol A , Santibanez S , Mankertz A , Hubschen JM , Mihaescu G , Necula G , Lupulescu E . Euro Surveill 2016 21 (38) 30345 We describe a rubella outbreak that occurred in Romania between September 2011 and December 2012. During this period 24,627 rubella cases, 41.1% (n=10,134) of which female, were notified based on clinical criteria, and a total of 6,182 individuals were found serologically positive for IgM-specific rubella antibody. The median age of notified cases was 18 years (range: <1-65) and the most affected age group 15 to 19 years (n=16,245 cases). Of all notified cases, 24,067 cases (97.7%) reported no history of vaccination. Phylogenetic analysis of 19 sequences (739 nucleotides each), from 10 districts of the country revealed that the outbreak was caused by two distinct rubella virus strains of genotype 2B, which co-circulated with both temporal and geographical overlap. In addition to the 6,182 IgM-positive rubella cases, 28 cases of congenital rubella syndrome (CRS) were identified, including 11 neonatal deaths and one stillbirth. The outbreak underscores the need to encourage higher vaccination uptake in the population, particularly in women of reproductive age, and to strengthen epidemiological and laboratory investigations of suspected rubella cases. Genetic characterisation of wild-type rubella virus is an essential component to enhance surveillance and here we report rubella virus sequences from Romania. |
Estimated prevalence of cryptococcus antigenemia (CrAg) among HIV-infected adults with advanced immunosuppression in Namibia justifies routine screening and preemptive treatment
Sawadogo S , Makumbi B , Purfield A , Ndjavera C , Mutandi G , Maher A , Kaindjee-Tjituka F , Kaplan JE , Park BJ , Lowrance DW . PLoS One 2016 11 (10) e0161830 BACKGROUND: Cryptococcal meningitis is common and associated with high mortality among HIV infected persons. The World Health Organization recommends that routine Cryptococcal antigen (CrAg) screening in ART-naive adults with a CD4+ count <100 cells/muL followed by pre-emptive antifungal therapy for CrAg-positive patients be considered where CrAg prevalence is ≥3%. The prevalence of CrAg among HIV adults in Namibia is unknown. We estimated CrAg prevalence among HIV-infected adults receiving care in Namibia for the purpose of informing routine screening strategies. METHODS: The study design was cross-sectional. De-identified plasma specimens collected for routine CD4+ testing from HIV-infected adults enrolled in HIV care at 181 public health facilities from November 2013 to January 2014 were identified at the national reference laboratory. Remnant plasma from specimens with CD4+ counts <200 cells/muL were sampled and tested for CrAg using the IMMY(R) Lateral Flow Assay. CrAg prevalence was estimated and assessed for associations with age, sex, and CD4+ count. RESULTS: A total of 825 specimens were tested for CrAg. The median (IQR) age of patients from whom specimens were collected was 38 (32-46) years, 45.9% were female and 62.9% of the specimens had CD4 <100 cells/muL. CrAg prevalence was 3.3% overall and 3.9% and 2.3% among samples with CD4+ counts of CD4+<100 cells/muL and 100-200 cells/muL, respectively. CrAg positivity was significantly higher among patients with CD4+ cells/muL < 50 (7.2%, P = 0.001) relative to those with CD4 cells/muL 50-200 (2.2%). CONCLUSION: This is the first study to estimate CrAg prevalence among HIV-infected patients in Namibia. CrAg prevalence of ≥3.0% among patients with CD4+<100 cells/muL justifies routine CrAg screening and preemptive treatment among HIV-infected in Namibia in line with WHO recommendations. Patients with CD4+<100 cells/muL have a significantly greater risk for CrAg positivity. Revised guidelines for ART in Namibia now recommend routine screening for CrAg. |
Evaluation of knowledge and practices regarding cholera, water treatment, hygiene, and sanitation before and after an oral cholera vaccination campaign-Haiti, 2013-2014
Childs L , Francois J , Choudhury A , Wannemuehler K , Dismer A , Hyde TB , Yen CY , Date KA , Juin S , Katz MA , Kantor EF , Routh J , Etheart M , Wright T , Adrien P , Tohme RA . Am J Trop Med Hyg 2016 95 (6) 1305-1313 In 2013, the Government of Haiti implemented its first oral cholera vaccine (OCV) campaign in Petite Anse, an urban setting, and Cerca Carvajal, a rural commune. We conducted and compared responses to two independent cross-sectional knowledge and practices household surveys pre- (N = 297) and post- (N = 302) OCV campaign in Petite Anse. No significant differences in knowledge about causes, symptoms, and prevention of cholera were noted. Compared with precampaign respondents, fewer postcampaign respondents reported treating (66% versus 27%, P < 0.001) and covering (96% versus 89%, P = 0.02) their drinking water. Compared with precampaign, postcampaign survey household observations showed increased availability of soap (16.2% versus 34.5%, P = 0.001) and handwashing stations (14.7% versus 30.1%, P = 0.01), but no significant changes in handwashing practices were reported. Although there was no change in knowledge, significant decreases in water treatment practices necessary for cholera and other diarrheal diseases prevention were noted in the postcampaign survey. Future OCV campaigns in Haiti should be used as an opportunity to emphasize the importance of maintaining good water, sanitation, and hygiene practices, and include a comprehensive, integrated approach for cholera control. |
Exposures among MERS case-patients, Saudi Arabia, January-February 2016
Alhakeem RF , Midgley CM , Assiri AM , Alessa M , Al Hawaj H , Saeed AB , Almasri MM , Lu X , Abedi GR , Abdalla O , Mohammed M , Algarni HS , Al-Abdely HM , Alsharef AA , Nooh R , Erdman DD , Gerber SI , Watson JT . Emerg Infect Dis 2016 22 (11) 2020-2022 Risk factors for primary acquisition of Middle East respiratory syndrome (MERS) coronavirus (CoV) include recent direct contact with dromedary camels (1), but secondary transmission, associated with healthcare settings (2–4) or household contact (5), accounts for most reported cases. Because persons with MERS often do not report any of these risk factors, we investigated MERS cases in Saudi Arabia during an apparent period of limited hospital transmission. Through telephone interviews of case-patients and information from routine investigations, we aimed to characterize exposures and to explore additional factors potentially important in disease transmission. We also genetically sequenced MERS-CoV from respiratory specimens to identify circulating strains. | For confirmed MERS cases (6) reported in Saudi Arabia during January–February 2016, we assessed exposures during the 2 weeks before illness onset (exposure period), including direct (1) and indirect camel contact; indirect contact was defined as 1) having visited settings where camels were kept but without having direct contact or 2) exposure to friends or household members who themselves had direct camel exposure (1). We assessed whether case-patients had worked at, visited, or been admitted to a healthcare setting or had contact with a person known to have MERS during the case-patient’s exposure period. We also asked about recent travel and if any household members were healthcare personnel. For persons too ill to participate or deceased, we interviewed relatives or close friends. |
Gonorrhea control, United States, 1972–2015, a narrative review
Peterman TA , O’Connor K , Bradley HM , Torrone EA , Bernstein KT . Sex Transm Dis 2016 43 (12) 725-730 ABSTRACT: Gonorrhea is the second most commonly reported infection. It can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. Rates of gonorrhea decreased after the National Gonorrhea Control Program began in 1972, but stabilized in the mid 1990s. The emergence of antimicrobial resistant strains increases the urgency for enhanced gonorrhea control efforts. To identify possible approaches for improving gonorrhea control, we reviewed historic protocols, reports, and other documents related to the activities of the National Gonorrhea Control Program using Centers for Disease Control and Prevention records and the published literature. The Program was a massive effort that annually tested up to 9.3 million women, and treated up to 85,000 infected partners and 100,000 additional exposed partners. Reported gonorrhea rates fell by 74% between 1976 and 1996, then stabilized. Testing positivity was 1.6–4.2% in different settings in 1976. In 1999–2008, the test positivity of a random sample of 14- to 25-year-olds was 0.4%. Gonorrhea testing rates remain high, however, partner notification efforts decreased in the 1990s as attention shifted to human immunodeficiency virus and other sexually transmitted diseases. The decrease and subsequent stabilization of gonorrhea rates was likely also influenced by changes in behavior, such as increases in condom use in response to acquired immune deficiency syndrome. Renewed emphasis on partner treatment might lead to further decreases in rates of gonorrhea. |
How underestimates of need contribute to biased conclusions
Ford CL , Mulatu MS , Gaines TL , Godette DC . Sex Transm Dis 2016 43 (11) 696-697 We thank Klein1 for discussing human immunodeficiency virus (HIV) testing among older adults, whom we define for the purposes of routine HIV testing as persons ages 50–64 years. Citing the U.S. Preventive Services Taskforce (USPSTF) guidelines2, Klein suggests routine HIV testing is not warranted among older adults as their relatively low rates of HIV infection render it an inefficient use of resources. Neither those guidelines nor CDC’s 2006 HIV testing recommendations3 prescriptively defines what time periods constitute “routine” for healthcare visits or HIV tests; we4 use “the last 12 months” as a proxy for an annual primary care visit and opportunity to test. We respectfully disagree with Klein on several assertions, including that providers must document HIV prevalence prior to implementing routine HIV testing. The recommendations explicitly state the opposite: “Health-care providers should initiate screening unless prevalence of undiagnosed HIV infection in their patients has been documented to be <0.1%. In the absence of existing data for HIV prevalence, health-care providers should initiate voluntary HIV screening until they establish that the diagnostic yield is <1 per 1,000 patients screened.3 (p.7)” This letter focuses on two of our concerns: Klein (1) underestimates the need for HIV testing among older adults and (2) does not consider issues of equity. The resulting conclusion about the appropriateness of HIV testing is biased downwards. |
Key ethical issues discussed at CDC-sponsored international, regional meetings to explore cultural perspectives and contexts on pandemic influenza preparedness and response
Lor A , Thomas JC , Barrett DH , Ortmann LW , Herrera Guibert DJ . Int J Health Policy Manag 2016 5 (11) 653-662 BACKGROUND: Recognizing the importance of having a broad exploration of how cultural perspectives may shape thinking about ethical considerations, the Centers for Disease Control and Prevention (CDC) funded four regional meetings in Africa, Asia, Latin America, and the Eastern Mediterranean to explore these perspectives relevant to pandemic influenza preparedness and response. The meetings were attended by 168 health professionals, scientists, academics, ethicists, religious leaders, and other community members representing 40 countries in these regions. METHODS: We reviewed the meeting reports, notes and stories and mapped outcomes to the key ethical challenges for pandemic influenza response described in the World Health Organization's (WHO's) guidance, Ethical Considerations in Developing a Public Health Response to Pandemic Influenza: transparency and public engagement, allocation of resources, social distancing, obligations to and of healthcare workers, and international collaboration. RESULTS: The important role of transparency and public engagement were widely accepted among participants. However, there was general agreement that no "one size fits all" approach to allocating resources can address the variety of economic, cultural and other contextual factors that must be taken into account. The importance of social distancing as a tool to limit disease transmission was also recognized, but the difficulties associated with this measure were acknowledged. There was agreement that healthcare workers often have competing obligations and that government has a responsibility to assist healthcare workers in doing their job by providing appropriate training and equipment. Finally, there was agreement about the importance of international collaboration for combating global health threats. CONCLUSION: Although some cultural differences in the values that frame pandemic preparedness and response efforts were observed, participants generally agreed on the key ethical principles discussed in the WHO's guidance. Most significantly the input gathered from these regional meetings pointed to the important role that procedural ethics can play in bringing people and countries together to respond to the shared health threat posed by a pandemic influenza despite the existence of cultural differences. |
Community-acquired bacterial meningitis
van de Beek D , Brouwer M , Hasbun R , Koedel U , Whitney CG , Wijdicks E . Nat Rev Dis Primers 2016 2 16074 Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. It can be acquired spontaneously in the community - community-acquired bacterial meningitis - or in the hospital as a complication of invasive procedures or head trauma (nosocomial bacterial meningitis). Despite advances in treatment and vaccinations, community-acquired bacterial meningitis remains one of the most important infectious diseases worldwide. Streptococcus pneumoniae and Neisseria meningitidis are the most common causative bacteria and are associated with high mortality and morbidity; vaccines targeting these organisms, which have designs similar to the successful vaccine that targets Haemophilus influenzae type b meningitis, are now being used in many routine vaccination programmes. Experimental and genetic association studies have increased our knowledge about the pathogenesis of bacterial meningitis. Early antibiotic treatment improves the outcome, but the growing emergence of drug resistance as well as shifts in the distribution of serotypes and groups are fuelling further development of new vaccines and treatment strategies. Corticosteroids were found to be beneficial in high-income countries depending on the bacterial species. Further improvements in the outcome are likely to come from dampening the host inflammatory response and implementing preventive measures, especially the development of new vaccines. |
Identification of Blood Meals from Potential Arbovirus Mosquito Vectors in the Peruvian Amazon Basin.
Palermo PM , Aguilar PV , Sanchez JF , Zorrilla V , Flores-Mendoza C , Huayanay A , Guevara C , Lescano AG , Halsey ES . Am J Trop Med Hyg 2016 95 (5) 1026-1030 The transmission dynamics of many arboviruses in the Amazon Basin region have not been fully elucidated, including the vectors and natural reservoir hosts. Identification of blood meal sources in field-caught mosquitoes could yield information for identifying potential arbovirus vertebrate hosts. We identified blood meal sources in 131 mosquitoes collected from areas endemic for arboviruses in the Peruvian Department of Loreto by sequencing polymerase chain reaction amplicons of the cytochrome b gene. Psorophora (Janthinosoma) albigenu, Psorophora (Grabhamia) cingulata, Mansonia humeralis, Anopheles oswaldoi s.l., and Anopheles benarrochi s.l. had mainly anthropophilic feeding preferences; Aedes (Ochlerotatus) serratus, and Aedes (Ochlerotatus) fulvus had feeding preferences for peridomestic animals; and Culex (Melanoconion) spp. fed on a variety of vertebrates, mainly rodents (spiny rats), birds, and amphibians. On the basis of these feeding preferences, many mosquitoes could be considered as potential enzootic and bridge arbovirus vectors in the Amazon Basin of Peru. |
High-precision (MC-ICPMS) isotope ratio analysis reveals contrasting sources of elevated blood lead levels of an adult with retained bullet fragments, and of his child, in Milwaukee, Wisconsin
Smith KE , Shafer MM , Weiss D , Anderson HA , Gorski PR . Biol Trace Elem Res 2016 177 (1) 33-42 Exposure to the neurotoxic element lead (Pb) continues to be a major human health concern, particularly for children in US urban settings, and the need for robust tools for assessment of exposure sources has never been greater. The latest generation of multicollector inductively coupled plasma mass spectrometry (MC-ICPMS) instrumentation offers the capability of using Pb isotopic signatures as a tool for environmental source tracking in public health. We present a case where MC-ICPMS was applied to isotopically resolve Pb sources in human clinical samples. An adult male and his child residing in Milwaukee, Wisconsin, presented to care in August 2015 with elevated blood lead levels (BLLs) (>200 mug/dL for the adult and 10 mug/dL for the child). The adult subject is a gunshot victim who had multiple bullet fragments embedded in soft tissue of his thigh for approximately 10 years. This study compared the high-precision isotopic fingerprints (<1 per thousand 2sigma external precision) of Pb in the adult's and child's whole blood (WB) to the following possible Pb sources: a surgically extracted bullet fragment, household paint samples and tap water, and a Pb water-distribution pipe removed from servicing a house in the same neighborhood. Pb in the bullet and adult WB were nearly isotopically indistinguishable (matching within 0.05-0.56 per thousand), indicating that bullet fragments embedded in soft tissue could be the cause of both acute and chronic elevated blood Pb levels. Among other sources investigated, no single source dominated the child's exposure profile as reflected in the elevated BLL. |
Complete Genome Sequence of Human Norovirus Strain GII.P7-GII.6 Detected in a Patient in the United States in 2014.
Yang Z , Vinje J , Elkins CA , Kulka M . Genome Announc 2016 4 (5) Homologous recombination is one of the driving forces contributing to the genetic variation of human norovirus, which is an important cause of sporadic and epidemic acute gastroenteritis globally. We report the near-complete genome of the novel recombinant norovirus strain GII.P7-GII.6, detected in an adult with norovirus gastroenteritis in the United States. |
Complete Genome Sequences of Four Different Bordetella sp. Isolates Causing Human Respiratory Infections.
Weigand MR , Peng Y , Loparev V , Batra D , Bowden KE , Cassiday PK , Davis JK , Johnson T , Juieng P , Miner CE , Rowe L , Sheth M , Tondella ML , Williams MM . Genome Announc 2016 4 (5) Species of the genus Bordetella associate with various animal hosts, frequently causing respiratory disease. Bordetella pertussis is the primary agent of whooping cough and other Bordetella species can cause similar cough illness. Here, we report four complete genome sequences from isolates of different Bordetella species recovered from human respiratory infections. |
Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries
Tangka FK , Subramanian S , Edwards P , Cole-Beebe M , Parkin DM , Bray F , Joseph R , Mery L , Saraiya M . Cancer Epidemiol 2016 45 Suppl 1 S50-S58 BACKGROUND: The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. METHODS: Using the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). RESULTS: Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. CONCLUSION: This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings. |
20 Years of public health economics and decision sciences at the US Centers for Disease Control and Prevention: The CDC Steven M. Teutsch Prevention Effectiveness Fellowship, 1995-2015
Skelton AG , Meltzer MI . J Public Health Manag Pract 2016 23 (4) e14-e21 The CDC Steven M. Teutsch Prevention Effectiveness Fellowship was started in 1995 to provide postdoctoral training in public health economics. This article describes the origins and state of the fellowship and the practice of prevention effectiveness research at the Centers for Disease Control and Prevention. The fellowship can be seen as one successful example of a demand-driven public health innovation to develop crucial capacity for the contemporary health system. Nearly 150 individuals have been trained through the program since its inception. |
Risk factors for Middle East respiratory syndrome coronavirus infection among healthcare personnel
Alraddadi BM , Al-Salmi HS , Jacobs-Slifka K , Slayton RB , Estivariz CF , Geller AI , Al-Turkistani HH , Al-Rehily SS , Alserehi HA , Wali GY , Alshukairi AN , Azhar EI , Haynes L , Swerdlow DL , Jernigan JA , Madani TA . Emerg Infect Dis 2016 22 (11) 1915-1920 Healthcare settings can amplify transmission of Middle East respiratory syndrome coronavirus (MERS-CoV), but knowledge gaps about the epidemiology of transmission remain. We conducted a retrospective cohort study among healthcare personnel in hospital units that treated MERS-CoV patients. Participants were interviewed about exposures to MERS-CoV patients, use of personal protective equipment, and signs and symptoms of illness after exposure. Infection status was determined by the presence of antibodies against MERS-CoV. To assess risk factors, we compared infected and uninfected participants. Healthcare personnel caring for MERS-CoV patients were at high risk for infection, but infection most often resulted in a relatively mild illness that might be unrecognized. In the healthcare personnel cohort reported here, infections occurred exclusively among those who had close contact with MERS-CoV patients. |
Prevalence of immunosuppression among US adults, 2013
Harpaz R , Dahl RM , Dooling KL . JAMA 2016 316 (23) 2547-2548 The number of immunosuppressed adults in the United States is unknown but thought to be increasing because of both greater life expectancy among immunosuppressed adults due to improvements in medical management, as well as new indications for immunosuppressive treatments.1-4 Immunosuppression increases the risks and severity of primary or reactivation infections; its prevalence has implications for food and water safety, tuberculosis control, vaccine programs, infection control strategies, outbreak preparedness, travel medicine, and other facets of public health.1 We present data on the prevalence of self-reported immunosuppressed adults in the United States. |
Refusal of recommended travel-related vaccines among U.S. international travellers in Global TravEpiNet
Lammert SM , Rao SR , Jentes ES , Fairley JK , Erskine S , Walker AT , Hagmann SH , Sotir MJ , Ryan ET , LaRocque RC . J Travel Med 2016 24 (1) BACKGROUND: International travellers are at risk of travel-related, vaccine-preventable diseases. More data are needed on the proportion of travellers who refuse vaccines during a pre-travel health consultation and their reasons for refusing vaccines. METHODS: We analyzed data on travellers seen for a pre-travel health consultation from July 2012 through June 2014 in the Global TravEpiNet (GTEN) consortium. Providers were required to indicate one of three reasons for a traveller refusing a recommended vaccine: (1) cost concerns, (2) safety concerns or (3) not concerned with the illness. We calculated refusal rates among travellers eligible for each vaccine based on CDC recommendations current at the time of travel. We used multivariable logistic regression models to examine the effect of individual variables on the likelihood of accepting all recommended vaccines. RESULTS: Of 24 478 travellers, 23 768 (97%) were eligible for at least one vaccine. Travellers were most frequently eligible for typhoid (N = 20 092), hepatitis A (N = 12 990) and influenza vaccines (N = 10 539). Of 23 768 eligible travellers, 6573 (25%) refused one or more recommended vaccine(s). Of those eligible, more than one-third refused the following vaccines: meningococcal: 2232 (44%) of 5029; rabies: 1155 (44%) of 2650; Japanese encephalitis: 761 (41%) of 1846; and influenza: 3527 (33%) of 10 539. The most common reason for declining vaccines was that the traveller was not concerned about the illness. In multivariable analysis, travellers visiting friends and relatives (VFR) in low or medium human development countries were less likely to accept all recommended vaccines, compared with non-VFR travellers (OR = 0.74 (0.59-0.95)). CONCLUSIONS: Travellers who sought pre-travel health care refused recommended vaccines at varying rates. A lack of concern about the associated illness was the most commonly cited reason for all refused vaccines. Our data suggest more effective education about disease risk is needed for international travellers, even those who seek pre-travel advice. |
Supporting human papillomavirus vaccination in adolescents: Perspectives from commercial and Medicaid health plans
Ng JH , Sobel K , Roth L , Byron SC , Lindley MC , Stokley S . J Public Health Manag Pract 2016 23 (3) 283-290 CONTEXT: An estimated 79 million Americans are infected with human papillomavirus (HPV). Vaccination can reduce the burden of infection and HPV-associated cancers; yet, vaccination rates remain low. Little is known about why some health plans achieve higher vaccination rates. OBJECTIVE: This study sought to identify strategies used by higher-performing health plans to support HPV vaccination. DESIGN: We used 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS) Human Papillomavirus Vaccine for Female Adolescents measure to identify high-performing plans. The measure examines the percentage of female adolescent plan members who received 3 doses of HPV vaccine by their 13th birthday. High performers were defined as the subset of commercial plans with the top 10 rates and the subset of Medicaid plans with the top 10 rates. An interview guide was developed to assess activities related to providing HPV vaccination. Interviews were conducted with selected plans and audio-recorded. Transcripts were reviewed independently by 2 interviewers and analyzed by hand to identify key themes. PARTICIPANTS: Staff members representing 10 plans agreed to be interviewed, representing a diversity of plan size (range, 5500 to >2.7 million members); plan type (about half were commercial, half were Medicaid plans); patient population, from predominantly white to predominantly nonwhite; and geographic region. RESULTS: Plans Participants highlighted multiple strategies that support HPV vaccination, particularly the "normalizing" of the vaccine. Plans' efforts highlighted patient and provider education, reminders, feedback loops, community collaborations, immunization registries, and use of medical home concepts-including team-driven efforts and coordination. IMPLICATIONS: There is an important need to improve the uptake of HPV vaccination. As health coverage expands to more organizations and individuals, it will be critical for health plans to consider the strategies implemented by higher-performing organizations. CONCLUSION: Although HPV immunization rates are low nationally, health plans can employ multiple efforts to encourage vaccination by implementing activities that involve the patient, the provider, and the community. |
Tdap vaccination during pregnancy and microcephaly and other structural birth defects in offspring
DeSilva M , Vazquez-Benitez G , Nordin JD , Lipkind HS , Romitti PA , DeStefano F , Kharbanda EO . JAMA 2016 316 (17) 1823-1825 In 2012, the US Advisory Committee on Immunization Practices recommended tetanus, diphtheria, and acellular pertussis (Tdap) vaccine be administered during every pregnancy, ideally between 27 and 36 weeks’ gestation.1 Previously, Tdap was recommended for unvaccinated pregnant women since 2010 in California and since 2011 across the United States. | Cases of microcephaly in Brazil increased substantially during 2015, likely associated with maternal Zika virus infections. However, these cases overlapped with the November 2014 initiation of Brazil’s maternal Tdap program.2 Previous small observational studies reported no increased risks for birth defects following maternal Tdap vaccination; none focused on microcephaly.3 This large study examined associations between maternal Tdap vaccination and structural birth defects, including microcephaly, in offspring. |
Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication
Frew PM , Chung Y , Fisher AK , Schamel J , Basket MM . Vaccine 2016 34 (48) 5840-5844 OBJECTIVE: We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions. METHODS: We conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility. RESULTS: Most parents received a VIS (77.2%; [95% CI: 74.5-79.7%]), 59.7% [56.6-62.7%] before vaccination but 14.5% [12.5-16.8%] reported receiving it after their child's immunization; 15.1% [13.0-17.6%] were unsure of receipt status or timing; another 10.7% [9.0-12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8-97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions. CONCLUSIONS: Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication. |
Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries
Kobayashi M , Vekemans J , Baker CJ , Ratner AJ , Le Doare K , Schrag SJ . F1000Res 2016 5 2355 Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations. |
Hospital-based surveillance for Rotavirus gastroenteritis among young children in Bangladesh: defining the potential impact of a rotavirus vaccine program
Satter S , Gastanaduy P , Islam K , Rahman M , Rahman M , Luby S , Heffelfinger J , Parashar U , Gurley E . Pediatr Infect Dis J 2016 36 (2) 168-172 BACKGROUND: In anticipation of introduction of a rotavirus vaccine into the national immunization program of Bangladesh, active hospital-based surveillance was initiated to provide pre-vaccine baseline data on rotavirus disease. METHODS: Children 5 years of age and younger admitted with acute gastroenteritis (AGE) (≥3 watery or looser-than-normal stools or ≥1 episode of forceful vomiting) at 7 hospitals throughout Bangladesh were identified. Clinical information and stool specimens were collected from every 4th patient. Specimens were tested for rotavirus antigen by enzyme immunoassays; 25% of detected rotaviruses were genotyped. RESULTS: From July 2012-June 2015, rotavirus was detected in 2,432 (64%) of 3,783 children hospitalized for AGE. Eight enrolled children died, including 4 (50%) who were rotavirus positive. Rotavirus was detected year-round in Bangladesh with peak detection rates of >80% during November-February. Most (86%) rotavirus AGE cases were 6-23 months of age. Sixty-nine percent of children with rotavirus had severe disease (Vesikari score ≥11). Among 543 strains genotyped, G1P[8] (31%) and G12P[8] (29%) were the most common. CONCLUSIONS: Rotavirus is a major cause of morbidity in Bangladeshi children, accounting for nearly two-thirds of AGE hospitalizations. These data highlight the potential value of rotavirus vaccination in Bangladesh, and will be key for future measurement of vaccine impact. |
Physician opinions about EHR use by EHR experience and by whether the practice had optimized its EHR use
Jamoom EW , Heisey-Grove D , Yang N , Scanlon P . J Health Med Inform 2016 7 (4) 1000240 Optimization and experience with using EHRs may improve physician experiences. Physician opinions about EHR-related impacts, and the extent to which these impacts differ by self-reported optimized EHR use and length of experience are examined through nationally representative physician data of EHR users from the National Electronic Health Records Survey extended survey (n=1,471). Logistic regression models first estimated how physicians' length of times using an EHR were associated with each EHR-related impact. Additionally, a similar set of models estimated the association of self-reported optimized EHR use with each EHR impact. At least 70% of physicians using EHRs continue to attribute their administrative burdens to their EHR use. Physicians with 4 or more years of EHR experience accounted for 58% of those using EHRs. About 71% of EHR users self-reported using an optimized EHR. Physicians with more EHR experience and those in practices that optimized EHR use had positive opinions about the impacts of using EHRs, compared to their counterparts. These findings suggest that longer experience with EHRs improves perceptions about EHR use; and that perceived EHR use optimization is crucial to identifying EHR-related benefits. Finding ways to reduce EHR-related administrative burden has yet to be addressed. |
Violent experiences in childhood are associated with men's perpetration of intimate partner violence as a young adult: a multistage cluster survey in Malawi
VanderEnde K , Mercy J , Shawa M , Kalanda M , Hamela J , Maksud N , Ross B , Gupta S , Wadonda-Kabondo N , Hillis S . Ann Epidemiol 2016 26 (10) 723-728 PURPOSE: To examine the association between exposures to violence in childhood, including exposure to multiple forms of violence, with young men's perpetration of intimate partner violence (IPV) in Malawi. METHODS: We analyzed data from 450 ever-partnered 18- to 24-year-old men interviewed in the Malawi Violence Against Children and Young Woman Survey, a nationally representative, multistage cluster survey conducted in 2013. We estimated the weighted prevalence for perpetration of physical and/or sexual IPV and retrospective reporting of experiences of violence in childhood and examined the associations between childhood experiences of violence and perpetration of IPV using logistic regression. RESULTS: Among young men in Malawi, lifetime prevalence for perpetration of sexual IPV (24%) was higher than for perpetration of physical IPV (9%). In logistic regression analyses, the adjusted odds ratios for perpetration of sexual IPV increased in a statistically significant gradient fashion, from 1.2 to 1.4 to 3.7 to 4.3 for young men with exposures to one, two, three, and four or more forms of violence in childhood, respectively. CONCLUSIONS: Among young men in Malawi, exposure to violence in childhood is associated with an increased odds of perpetrating IPV, highlighting the need for programs and policies aimed at interrupting the intergenerational transmission of violence. |
Bicycle helmet use among persons 5 years and older in the United States, 2012
Jewett A , Beck LF , Taylor C , Baldwin G . J Safety Res 2016 59 1-7 Introduction In 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States. Method CDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18+years) were asked about bicycle riding and helmet use in the last 30days for themselves and their children (5 to 17years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use. Results Among adults, 21% rode bicycles within the past 30days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%). Conclusions Despite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding. Practical application States and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14. |
A Pyrosequencing-Based Approach to High-Throughput Identification of Influenza A(H3N2) Virus Clades Harboring Antigenic Drift Variants.
Mishin VP , Baranovich T , Garten R , Chesnokov A , Abd Elal AI , Adamczyk M , LaPlante J , George KS , Fry AM , Barnes J , Chester SC , Xu X , Katz JM , Wentworth DE , Gubareva LV . J Clin Microbiol 2016 55 (1) 145-154 Rapid evolution of influenza A(H3N2) viruses necessitates close monitoring of their antigenic properties so emergence and spread of antigenic drift variants can be rapidly identified. Changes in hemagglutinin (HA) acquired by contemporary A(H3N2) viruses hinder antigenic characterization by traditional methods, thus complicating vaccine strain selection. Sequence-based approaches have been used to infer virus antigenicity; however, they are time-consuming and mid-throughput. To facilitate virological surveillance and epidemiological studies, we have developed and validated a pyrosequencing approach that enables identification of six HA clades of contemporary A(H3N2) viruses. The identification scheme of H3 clade 3C.2, 3C.2a, 3C.2b, 3C.3, 3C.3a and 3C.3b viruses is based on the interrogation of five SNPs within three neighboring HA regions: 412-431; 465-481; and 559-571. Two bioinformatics tools, IdentiFire (Qiagen) and FireComb (developed in-house) were utilized to expedite pyrosequencing data analysis. The assay's analytical sensitivity was 10 focus forming units; and respiratory specimens with CT value < 34 typically produced good quality pyrograms. When applied to 120 A(H3N2) virus isolates and 27 respiratory specimens, the assay displayed 100% agreement with clades determined by HA sequencing coupled with phylogenetics. The multi-SNP analysis described here was readily adopted by another laboratory with pyrosequencing capabilities. Implementation of this approach enhanced virological surveillance and epidemiological studies from 2013-2016 when over 3000 A(H3N2) viruses were examined. |
Serology Enhances Molecular Diagnosis of Respiratory Virus Infections Other than Influenza in Children and Adults Hospitalized with Community-Acquired Pneumonia.
Zhang Y , Sakthivel SK , Bramley A , Jain S , Haynes A , Chappell JD , Hymas W , Lenny N , Patel A , Qi C , Ampofo K , Arnold SR , Self WH , Williams DJ , Hillyard D , Anderson EJ , Grijalva CG , Zhu Y , Wunderink RG , Edwards KM , Pavia AT , McCullers JA , Erdman DD . J Clin Microbiol 2016 55 (1) 79-89 Both molecular and serological assays have been used previously to determine the etiology of community-acquired pneumonia (CAP). However, the correlation of these methods and added diagnostic value of serology has not been fully evaluated. Using data from patients enrolled in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, we compared real-time RT-PCR and serology for diagnosis of respiratory syncytial virus (RSV), human metapneumovirus (HMPV), parainfluenza viruses 1-3 (PIV) and adenovirus (AdV) infections. Of 5126 patients enrolled, RT-PCR and serology test results were available for 2023, including 1087 children <18 years of age and 936 adults. For RSV, 287 (14.2%) patients were positive by RT-PCR and 234 (11.6%) were positive by serology; HMPV, 172 (8.5%) tested positive by RT-PCR and 147 (7.3%) by serology; PIVs, 94 (4.6%) tested positive by RT-PCR and 92 (4.6%) by serology; and AdV, 111 (5.5%) positive by RT-PCR and 62 (3.1%) by serology. RT-PCR provided the most positive detections overall, but serology increased diagnostic yield for RSV (by 11.8%), HMPV (by 25.0%), AdV (by 32.4%), and PIV (by 48.9%). Method concordance estimated by Cohen's kappa (kappa) coefficient ranged from good (RSV, 0.73 kappa) to fair (AdV, 0.27 kappa). Heterotypic seroresponses observed between PIV and persistent low-level AdV shedding may account for higher method discordance observed with each of these viruses. Serology can be a helpful adjunct to RT-PCR for research-based assessment of the etiologic contribution of non-influenza respiratory viruses to CAP. |
Use of Transportable Radiation Detection Instruments to Assess Internal Contamination from Intakes of Radionuclides Part II: Calibration Factors and ICAT Computer Program.
Anigstein R , Olsher RH , Loomis DA , Ansari A . Health Phys 2016 111 (6) 542-558 The detonation of a radiological dispersion device or other radiological incidents could result in widespread releases of radioactive materials and intakes of radionuclides by affected individuals. Transportable radiation monitoring instruments could be used to measure radiation from gamma-emitting radionuclides in the body for triaging individuals and assigning priorities to their bioassay samples for in vitro assessments. The present study derived sets of calibration factors for four instruments: the Ludlum Model 44-2 gamma scintillator, a survey meter containing a 2.54 x 2.54-cm NaI(Tl) crystal; the Captus 3000 thyroid uptake probe, which contains a 5.08 x 5.08-cm NaI(Tl) crystal; the Transportable Portal Monitor Model TPM-903B, which contains two 3.81 x 7.62 x 182.9-cm polyvinyltoluene plastic scintillators; and a generic instrument, such as an ionization chamber, that measures exposure rates. The calibration factors enable these instruments to be used for assessing inhaled or ingested intakes of any of four radionuclides: Co, I, Cs, and Ir. The derivations used biokinetic models embodied in the DCAL computer software system developed by the Oak Ridge National Laboratory and Monte Carlo simulations using the MCNPX radiation transport code. The three physical instruments were represented by MCNP models that were developed previously. The affected individuals comprised children of five ages who were represented by the revised Oak Ridge National Laboratory pediatric phantoms, and adult men and adult women represented by the Adult Reference Computational Phantoms described in Publication 110 of the International Commission on Radiological Protection. These calibration factors can be used to calculate intakes; the intakes can be converted to committed doses by the use of tabulated dose coefficients. These calibration factors also constitute input data to the ICAT computer program, an interactive Microsoft Windows-based software package that estimates intakes of radionuclides and cumulative and committed effective doses, based on measurements made with these instruments. This program constitutes a convenient tool for assessing intakes and doses without consulting tabulated calibration factors and dose coefficients. |
Respirable size-selective sampler for end-of-shift quartz measurement: Development and performance
Lee T , Lee L , Cauda E , Hummer J , Harper M . J Occup Environ Hyg 2016 14 (5) 0 Aims of this study were to develop a respirable size-selective sampler for direct-on-filter (DoF) quartz measurement at the end-of-shift (EoS) using a portable Fourier transform infrared (FTIR) spectrometer and to determine its size-selective sampling performance. A new miniaturized sampler has been designed to have an effective particle deposition diameter close to the portable FTIR beam diameter (6-mm). The new sampler (named the EoS cyclone) was constructed using a 3 dimensional printer. The sampling efficiency of the EoS cyclone was determined using polydisperse glass sphere particles and a time-of-flight direct reading instrument. Respirable dust mass concentration and quartz absorbance levels of samples collected with the EoS cyclone were compared to those collected with the 10-mm nylon cyclone. The EoS cyclone operated at a flow rate of 1.2 l min-1 showed minimum bias compared to the international standard respirable convention. The use of the EoS cyclone induced respirable dust mass concentration results similar but significantly larger (5%) than those obtained from samples collected with 10-mm nylon cyclones. The sensitivity of the DoF-FTIR analysis in estimating quartz was found increased more than 10 times when the samples were collected with the EoS cyclone. The average particle deposition diameter was 8.8 mm in sixty samples. The newly developed user friendly EoS cyclone may provide a better sampling strategy in quartz exposure assessment with faster feedback. |
Serological responses to filarial antigens in Malian children attending elementary schools
Moss DM , Chard AN , Trinies V , Doumbia S , Freeman MC , Lammie PJ . Am J Trop Med Hyg 2016 96 (1) 229-232 Dried blood spots (DBS) were collected from 805 children attending 42 elementary schools in the regions of Mopti, Sikasso, Koulikoro, and the regional capital of Bamako in Mali as part of an evaluation of a school health intervention. Eluted immunoglobulin (Ig) G from the DBS was assessed by a multiplex bead assay (MBA) for two filariasis antigens, Wuchereria bancrofti, Wb123, and Brugia malayi, Bm14, to determine the effectiveness of mass drug administration (MDA) programs to eliminate lymphatic filariasis (LF). The prevalence of positive IgG responses in the children to each antigen was less than 1%, indicating effectiveness of the MDA against LF. The MBA is an excellent serological platform that provides cost-effective opportunities to evaluate public health activities beyond the survey targets. |
Quantification of urinary mono-hydroxylated metabolites of polycyclic aromatic hydrocarbons by on-line solid phase extraction-high performance liquid chromatography-tandem mass spectrometry
Wang Y , Meng L , Pittman EN , Etheredge A , Hubbard K , Trinidad DA , Kato K , Ye X , Calafat AM . Anal Bioanal Chem 2016 409 (4) 931-937 Human exposure to polycyclic aromatic hydrocarbons (PAHs) can be assessed through monitoring of urinary mono-hydroxylated PAHs (OH-PAHs). Gas chromatography (GC) has been widely used to separate OH-PAHs before quantification by mass spectrometry in biomonitoring studies. However, because GC requires derivatization, it can be time consuming. We developed an on-line solid phase extraction coupled to isotope dilution-high performance liquid chromatography-tandem mass spectrometry (on-line-SPE-HPLC-MS/MS) method for the quantification in urine of 1-OH-naphthalene, 2-OH-naphthalene, 2-OH-fluorene, 3-OH-fluorene, 1-OH-phenanthrene, the sum of 2-OH and 3-OH-phenanthrene, 4-OH-phenanthrene, and 1-OH-pyrene. The method, which employed a 96-well plate platform and on-line SPE, showed good sensitivity (i.e., limits of detection ranged from 0.007 to 0.09 ng/mL) and used only 100 muL of urine. Accuracy, calculated from the recovery percentage at three spiking levels, varied from 94 to 113 %, depending on the analyte. The inter- and intra-day precision, calculated from 20 repeated measurements of two quality control materials, varied from 5.2 to 16.7 %. Adequate method performance was also confirmed by acceptable recovery (83-102 %) of two NIST standard reference materials (3672 and 3673). This high-throughput on-line-SPE-HPLC-MS/MS method can be applied in large-scale epidemiological studies. Graphical abstract Example LC-MS chromatogram of urinary mono-hydroxylated PAH metabolites. |
Evaluation of smartphone sound measurement applications (apps) using external microphones-A follow-up study
Kardous CA , Shaw PB . J Acoust Soc Am 2016 140 (4) El327 This follow-up study examines the accuracy of selected smartphone sound measurement applications (apps) using external calibrated microphones. The initial study examined 192 apps on the iOS and Android platforms and found four iOS apps with mean differences of +/-2 dB of a reference sound level measurement system. This study evaluated the same four apps using external microphones. The results showed measurements within +/-1 dB of the reference. This study suggests that using external calibrated microphones greatly improves the overall accuracy and precision of smartphone sound measurements, and removes much of the variability and limitations associated with the built-in smartphone microphones. |
Glycosylation changes in the globular head of H3N2 influenza hemagglutinin modulate receptor binding without affecting virus virulence
Alymova IV , York IA , Air GM , Cipollo JF , Gulati S , Baranovich T , Kumar A , Zeng H , Gansebom S , McCullers JA . Sci Rep 2016 6 36216 Since the emergence of human H3N2 influenza A viruses in the pandemic of 1968, these viruses have become established as strains of moderate severity. A decline in virulence has been accompanied by glycan accumulation on the hemagglutinin globular head, and hemagglutinin receptor binding has changed from recognition of a broad spectrum of glycan receptors to a narrower spectrum. The relationship between increased glycosylation, binding changes, and reduction in H3N2 virulence is not clear. We evaluated the effect of hemagglutinin glycosylation on receptor binding and virulence of engineered H3N2 viruses. We demonstrate that low-binding virus is as virulent as higher binding counterparts, suggesting that H3N2 infection does not require either recognition of a wide variety of, or high avidity binding to, receptors. Among the few glycans recognized with low-binding virus, there were two structures that were bound by the vast majority of H3N2 viruses isolated between 1968 and 2012. We suggest that these two structures support physiologically relevant binding of H3N2 hemagglutinin and that this physiologically relevant binding has not changed since the 1968 pandemic. Therefore binding changes did not contribute to reduced severity of seasonal H3N2 viruses. This work will help direct the search for factors enhancing influenza virulence. |
Improved detection of respiratory pathogens using high-quality sputum with TaqMan Array Card technology
Wolff BJ , Bramley AM , Thurman KA , Whitney CG , Whitaker B , Self WH , Arnold SR , Trabue C , Wunderink RG , McCullers J , Edwards KM , Jain S , Winchell JM . J Clin Microbiol 2016 55 (1) 110-121 New diagnostic platforms often use naso- or oropharyngeal (NP/OP) swabs for pathogen detection for patients hospitalized with community-acquired pneumonia (CAP). We applied multi-pathogen testing to high-quality sputum specimens to determine if more pathogens could be identified relative to NP/OP swabs. Children (<18 years old) and adults hospitalized with CAP were enrolled over 2.5 years through the Etiology of Pneumonia in the Community (EPIC) study. NP/OP specimens with matching high-quality sputum (defined as ≤10 epithelial cells/low power field [lpf] and ≥25 white blood cells/lpf or a q-score definition of 2+) were tested by TaqMan Array Card (TAC), a multi-pathogen real-time polymerase chain reaction (PCR) detection platform. Among 236 patients with matched specimens, a higher proportion of sputum specimens had ≥1 pathogen detected compared with NP/OP specimens in children (93% v. 68%, P<0.0001) and adults (88% v. 61%; P<0.0001); for each pathogen targeted, crossing threshold (Ct) values were earlier in sputum. Both bacterial (361 vs. 294) and viral detections (245 vs. 140) were more common in sputum versus NP/OP specimens, respectively, in both children and adults. When available, high-quality sputum may be useful for testing in hospitalized CAP patients. |
Increased sensitivity of OSHA method analysis of diacetyl and 2,3-pentanedione in air
LeBouf R , Simmons M . J Occup Environ Hyg 2016 14 (5) 0 Gas chromatography/mass spectrometry (GC/MS) operated in selected ion monitoring mode was used to enhance the sensitivity of OSHA Methods 1013/1016 for measuring diacetyl and 2,3-pentanedione in air samples. The original methods use flame ionization detection which cannot achieve the required sensitivity to quantify samples at or below the NIOSH recommended exposure limits (REL: 5 ppb for diacetyl and 9.3 ppb for 2,3-pentanedione) when sampling for both diacetyl and 2,3-pentanedione. OSHA Method 1012 was developed to measure diacetyl at lower levels but requires an electron capture detector, and a sample preparation time of 36 hours. Using GC/MS allows detection of these two alpha-diketones at lower levels than OSHA Method 1012 for diacetyl and OSHA Method 1016 for 2,3-pentanedione. Acetoin and 2,3-hexanedione may also be measured using this technique. Method quantification limits were 1.1 ppb for diacetyl (22% of the REL), 1.1 ppb for 2,3-pentanedione (12% of the REL), 1.1 ppb for 2,3-hexanedione, and 2.1 ppb for acetoin. Average extraction efficiencies above the limit of quantitation were 100% for diacetyl, 92% for 2,3-pentanedione, 89% for 2,3-hexanedione, and 87% for acetoin. Mass spectrometry with OSHA Methods 1013/1016 could be used by analytical laboratories to provide more sensitive and accurate measures of exposure to diacetyl and 2,3-pentanedione. |
Isotope dilution UPLC-APCI-MS/MS method for the quantitative measurement of aromatic diamines in human urine: Biomarkers of diisocyanate exposure
Bhandari D , Ruhl J , Murphy A , McGahee E , Chambers D , Blount BC . Anal Chem 2016 88 (21) 10687-10692 Urinary diamines are biomarkers of diisocyanate exposure. Diisocyanates are considered as skin and respiratory sensitizers and are the most frequently reported cause of occupational asthma. Herein we report on the development and validation of an ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for the measurement of five aromatic diamines, 4,4'-methylenedianiline (MDA), 2,4-toluenediamine (4TDA), 2,6-toluenediamine (6TDA), 1,5-naphthalenediamine (NDA), and p-phenylenediamine (PPDA) in human urine. The method incorporates sample preparation steps, which include a 4 h acid hydrolysis followed by high-throughput solid-phase extraction prior to chromatographic separation. Chromatographic separation was achieved using a C18 reversed phase column with gradient elution of basic mobile phases (pH 9.2). The duty cycle of the method was less than 5 min, including both the column equilibration and autosampler movement. Analytical detection was performed using positive ion atmospheric pressure chemical ionization tandem mass spectrometry (APCI-MS/MS) in scheduled multiple reaction monitoring (sMRM) mode. Excellent linearity was observed over standard calibration curve concentration ranges of 3 orders of magnitude with method detection limit ranging from 10 to 100 pg/mL. The interday and intraday reproducibility and accuracy were within +/-15%. This method is fast, accurate, and reproducible and is suitable for assessment of exposure to the most common aromatic diisocyanates within targeted groups as well as larger population studies such as the National Health and Nutrition Examination Survey (NHANES). |
Antiretroviral drug activity in macaques infected during pre-exposure prophylaxis has a transient effect on cell-associated SHIV DNA reservoirs
Cong ME , Pau CP , Heneine W , Garcia-Lerma JG . PLoS One 2016 11 (11) e0164821 BACKGROUND: Pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) is a novel HIV prevention strategy. Suboptimal PrEP adherence and HIV infection creates an opportunity for continued antiretroviral drug activity during undiagnosed infection. We previously showed that macaques infected with SHIV during PrEP with FTC/TDF display reduced acute plasma viremias and limited virus diversity. We investigated the effect of PrEP on acute SHIV DNA dynamics and on the size of the persistent virus reservoir in lymphoid tissues. DESIGN: Cell-associated SHIV DNA levels in PBMCs were measured in 8 macaques infected during PrEP with FTC/TDF or single-agent TAF and was compared to those seen in untreated infections (n = 10). PrEP breakthrough infections continued treatment with 1-2 weekly drug doses to model suboptimal drug exposure during undiagnosed HIV infection in humans. SHIV DNA was also measured in lymphoid tissues collected from FTC/TDF PrEP breakthroughs after 1 year of infection. RESULTS: Compared to untreated controls, PrEP infections had reduced plasma RNA viremias both at peak and throughout weeks 1-12 (p<0.005). SHIV DNA levels were also reduced at peak and during the first 12 weeks of infection (p<0.043) but not throughout weeks 12-20. At 1 year, SHIV DNA reservoirs in lymphoid tissues were similar in size among macaques that received PrEP or placebo. CONCLUSIONS: Antiviral drug activity due to PrEP limits acute SHIV replication but has only a transient effect on cell-associated SHIV DNA levels. Our model suggests that suboptimal drug exposure in persons that are taking PrEP and become infected with HIV may not be sufficient to reduce the pool of HIV-infected cells, and that treatment intensification may be needed to sustain potential virological benefits from the PrEP regimen. |
Co-exposure to non-persistent organic chemicals among American pre-school aged children: A pilot study
Calafat AM , Ye X , Valentin-Blasini L , Li Z , Mortensen ME , Wong LY . Int J Hyg Environ Health 2016 220 55-63 BACKGROUND: General population human biomonitoring programs such as the National Health and Nutrition Examination Survey (NHANES) in the United States suggest that chemical exposures are common. Exposures during childhood may affect health later in life, but biomonitoring data in NHANES among pre-school aged children are limited. METHODS: A convenience group of 122 3-5year old American boys and girls were recruited in 2013 for a pilot study to assess the feasibility of collecting urine from young children and analyzing it for select chemical exposure biomarkers for future NHANES. Children were primarily Hispanic (64.8%); the remainder was divided between non-Hispanic black, and non-Hispanic white and "other." We measured 52 urinary biomarkers: 13 phthalates and one non-phthalate plasticizer, five phenols and four parabens, 10 polycyclic aromatic hydrocarbons (PAHs), and 19 pesticides. For each biomarker, we calculated descriptive statistics. We also calculated the number of biomarkers detected within each child, and performed principal components analysis (PCA). RESULTS: NHANES staff obtained permission to attempt collection of 60mL urine from 3 to 5year olds who participated in the 2013 NHANES health examination; 83% of children successfully provided the target volume. We detected 24 individual biomarkers of pesticides, phenols and parabens, phthalates/non-phthalate plasticizers, and PAHs in 95-100% of children. The median number of biomarkers detected was 37: nine pesticides, five phenols and parabens, 13 phthalates and non-phthalate plasticizers, and 10 PAHs. Biomarkers concentrations appear to be similar to national estimates among 6-11year old children from previous NHANES. PCA suggested high within-class correlations among biomarkers. CONCLUSIONS: These young children successfully adhered to the collection protocol and produced enough urine for the quantification of environmental biomarkers currently being measured in NHANES participants 6 years of age and older. Using the same analytical methods employed for the analysis of samples collected from older NHANES participants, in this sample of pre-school aged children we detected multiple chemicals including plasticizers, combustion products, personal-care product chemicals, and pesticides. Starting with NHANES 2015-2016, the NHANES biomonitoring program will include urinary biomarkers for 3-5year old children to provide exposure data to select chemicals at the national level among this age group. |
Optimizing Infant HIV Diagnosis in Resource-Limited Settings: Modeling the Impact of HIV DNA PCR Testing at Birth.
Chiu A , Modi S , Rivadeneira ED , Koumans EH . J Acquir Immune Defic Syndr 2016 73 (4) 454-462 BACKGROUND: Early antiretroviral therapy (ART) initiation in HIV-infected infants significantly improves survival but is often delayed in resource-limited settings. Adding HIV testing of infants at birth to the current recommendation of testing at age 4-6 weeks may improve testing rates and decrease time to ART initiation. We modeled the benefit of adding HIV testing at birth to the current 6-week testing algorithm. METHODS: Microsoft Excel was used to create a decision-tree model of the care continuum for the estimated 1,400,000 HIV-infected women and their infants in sub-Saharan Africa in 2012. The model assumed average published rates for facility births (42.9%), prevention of mother-to-child HIV transmission utilization (63%), mother-to-child-transmission rates based on prevention of mother-to-child HIV transmission regimen (5%-40%), return of test results (41%), enrollment in HIV care (52%), and ART initiation (54%). We conducted sensitivity analyses to model the impact of key variables and applied the model to specific country examples. RESULTS: Adding HIV testing at birth would increase the number of infants on ART by 204% by age 18 months. The greatest increase is seen in early ART initiations (543% by age 3 months). The increase would lead to a corresponding increase in survival at 12 months of age, with 5108 fewer infant deaths (44,550, versus 49,658). CONCLUSION: Adding HIV testing at birth has the potential to improve the number and timing of ART initiation of HIV-infected infants, leading to a decrease in infant mortality. Using this model, countries should investigate a combination of HIV testing at birth and during the early infant period. |
Role of maternal occupational physical activity and psychosocial stressors on adverse birth outcomes
Lee LJ , Symanski E , Lupo PJ , Tinker SC , Razzaghi H , Chan W , Hoyt AT , Canfield MA . Occup Environ Med 2016 74 (3) 192-199. Objectives We examined the association of an array of estimated maternal occupational physical activities and psychosocial stressors during pregnancy with odds for preterm birth (PTB) and small-for-gestational age (SGA). Methods Data for infants born without major birth defects delivered from 1997 to 2009 whose mothers reported working at least 1 month during pregnancy were obtained from the National Birth Defects Prevention Study. We linked occupational codes to the US Department of Labor's Occupational Information Network, which provides estimates of exposure for multiple domains of physical activity and psychosocial stressors by occupational categories. We conducted factor analysis using principal components extraction with 17 occupational activities and calculated factor scores. ORs for PTB and SGA across quartiles of factor scores in each trimester were computed using logistic regression. Results Factor analysis grouped occupational domains into 4 groups based on factor loadings. These groups were 'occupational physical activity', 'interpersonal stressor', 'automated work' and 'job responsibility'. High levels of 'occupational physical activity' were significantly associated with SGA (adjusted OR (AOR) for highest quartile compared with lowest quartile of factor score: 1.36; 95% CIs 1.02 to 1.82; p for trend=0.001) and were also positively associated with PTB (AOR: 1.24; 95% CI 0.93 to 1.64; p for trend=0.01). No clear results were observed across domains of psychosocial stressors. Conclusions Our findings expand understanding of associations between occupational physical activity and psychosocial stressors and PTB and SGA and suggest that additional research is needed to further examine these relationships. |
Cuba validated as the first country to eliminate mother-to-child transmission of human immunodeficiency virus and congenital syphilis: Lessons learned from the implementation of the global validation methodology
Caffe S , Perez F , Kamb ML , Gomez Ponce de Leon R , Alonso M , Midy R , Newman L , Hayashi C , Ghidinelli M . Sex Transm Dis 2016 43 (12) 733-736 The World Health Organization (WHO) estimates that each year 150,000 [110,000–190,000] infants are born with human immunodeficiency virus (HIV)1 and 350,000 perinatal deaths are caused by untreated maternal syphilis at the global level.2 Results from HIV clinical trials demonstrated effectiveness of antiretroviral therapy for prevention of HIV transmission from mother to child.3,4 However, the goal of elimination of mother-to-child transmission (EMTCT) of HIV remained largely aspirational until the adoption of the HIV elimination target by the Americas region in 20105 and the launch of the Global Plan for EMTCT of HIV in 2011.6 | An effective intervention against congenital syphilis—early serologic detection of infection in women before or during pregnancy, and treatment of syphilis-infected women with parenteral penicillin—has been available for 70 years.7 However, until recently, syphilis testing in antenatal care (ANC) remained limited in countries with constrained laboratory capacity. In 2007, WHO launched a strategy for the elimination of congenital syphilis as a public health problem.8 Congenital syphilis elimination had already been established as a priority in the Americas a decade before the launch of the global strategy.9 |
Supporting a neuroimmune basis of Gulf War illness
O'Callaghan JP , Michalovicz LT , Kelly KA . EBioMedicine 2016 13 5-6 Gulf War Illness (GWI) is a complex multi-symptom disorder that has proven elusive to understand and treat and it afflicts as many as a quarter of the 700,000 soldiers deployed (Steele, 2000) to the Persian Gulf in the 1991 war. These ill veterans were exposed to a number of agents and conditions, but no specific sets of exposures can explain the persistent symptoms (e.g. headaches, chronic fatigue, memory loss, confusion, skin and gastrointestinal problems) and, not surprisingly, the pathophysiology of GWI has remained unclear (RAC, 2008). However, recent examinations of ill veterans reveal a systemic immune dysfunction that is exacerbated by physiological stress (Broderick et al., 2013). Congruently, animal models now exist that point to a heightened neuroinflammation resulting from several Gulf War-relevant chemical and physiological exposures (O'Callaghan et al., 2015). Neuroinflammation, the elaboration of proinflammatory cytokines and chemokines in the CNS, is known to serve as an underlying cause of sickness behavior, the features of which resemble those associated with GWI. Thus, a convergence of animal and human data now point to a neuroimmune mechanism underlying this disease. | While there is strong evidence suggesting that GWI is the result of exposure to chemical toxicants during the war, there also have been several studies suggesting that this illness is the result of an interaction between exposures and genetics. A prior report in EBioMedicine by Georgopoulos and colleagues (Georgopoulos et al., 2015) provided insight into a basis for a genetic/immune role in GWI by showing that higher counts for six Class II human leukocyte antigen (HLA) alleles conferred protective effects in GW veterans based on lowered symptom severity. In a recent follow-up from this group (Engdahl et al., 2016), a difference in neural synchrony was found between ill and healthy GW veterans. In an important extension of these findings in the current issue, James et al. (2016) integrate these “neuro” and immune components. Using analyses by magnetoencephalography (MEG), they show that the HLA alleles have their action via modulation of neural signaling patterns based on a sophisticated mapping of brain regional neural synchrony. The MEG signatures and their analyses by statistical heat mapping, approaches pioneered by this laboratory, have allowed for the separation of reported symptoms of GWI into distinct HLA and non-HLA related domains. These findings lend further credence to an immune/neuroimmune basis for the symptoms associated with GWI and link them with the concepts of exposure/genetic interactions. However, the non-HLA related cluster also suggests that other mechanisms are at play in the pathophysiology of GWI. The authors present ample speculation as to the roles of both HLA and non-HLA-related factors relevant to GWI, but also provoke many additional questions. For example, what is the next step in understanding the meaning of these HLA and non-HLA domains? Additionally, does the implied autoimmune mechanism provide clear steps to pursue that will lead to treatable targets or provide a path to the discovery of viable treatments for GWI? |
State-level farmers market activities: A review of CDC-funded state public health actions that support farmers markets
Kahin SA , Wright DS , Pejavara A , Kim SA . J Public Health Manag Pract 2016 23 (2) 96-103 CONTEXT: Introducing farmers markets to underserved areas, or supporting existing farmers markets, can increase access and availability of fruits and vegetables and encourage healthy eating. Since 2003, the Centers for Disease Control and Prevention (CDC)'s Division of Nutrition, Physical Activity, and Obesity (DNPAO) has provided guidance and funding to state health departments (SHDs) to support the implementation of interventions, including activities around farmers markets, to address healthy eating, and improve the access to and availability of fruits and vegetables at state and community levels. OBJECTIVE: For this project, we identified state-level farmers market activities completed with CDC's DNPAO funding from 2003 to 2013. State-level was defined as actions taken by the state health department that influence or support farmers market work across the state. DESIGN AND PARTICIPANTS: We completed an analysis of SHD farmers market activities of 3 DNPAO cooperative agreements from 2003 to 2013: State Nutrition and Physical Activity Programs to Prevent Obesity and Other Chronic Diseases; Nutrition, Physical Activity and Obesity Program; and Communities Putting Prevention to Work. To identify state farmers market activities, data sources for each cooperative agreement were searched using the key words "farm," "market," "produce market," and "produce stand." State data with at least one state-level farmers market action present were then coded for the presence of itemized activities. RESULTS: Across all cooperative agreements, the most common activities identified through analysis included the following: working on existing markets and nutrition assistance benefit programs, supporting community action, and providing training and technical assistance. Common partners were nutrition assistance benefit program offices and state or regional Department of Agriculture or agricultural extension offices. IMPLICATIONS FOR POLICY & PRACTICE: Common farmers market practices and evidence-based activities, such as nutrition assistance benefits programs and land-use policies, can be adopted as methods for farmers market policy and practice work. CONCLUSION: The activities identified in this study can inform future planning at the state and federal levels on environment, policy, and systems approaches that improve the food environment through farmers markets. |
Farm to preschool: The state of the research literature and a snapshot of national practice
Hoffman JA , Schmidt EM , Wirth C , Johnson S , Sobell SA , Pelissier K , Harris DM , Izumi BT . J Hunger Environ Nutr 2016 12 (4) 443-465 Farm to preschool connects early care and education settings to local food and/or food producers with the objectives of serving locally grown, healthy foods to young children, improving child nutrition, and providing related educational opportunities. This study systematically reviewed the farm to preschool research literature from 1994 to 2015 and described findings from the 2012 National Farm to Preschool Survey. A wide range of activities was represented in the 14 studies reviewed; most employed participatory research collaborations, assessed process outcomes, and used uncontrolled research designs. Survey findings indicated that programs operate in at least 39 states and Puerto Rico, in many types of communities and settings. Respondents identified types of foods and activities, motivations for participation, and parent engagement. There is still much to be learned about farm to preschool programs, and well-controlled research is necessary. |
Evaluation of a "walk-through" ladder top design during ladder-roof transitioning tasks
Simeonov P , Hsiao H , Powers J , Ammons D , Kau T , Cantis D , Zwiener J , Weaver D . Appl Ergon 2017 59 460-469 This study evaluated the effect of an extension ladder "walk-through” top design on kinetic and kinematic behaviors and the outward destabilizing forces induced on the ladder during transitioning at elevation. Thirty-two male participants performed stepping tasks between a ladder top and a roof at simulated elevation in a surround-screen virtual-reality system. The experimental conditions included a "walk-through” and a standard ladder top section supported on flat and sloped roof surfaces. Three force platforms were placed under the ladder section and in the roof to measure propulsion forces during transitions. A motion measurement system was used to record trunk kinematics. The frictional demand at the virtual ladder base was also calculated. The results indicate that under optimal ladder setup (angle 75.5 °), the frictional demand at the ladder base remains relatively small for all experimental conditions. Also, the "walk through” ladder top eased the ladder-to-roof transitions but not the roof-to-ladder transitions. |
Correlation between X-ray diffraction and Raman spectra of 16 commercial graphene based materials and their resulting classification
Seehra MS , Narang V , Geddam UK , Stefaniak AB . Carbon N Y 2017 111 380-385 Structural properties of sixteen (16) commercial samples of graphene-based materials (GBM) labelled as graphene, graphene oxide or reduced graphene oxide are investigated at room temperature using X-ray diffraction (XRD) and Raman spectroscopy. Based on the observed correlation between the results obtained with these two techniques, these samples are classified into three groups: Group A of seven samples consisting of graphitic nanosheets with evaluated thickness 20nm and exhibiting both the 2H and 3R phases in XRD; Group B of six samples exhibiting XRD spectra characteristic of either graphene oxides (GO) or carbons with some order; and Group C of three samples with XRD spectra characteristic of disordered carbons. The relative intensities and widths of D, G, D, 2D and (D+D) bands in the Raman spectra are equally distinguishable between the samples in groups A, B and C. The width of the D-band is the smallest for Group A samples, intermediate for group B and the largest for group C samples. The intensity ratio I(D)/I(G) of the D and G bands in the Raman spectra of the samples is used to quantify the Raman-active defects whose concentration increases in going from samples in Group A to those in Group C. |
Low back pain prevalence and related workplace psychosocial risk factors: a study using data from the 2010 National Health Interview Survey
Yang H , Haldeman S , Lu ML , Baker D . J Manipulative Physiol Ther 2016 39 (7) 459-72 OBJECTIVES: The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States. METHODS: The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined. RESULTS: The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of low back pain. CONCLUSIONS: This study linked low back pain to work-family imbalance, exposure to a hostile work environment, job insecurity, long work hours, and certain occupation groups. These factors should be considered by employers, policymakers, and health care practitioners who are concerned about the impact of low back pain in workers. |
Occupational exposure to chlorinated solvents and kidney cancer: a case-control study
Purdue MP , Stewart PA , Friesen MC , Colt JS , Locke SJ , Hein MJ , Waters MA , Graubard BI , Davis F , Ruterbusch J , Schwartz K , Chow WH , Rothman N , Hofmann JN . Occup Environ Med 2016 74 (4) 268-274 OBJECTIVES: Trichloroethylene, a chlorinated solvent widely used for metal degreasing, is classified by the International Agency for Research on Cancer as a kidney carcinogen. Other chlorinated solvents are suspected carcinogens, most notably the cleaning solvent perchloroethylene, although it is unclear whether they are associated with kidney cancer. We investigated kidney cancer associations with occupational exposure to 6 chlorinated solvents (trichloroethylene, perchloroethylene, 1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride) within a case-control study using detailed exposure assessment methods. METHODS: Cases (n=1217) and controls (n=1235) provided information on their occupational histories and, for selected occupations, on tasks involving potential exposure to chlorinated solvents through job-specific interview modules. Using this information, an industrial hygienist assessed potential exposure to each solvent. We computed ORs and 95% CIs for different exposure metrics, with unexposed participants as the referent group. RESULTS: 1,1,1-trichloroethane, carbon tetrachloride, chloroform, and methylene chloride were not associated with kidney cancer. Among jobs with high exposure intensity, high cumulative hours exposed to perchloroethylene was associated with increased risk, both overall (third tertile vs unexposed: OR 3.1, 95% CI 1.3 to 7.4) and after excluding participants with ≥50% exposure probability for trichloroethylene (OR 3.0, 95% CI 0.99 to 9.0). A non-significant association with high cumulative hours exposed to trichloroethylene was observed (OR 1.7, 95% CI 0.8 to 3.8). CONCLUSIONS: In this study, high exposure to perchloroethylene was associated with kidney cancer, independent of trichloroethylene. Additional studies are needed to further investigate this finding. |
Occupational respiratory allergic diseases in healthcare workers
Mazurek JM , Weissman DN . Curr Allergy Asthma Rep 2016 16 (11) 77 Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs. |
Elemental properties of coal slag and measured airborne exposures at two coal slag processing facilities
Mugford C , Boylstein R , Gibbs JL . J Occup Environ Hyg 2016 14 (5) 0 In 1974, the National Institute for Occupational Safety and Health recommended a ban on the use of silica sand abrasives containing >1% silica due to the risk of silicosis. This gave rise to substitutes including coal slag. An Occupational Safety and Health Administration investigation in 2010 uncovered a case cluster of suspected pneumoconiosis in four former workers at a coal slag processing facility in Illinois, possibly attributable to occupational exposure to coal slag dust. This article presents the results from a National Institute for Occupational Safety and Health industrial hygiene survey at the same coal slag processing facility and a second facility. The industrial hygiene survey consisted of the collection of: a) bulk samples of unprocessed coal slag, finished granule product, and settled dust for metals and silica; b) full-shift area air samples for dust, metals, and crystalline silica; and c) full-shift personal air samples for dust, metals, and crystalline silica. Bulk samples consisted mainly of iron, manganese, titanium, and vanadium. Some samples had detectable levels of arsenic, beryllium, cadmium, and cobalt. Unprocessed coal slags from Illinois and Kentucky contained 0.43-0.48% (4,300-4,800 mg/kg) silica. Full-shift area air samples identified elevated total dust levels in the screen (2-38 mg/m3) and bag house (21 mg/m3) areas. Full-shift area air samples identified beryllium, chromium, cobalt, copper, iron, nickel, manganese, and vanadium. Overall, personal air samples for total and respirable dust (0.1-6.6 mg/m3 total; and 0.1-0.4 mg/m3 respirable) were lower than area air samples. All full-shift personal air samples for metals and silica were below published occupational exposure limits. All bulk samples of finished product granules contained less than 1% silica, supporting the claim coal slag may present less risk for silicosis than silica sand. We note that the results presented here are solely from two coal slag processing facilities, and more in-depth air monitoring is needed to better characterize occupational exposure to coal slag dust, metals, and silica at similar facilities. |
Lymphatic Filariasis Elimination in American Samoa: Evaluation of Molecular Xenomonitoring as a Surveillance Tool in the Endgame.
Lau CL , Won KY , Lammie PJ , Graves PM . PLoS Negl Trop Dis 2016 10 (11) e0005108 The Global Programme to Eliminate Lymphatic Filariasis has made significant progress toward interrupting transmission of lymphatic filariasis (LF) through mass drug administration (MDA). Operational challenges in defining endpoints of elimination programs include the need to determine appropriate post-MDA surveillance strategies. As humans are the only reservoirs of LF parasites, one such strategy is molecular xenomonitoring (MX), the detection of filarial DNA in mosquitoes using molecular methods (PCR), to provide an indirect indicator of infected persons nearby. MX could potentially be used to evaluate program success, provide support for decisions to stop MDA, and conduct post-MDA surveillance. American Samoa has successfully completed MDA and passed WHO recommended Transmission Assessment Surveys in 2011 and 2015, but recent studies using spatial analysis of antigen (Ag) and antibody (Ab) prevalence in adults (aged ≥18 years) and entomological surveys showed evidence of possible ongoing transmission. This study evaluated MX as a surveillance tool in American Samoa by linking village-level results of published human and mosquito studies. Of 32 villages, seropositive persons for Og4C3 Ag were identified in 11 (34.4%), for Wb123 Ab in 18 (56.3%) and for Bm14 Ab in 27 (84.4%) of villages. Village-level seroprevalence ranged from 0-33%, 0-67% and 0-100% for Og4C3 Ag, Wb123 Ab and Bm14 Ab respectively. PCR-positive Aedes polynesiensis mosquitoes were found in 15 (47%) villages, and their presence was significantly associated with seropositive persons for Og4C3 Ag (67% vs 6%, p<0.001) and Wb123 Ab (87% vs 29%, p = 0.001), but not Bm14 Ab. In villages with persons seropositive for Og4C3 Ag and Wb123 Ab, PCR-positive Ae. polynesiensis were found in 90.9% and 72.2% respectively. In villages without seropositive persons for Og4C3 Ag or Wb123 Ab, PCR-positive Ae. polynesiensis were also absent in 94.1% and 70.6% of villages respectively. Our study provides promising evidence to support the potential usefulness of MX in post-MDA surveillance in an Aedes transmission area in the Pacific Islands setting. |
Guinea worm (Dracunculus medinensis) infection in a wild-caught frog, Chad
Eberhard ML , Cleveland CA , Zirimwabagabo H , Yabsley MJ , Ouakou PT , Ruiz-Tiben E . Emerg Infect Dis 2016 22 (11) 1961-1962 A third-stage (infective) larva of Dracunculus medinensis, the causative agent of Guinea worm disease, was recovered from a wild-caught Phrynobatrachus francisci frog in Chad. Although green frogs (Lithobates clamitans) have been experimentally infected with D. medinensis worms, our findings prove that frogs can serve as natural paratenic hosts. |
Implications of Plasmodium vivax biology for control, elimination, and research
Olliaro PL , Barnwell JW , Barry A , Mendis K , Mueller I , Reeder JC , Shanks GD , Snounou G , Wongsrichanalai C . Am J Trop Med Hyg 2016 95 4-14 This paper summarizes our current understanding of the biology of Plasmodium vivax, how it differs from Plasmodium falciparum, and how these differences explain the need for P. vivax-tailored interventions. The article further pinpoints knowledge gaps where investments in research are needed to help identify and develop such specific interventions. The principal obstacles to reduce and eventually eliminate P. vivax reside in 1) its higher vectorial capacity compared with P. falciparum due to its ability to develop at lower temperature and over a shorter sporogonic cycle in the vector, allowing transmission in temperate zones and making it less sensitive to vector control measures that are otherwise effective on P. falciparum; 2) the presence of dormant liver forms (hypnozoites), sustaining multiple relapsing episodes from a single infectious bite that cannot be diagnosed and are not susceptible to any available antimalarial except primaquine, with routine deployment restricted by toxicity; 3) low parasite densities, which are difficult to detect with current diagnostics leading to missed diagnoses and delayed treatments (and protracted transmission), coupled with 4) transmission stages (gametocytes) occurring early in acute infections, before infection is diagnosed. |
Dogs and Guinea worm eradication
Eberhard ML , Ruiz-Tiben E , Hopkins DR . Lancet Infect Dis 2016 16 (11) 1225-1226 Teresa Galán-Puchades, in her Correspondence on dogs and Guinea worm eradication,1 noted several critical points about the Guinea Worm Eradication Program (GWEP) in Chad. We would like to clarify several of the issues. | Dog infections have been addressed programmatically in Chad for the past 4 and a half years. The situation in Chad is different from previous reports of sporadic Guinea worm infections in dogs. What is not made clear by Galán-Puchade is that human Guinea worm has infected dogs occasionally, but when eliminated from the human population, dog infections disappear.2, 3 By contrast, in Chad, dog infections are probably responsible for the small number of cases in human beings.4 We expect human infections in Chad to stop once transmission of Guinea worms among dogs is interrupted. Lastly, all evidence suggests transmission is not occurring via common drinking water sources, but via a paratenic aquatic host that people and dogs are eating raw or only partly cooked.4 | Previous laboratory studies have shown that dogs (and cats and monkeys) are good experimental hosts for Dracunculus medinensis.5, 6 Hence, the ease with which this infection was established in dogs is not surprising. |
Health care communication laws in the United States, 2013: Implications for access to sensitive services for insured dependents
Kristoff I , Cramer R , Leichliter JS . J Public Health Manag Pract 2016 23 (2) 148-151 Young adults may not seek sensitive health services when confidentiality cannot be ensured. To better understand the policy environment for insured dependent confidentiality, we systematically assessed legal requirements for health insurance plan communications using WestlawNext to create a jurisdiction-level data set of health insurance plan communication regulations as of March 2013. Two jurisdictions require plan communications be sent to a policyholder, 22 require plan communications to be sent to an insured, and 36 give insurers discretion to send plan communications to the policyholder or insured. Six jurisdictions prohibit disclosure, and 3 allow a patient to request nondisclosure of certain patient information. Our findings suggest that in many states, health insurers are given considerable discretion in determining to whom plan communications containing sensitive health information are sent. Future research could use this framework to analyze the association between state laws concerning insured dependent confidentiality and public health outcomes and related sensitive services. |
Sexually transmitted disease program evolution in response to changes in the public health environment: A Massachusetts example
Carter MW , Hsu KK , Loosier PS , Maddox BLP , Doshi SR , Kroeger K , Cranston K . Sex Transm Dis 2016 43 (11) 668-672 Background In 2008, the line item supporting sexually transmitted disease (STD) services in the Massachusetts state budget was cut as a result of budget shortfalls. Shortly thereafter, direct provision of STD clinical services supported by the Massachusetts Department of Public Health (MDPH) was suspended. Massachusetts Department of Public Health requested an initial assessment of its internal response and impact in 2010. A follow-up assessment occurred in September 2013. Methods In 2010 and 2013, 39 and 46 staff, respectively, from MDPH and from clinical partner agencies, were interviewed about changes in the role of the MDPH, partnerships, STD services, challenges, and recommendations. Interview notes were summarized, analyzed, and synthesized by coauthors using qualitative analysis techniques and NVivo software. Results The withdrawal of state funding for STD services, and the subsequent reduction in clinical service hours, erected numerous barriers for Disease Intervention Specialists (DIS) seeking to ensure timely STD treatment for index cases and their partners. After initial instability, MDPH operations stabilized due partly to strong management, new staff, and intensified integration with human immunodeficiency virus services. Existing contracts with human immunodeficiency virus providers were leveraged to support alternative STD testing and care sites. Massachusetts Department of Public Health strengthened its clinical and epidemiologic expertise. The DIS expanded their scope of work and were outposted to select new sites. Challenges remained, however, such as a shortage of DIS staff to meet the needs. Conclusions Although unique in many ways, MA offers experiences and lessons for how a state STD program can adapt to a changing public health context. |
Trends in Testosterone Replacement Therapy Use from 2003 to 2013 among Reproductive-Age Men in the United States
Rao PK , Boulet SL , Mehta A , Hotaling J , Eisenberg ML , Honig SC , Warner L , Kissin DM , Nangia AK , Ross LS . J Urol 2016 197 (4) 1121-1126 PURPOSE: Although testosterone replacement therapy (TRT) use in the US has increased dramatically over the past decade, trends in TRT use among reproductive-aged men have not been investigated. We assessed changes in TRT use and practice patterns among 18-45-year-old US men from 2003-2013, and compared them to older men. MATERIALS AND METHODS: This is a retrospective, cross-sectional analysis of men ages 18-45 and 56-64 enrolled in the Truven Health MarketScan Commercial Claims Databases throughout each given calendar year from 2003-2013 (n=5,094,868 in 2013). Trends in the yearly rates of TRT use were calculated using Poisson regression. Among TRT users, Cochran-Armitage tests were used to assess temporal trends in age, formulation type, and semen analysis and serum testosterone level testing during the 12 months preceding documented use of TRT. RESULTS: Between 2003 and 2013, there was a 4-fold increase in the rate of testosterone use among 18-45-year-old men from 29.2 per 10,000 person-years to 118.1 per 10,000 person-years (p<.0001). Among TRT users, topical gel formulations were initially used most. Injection use then doubled between 2009 (23.5%) and 2012 (46.2%), and surpassed topical gel use in 2013. Men 56-64 saw a statistically significant 3-fold increase in TRT use (p<.0001), which was significantly smaller than the 4-fold increase seen in younger men (p<.0001). CONCLUSIONS: In 2003-2013, TRT use increased 4-fold in men 18-45, compared to 3-fold in older men. This younger age group should be a focus for future studies due to effects on fertility and unknown long-term sequelae. |
Smoke-free rules and secondhand smoke exposure in vehicles among U.S. Adults - National Adult Tobacco Survey, 2009-2010 and 2013-2014
Kruger J , Jama A , Kegler M , Baker Holmes C , Hu S , King B . Int J Environ Res Public Health 2016 13 (11) In the United States (U.S.), secondhand smoke (SHS) exposure causes more than 41,000 deaths among nonsmoking adults annually. Adoption of smoke-free laws in public areas has increased, but private settings such as vehicles remain a source of SHS exposure. This study assessed change in voluntary smoke-free vehicle rules and SHS exposure in personal vehicles among U.S. adults between two periods, 2009-2010 and 2013-2014, using data from the National Adult Tobacco Survey (NATS). NATS is a national landline and cellular telephone survey of non-institutionalized adults aged ≥18 years in the 50 U.S. states and the District of Columbia. We assessed percentage change in the prevalence of smoke-free vehicle rules among all adults and SHS exposure in vehicles among nonsmoking adults, overall, by sociodemographic factors (sex, age, race/ethnicity, education, marital status, annual household income, U.S. region), and by cigarette smoking status. During 2009-2010 to 2013-2014, the percentage of adults with a 100% smoke-free vehicle rule increased from 73.6% to 79.5% (% change = +8.0%; p < 0.05). Among nonsmokers, SHS exposure in vehicles in the previous 7 days decreased from 9.2% to 8.2% (% change = -10.9%; p < 0.05). Smoke-free rules in private settings such as vehicles, in coordination with comprehensive smoke-free policies in indoor public settings, can help reduce SHS exposure and promote smoke-free norms. |
Flavoured non-cigarette tobacco product use among US adults: 2013-2014
Bonhomme MG , Holder-Hayes E , Ambrose BK , Tworek C , Feirman SP , King BA , Apelberg BJ . Tob Control 2016 25 ii4-ii13 INTRODUCTION: Limited data exist on flavoured non-cigarette tobacco product (NCTP) use among US adults. METHODS: Data from the 2013 to 2014 National Adult Tobacco Survey (N=75 233), a landline and cellular telephone survey of US adults aged ≥18, were assessed to estimate past 30-day NCTP use, flavoured NCTP use and flavour types using bivariate analyses. RESULTS: During 2013-2014, 14.4% of US adults were past 30-day NCTP users. Nationally, an estimated 10.2 million e-cigarette users (68.2%), 6.1 million hookah users (82.3%), 4.1 million cigar smokers (36.2%) and 4.0 million smokeless tobacco users (50.6%) used flavoured products in the past 30 days. The most prevalent flavours reported were menthol/mint (76.9%) for smokeless tobacco; fruit (74.0%) for hookah; fruit (52.4%), candy/chocolate/other sweet flavours (22.0%) and alcohol (14.5%) for cigars/cigarillos/filtered little cigars; fruit (44.9%), menthol/mint (43.9%) and candy/chocolate/other sweet flavours (25.7%) for e-cigarettes and fruit (56.6%), candy/chocolate/other sweet flavours (26.5%) and menthol/mint (24.8%) for pipes. Except for hookah and pipes, past 30-day flavoured product use was highest among 18-24-year olds. By cigarette smoking, never smoking e-cigarette users (84.8%) were more likely to report flavoured e-cigarette use, followed by recent former smokers (78.1%), long-term former smokers (70.4%) and current smokers (63.2%). CONCLUSIONS: Flavoured NCTP use is prominent among US adult tobacco users, particularly among e-cigarette, hookah and cigar users. Flavoured product use, especially fruit and sweet-flavoured products, was higher among younger adults. It is important for tobacco prevention and control strategies to address all forms of tobacco use, including flavoured tobacco products. |
Development and Characterization of Recombinant Virus Generated from a New World Zika Virus Infectious Clone.
Weger-Lucarelli J , Duggal NK , Bullard-Feibelman K , Veselinovic M , Romo H , Nguyen C , Ruckert C , Brault AC , Bowen RA , Stenglein M , Geiss BJ , Ebel GD . J Virol 2016 91 (1) Zika virus (ZIKV; Family Flaviviridae, genus Flavivirus) is a rapidly expanding global pathogen that has been associated with severe clinical manifestations, including devastating neurological disease in infants. There are currently no molecular clones of a New World ZIKV available, hindering progress toward understanding determinants of transmission and pathogenesis. Here we report the development and characterization of a novel ZIKV reverse genetics system based on a 2015 isolate from Puerto Rico (PRVABC59). We generated a two-plasmid infectious clone system from which infectious virus was rescued that replicates in human and mosquito cells with growth kinetics representative of wild-type ZIKV. Infectious clone-derived virus initiated comparable infection and transmission rates in Aedes aegypti mosquitoes compared to the primary isolate and displayed similar pathogenesis in AG129 mice. This infectious clone system provides a valuable resource to the research community to explore ZIKV molecular biology, vaccine development, antiviral development, diagnostics, vector competence, and disease pathogenesis. IMPORTANCE: ZIKV is a rapidly spreading mosquito-borne pathogen that has been linked to Guillain-Barre syndrome in adults and congenital microcephaly in developing fetuses and infants. ZIKV can also be sexually transmitted. The viral molecular determinants of any of these phenotypes are not well understood. There is no reverse genetics system available for the current epidemic virus that will allow researchers to study ZIKV immunity, develop novel vaccines, or develop antiviral drugs. Here we provide a novel infectious clone system generated from a recent ZIKV isolated from a patient infected in Puerto Rico. This infectious clone produces virus with similar in vitro and in vivo characteristics to the primary isolate, providing a critical tool to study ZIKV infection and disease. |
Transmission of Babesia microti parasites by solid organ transplantation
Brennan MB , Herwaldt BL , Kazmierczak JJ , Weiss JW , Klein CL , Leith CP , He R , Oberley MJ , Tonnetti L , Wilkins PP , Gauthier GM . Emerg Infect Dis 2016 22 (11) 1869-76 Babesia microti, an intraerythrocytic parasite, is tickborne in nature. In contrast to transmission by blood transfusion, which has been well documented, transmission associated with solid organ transplantation has not been reported. We describe parasitologically confirmed cases of babesiosis diagnosed approximately 8 weeks posttransplantation in 2 recipients of renal allografts from an organ donor who was multiply transfused on the day he died from traumatic injuries. The organ donor and recipients had no identified risk factors for tickborne infection. Antibodies against B. microti parasites were not detected by serologic testing of archived pretransplant specimens. However, 1 of the organ donor's blood donors was seropositive when tested postdonation and had risk factors for tick exposure. The organ donor probably served as a conduit of Babesia parasites from the seropositive blood donor to both kidney recipients. Babesiosis should be included in the differential diagnosis of unexplained fever and hemolytic anemia after blood transfusion or organ transplantation. |
Operational aspects of the Centers for Disease Control and Prevention autocidal gravid ovitrap
Acevedo V , Amador M , Felix G , Barrera R . J Am Mosq Control Assoc 2016 32 (3) 254-257 Dengue viruses cause hundreds of millions of infections every year in tropical and subtropical countries. Unfortunately, there is not a single universal vector control method capable of suppressing Aedes aegypti (L.) populations. Amongst novel control tools or approaches are various types of traps targeting gravid females or their eggs. Here, we provide details of the operational use of the Centers for Disease Control and Prevention autocidal gravid ovitrap (CDC-AGO trap) for the surveillance and control of Ae. aegypti. Adult mosquitoes were monitored every week in 2 isolated neighborhoods treated with 3 AGO traps per house in 85% of houses and in 2 reference neighborhoods without control traps. Between March 2013 and April 2015 we serviced the AGO traps 14 times in each community (every 2 months). Common trap problems were absent or broken trap tops (1-1.5%), flooded (0.1-0.7%) or dry (0.5-1.3%) traps, and missing (0.3-0.8%) or vandalized (0.5-1.4%) traps. Most traps kept a volume of infusion between 45% and 97% of their original volume (10 liters). Nontarget organisms captured in AGO traps were mostly small flies, and to a lesser extent ants, cockroaches, grasshoppers, butterflies, dragonflies, and lizards. Trap coverage ranged between 83% and 87% of houses in both communities throughout the study. We interpret such high levels of trap retention over time as an expression of acceptance by the community. |
Dog-mediated human rabies death, Haiti, 2016
Wallace RM , Etheart MD , Doty J , Monroe B , Crowdis K , Augustin PD , Blanton J , Fenelon N . Emerg Infect Dis 2016 22 (11) 1963-1965 Haiti has experienced numerous barriers to rabies control over the past decades and is one of the remaining Western Hemisphere countries to report dog-mediated human rabies deaths. We describe the circumstances surrounding a reported human rabies death in 2016 as well as barriers to treatment and surveillance reporting. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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- Reproductive Health
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