Effects of total-body digital photography on cancer worry in patients with atypical mole syndrome.
Moye MS , King SM , Rice ZP , DeLong LK , Seidler AM , Veledar E , Curiel-Lewandrowski C , Chen SC . JAMA Dermatol 2014 151 (2) 137-43 IMPORTANCE: Cancer worry about developing melanoma in at-risk patients may affect one's quality of life and adherence to screening. Little is known about melanoma-related worry in patients with atypical mole syndrome (AMS). OBJECTIVES: To quantify levels and elucidate predictors of worry related to developing melanoma in patients with AMS and to determine whether total-body digital photography (TBDP) in pigmented lesion clinics (PLCs) reduces worry. DESIGN, SETTING, AND PARTICIPANTS: In this pretest-posttest study, patients with AMS from PLCs at 2 academic medical centers were recruited from June 1, 2005, through October 31, 2008, to answer questions about cancer worry before and after undergoing TBDP. Questionnaires used included the new melanoma and recurrent melanoma Revised Impact of Event Scale (RIES), the Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale, and the Life Orientation Test. INTERVENTIONS: All patients underwent TBDP. Main Outcomes and Measures: Changes in the MWS and new melanoma RIES scores. RESULTS: A total of 138 patients completed baseline questionnaires; 108 patients (78.3%) completed questionnaires after TBDP. Baseline levels of worry were low and reduced further after TBDP. In patients with a personal history of melanoma, worry was reduced on all scales. In patients without a personal history of melanoma, only the new melanoma RIES score was significantly decreased. Predictors of baseline MWS scores include female sex, personal history of melanoma, and higher Hospital Anxiety and Depression Scale scores, adjusted for demographics, family history of melanoma, and Life Orientation Test scores. Adjusted predictors of the baseline new melanoma RIES score were similar but also included lower educational level and did not include sex. CONCLUSIONS AND RELEVANCE: Patients with AMS have low levels of melanoma-related worry, which is similar to data from other populations at high risk of cancers. We found that TBDP is a clinically useful tool that can be used in PLCs to help decrease worry about developing melanoma in at-risk patients. |
Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine
Owsley C , McGwin G Jr , Lee DJ , Lam BL , Friedman DS , Gower EW , Haller JA , Hark LA , Saaddine J . JAMA Ophthalmol 2014 133 (2) 174-81 IMPORTANCE: The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes mellitus from ethnic/racial minority populations with low utilization of eye care. OBJECTIVE: To examine the rate and types of DR identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study (Innovative Network for Sight [INSIGHT]) was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. Participants included persons aged 18 years or older who had type 1 or 2 diabetes mellitus and presented to the community-based settings. MAIN OUTCOMES AND MEASURES: The percentage of DR detection, including type of DR, and the percentage of detection of other ocular findings. RESULTS: A total of 1894 persons participated in the INSIGHT screening program across sites, with 21.7% having DR in at least 1 eye. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR; 30.7% of the other ocular findings were cataract. CONCLUSIONS AND RELEVANCE: In a DR telemedicine screening program in urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority populations, DR was identified on screening in approximately 1 in 5 persons with diabetes. The vast majority of DR was background, indicating high public health potential for intervention in the earliest phases of DR when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be underappreciated. |
Environmental surveillance for toxigenic Vibrio cholerae in surface waters of Haiti.
Kahler AM , Haley BJ , Chen A , Mull BJ , Tarr CL , Turnsek M , Katz LS , Humphrys MS , Derado G , Freeman N , Boncy J , Colwell RR , Huq A , Hill VR . Am J Trop Med Hyg 2014 92 (1) 118-25 Epidemic cholera was reported in Haiti in 2010, with no information available on the occurrence or geographic distribution of toxigenic Vibrio cholerae in Haitian waters. In a series of field visits conducted in Haiti between 2011 and 2013, water and plankton samples were collected at 19 sites. Vibrio cholerae was detected using culture, polymerase chain reaction, and direct viable count methods (DFA-DVC). Cholera toxin genes were detected by polymerase chain reaction in broth enrichments of samples collected in all visits except March 2012. Toxigenic V. cholerae was isolated from river water in 2011 and 2013. Whole genome sequencing revealed that these isolates were a match to the outbreak strain. The DFA-DVC tests were positive for V. cholerae O1 in plankton samples collected from multiple sites. Results of this survey show that toxigenic V. cholerae could be recovered from surface waters in Haiti more than 2 years after the onset of the epidemic. |
Von Willebrand factor is elevated in individuals infected with Sudan virus and is associated with adverse clinical outcomes
McElroy AK , Erickson BR , Flietstra TD , Rollin PE , Towner JS , Nichol ST , Spiropoulou CF . Viral Immunol 2014 28 (1) 71-3 Sudan virus (SUDV) is a member of the Filoviridae family that has been associated with sporadic outbreaks of human disease in sub-Saharan Africa. The filoviruses are notable for the high frequencies with which they cause both hemorrhagic manifestations and death in infected individuals. Recently, we reported an extensive biomarker analysis of patient specimens from the Gulu SUDV outbreak. In that study, we found evidence of endothelial dysfunction and alterations of factors important to the coagulation pathways. The complex intersection between the endothelium, coagulation, and immunity is further explored in this study where we examine several additional biomarkers using the same patient specimens. We report that von Willebrand factor (vWF), a protein that promotes platelet adhesion to the injured endothelium, is elevated in SUDV-infected individuals compared to normally reported values in healthy individuals. Furthermore, vWF is associated with a fatal outcome in SUDV-infected pediatric patients. In addition, we find that vWF is elevated in individuals who have hemorrhagic manifestations of disease, suggesting excessive thrombosis in these patients. |
Possible eradication of wild poliovirus type 3 - worldwide, 2012
Kew OM , Cochi SL , Jafari HS , Wassilak SG , Mast EE , Diop OM , Tangermann RH , Armstrong GL . MMWR Morb Mortal Wkly Rep 2014 63 (45) 1031-1033 In 1988, the World Health Assembly resolved to eradicate polio worldwide. Since then, four of the six World Health Organization (WHO) regions have been certified as polio-free: the Americas in 1994, the Western Pacific Region in 2000, the European Region in 2002, and the South-East Asia Region in 2014. Currently, nearly 80% of the world's population lives in areas certified as polio-free. Certification may be considered when ≥3 years have passed since the last isolation of wild poliovirus (WPV) in the presence of sensitive, certification-standard surveillance. Although regional eradication has been validated in the European Region and the Western Pacific Region, outbreaks resulting from WPV type 1 (WPV1) imported from known endemic areas were detected and controlled in these regions in 2010 and 2011, respectively. The last reported case associated with WPV type 2 (WPV2) was in India in 1999, marking global interruption of WPV2 transmission. The completion of polio eradication was declared a programmatic emergency for public health in 2012, and the international spread of WPV1 was declared a public health emergency of international concern in May 2014. The efforts needed to interrupt all indigenous WPV1 transmission are now being focused on the remaining endemic countries: Nigeria, Afghanistan, and Pakistan. WPV type 3 (WPV3) has not been detected in circulation since November 11, 2012. This report summarizes the evidence of possible global interruption of transmission of WPV3, based on surveillance for acute flaccid paralysis (AFP) and environmental surveillance. |
Progress toward regional measles elimination - worldwide, 2000-2013
Perry RT , Gacic-Dobo M , Dabbagh A , Mulders MN , Strebel PM , Okwo-Bele JM , Rota PA , Goodson JL . MMWR Morb Mortal Wkly Rep 2014 63 (45) 1034-1038 In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015. Member states of all six WHO regions have adopted measles elimination goals. In 2010, the World Health Assembly established three milestones for 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to ≥90% nationally and ≥80% in every district; 2) reduce global annual measles incidence to <5 cases per million; and 3) reduce global measles mortality by 95% from the 2000 estimate. This report updates the 2000-2012 report and describes progress toward global control and regional measles elimination during 2000-2013. During this period, annual reported measles incidence declined 72% worldwide, from 146 to 40 per million population, and annual estimated measles deaths declined 75%, from 544,200 to 145,700. Four of six WHO regions have established regional verification commissions (RVCs); in the European (EUR) and Western Pacific regions (WPR), 19 member states successfully documented the absence of endemic measles. Resuming progress toward 2015 milestones and elimination goals will require countries and their partners to raise the visibility of measles elimination, address barriers to measles vaccination, and make substantial and sustained additional investments in strengthening health systems. |
Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?
Harpaz R , Leung JW , Brown CJ , Zhou FJ . Clin Infect Dis 2014 60 (5) 781-5 The causes for zoster remain largely unknown. Psychological stress is one commonly-considered risk factor. We used self-controlled case series methods to look for increases in zoster following death or catastrophic health event occurring in a previously-healthy spouse. We found no increase, although this stressor led to increased mental health visits. |
Enteric bacteria promote human and mouse norovirus infection of B cells
Jones MK , Watanabe M , Zhu S , Graves CL , Keyes LR , Grau KR , Gonzalez-Hernandez MB , Iovine NM , Wobus CE , Vinje J , Tibbetts SA , Wallet SM , Karst SM . Science 2014 346 (6210) 755-9 The cell tropism of human noroviruses and the development of an in vitro infection model remain elusive. Although susceptibility to individual human norovirus strains correlates with an individual's histo-blood group antigen (HBGA) profile, the biological basis of this restriction is unknown. We demonstrate that human and mouse noroviruses infected B cells in vitro and likely in vivo. Human norovirus infection of B cells required the presence of HBGA-expressing enteric bacteria. Furthermore, mouse norovirus replication was reduced in vivo when the intestinal microbiota was depleted by means of oral antibiotic administration. Thus, we have identified B cells as a cellular target of noroviruses and enteric bacteria as a stimulatory factor for norovirus infection, leading to the development of an in vitro infection model for human noroviruses. |
Epidemiology of meningitis in an HIV-infected Ugandan cohort
Rajasingham R , Rhein J , Klammer K , Musubire A , Nabeta H , Akampurira A , Mossel EC , Williams DA , Boxrud DJ , Crabtree MB , Miller BR , Rolfes MA , Tengsupakul S , Andama AO , Meya DB , Boulware DR . Am J Trop Med Hyg 2014 92 (2) 274-9 There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay. Cryptococcal meningitis accounted for 60% (188 of 314) of all causes of meningitis. Of 117 samples sent for viral PCR, 36% were EBV positive. Among cryptococcal antigen negative patients, the yield of Xpert MTB/RIF assay was 22% (8 of 36). After exclusion of cryptococcosis and bacterial meningitis, 61% (43 of 71) with an abnormal CSF profile had no definitive diagnosis. Exploration of new TB diagnostics and diagnostic algorithms for evaluation of meningitis in resource-limited settings remains critical. |
Estimated burden of keratitis - United States, 2010
Collier SA , Gronostaj MP , MacGurn AK , Cope JR , Awsumb KL , Yoder JS , Beach MJ . MMWR Morb Mortal Wkly Rep 2014 63 (45) 1027-1030 Keratitis, inflammation of the cornea, can result in partial or total loss of vision and can result from infectious agents (e.g., microbes including bacteria, fungi, amebae, and viruses) or from noninfectious causes (e.g., eye trauma, chemical exposure, and ultraviolet exposure). Contact lens wear is the major risk factor for microbial keratitis; outbreaks of Fusarium and Acanthamoeba keratitis have been associated with contact lens multipurpose solution use, and poor contact lens hygiene is a major risk factor for a spectrum of eye complications, including microbial keratitis and other contact lens-related inflammation. However, the overall burden and the epidemiology of keratitis in the United States have not been well described. To estimate the incidence and cost of keratitis, national ambulatory-care and emergency department databases were analyzed. The results of this analysis showed that an estimated 930,000 doctor's office and outpatient clinic visits and 58,000 emergency department visits for keratitis or contact lens disorders occur annually; 76.5% of keratitis visits result in antimicrobial prescriptions. Episodes of keratitis and contact lens disorders cost an estimated $175 million in direct health care expenditures, including $58 million for Medicare patients and $12 million for Medicaid patients each year. Office and outpatient clinic visits occupied over 250,000 hours of clinician time annually. Developing effective prevention messages that are disseminated to contact lens users and investigation of additional preventive efforts are important measures to reduce the national incidence of microbial keratitis. |
Estimating contact rates at a mass gathering by using video analysis: a proof-of-concept project
Rainey JJ , Cheriyadat A , Radke RJ , Crumly JS , Koch DB . BMC Public Health 2014 14 1101 BACKGROUND: Current approaches for estimating social mixing patterns and infectious disease transmission at mass gatherings have been limited by various constraints, including low participation rates for volunteer-based research projects and challenges in quantifying spatially and temporally accurate person-to-person interactions. We developed a proof-of-concept project to assess the use of automated video analysis for estimating contact rates of attendees of the GameFest 2013 event at Rensselaer Polytechnic Institute (RPI) in Troy, New York. METHODS: Video tracking and analysis algorithms were used to estimate the number and duration of contacts for 5 attendees during a 3-minute clip from the RPI video. Attendees were considered to have a contact event if the distance between them and another person was ≤1 meter. Contact duration was estimated in seconds. We also simulated 50 attendees assuming random mixing using a geo-spatially accurate representation of the same GameFest location. RESULTS: The 5 attendees had an overall median of 2 contact events during the 3-minute video clip (range: 0-6). Contact events varied from less than 5 seconds to the full duration of the 3-minute clip. The random mixing simulation was visualized and presented as a contrasting example. CONCLUSION: We were able to estimate the number and duration of contacts for 5 GameFest attendees from a 3-minute video clip that can be compared to a random mixing simulation model at the same location. The next phase will involve scaling the system for simultaneous analysis of mixing patterns from hours-long videos and comparing our results with other approaches for collecting contact data from mass gathering attendees. |
H7N9: preparing for the unexpected in influenza
Jernigan DB , Cox NJ . Annu Rev Med 2014 66 361-71 In the years prior to 2013, avian influenza A H7 viruses were a cause of significant poultry mortality; however, human illness was generally mild. In March 2013, a novel influenza A(H7N9) virus emerged in China as an unexpected cause of severe human illness with 36% mortality. Chinese and other public health officials responded quickly, characterizing the virus and identifying more than 400 cases through use of new technologies and surveillance tools made possible by past preparedness and response efforts. Genetic sequencing, glycan-array receptor-binding assays, and ferret studies reveal theH7N9 virus to have increased binding to mammalian respiratory cells and to have mutations associated with higher virus replication rates and illness severity. New risk-assessment tools indicate H7N9 has the potential for further mammalian adaptation with possible human-to-human transmission. Vigilant virologic and epidemiologic surveillance are needed to monitor H7N9 and detect other unexpected novel influenza viruses that may emerge. Expected final online publication date for the Annual Review of Medicine Volume 66 is January 14, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates. |
HIV laboratory monitoring reliably identifies persons engaged in care
Dean BB , Debes R , Buchacz K , Bozzette SA , Wood K , Brooks JT . J Acquir Immune Defic Syndr 2014 68 (2) 133-9 BACKGROUND: Attendance at biannual medical encounters has been proposed as a minimum national standard for adequate engagement in HIV care. Using data from the HIV Outpatient Study (HOPS), we analyzed how well dates of HIV-related laboratory testing correlated with attendance at biannual medical encounters. METHODS: HOPS is an open prospective cohort study of HIV-infected patients receiving outpatient care in the United States. The data set included dates for laboratory measurements and medical encounters. We included patients with at least one HIV laboratory test (CD4 cell count or plasma HIV RNA viral load) during 2010-2011. An HIV laboratory test was defined as associated with a medical encounter if it occurred within three weeks of the encounter. We assessed the predictive value of HIV laboratory tests as a proxy for adequate engagement in clinical care, defined as having had ≥2 HIV laboratory tests within one year and performed >90 days apart. RESULTS: A total of 10,321 HIV laboratory tests were recorded from 2,909 patients. Adequate engagement in clinical care based on medical encounters was 88.2%, and 77.3% when based on laboratory tests. Using HIV laboratory tests to assess engagement had a sensitivity of 85.7%, specificity of 86.0%, and positive and negative predictive values of 97.9% and 44.5%. Of the 22.7% classified as not engaged in care by the proxy measure, over half (55.5%) were actually engaged. CONCLUSION: Using laboratory monitoring reliably classified persons as engaged in care. Of the 22.7% of patients classified as not engaged in care, most were actually engaged. |
HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
Streatfield PK , Khan WA , Bhuiya A , Hanifi SM , Alam N , Millogo O , Sie A , Zabre P , Rossier C , Soura AB , Bonfoh B , Kone S , Ngoran EK , Utzinger J , Abera SF , Melaku YA , Weldearegawi B , Gomez P , Jasseh M , Ansah P , Azongo D , Kondayire F , Oduro A , Amu A , Gyapong M , Kwarteng O , Kant S , Pandav CS , Rai SK , Juvekar S , Muralidharan V , Wahab A , Wilopo S , Bauni E , Mochamah G , Ndila C , Williams TN , Khagayi S , Laserson KF , Nyaguara A , Van Eijk AM , Ezeh A , Kyobutungi C , Wamukoya M , Chihana M , Crampin A , Price A , Delaunay V , Diallo A , Douillot L , Sokhna C , Gómez-Olivé FX , Mee P , Tollman SM , Herbst K , Mossong J , Chuc NT , Arthur SS , Sankoh OA , Byass P . Glob Health Action 2014 7 25370 BACKGROUND: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. OBJECTIVE: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. DESIGN: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. RESULTS: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. CONCLUSIONS: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS. |
Application of WHO's guideline for the selection of sentinel sites for hospital-based influenza surveillance in Indonesia
Susilarini NK , Sitorus M , Praptaningsih CY , Sampurno OD , Bratasena A , Mulyadi E , Rusli R , Fandil A , Mangiri A , Apsari H , Hariyanto E , Samaan G . BMC Health Serv Res 2014 14 424 BACKGROUND: A sentinel hospital-based severe acute respiratory infection (SARI) surveillance system was established in Indonesia in 2013. Deciding on the number, geographic location and hospitals to be selected as sentinel sites was a challenge. Based on the recently published WHO guideline for influenza surveillance (2012), this study presents the process for hospital sentinel site selection. METHODS: From the 2,165 hospitals in Indonesia, the first step was to shortlist to hospitals that had previously participated in respiratory disease surveillance systems and had acceptable surveillance performance history. The second step involved categorizing the shortlist according to five regions in Indonesia to maximize geographic representativeness. A checklist was developed based on the WHO recommended attributes for sentinel site selection including stability, feasibility, representativeness and the availability of data to enable disease burden estimation. Eight hospitals, a maximum of two per geographic region, were visited for checklist administration. Checklist findings from the eight hospitals were analyzed and sentinel sites selected in the third step. RESULTS: Six hospitals could be selected based on resources available to ensure system stability over a three-year period. For feasibility, all eight hospitals visited had mechanisms for specimen shipment and the capacity to report surveillance data, but two had limited motivation for system participation. For representativeness, the eight hospitals were geographically dispersed around Indonesia, and all could capture cases in all age and socio-economic groups. All eight hospitals had prerequisite population data to enable disease burden estimation. The two hospitals with low motivation were excluded and the remaining six were selected as sentinel sites. CONCLUSIONS: The multi-step process enabled sentinel site selection based on the WHO recommended attributes that emphasize right-sizing the surveillance system to ensure its stability and maximizing its geographic representativeness. This experience may guide other countries interested in adopting WHO's influenza surveillance standards for sentinel site selection. |
Behavioral convergence: implications for mathematical models of sexually transmitted infection transmission
Aral SO , Ward H . J Infect Dis 2014 210 Suppl 2 S600-4 Recent trends in the behaviors of some groups with high sexual activity and of the general population in some countries suggest that sexual behavior profiles of high and low sexual activity categories may be converging and may call into question the assumptions around sexual mixing that are built into theoretical models of sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) transmission dynamics. One category of high sexual activity, sex work, has been undergoing modification in many societies, becoming more acceptable, more dispersed, and larger in volume in some societies and shrinking in others. Concurrent with changes in the characteristics of sex work, the accumulating data on the sexual behaviors of the general population suggest a shift toward those of sex workers, including large numbers of sex partners and short-duration partnerships. The closing of the gap between behaviors associated with high and low sexual activity may have important implications for theories of sexual structure and models of transmission dynamics for STIs, including HIV infection. |
Clinical care of two patients with Ebola virus disease in the United States
Lyon GM , Mehta AK , Varkey JB , Brantly K , Plyler L , McElroy AK , Kraft CS , Towner JS , Spiropoulou C , Stroher U , Uyeki TM , Ribner BS . N Engl J Med 2014 371 (25) 2402-9 West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients' condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma. |
Clinical features and patient management of Lujo hemorrhagic fever
Sewlall NH , Richards G , Duse A , Swanepoel R , Paweska J , Blumberg L , Dinh TH , Bausch D . PLoS Negl Trop Dis 2014 8 (11) e3233 BACKGROUND: In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries. METHODS AND FINDINGS: We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa. CONCLUSIONS: Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks. Clinical observations should be systematically recorded to facilitate objective evaluation of treatment efficacy. Due to the risk of secondary transmission, viral hemorrhagic fever precautions should be implemented for all cases of Lujo virus infection, with specialized precautions to protect against aerosols when performing enhanced-risk procedures such as endotracheal intubation. |
Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting
Puttkammer N , Zeliadt S , Balan JG , Baseman J , Destine R , Domercant JW , France G , Hyppolite N , Pelletier V , Raphael NA , Sherr K , Yuhas K , Barnhart S . PLoS One 2014 9 (11) e112261 BACKGROUND: The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk. METHODS: Among adult patients enrolled on ART from 2005-2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6-12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves. RESULTS: Among 923 patients with CD4 results available during the period 6-12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation. CONCLUSIONS: Pharmacy data are most useful for new ART adherence alerts within iSante. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs. |
Wyeomyia (Nunezia) paucartamboensis, a new species of Sabethini (Diptera: Culicidae) from the Peruvian Andes with a diagnosis of the subgenus Nunezia
Porter CH . Proc Entomol Soc Wash 2014 116 (3) 311-338 Wyeomyia (Nunezia) paucartamboensis Porter, new species is described from specimens reared from tank bromeliads growing in humid premontane forest on the eastern slopes of the Peruvian Andes. The description, with relevant illustrations and images, is of the adult male and female, as well as of the pupal and fourth-instar larval stages. In addition, a diagnosis of the subgenus Nunezia is presented with emphasis on differentiation from other subgenera of Wyeomyia. |
Urinary phthalate metabolite concentrations among men with inflammatory bowel disease on mesalamine therapy
Hait EJ , Calafat AM , Hauser R . Endocr Disruptors (Austin) 2014 1 (1) BACKGROUND: Phthalates, a family of compounds used in a variety of consumer products, are reproductive and developmental toxicants in experimental animals. One of these phthalates, dibutyl phthalate (DBP), is an inactive ingredient in the coating of Asacol. AIM: To determine if men with inflammatory bowel disease taking Asacol have higher urinary concentrations of monobutyl phthalate (MBP), a metabolite of DBP, compared to the general population in the United States. METHODS: Five patients at the Massachusetts General Hospital Crohn's and Colitis Center, taking at least 800 mg of Asacol three times a day, provided one spot urine sample. Urinary MBP and other phthalate metabolite concentrations were measured by using online solid phase extraction coupled with isotope dilution high-performance liquid chromatography tandem mass spectrometry. RESULTS: In four of the five men, the urinary concentrations of MBP (9888 ng/mL, 12,308 ng/mL, 10,124 ng/mL, and 41,590 ng/mL) and of a minor DBP metabolite, mono(3-carboxypropyl) phthalate (MCPP, 116.4 ng/mL, 163.4 ng/mL 72.6 ng/mL, 5604 ng/mL) were orders of magnitude higher than the background concentrations among the US general population. One subject missed his morning Asacol dose and had urinary MBP concentrations (17.5 ng/mL) similar to background levels. CONCLUSION: We confirmed that men with inflammatory bowel disease taking Asacol have urinary concentrations of MBP and MCPP much higher than background levels. |
Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
Streatfield PK , Khan WA , Bhuiya A , Hanifi SM , Alam N , Diboulo E , Niamba L , Sie A , Lankoande B , Millogo R , Soura AB , Bonfoh B , Kone S , Ngoran EK , Utzinger J , Ashebir Y , Melaku YA , Weldearegawi B , Gomez P , Jasseh M , Azongo D , Oduro A , Wak G , Wontuo P , Attaa-Pomaa M , Gyapong M , Manyeh AK , Kant S , Misra P , Rai SK , Juvekar S , Patil R , Wahab A , Wilopo S , Bauni E , Mochamah G , Ndila C , Williams TN , Khaggayi C , Nyaguara A , Obor D , Odhiambo FO , Ezeh A , Oti S , Wamukoya M , Chihana M , Crampin A , Collinson MA , Kabudula CW , Wagner R , Herbst K , Mossong J , Emina JB , Sankoh OA , Byass P . Glob Health Action 2014 7 25366 BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs. |
Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
Streatfield PK , Khan WA , Bhuiya A , Hanifi SM , Alam N , Bagagnan CH , Sie A , Zabre P , Lankoande B , Rossier C , Soura AB , Bonfoh B , Kone S , Ngoran EK , Utzinger J , Haile F , Melaku YA , Weldearegawi B , Gomez P , Jasseh M , Ansah P , Debpuur C , Oduro A , Wak G , Adjei A , Gyapong M , Sarpong D , Kant S , Misra P , Rai SK , Juvekar S , Lele P , Bauni E , Mochamah G , Ndila C , Williams TN , Laserson KF , Nyaguara A , Odhiambo FO , Phillips-Howard P , Ezeh A , Kyobutungi C , Oti S , Crampin A , Nyirenda M , Price A , Delaunay V , Diallo A , Douillot L , Sokhna C , Gómez-Olivé FX , Kahn K , Tollman SM , Herbst K , Mossong J , Chuc NT , Bangha M , Sankoh OA , Byass P . Glob Health Action 2014 7 25365 BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality. DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work. |
Cause-specific mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
Streatfield PK , Khan WA , Bhuiya A , Alam N , Sie A , Soura AB , Bonfoh B , Ngoran EK , Weldearegawi B , Jasseh M , Oduro A , Gyapong M , Kant S , Juvekar S , Wilopo S , Williams TN , Odhiambo FO , Beguy D , Ezeh A , Kyobutungi C , Crampin A , Delaunay V , Tollman SM , Herbst K , Chuc NT , Sankoh OA , Tanner M , Byass P . Glob Health Action 2014 7 25362 BACKGROUND: Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To build a large standardised mortality database from African and Asian sites, detailing the relevant methods, and use it to describe cause-specific mortality patterns. DESIGN: Individual demographic and verbal autopsy (VA) data from 22 INDEPTH sites were collated into a standardised database. The INDEPTH 2013 population was used for standardisation. The WHO 2012 VA standard and the InterVA-4 model were used for assigning cause of death. RESULTS: A total of 111,910 deaths occurring over 12,204,043 person-years (accumulated between 1992 and 2012) were registered across the 22 sites, and for 98,429 of these deaths (88.0%) verbal autopsies were successfully completed. There was considerable variation in all-cause mortality between sites, with most of the differences being accounted for by variations in infectious causes as a proportion of all deaths. CONCLUSIONS: This dataset documents individual deaths across Africa and Asia in a standardised way, and on an unprecedented scale. While INDEPTH sites are not constructed to constitute a representative sample, and VA may not be the ideal method of determining cause of death, nevertheless these findings represent detailed mortality patterns for parts of the world that are severely under-served in terms of measuring mortality. Further papers explore details of mortality patterns among children and specifically for NCDs, external causes, pregnancy-related mortality, malaria, and HIV/AIDS. Comparisons will also be made where possible with other findings on mortality in the same regions. Findings presented here and in accompanying papers support the need for continued work towards much wider implementation of universal civil registration of deaths by cause on a worldwide basis. |
Comparative analysis of subtyping methods against a whole-genome-sequencing standard for Salmonella enterica serotype Enteritidis.
Deng X , Shariat N , Driebe EM , Roe CC , Tolar B , Trees E , Keim P , Zhang W , Dudley EG , Fields PI , Engelthaler DM . J Clin Microbiol 2014 53 (1) 212-8 A retrospective investigation was performed to evaluate whole genome sequencing as a benchmark for comparing molecular subtyping methods for Salmonella enterica serotype Enteritidis (SE) and survey the population structure of commonly encountered SE outbreak isolates in the United States. A total of 52 SE isolates representing 16 major outbreaks and three sporadic cases between 2001 and 2012 were sequenced and subjected to subtyping by four different methods: 1) whole genome single nucleotide polymorphism typing (WGST), 2) multiple loci VNTR (variable-number tandem repeat) analysis (MLVA), 3) clustered regularly interspaced short palindromic repeats combined with multi-virulence-locus sequence typing (CRISPR-MVLST) and 4) pulsed-field gel electrophoresis (PFGE). WGST resolved all outbreak clusters and provided useful robust phylogenetic inference with high epidemiological correlation. While both MLVA and CRISPR-MVLST yielded higher discriminatory power than PFGE, MLVA outperformed in delineating outbreak clusters whereas CRISPR-MVLST showed the potential to trace major lineages and ecological origins of SE. Our results suggested that whole genome sequencing makes a viable platform for the evaluation and benchmarking molecular subtyping methods. |
Disparities in capreomycin resistance levels associated with the rrs A1401G mutation in clinical isolates of Mycobacterium tuberculosis.
Reeves AZ , Campbell PJ , Willby MJ , Posey JE . Antimicrob Agents Chemother 2014 59 (1) 444-9 As the prevalence of multidrug-resistant and extensively drug-resistant tuberculosis strains continues to rise, so does the need to develop accurate and rapid molecular tests to complement time consuming growth-based drug susceptibility testing. Performance of molecular methods relies on the association of specific mutations with phenotypic drug resistance and while considerable progress has been made for resistance detection of first-line antituberculosis drugs, rapid detection of resistance for second-line drugs lags behind. The rrs A1401G allele is considered a strong predictor of cross-resistance between the three second-line injectable drugs, capreomycin (CAP), kanamycin, and amikacin. However, discordance is often observed between the rrs A1401G mutation and CAP resistance, with up to 40% of rrs A1401G mutants being classified as CAP susceptible. We measured the minimal inhibitory concentrations (MICs) to CAP in 53 clinical isolates harboring the A1401G mutation and found that the CAP MICs ranged from 8 mug/ml to 40 mug/ml. These results were drastically different from engineered A1401G mutants generated in isogenic Mycobacterium tuberculosis, which exclusively exhibited high-level CAP MICs of 40 mug/ml. These data support prior studies suggesting the critical concentration of CAP (10 mug/ml) used to determine resistance by indirect agar proportion may be too high to detect all CAP resistant strains and suggests that a larger percentage of resistant isolates could be identified by lowering the critical concentration. These data also suggest that differences in resistance levels among clinical isolates are possibly due to second site or compensatory mutations located elsewhere in the genome. |
Unencapsulated Streptococcus pneumoniae from conjunctivitis encode variant traits and belong to a distinct phylogenetic cluster.
Valentino MD , McGuire AM , Rosch JW , Bispo PJ , Burnham C , Sanfilippo CM , Carter RA , Zegans ME , Beall B , Earl AM , Tuomanen EI , Morris TW , Haas W , Gilmore MS . Nat Commun 2014 5 5411 Streptococcus pneumoniae, an inhabitant of the upper respiratory mucosa, causes respiratory and invasive infections as well as conjunctivitis. Strains that lack the capsule, a main virulence factor and the target of current vaccines, are often isolated from conjunctivitis cases. Here we perform a comparative genomic analysis of 271 strains of conjunctivitis-causing S. pneumoniae from 72 postal codes in the United States. We find that the vast majority of conjunctivitis strains are members of a distinct cluster of closely related unencapsulated strains. These strains possess divergent forms of pneumococcal virulence factors (such as CbpA and neuraminidases) that are not shared with other unencapsulated nasopharyngeal S. pneumoniae. They also possess putative adhesins that have not been described in encapsulated pneumococci. These findings suggest that the unencapsulated strains capable of causing conjunctivitis utilize a pathogenesis strategy substantially different from that described for S. pneumoniae at other infection sites. |
Effects of vaccination on invasive pneumococcal disease in South Africa
von Gottberg A , de Gouveia L , Tempia S , Quan V , Meiring S , von Mollendorf C , Madhi SA , Zell ER , Verani JR , O'Brien KL , Whitney CG , Klugman K , Cohen C . N Engl J Med 2014 371 (20) 1889-99 BACKGROUND: In South Africa, a 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009 with a three-dose schedule for infants at 6, 14, and 36 weeks of age; a 13-valent vaccine (PCV13) replaced PCV7 in 2011. In 2012, it was estimated that 81% of 12-month-old children had received three doses of vaccine. We assessed the effect of vaccination on invasive pneumococcal disease. METHODS: We conducted national, active, laboratory-based surveillance for invasive pneumococcal disease. We calculated the change in the incidence of the disease from a prevaccine (baseline) period (2005 through 2008) to postvaccine years 2011 and 2012, with a focus on high-risk age groups. RESULTS: Surveillance identified 35,192 cases of invasive pneumococcal disease. The rates among children younger than 2 years of age declined from 54.8 to 17.0 cases per 100,000 person-years from the baseline period to 2012, including a decline from 32.1 to 3.4 cases per 100,000 person-years in disease caused by PCV7 serotypes (-89%; 95% confidence interval [CI], -92 to -86). Among children not infected with the human immunodeficiency virus (HIV), the estimated incidence of invasive pneumococcal disease caused by PCV7 serotypes decreased by 85% (95% CI, -89 to -79), whereas disease caused by nonvaccine serotypes increased by 33% (95% CI, 15 to 48). Among adults 25 to 44 years of age, the rate of PCV7-serotype disease declined by 57% (95% CI, -63 to -50), from 3.7 to 1.6 cases per 100,000 person-years. CONCLUSIONS: Rates of invasive pneumococcal disease among children in South Africa fell substantially by 2012. Reductions in the rates of disease caused by PCV7 serotypes among both children and adults most likely reflect the direct and indirect effects of vaccination. (Funded by the National Institute for Communicable Diseases of the National Health Laboratory Service and others.). |
Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes
Kharbanda EO , Vazquez-Benitez G , Lipkind HS , Klein NP , Cheetham TC , Naleway A , Omer SB , Hambidge SJ , Lee GM , Jackson ML , McCarthy NL , DeStefano F , Nordin JD . JAMA 2014 312 (18) 1897-904 IMPORTANCE: In 2010, due to a pertussis outbreak and neonatal deaths, the California Department of Health recommended that the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) be administered during pregnancy. Tdap is now recommended by the Advisory Committee on Immunization Practices for all pregnant women, preferably between 27 and 36 weeks' gestation. Limited data exist on Tdap safety during pregnancy. OBJECTIVE: To evaluate whether maternal Tdap vaccination during pregnancy is associated with increased risks of adverse obstetric events or adverse birth outcomes. DESIGN AND SETTING: Retrospective, observational cohort study using administrative health care databases from 2 California Vaccine Safety Datalink sites. PARTICIPANTS AND EXPOSURES: Of 123,494 women with singleton pregnancies ending in a live birth between January 1, 2010, and November 15, 2012, 26,229 (21%) received Tdap during pregnancy and 97,265 did not. MAIN OUTCOMES AND MEASURES: Risks of small-for-gestational-age (SGA) births (<10th percentile), chorioamnionitis, preterm birth (<37 weeks' gestation), and hypertensive disorders of pregnancy were evaluated. Relative risk (RR) estimates were adjusted for site, receipt of another vaccine during pregnancy, and propensity to receive Tdap during pregnancy. Cox regression was used for preterm delivery, and Poisson regression for other outcomes. RESULTS: Vaccination was not associated with increased risks of adverse birth outcomes: crude estimates for preterm delivery were 6.3% of vaccinated and 7.8% of unvaccinated women (adjusted RR, 1.03; 95% CI, 0.97-1.09); 8.4% of vaccinated and 8.3% of unvaccinated had an SGA birth (adjusted RR, 1.00; 95% CI, 0.96-1.06). Receipt of Tdap before 20 weeks was not associated with hypertensive disorder of pregnancy (adjusted RR, 1.09; 95% CI, 0.99-1.20); chorioamnionitis was diagnosed in 6.1% of vaccinated and 5.5% of unvaccinated women (adjusted RR, 1.19; 95% CI, 1.13-1.26). CONCLUSIONS AND RELEVANCE: In this cohort of women with singleton pregnancies that ended in live birth, receipt of Tdap during pregnancy was not associated with increased risk of hypertensive disorders of pregnancy or preterm or SGA birth, although a small but statistically significant increased risk of chorioamnionitis diagnosis was observed. |
Adolescent vaccine co-administration and coverage in New York City: 2007-2013
Sull M , Eavey J , Papadouka V , Mandell R , Hansen MA , Zucker JR . Pediatrics 2014 134 (6) e1576-83 OBJECTIVES: To investigate adolescent vaccination in New York City, we assessed tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal conjugate (MCV4), and human papillomavirus (HPV) vaccine uptake, vaccine co-administration, and catch-up coverage over time. METHODS: We analyzed data from the Citywide Immunization Registry, a population-based immunization information system, to measure vaccine uptake and co-administration, defined as a Tdap vaccination visit where MCV4 or HPV vaccine was co-administered, among 11-year-olds. Catch-up vaccinations were evaluated through 2013 for adolescents born 1996 to 2000, by birth cohort. HPV vaccination among boys included data from 2010 to 2013. RESULTS: Adolescent vaccine administration was greatest during the back-to-school months of August to October and was highest for Tdap. Although MCV4 uptake improved over the study years, HPV vaccine uptake among girls stagnated; boys achieved similar uptake of HPV vaccine by 2012. By 2013, 65.4% had MCV4 co-administered with Tdap vaccine, whereas 28.4% of girls and 25.9% of boys had their first dose of HPV vaccine co-administered. By age 17, Tdap and MCV4 vaccination coverage increased to 97.5% and 92.8%, respectively, whereas ≥1-dose and 3-dose HPV vaccination coverage were, respectively, 77.5% and 53.1% for girls and 49.3% and 21.6% for boys. Age-specific vaccination coverage increased with each successive birth cohort (P < .001). CONCLUSIONS: From 2007 to 2013, there were greater improvements in Tdap and MCV4 vaccination than HPV vaccination, for which co-administration with Tdap vaccine and coverage through adolescence remained lower. Parent and provider outreach efforts should promote timely HPV vaccination for all adolescents and vaccine co-administration. |
Communication from primary care practices regarding adolescent immunization
Clark SJ , Reeves SL , Gebremariam A , Stokley SM , Dombkowski KJ . Clin Pediatr (Phila) 2014 54 (11) 1107-9 Primary care practices often remind patients and parents about upcoming appointments or needed immunizations, a strategy shown to be effective in a range of settings, using a variety of methods.1 Immunization reminders may be a particularly valuable strategy for increasing adolescent immunization coverage rates, which are lower than rates for the primary series, as parents may be unaware of recent additions to the recommended immunization schedule for adolescents.2 Also, with the large time gap between kindergarten booster shots and adolescent doses, parents may forget about the need to continue with vaccination. In addition, adolescents are less likely than younger children to visit primary care practices, leading to limited opportunities to catch-up immunizations.3 | Traditionally, reminders have been sent through mail and calls to home phones; in recent years, text messaging has been used in limited instances.4,5 Our objective was to assess the degree to which parents of adolescents have received reminders, the mode of contact for those messages, parents’ preferences for future reminders, and stability of contact information for different communication modes. |
The role of social connectedness and sexual orientation in the prevention of youth suicide ideation and attempts among sexually active adolescents
Stone DM , Luo F , Lippy C , McIntosh WL . Suicide Life Threat Behav 2014 45 (4) 415-30 The impact of types of social connectedness-family, other adult, and school-on suicide ideation and attempts among all youth, the relative impact of each type, and effect modification by sexual orientation was assessed. Data were from the 2007-2009 Milwaukee Youth Risk Behavior Surveys. Multivariable logistic regression analyses calculated the risk of suicide ideation and attempts by sexual orientation, types of social connectedness, and their interaction. Among all youth, each type of connectedness modeled singly conferred protective effects for suicide ideation. Family and other adult connectedness protected against suicide attempts. When modeled simultaneously, family connectedness protected against ideation and attempts. Sexual orientation modified the association between other adult connectedness and suicide ideation. Findings suggest that family connectedness confers the most consistent protection among all youth and sexual orientation does not generally modify the association between connectedness and suicidal behavior. |
Moderating effect of negative peer group climate on the relation between men's locus of control and aggression toward intimate partners
Schmidt MR , Lisco CG , Parrott DJ , Tharp AT . J Interpers Violence 2014 31 (5) 755-73 The present study sought to examine the interactive effects of an external locus of control and interaction in a negative peer group climate on men's perpetration of physical aggression and infliction of injury toward their female intimate partners. Participants were 206 heterosexual males recruited from the metro-Atlanta community who completed self-report measures of external locus of control, involvement in a negative peer group climate, and physical aggression and infliction of injury against intimate partners during the past 12 months. Negative peer group climate was conceptualized as a peer group that displays behavior which may instigate aggressive norms, attitudes, and behaviors. Results indicated that men with an external locus of control were more likely to perpetrate physical aggression toward and inflict injury on their intimate partners if they reported high, but not low, involvement in a negative peer group climate. These results extend current research suggesting external locus of control as a risk factor for intimate partner aggression by highlighting the impact of negative peer groups. Implications and future intervention research are discussed. |
The association between childhood sexual and physical abuse with incident adult severe obesity across 13 years of the National Longitudinal Study of Adolescent Health
Richardson AS , Dietz WH , Gordon-Larsen P . Pediatr Obes 2014 9 (5) 351-61 BACKGROUND: Severe obesity has increased, yet childhood antecedents of adult severe obesity are not well understood. OBJECTIVE: Estimate adult-onset severe obesity risk in individuals with history of childhood physical and/or sexual abuse compared with those who did not report abuse. METHODS: Longitudinal analysis of participants from the US National Longitudinal Study of Adolescent Health (n = 10,774) wave II (1996; aged 12-22 years) followed through wave IV (2008-2009; aged 24-34 years). New cases of adult-onset severe obesity (body mass index [BMI] ≥ 40 kg/m2 using measured height and weight) in individuals followed over 13 years who were not severely obese during adolescence (BMI <120% of 95th percentile Centers for Disease Control and Prevention National Center for Health Statistics growth curves). RESULTS: The combined occurrence of self-reported sexual and physical abuse during childhood was associated with an increased risk of incident severe obesity in adulthood in non-minority females (hazard ratio [HR; 95% Confidence Interval] = 2.5; 1.3, 4.8) and males (HR = 3.6; 1.5, 8.5) compared with individuals with no history of abuse. CONCLUSION: In addition to other social and emotional risks, exposure to sexual and physical abuse during childhood may increase risk of severe obesity later in life. Consideration of the confluence of childhood abuse might be considered as part of preventive and therapeutic approaches to address severe obesity. |
Volitional weight-lifting in rats promotes adaptation via performance and muscle morphology prior to gains in muscle mass
Rader EP , Miller GR , Chetlin RD , Wirth O , Baker BA . Environ Health Insights 2014 8 1-9 Investigation of volitional animal models of resistance training has been instrumental in our understanding of adaptive training. However, these studies have lacked reactive force measurements, a precise performance measure, and morphological analysis at a distinct phase of training - when initial strength gains precede muscle hypertrophy. Our aim was to expose rats to one month of training (70 or 700 g load) on a custom-designed weight-lifting apparatus for analysis of reactive forces and muscle morphology prior to muscle hypertrophy. Exclusively following 700 g load training, forces increased by 21% whereas muscle masses remained unaltered. For soleus (SOL) and tibialis anterior (TA) muscles, 700 g load training increased muscle fiber number per unit area by approximately 20% and decreased muscle fiber area by approximately 20%. Additionally, number of muscle fibers per section increased by 18% for SOL muscles. These results establish that distinct morphological alterations accompany early strength gains in a volitional animal model of load-dependent adaptive resistance training. |
A new agent for derivatizing carbonyl species used to investigate limonene ozonolysis
Wells JR , Ham Jason E . Atmos Environ (1994) 2014 99 519-526 A new method for derivatizing carbonyl compounds is presented. The conversion of a series of dicarbonyls to oximes in aqueous solution and from gas-phase sampling was achieved using O-tert-butylhydroxylamine hydrochloride (TBOX). Some advantages of using this derivatization agent include: aqueous reactions, lower molecular weight oximes, and shortened oxime-formation reaction time. Additionally, the TBOX derivatization technique was used to investigate the carbonyl reaction products from limonene ozonolysis. With ozone (O3) as the limiting reagent, four carbonyl compounds were detected: 7-hydroxy-6-oxo-3-(prop-1-en-2-yl)heptanal; 3-Isopropenyl-6-oxoheptanal (IPOH), 3-acetyl-6-oxoheptanal (3A6O) and one carbonyl of unknown structure. Using cyclohexane as a hydroxyl (OH) radical scavenger, the relative yields (peak area) of the unknown carbonyl, IPOH, and 3A6O were reduced indicating the influence secondary OH radicals have on limonene ozonolysis products. The relative yield of the hydroxy-dicarbonyl based on the chromatogram was unchanged suggesting it is only made by the limonene+O3 reaction. The detection of 3A6O using TBOX highlights the advantages of a smaller molecular weight derivatization agent for the detection of multi-carbonyl compounds. The use of TBOX derivatization if combined with other derivatization agents may address a recurring need to simply and accurately detect multi-functional oxygenated species in air. |
Primary care physicians and the laboratory: now and the future
Marques MB , Hickner J , Thompson PJ , Taylor JR . Am J Clin Pathol 2014 142 (6) 738-40 Steven Kroft,1 past president of the American Society for Clinical Pathology, challenged the laboratory community at the beginning of 2014 to remember 10 things that we must do to face and thrive in the future. His premise: the landscape in health care is changing dramatically, and the laboratory is right in the middle and must adapt. His list included the following: (10) “Be smart about your human resources.” (9)“Get lean.” (8) “Take charge of test utilization.” (7) “Take up permanent residence in the patient-centered medical home.” (6) “Create true value.” (5) “Locate your inner informatician.” (4) “Get out of the lab.” (3) “Quality is not optional.” (2) “Never, EVER forget who our final customers are.” (1) “Don’t fight the future. Embrace it.” A common theme is that laboratorians (pathologists and nonpathologists) must add value to the health care team by providing high-quality and cost-effective results, optimizing utilization of the clinical laboratory, and being visible to be relevant. Serendipitously, Kroft’s advice directly relates to findings of a survey of primary care physicians (PCPs) published soon thereafter in the Journal of the American Board of Family Medicine.2 |
Obstetrician-gynecologists' knowledge of sickle cell disease screening and management
Azonobi IC , Anderson BL , Byams VR , Grant AM , Schulkin J . BMC Pregnancy Childbirth 2014 14 356 BACKGROUND: Although obstetrician/gynecologists (OB/GYNs) play an important role in sickle cell disease (SCD) screening and patient care, there is little information on knowledge of SCD or sickle cell trait (SCT) or related practices in this provider group. Our objective was to assess SCD screening and prenatal management practices among OB/GYNs. METHODS: Twelve hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (the College)a were invited to complete a mailed survey, of which half (n = 600) belonged to the Collaborative Ambulatory Research Network.b Participants answered questions regarding appropriate target patient groups for prenatal SCD screening, folic acid requirements, practice behaviors and adequacy of their medical school and residency training. RESULTS: A total of 338 CARN members (56.3%) and 165 non-CARN members (27.5%) returned a survey. Of the 503 responders, 382 provided obstetric services and were included in the analyses. Forty percent of these respondents (n = 153) reported seeing at least 1 patient with SCD in the last year. Of these, 97.4% reported regularly screening people of African descent for SCD or SCT, whereas 52.9% reported regularly screening people of Mediterranean descent and 30.1% reported regularly screening people of Asian descent. Only 56.2% knew the correct recommended daily dose of folic acid for pregnant women with SCD. The proportion of respondents that rated training on SCD screening, assessment and treatment as barely adequate or inadequate ranged from 19.7% to 39.3%. CONCLUSIONS: The practice of many OB/GYNs who care for patients with SCD are not consistent with the College Practice Guidelines on the screening of certain target groups and on folic acid supplementation. There may be an opportunity to improve this knowledge gap through enhanced medical education. |
Pregnancy-related mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
Streatfield PK , Alam N , Compaore Y , Rossier C , Soura AB , Bonfoh B , Jaeger F , Ngoran EK , Utzinger J , Gomez P , Jasseh M , Ansah A , Debpuur C , Oduro A , Williams J , Addei S , Gyapong M , Kukula VA , Bauni E , Mochamah G , Ndila C , Williams TN , Desai M , Moige H , Odhiambo FO , Ogwang S , Beguy D , Ezeh A , Oti S , Chihana M , Crampin A , Price A , Delaunay V , Diallo A , Douillot L , Sokhna C , Collinson MA , Kahn K , Tollman SM , Herbst K , Mossong J , Emina JB , Sankoh OA , Byass P . Glob Health Action 2014 7 25368 BACKGROUND: Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps. OBJECTIVE: To describe patterns of pregnancy-related mortality at INDEPTH Network Health and Demographic Surveillance System sites in sub-Saharan Africa and southeast Asia in terms of maternal mortality ratio (MMR) and cause-specific mortality rates. DESIGN: Data on individual deaths among women of reproductive age (WRA) (15-49) resident in INDEPTH sites were collated into a standardised database using the INDEPTH 2013 population standard, the WHO 2012 verbal autopsy (VA) standard, and the InterVA model for assigning cause of death. RESULTS: These analyses are based on reports from 14 INDEPTH sites, covering 14,198 deaths among WRA over 2,595,605 person-years observed. MMRs varied between 128 and 461 per 100,000 live births, while maternal mortality rates ranged from 0.11 to 0.74 per 1,000 person-years. Detailed rates per cause are tabulated, including analyses of direct maternal, indirect maternal, and incidental pregnancy-related deaths across the 14 sites. CONCLUSIONS: As expected, these findings confirmed unacceptably high continuing levels of maternal mortality. However, they also demonstrate the effectiveness of INDEPTH sites and of the VA methods applied to arrive at measurements of maternal mortality that are essential for planning effective solutions and monitoring programmatic impacts. |
Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites
Streatfield PK , Khan WA , Bhuiya A , Hanifi SM , Alam N , Ouattara M , Sanou A , Sie A , Lankoande B , Soura AB , Bonfoh B , Jaeger F , Ngoran EK , Utzinger J , Abreha L , Melaku YA , Weldearegawi B , Ansah A , Hodgson A , Oduro A , Welaga P , Gyapong M , Narh CT , Narh-Bana SA , Kant S , Misra P , Rai SK , Bauni E , Mochamah G , Ndila C , Williams TN , Hamel MJ , Ngulukyo E , Odhiambo FO , Sewe M , Beguy D , Ezeh A , Oti S , Diallo A , Douillot L , Sokhna C , Delaunay V , Collinson MA , Kabudula CW , Kahn K , Herbst K , Mossong J , Chuc NT , Bangha M , Sankoh OA , Byass P . Glob Health Action 2014 7 25363 BACKGROUND: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. DESIGN: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1-4 year and 5-14 year age groups. RESULTS: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. CONCLUSIONS: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates. External causes of death are a significant childhood problem in some settings. |
Childhood cause-specific mortality in rural western Kenya: application of the InterVA-4 model
Amek NO , Odhiambo FO , Khagayi S , Moige H , Orwa G , Hamel MJ , Van Eijk A , Vulule J , Slutsker L , Laserson KF . Glob Health Action 2014 7 25581 BACKGROUND: Assessing the progress in achieving the United Nation's Millennium Development Goals in terms of population health requires consistent and reliable information on cause-specific mortality, which is often rare in resource-constrained countries. Health and demographic surveillance systems (HDSS) have largely used medical personnel to review and assign likely causes of death based on the information gathered from standardized verbal autopsy (VA) forms. However, this approach is expensive and time consuming, and it may lead to biased results based on the knowledge and experience of individual clinicians. We assessed the cause-specific mortality for children under 5 years old (under-5 deaths) in Siaya County, obtained from a computer-based probabilistic model (InterVA-4). DESIGN: Successfully completed VA interviews for under-5 deaths conducted between January 2003 and December 2010 in the Kenya Medical Research Institute/US Centers for Disease Control and Prevention HDSS were extracted from the VA database and processed using the InterVA-4 (version 4.02) model for interpretation. Cause-specific mortality fractions were then generated from the causes of death produced by the model. RESULTS: A total of 84.33% (6,621) childhood deaths had completed VA data during the study period. Children aged 1-4 years constituted 48.53% of all cases, and 42.50% were from infants. A single cause of death was assigned to 89.18% (5,940) of cases, 8.35% (556) of cases were assigned two causes, and 2.10% (140) were assigned 'indeterminate' as cause of death by the InterVA-4 model. Overall, malaria (28.20%) was the leading cause of death, followed by acute respiratory infection including pneumonia (25.10%), in under-5 children over the study period. But in the first 5 years of the study period, acute respiratory infection including pneumonia was the main cause of death, followed by malaria. Similar trends were also reported in infants (29 days-11 months) and children aged 1-4 years. CONCLUSIONS: Under-5 cause-specific mortality obtained using the InterVA-4 model is consistent with existing knowledge on the burden of childhood diseases in rural western Kenya. |
Laboratory and workplace assessments of rivet bucking bar vibration emissions
McDowell TW , Warren C , Xu XS , Welcome DE , Dong RG . Ann Occup Hyg 2014 59 (3) 382-97 Sheet metal workers operating rivet bucking bars are at risk of developing hand and wrist musculoskeletal disorders associated with exposures to hand-transmitted vibrations and forceful exertions required to operate these hand tools. New bucking bar technologies have been introduced in efforts to reduce workplace vibration exposures to these workers. However, the efficacy of these new bucking bar designs has not been well documented. While there are standardized laboratory-based methodologies for assessing the vibration emissions of many types of powered hand tools, no such standard exists for rivet bucking bars. Therefore, this study included the development of a laboratory-based method for assessing bucking bar vibrations which utilizes a simulated riveting task. With this method, this study evaluated three traditional steel bucking bars, three similarly shaped tungsten alloy bars, and three bars featuring spring-dampeners. For comparison the bucking bar vibrations were also assessed during three typical riveting tasks at a large aircraft maintenance facility. The bucking bars were rank-ordered in terms of unweighted and frequency-weighted acceleration measured at the hand-tool interface. The results suggest that the developed laboratory method is a reasonable technique for ranking bucking bar vibration emissions; the lab-based riveting simulations produced similar rankings to the workplace rankings. However, the laboratory-based acceleration averages were considerably lower than the workplace measurements. These observations suggest that the laboratory test results are acceptable for comparing and screening bucking bars, but the laboratory measurements should not be directly used for assessing the risk of workplace bucking bar vibration exposures. The newer bucking bar technologies exhibited significantly reduced vibrations compared to the traditional steel bars. The results of this study, together with other information such as rivet quality, productivity, tool weight, comfort, worker acceptance, and initial cost can be used to make informed bucking bar selections. |
Early prognosis of noise-induced hearing loss: prioritising prevention over prediction
Themann CL , Byrne DC , Davis RR , Morata TC , Murphy WJ , Stephenson MR . Occup Environ Med 2014 72 (2) 83-4 Moshammer and colleagues (1) have recommended routine implementation of a temporary threshold shift (TTS) screening test to identify workers particularly at risk of developing noise-induced hearing loss (NIHL) from occupational exposure to hazardous noise. Their work addresses an important occupational health problem. NIHL ranks among the most common work-related injuries in many countries, with an estimated global annual incidence of 1.6 million cases and accounting for approximately 16% of disabling adult hearing losses worldwide (2,3). Individuals vary in their susceptibility to the damaging effects of noise and no suitable method currently exists to predict the susceptibility of a particular worker. | In their study, Moshammer et al. measured TTS in newly-hired employees following exposure to a 20-minute, high intensity, low frequency experimental noise. They then followed the workers over time to see who ultimately developed a permanent threshold shift (PTS). The authors report that a TTS of 14 dB or more measured 2.5 minutes after the experimental exposure identifies workers at greater risk for PTS. They recommend routinely using this procedure to screen for susceptibility to noise in workplace hearing loss prevention programs. | However, this recommendation is premature in view of the study results. The TTS measure had a sensitivity of 82%, meaning that 18% of those who developed PTS were not identified by the TTS screening – a high false negative rate, particularly as we already know how to prevent PTS through reduction of noise exposures and consistent use of properly-fit hearing protection. Specificity was 70% at best, corresponding to a false positive rate 30%. If this procedure were implemented, approximately a third of the workers would be told that they are particularly at risk for NIHL when they aren’t, raising unnecessary alarm and opening the door to potential discrimination in work assignments, promotions, etc. |
Anti-vibration gloves?
Hewitt S , Dong RG , Welcome DE , McDowell TW . Ann Occup Hyg 2014 59 (2) 127-41 For exposure to hand-transmitted vibration (HTV), personal protective equipment is sold in the form of anti-vibration (AV) gloves, but it remains unclear how much these gloves actually reduce vibration exposure or prevent the development of hand-arm vibration syndrome in the workplace. This commentary describes some of the issues that surround the classification of AV gloves, the assessment of their effectiveness and their applicability in the workplace. The available information shows that AV gloves are unreliable as devices for controlling HTV exposures. Other means of vibration control, such as using alternative production techniques, low-vibration machinery, routine preventative maintenance regimes, and controlling exposure durations are far more likely to deliver effective vibration reductions and should be implemented. Furthermore, AV gloves may introduce some adverse effects such as increasing grip force and reducing manual dexterity. Therefore, one should balance the benefits of AV gloves and their potential adverse effects if their use is considered. |
Associations of work hours, job strain, and occupation with endothelial function: the Multi-Ethnic Study of Atherosclerosis (MESA)
Charles LE , Fekedulegn D , Landsbergis P , Burchfiel CM , Baron S , Kaufman JD , Stukovsky KH , Fujishiro K , Foy CG , Andrew ME , Diez Roux AV . J Occup Environ Med 2014 56 (11) 1153-60 OBJECTIVE: To investigate associations of work hours, job control, job demands, job strain, and occupational category with brachial artery flow-mediated dilation (FMD) in 1499 Multi-Ethnic Study of Atherosclerosis participants. METHODS: Flow-mediated dilation was obtained using high-resolution ultrasound. Mean values of FMD were examined across categories of occupation, work hours, and the other exposures using regression analyses. RESULTS: Occupational category was significantly associated with FMD overall, with blue-collar workers showing the lowest mean values-management/professional = 4.97 +/- 0.22%; sales/office = 5.19 +/- 0.28%; services = 4.73 +/- 0.29%; and blue-collar workers = 4.01 +/- 0.26% (adjusted P < 0.001). There was evidence of effect modification by sex (interaction P = 0.031)-significant associations were observed among women (adjusted P = 0.002) and nearly significant results among men (adjusted P = 0.087). Other exposures were not significantly associated with FMD. CONCLUSIONS: Differences in endothelial function may account for some of the variation in cardiovascular disease across occupational groups. |
The relationship between elemental carbon and diesel particulate matter in underground metal/nonmetal mines in the United States and coal mines in Australia
Noll J , Gilles S , Wu HW , Rubinstein E . J Occup Environ Hyg 2014 12 (3) 205-11 In the United States, total carbon (TC) is used as a surrogate for determining diesel particulate matter (DPM) compliance exposures in underground metal/nonmetal mines. Since TC can be affected by interferences and elemental carbon (EC) is not, one method used to estimate the TC concentration is to multiply the EC concentration from the personal sample by a conversion factor in order to avoid the influence of potential interferences. Since there is no accepted single conversion factor for all metal/nonmetal mines, one is determined every time an exposure sample is taken by collecting an area sample that represents the TC/EC ratio in the miner's breathing zone and is away from potential interferences. As an alternative to this procedure, this paper investigates the relationship between TC and EC from DPM samples to determine if a single conversion factor can be used for all metal/nonmetal mines. In addition, this paper also investigates how well EC represents DPM concentrations in Australian coal mines since the recommended exposure limit for DPM in Australia is an EC value. When TC was predicted from EC values using a single conversion factor of 1.27 in 14 US metal/nonmetal mines, 95% of the predicted values were within 18% of the measured value, even at the PEL concentration of 160 mug/m3 TC. A strong correlation between TC and EC was also found in nine underground coal mines in Australia. |
Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites
Streatfield PK , Khan WA , Bhuiya A , Hanifi SM , Alam N , Diboulo E , Sie A , Ye M , Compaore Y , Soura AB , Bonfoh B , Jaeger F , Ngoran EK , Utzinger J , Melaku YA , Mulugeta A , Weldearegawi B , Gomez P , Jasseh M , Hodgson A , Oduro A , Welaga P , Williams J , Awini E , Binka FN , Gyapong M , Kant S , Misra P , Srivastava R , Chaudhary B , Juvekar S , Wahab A , Wilopo S , Bauni E , Mochamah G , Ndila C , Williams TN , Hamel MJ , Lindblade KA , Odhiambo FO , Slutsker L , Ezeh A , Kyobutungi C , Wamukoya M , Delaunay V , Diallo A , Douillot L , Sokhna C , Gómez-Olivé FX , Kabudula CW , Mee P , Herbst K , Mossong J , Chuc NT , Arthur SS , Sankoh OA , Tanner M , Byass P . Glob Health Action 2014 7 25369 BACKGROUND: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. OBJECTIVE: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. DESIGN: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. RESULTS: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. CONCLUSIONS: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology. |
Circulating serum markers and QRS scar score in Chagas cardiomyopathy
Clark EH , Marks MA , Gilman RH , Fernandez AB , Crawford TC , Samuels AM , Hidron AI , Galdos-Cardenas G , Menacho-Mendez GS , Bozo-Gutierrez RW , Martin DL , Bern C . Am J Trop Med Hyg 2014 92 (1) 39-44 Approximately 8 million people have Trypanosoma cruzi infection, and nearly 30% will manifest Chagas cardiomyopathy (CC). Identification of reliable early indicators of CC risk would enable prioritization of treatment to those with the highest probability of future disease. Serum markers and EKG changes were measured in 68 T. cruzi-infected individuals in various stages of cardiac disease and 17 individuals without T. cruzi infection or cardiac disease. T. cruzi-infected individuals were assigned to stage A (normal EKG/chest x-ray [CXR]), B (abnormal EKG/normal CXR), or C (abnormal EKG/cardiac structural changes). Ten serum markers were measured using enzyme-linked immunosorbent assay (ELISA)/Luminex, and QRS scores were calculated. Higher concentrations of transforming growth factor-beta1 (TGFbeta1), and TGFbeta2 were associated with stage B compared with stage A. Matrix Metalloproteinase 2 (MMP2), Tissue Inhibitors of MMP 1, QRS score, and Brain Natriuretic Protein rose progressively with increasing CC severity. Elevated levels of several markers of cardiac damage and inflammation are seen in early CC and warrant additional evaluation in longitudinal studies. |
Cysticercosis-related hospitalizations in the United States, 1998-2011
O'Keefe KA , Eberhard ML , Shafir SC , Wilkins P , Ash LR , Sorvillo FJ . Am J Trop Med Hyg 2014 92 (2) 354-9 Cysticercosis has become increasingly recognized as an important infection in the United States in recent decades. Despite its potential impact, there is a lack of comprehensive information on the nationwide burden of disease. To better define the burden of cysticercosis in the United States, we analyzed in-patient records using the Nationwide Inpatient Sample for 1998-2011 to estimate cysticercosis-related hospitalizations and patient/institutional characteristics. There were an estimated 33,060 (95% confidence interval [CI] [29,610.5-36,510.3]) cysticercosis-related hospitalizations nationwide, representing a hospitalization rate of 8.03 per million population. The highest proportion of cases were male (54.8%), Hispanic (62.0%), aged 18-44 (58.8%), and occurred in the West (45.1%). An estimated 459 deaths occurred, representing an in-hospital case-fatality rate of 1.4%. These findings indicate the burden of cysticercosis-related hospitalizations in the United States. is considerable and may be greater than currently appreciated. Cysticercosis should be a nationally reportable disease. |
A strategic approach to public health workforce development and capacity building
Dean HD , Myles RL , Spears-Jones C , Bishop-Cline A , Fenton KA . Am J Prev Med 2014 47 S288-296 In February 2010, CDC's National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention (NCHHSTP) formally institutionalized workforce development and capacity building (WDCB) as one of six overarching goals in its 2010-2015 Strategic Plan. Annually, workforce team members finalize an action plan that lays the foundation for programs to be implemented for NCHHSTP's workforce that year. This paper describes selected WDCB programs implemented by NCHHSTP during the last 4 years in the three strategic goal areas: (1) attracting, recruiting, and retaining a diverse and sustainable workforce; (2) providing staff with development opportunities to ensure the effective and innovative delivery of NCHHSTP programs; and (3) continuously recognizing performance and achievements of staff and creating an atmosphere that promotes a healthy work-life balance. Programs have included but are not limited to an Ambassador Program for new hires, career development training for all staff, leadership and coaching for mid-level managers, and a Laboratory Workforce Development Initiative for laboratory scientists. Additionally, the paper discusses three overarching areas-employee communication, evaluation and continuous review to guide program development, and the implementation of key organizational and leadership structures to ensure accountability and continuity of programs. Since 2010, many lessons have been learned regarding strategic approaches to scaling up organization-wide public health workforce development and capacity building. Perhaps the most important is the value of ensuring the high-level strategic prioritization of this issue, demonstrating to staff and partners the importance of this imperative in achieving NCHHSTP's mission. |
Training racial and ethnic minority students for careers in public health sciences
Duffus WA , Trawick C , Moonesinghe R , Tola J , Truman BI , Dean HD . Am J Prev Med 2014 47 S368-375 BACKGROUND: A workforce that resembles the society it serves is likely to be more effective in improving health equity for racial and ethnic minorities in the U.S. Racial and ethnic minorities are underrepresented in the U.S. public health professions. Project Imhotep is operated by Morehouse College with funding and technical assistance from CDC. Imhotep trains racial and ethnic minority students for entry into graduate and professional training programs for careers in the public health sciences. The curriculum focuses on biostatistics, epidemiology, and occupational safety and health with practical training in statistical data analysis, scientific writing, and oral presentation skills. PURPOSE: To describe the Imhotep program and highlight some of its outcomes. METHODS: Data were collected every year by self-administered questionnaire or follow-up telephone and e-mail interviews of students who participated in Imhotep during 1982-2010 and were followed through December 2013. RESULTS: Findings demonstrated that 100% of the 481 trained students earned bachelor's degrees; 73.2% earned graduate degrees (53% earned master's degrees, 11.1% earned medical degrees, and 7.3% earned other doctoral degrees); and 60% entered public health careers. CONCLUSIONS: The Imhotep program has improved the representation of racial and ethnic minorities among public health professionals in the U.S. A diverse workforce involving Imhotep graduates could augment the pool of pubic health professionals who make strategic and tactical decisions around program design and resource allocation that impact health in the most affected communities. |
On the road to a stronger public health workforce: visual tools to address complex challenges
Drehobl P , Stover BH , Koo D . Am J Prev Med 2014 47 S280-285 The public health workforce is vital to protecting the health and safety of the public, yet for years, state and local governmental public health agencies have reported substantial workforce losses and other challenges to the workforce that threaten the public's health. These challenges are complex, often involve multiple influencing or related causal factors, and demand comprehensive solutions. However, proposed solutions often focus on selected factors and might be fragmented rather than comprehensive. This paper describes approaches to characterizing the situation more comprehensively and includes two visual tools: (1) a fishbone, or Ishikawa, diagram that depicts multiple factors affecting the public health workforce; and (2) a roadmap that displays key elements-goals and strategies-to strengthen the public health workforce, thus moving from the problems depicted in the fishbone toward solutions. The visual tools aid thinking about ways to strengthen the public health workforce through collective solutions and to help leverage resources and build on each other's work. The strategic roadmap is intended to serve as a dynamic tool for partnership, prioritization, and gap assessment. These tools reflect and support CDC's commitment to working with partners on the highest priorities for strengthening the workforce to improve the public's health. |
Sexual health discussions between African-American mothers and mothers of Latino descent and their children
Murray A , Ellis MU , Castellanos T , Gaul Z , Sutton MY , Sneed CD . Sex Educ 2014 14 (5) 597-608 We examined approaches used by African-American mothers and mothers of Latino descent for informal sex-related discussions with their children to inform sexually transmitted infection (STI)/HIV intervention development efforts. We recruited mothers (of children aged 12-15) from youth service agencies and a university in southern California. Fourteen focus groups were conducted: eight with African-American mothers (n = 31) and six with mothers of Latino descent (n = 24). Data were transcribed, coded for most common themes by four of the authors and reviewed for differences by gender of child. Four key themes emerged when focusing on parent-child discussions about sex: (1) sexual activity discussions took place for both sons and daughters; (2) protection from STI/HIV and pregnancy was a key topic; (3) the use of a direct, honest approach was preferred by mothers; and (4) seizing the moment was important for discussion opportunities. These data help broaden our understanding about the strategies used by African-American mothers and mothers of Latino descent for sexual health discussions with their sons and daughters. Evaluations of these for their potential impact on youth sexual health outcomes are warranted. The data can also contribute to the development of new culturally tailored parent-child communication strategies and HIV prevention interventions for young people of colour. |
Tobacco use among middle and high school students - United States, 2013
Arrazola RA , Neff LJ , Kennedy SM , Holder-Hayes E , Jones CD . MMWR Morb Mortal Wkly Rep 2014 63 (45) 1021-1026 Tobacco use is the leading preventable cause of disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood. Among U.S. youths, cigarette smoking has declined in recent years; however, the use of some other tobacco products has increased, and nearly half of tobacco users use two or more tobacco products. CDC analyzed data from the 2013 National Youth Tobacco Survey to determine the prevalence of ever (at least once) and current (at least 1 day in the past 30 days) use of one or more of 10 tobacco products (cigarettes, cigars, hookahs, smokeless tobacco, electronic cigarettes [e-cigarettes], pipes, snus, bidis, kreteks, and dissolvable tobacco) among U.S. middle school (grades 6-8) and high school (grades 9-12) students. In 2013, 22.9% of high school students reported current use of any tobacco product, and 12.6% reported current use of two or more tobacco products; current use of combustible products (i.e., cigarettes, cigars, pipes, bidis, kreteks, and/or hookahs) was substantially greater (20.7%) than use of other types of tobacco. Also, 46.0% of high school students reported having ever tried a tobacco product, and 31.4% reported ever trying two or more tobacco products. Among middle school students, 3.1% reported current use of cigars, and 2.9% reported current use of cigarettes, with non-Hispanic black students more than twice as likely to report current use of cigars than cigarettes. Monitoring the prevalence of the use of all available tobacco products, including new and emerging products, is critical to support effective population-based interventions to prevent and reduce tobacco use among youths as part of comprehensive tobacco prevention and control programs. |
Validation of self-reported smokeless tobacco use by measurement of serum cotinine concentration among US adults
Agaku IT , King BA . Am J Epidemiol 2014 180 (7) 749-54 Although investigators have assessed the relationship between self-reported cigarette smoking and biomarker levels, the validity of self-reported information on smokeless tobacco (SLT) use is uncertain. We used aggregated data from the 2003-2004, 2005-2006, 2007-2008, and 2009-2010 administrations of the National Health and Nutrition Examination Survey (NHANES) to compare self-reported SLT use with serum concentrations of cotinine, a metabolite of nicotine, among US adults aged ≥18 years. Receiver operating characteristic analysis was used to determine the optimal serum cotinine cutpoint for discriminating SLT users from nonusers of tobacco, and concordance analysis was used to compare self-reported SLT use with cotinine levels. Among the 30,298 adult respondents who completed the NHANES during 2003-2010, 418 reported having exclusively used SLT and no other type of tobacco (cigarettes, cigars, or pipes) during the past 5 days, while 23,457 reported not using any tobacco. The optimal cotinine cutpoint for discriminating SLT users from non-tobacco users was 3.0 ng/mL (sensitivity=97.0%, specificity=93.0%), which was comparable to a revised cutpoint recommended for identifying adult cigarette smokers. Concordance with cotinine was 96.4% and 93.7% for self-reported SLT use and tobacco nonuse, respectively. These findings indicate that self-reported SLT use among adults correlates highly with serum cotinine levels and that the optimal cutpoint for minimizing misclassification of self-reported use is a serum cotinine concentration of 3.0 ng/mL. |
Marijuana use from middle to high school: co-occurring problem behaviors, teacher-rated academic skills and sixth-grade predictors
Ehrenreich H , Nahapetyan L , Orpinas P , Song X . J Youth Adolesc 2014 44 (10) 1929-40 Rising marijuana use and its lowered perceived risk among adolescents highlight the importance of examining patterns of marijuana use over time. This study identified trajectories of marijuana use among adolescents followed from middle through high school, characterized these by co-occurring problem behaviors and teacher-rated academic skills (study skills, attention problems, and learning problems), and tested sixth-grade predictors of trajectory membership. The sample consisted of a randomly-selected cohort of 619 students assessed annually from sixth to twelfth grade. Using group-based modeling, we identified four trajectories of marijuana use: Abstainer (65.6 %), Sporadic (13.9 %), Experimental (11.5 %), and Increasing (9.0 %). Compared to Abstainers, students in the Sporadic, Experimental and Increasing trajectories reported significantly more co-occurring problem behaviors of alcohol use, cigarette smoking, and physical aggression. Sporadic and Experimental users reported significantly less smoking and physical aggression, but not alcohol use, than Increasing users. Teachers consistently rated Abstainers as having better study skills and less attention and learning problems than the three marijuana use groups. Compared to Abstainers, the odds of dropping out of high school was at least 2.7 times higher for students in the marijuana use trajectories. Dropout rates did not vary significantly between marijuana use groups. In sixth grade, being male, cigarette smoking, physical aggression and attention problems increased the odds of being in the marijuana use trajectories. Multiple indicators-student self-reports, teacher ratings and high school dropout records-showed that marijuana was not an isolated or benign event in the life of adolescents but part of an overall problem behavior syndrome. |
Association between electronic cigarette use and openness to cigarette smoking among U.S. young adults
Coleman BN , Apelberg BJ , Ambrose BK , Green KM , Choiniere CJ , Bunnell R , King BA . Nicotine Tob Res 2014 17 (2) 212-8 INTRODUCTION: Use of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes), is increasing. One concern is the appeal of these products to youth and young adults and their potential to influence perceptions and use of conventional cigarettes. METHODS: Using data from the 2012-2013 National Adult Tobacco Survey, characteristics of adults aged 18-29 who had never established cigarette smoking behavior were examined by ever use of e-cigarettes, demographics, and ever use of other tobacco products (smokeless tobacco, cigars, hookah, and cigarettes). Multivariate logistic regression was employed to examine the relationship between e-cigarette use and openness to cigarette smoking among young adults, defined as the lack of a firm intention not to smoke soon or in the next year. RESULTS: Among young adults who had never established cigarette smoking behavior (unweighted n = 4,310), 7.9% reported having ever tried e-cigarettes-14.6% of whom reported current use of the product. Ever e-cigarette use was associated with being open to cigarette smoking (adjusted odds ratio = 2.4; 95% confidence interval = 1.7, 3.3), as was being male, aged 18-24, less educated, and having ever used hookah or experimented with conventional cigarettes. CONCLUSIONS: Ever use of e-cigarettes, as well as other tobacco products, was associated with being open to cigarette smoking. This study does not allow us to assess the directionality of this association, so future longitudinal research is needed to illuminate tobacco use behaviors over time, as well as provide additional insight on the relationship between ENDS use and conventional cigarette use among young adult populations. |
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