Obesity prevention and control: from clinical tools to public health strategies
Belay B , Dietz WH . Acad Pediatr 2009 9 (5) 291-2 Four papers in this issue of Academic Pediatrics address several key aspects of the clinical and community approach to the obesity epidemic. Despite the centrality of body mass index to the assessment of obesity, the study by Oettinger and colleagues1 demonstrates that few parents in that sample had a clear understanding of the meaning of the measure. Nonetheless, the color-coding intervention of the growth charts to demonstrate healthy weight, overweight, and obesity increased parental understanding of risk. The high prevalence of severe obesity reported by Skelton and colleagues2 emphasizes again the importance of the need for tertiary centers to care for this high-risk population. | However, successful control of the obesity epidemic will require not only changes in how we deliver medical care for this widespread disease but also complementary changes in the environment. The contribution of the environment to childhood and adolescent obesity is emphasized by Galvez and colleagues3 and Oreskovic and colleagues,4 who demonstrate that access to convenience stores and fast-food restaurants is associated with an increased prevalence of obesity. It also appears that the opposite is true—that increased access to supermarkets has been inversely related to adolescent body mass index.5 Access affects both sides of the energy balance equation. On the energy expenditure side, community infrastructure such as sidewalks and recreational facilities fosters physical activity and may also play a role in the prevention and control of obesity.6 |
Performance of maximum inspiratory pressure tests and maximum inspiratory pressure reference equations for 4 race/ethnic groups
Sachs MC , Enright PL , Hinckley Stukovsky KD , Jiang R , Barr RG , Multi-Ethnic Study of Atherosclerosis Lung Study . Respir Care 2009 54 (10) 1321-8 BACKGROUND: Maximum inspiratory pressure (MIP) is an important and noninvasive index of diaphragm strength and an independent predictor of all-cause mortality. The ability of adults over a wide age range and multiple race/ethnicities to perform MIP tests has previously not been evaluated. METHODS: The Multi-Ethnic Study of Atherosclerosis recruited white, African American, Hispanic, and Chinese American participants, ages 45-84 years, and free of clinical cardiovascular disease in 6 United States cities. MIP was measured using standard techniques among 3,849 Multi-Ethnic Study of Atherosclerosis participants. The MIP quality goal was 5 maneuvers, with the 2 largest values matching within 10 cm H2O. Correlates of MIP quality and values were assessed in logistic and linear regression models. RESULTS: The 3,849 participants with MIP measures were 51% female, 35% white, 26% African American, 23% Hispanic, and 16% Chinese American. Mean+/-SD MIP was 73+/-26 cm H2O for women and 97+/-29 cm H2O for men. The quality goal was achieved by 83% of the cohort and was associated with female sex, older age, race/ethnicity, study site, low ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), and wheeze with dyspnea. The multivariate correlates of MIP were male sex, younger age, higher body mass index, shorter height, higher FVC, higher systolic blood pressure (in women) and health status (in men). There were no clinically important race/ethnic differences in MIP values. CONCLUSIONS: Race-specific reference equations for MIP are unnecessary in the United States. More than 80% of adults can be successfully coached for 5 maneuvers, with repeatability within 10 cm H2O. |
Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence
Gooch BF , Griffin SO , Gray SK , Kohn WG , Rozier RG , Siegal M , Fontana M , Brunson D , Carter N , Curtis DK , Donly KJ , Haering H , Hill LF , Hinson HP , Kumar J , Lampiris L , Mallatt M , Meyer DM , Miller WR , Sanzi-Schaedel SM , Simonsen R , Truman BI , Zero DT . J Am Dent Assoc 2009 140 (11) 1356-65 BACKGROUND: School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed. TYPES OF STUDIES REVIEWED: The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries. RESULTS: The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured. CLINICAL IMPLICATIONS: These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners' awareness of the SBSP as an important and effective public health approach that complements clinical care. |
The role of lay health advisors in cardiovascular risk reduction: a review
Fleury J , Keller C , Perez A , Lee SM . Am J Community Psychol 2009 44 28-42 Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches. |
Approaches to applying breast cancer risk prediction models in clinical practice
Bellcross C . Community Oncol 2009 6 (8) 373-382 Breast cancer risk stratification is becoming increasingly important as additional screening and prevention options are now available for women at different levels of risk. Use of screening breast MRI, tamoxifen chemoprevention, and genetic counseling and testing for hereditary breast cancer are appropriate for some women at increased susceptibility. However, there remain significant limitations in our ability to accurately predict breast cancer risk allowing for individualization of management strategies. Furthermore, communication of risk to patients in a meaningful way is critical to ensuring appropriate and autonomous decision-making. This article will review some of the key issues relevant to breast cancer risk prediction, including availability and limitations of existing models, considerations of risk communication, and use of risk stratification to individualize patient care. copyright 2009 Elsevier Inc. All rights reserved. |
Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the U.S. population: implications for diabetes diagnostic thresholds
Cheng YJ , Gregg EW , Geiss LS , Imperatore G , Williams DE , Zhang X , Albright AL , Cowie CC , Klein R , Saaddine JB . Diabetes Care 2009 32 (11) 2027-32 OBJECTIVE: To examine the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy in the U.S. population and to compare the ability of the two glycemic measures to discriminate between people with and without retinopathy. RESEARCH DESIGN AND METHODS: This study included 1,066 individuals aged >or=40 years from the 2005-2006 National Health and Nutrition Examination Survey. A1C, FPG, and 45 degrees color digital retinal images were assessed. Retinopathy was defined as a level >or=14 on the Early Treatment Diabetic Retinopathy Study severity scale. We used joinpoint regression to identify linear inflections of prevalence of retinopathy in the association between A1C and FPG. RESULTS: The overall prevalence of retinopathy was 11%, which is appreciably lower than the prevalence in people with diagnosed diabetes (36%). There was a sharp increase in retinopathy prevalence in those with A1C >or=5.5% or FPG >or=5.8 mmol/l. After excluding 144 people using hypoglycemic medication, the change points for the greatest increase in retinopathy prevalence were A1C 5.5% and FPG 7.0 mmol/l. The coefficients of variation were 15.6 for A1C and 28.8 for FPG. Based on the areas under the receiver operating characteristic curves, A1C was a stronger discriminator of retinopathy (0.71 [95% CI 0.66-0.76]) than FPG (0.65 [0.60 - 0.70], P for difference = 0.009). CONCLUSIONS: The steepest increase in retinopathy prevalence occurs among individuals with A1C >or=5.5% and FPG >or=5.8 mmol/l. A1C discriminates prevalence of retinopathy better than FPG. |
Norovirus highly prevalent cause of endemic acute diarrhea in children in the peruvian Amazon
Yori PP , Schwab K , Gilman RH , Nappier S , Portocarrero DV , Black RE , Olortegui MP , Hall ER , Moe C , Leon J , Cama VA , Kosek M . Pediatr Infect Dis J 2009 28 (9) 844-7 To determine the burden of norovirus infections in children stools from a longitudinal community cohort were evaluated using reverse transcription polymerase chain reaction. Norovirus was detected in 21.3% of diarrheal and 8.0% of nondiarrheal stools (P < 0.01). Norovirus diarrhea was highly associated with age and the odds ratio for norovirus diarrhea fell by 2.8% per month (OR = 0.97, 95% CI: 0.95-0.99). Norovirus seems to be an important etiology of community acquired diarrhea in this study population. |
Emergence of multidrug-resistant salmonella concord infections in Europe and the United States in children adopted from Ethiopia, 2003-2007
Hendriksen RS , Mikoleit M , Kornschober C , Rickert RL , Duyne SV , Kjelso C , Hasman H , Cormican M , Mevius D , Threlfall J , Angulo FJ , Aarestrup FM . Pediatr Infect Dis J 2009 28 (9) 814-818 BACKGROUND: Multidrug-resistant Salmonella serovar Concord infections have been reported from children adopted from Ethiopia. We interviewed patients, characterized the isolates, and gathered information about adoptions from Ethiopia to assess public health implications. METHODS: Information about Salmonella Concord cases and adoptions were provided from Austria, Denmark, England (and Wales), Ireland, the Netherlands and the United States. Patients from Denmark and the United States were interviewed to determine the orphanages of origin; orphanages in Ethiopia were visited. Isolates were subtyped by pulsed-field gel electrophoresis and antimicrobial susceptibility; specific antimicrobial resistance genes were characterized. RESULTS: Salmonella Concord was isolated from 78 persons from 2003 to 2007. Adoption status was known for 44 patients ≤3 years of age; 98% were adopted from Ethiopia. The children adopted from Ethiopia were from several orphanages; visited orphanages had poor hygiene and sanitation and frequent use of antimicrobial agents. The number of children adopted from Ethiopia in the participating countries increased 527% from 221 in 2003 to 1385 in 2007. Sixty-four Salmonella Concord isolates yielded 53 pulsed-field gel electrophoresis patterns including 6 patterns with >2 indistinguishable isolates; one isolate from an Ethiopia adoptee. Antimicrobial susceptibility was performed on 43 isolates; 81% were multidrug-resistant (≥3 agents). Multidrug-resistant isolates were from Ethiopian adoptees and were resistant to third and fourth generation cephalosporins and 14% had decreased susceptibility to ciprofloxacin. CONCLUSIONS: Improved hygiene and sanitation and more appropriate use of antimicrobial agents are needed in orphanages in Ethiopia. Culturing of stool specimens of children adopted from Ethiopia and appropriate hygiene may prevent further disease transmission. |
Outcomes among inmates treated for coccidioidomycosis at a correctional institution during a community outbreak, Kern County, California, 2004
Burwell LA , Park BJ , Wannemuehler KA , Kendig N , Pelton J , Chaput E , Jinadu BA , Emery K , Chavez G , Fridkin SK . Clin Infect Dis 2009 49 (11) e113-9 BACKGROUND: Treatment of pulmonary coccidioidomycosis is typically limited to patients with severe disease or those with increased risk of dissemination. In response to an increase of coccidioidomycosis at a correctional institution in an endemic area, physicians initiated an enhanced diagnosis and treatment program. METHODS: Case patients were inmates with laboratory-confirmed coccidioidomycosis during January 1, 2003, through October 31, 2004. We abstracted medical record data, including demographics, IgG complement fixation (CF) titers, treatment, and clinical outcome for initial and follow-up visits. Case patients receiving antifungal treatment were categorized into early (4 weeks from symptom onset) and late treatment groups (>4 weeks after symptom onset). We evaluated clinical outcome, median IgG CF titer, and time to clinical improvement. RESULTS: Eighty-seven persons were diagnosed with coccidioidomycosis; 79 (91%) records were available. Median age was 36 years (range, 21-71 years), 34 (43%) were black, and all were male. Median time from symptom onset to diagnosis was 3 weeks (range, <1-36 weeks). Most (95%) received antifungal therapy; 32 were in the early treatment and 43 were in the late treatment group. Good clinical outcome was equally likely. In both groups, median peak IgG CF titers were 1:64. Titers in patients with early treatment did not decrease more rapidly. Median time to improvement was similar in early and late treatment groups (7 and 6 months, respectively; [Formula: see text]). CONCLUSIONS: Persons incarcerated in endemic areas constitute a susceptible population that should be considered at risk for coccidioidomycosis. Further studies are needed to identify populations that may benefit from early antifungal treatment for pulmonary coccidioidomycosis. |
Partnerships for environmental and occupational justice: contributions to research, capacity and public health
Baron S , Sinclair R , Payne-Sturges D , Phelps J , Zenick H , Collman GW , O'Fallon LR . Am J Public Health 2009 99 S517-S525 In 1994, the National Institute of Environmental Health Sciences (NIEHS) initiated a program to address communication gaps between community residents, researchers and health care providers in the context of disproportionate environmental exposures. Over 13 years, together with the Environmental Protection Agency and National Institute for Occupational Health and Safety, NIEHS funded 54 environmental justice projects. Here we examine the methods used and outcomes produced based on data gathered from summaries submitted for annual grantees' meetings. Data highlight how projects fulfilled program objectives of improving community awareness and capacity and the positive public health and public policy outcomes achieved. Our findings underscore the importance of community participation in developing effective, culturally sensitive interventions and emphasize the importance of systematic program planning and evaluation. |
The role for community-based participatory research in formulating policy initiatives: promoting safety and health for in-home care workers and their consumers
Gong F , Baron S , Ayala L , Stock L , McDevitt S , Heaney C . Am J Public Health 2009 99 S531-S538 Although community-based participatory research (CBPR) can be effective in influencing policy, the process of formulating policy initiatives through CBPR is understudied. We describe a case study to illustrate how alliances among various community partners could be united to formulate policy directions. In collaboration with partners, the National Institute for Occupational Safety and Health initiated a project aimed at improving health and safety for low-income elderly and disabled persons and their in-home care workers. Community partners and stakeholders participated in focus groups, stakeholder interviews, and meetings; they played multiple roles including identifying organizational policy changes the partners could initiate immediately, as well as broader public policy goals. Results indicated that a strong community partnership, participation, and shared values contributed to successful formulation of policy initiatives. |
Latex as a significant source of Hevea brasiliensis allergen exposure
Kostyal D , Horton K , Beezhold D , Lockwood S , Hamilton RG . Ann Allergy Asthma Immunol 2009 103 (4) 354-5 The prevalence of allergic reactions to Hevea brasiliensis natural rubber latex among high-risk health care workers and patients undergoing multiple surgical procedures has diminished from epidemic levels in the mid-1990s. This decrease is attributed to avoidance of powdered latex medical gloves1 and improved quality control in the manufacturing process. However, sensitization to Hevea allergens continues through exposure to less well-established sources. To document this phenomenon, we used 3 standardized methods approved by the American Society for Testing Materials (ASTM) to quantify the total protein (ASTM Standard Test Method for Analysis of Aqueous Extractable Protein in Natural Rubber and Its Products Using the Modified Lowry Method, 2005),Hevea antigen (ASTM Standard Test Method for the Immunological Measurement of Antigenic Protein in Natural Rubber and Its Products, 2007), and Hevea allergen (ASTM Standard Test Method for Immunological Measurement of Four Principal Allergenic Proteins [H brasiliensis 1, 3, 5, and 6.02] in Natural Rubber and Its Products Derived From Latex, 2008 [D7427-08]) content in natural rubber latex toy balloons, dental dams, medical gloves, and nitrile and guayule medical gloves (negative controls). Although previous studies examined allergen/antigen content in rubber medical products,2, 3, 4 this study simultaneously investigatedHevea levels in balloons, dental dams, and glove products using the 3-tier ASTM test protocol. |
Lead poisoning in the United States
Baron SL , Brown TM . Am J Public Health 2009 99 S547-S549 ONLY A FEW YEARS AGO, we were most of us under the impression that our country was practically free from occupational poisoning, that American match factories never were troubled by cases of phossy jaw, and that our lead works were so much better built and managed, our lead workers so much better paid, and therefore better fed, than the European, that lead poisoning was not a problem here as it is in all other countries. | The investigation made by John Andrews for the United States Bureau of Labor disillusioned us about our freedom from phosphorus necrosis, and the studies published by the New York State Factory Investigating Commission and by the United States Bureau of Labor Statistics are teaching us that, far from being superior to Europe in the matter of industrial plumbism, we have a higher rate in many of the lead industries than have England and Germany. As a matter of fact, the supposed advantages of the American lead worker, good wages, short hours, a high standard of living, obtain only in a few of the lead trades, such as house painting, plumbing (hardly a lead trade now), printing, and white ware pottery work. Art potteries, tile factories, white and red lead works, storage battery plants, and lead smelters and refineries pay the rate of wages given to unskilled laborers in that particular section and the work day is ten hours, while the standard of living is often very low, the men employed being for the most part foreigners with no permanent relation to the community in which they are working. When to these factors are added the almost universal absence of sanitary control of the work places and of personal care of the working force, it is easy to understand why we have much lead poisoning in industries which in Great Britain and Germany are comparatively safe. |
Background levels of polychlorinated biphenyls in the U.S. population
Hopf NB , Ruder AM , Succop P . Sci Total Environ 2009 407 (24) 6109-19 BACKGROUND: Polychlorinated biphenyl (PCB) exposures are encountered by the general public by eating contaminated food or living near a previously operating PCB factory or hazardous waste site. PCBs affect the immune, reproductive, nervous, and endocrine systems and are carcinogens. PCBs were banned in the United States in 1977. For public health, it is important to be able to estimate individual risk, especially for vulnerable populations, to monitor the decline in risk over time and to alert the public health community if spikes occur in PCB exposures, by measuring serum PCB levels. The historical decline in PCB exposures cannot be documented within a repeatedly tested general population, since there is no such population. Therefore, our aim was to model serum PCB levels in the US general population over time using published data. METHODS: Models were developed based on 45 publications providing 16,914 background PCB levels in sera collected 1963-2003. Multiple linear regression and exponential decay were used to model the summary PCB levels. RESULTS: Background levels of higher-chlorinated PCBs (five or more chlorines) in sera increased before 1979 and decreased after 1979; a quadratic model was the best fit. However, the exponential decay model explained better the low PCB serum levels still seen in the general population. For lower-chlorinated serum PCBs, no increase or decrease was shown (1.7ppb for all years). CONCLUSIONS: Limitations for both models were lack of repeated measures, non-randomly selected study participants, selected years, concentration on geographic areas centered on PCB waste sites, lack of adjustment for BMI or for laboratory methods. Despite the limitations, this analysis shows that background PCB levels in the general population are still of concern. Future work should focus on uncertainties governing how to interpret the levels with respect to possible long term health effects. |
Tracking diabetes: New York City's A1C registry
Chamany S , Silver LD , Bassett MT , Driver CR , Berger DK , Neuhaus CE , Kumar N , Frieden TR . Milbank Q 2009 87 (3) 547-70 CONTEXT: In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States' first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor-patient relationship. METHODS: This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice. FINDINGS: For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population's health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider's letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow-up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients' health outcomes. CONCLUSIONS: Mandatory reporting has proven successful in helping combat other major epidemics. New York City's A1C Registry activities combine both traditional and novel public health approaches to reduce the burden of an epidemic chronic disease, diabetes. Despite criticism that mandatory reporting compromises individuals' right to privacy without clear benefit, the early feedback has been positive and suggests that the benefits will outweigh the potential harms. Further evaluation will provide additional information that other local health jurisdictions may use in designing their strategies to address chronic disease. |
Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe
Minnis AM , Steiner MJ , Gallo MF , Warner L , Hobbs MM , van der Straten A , Chipato T , Macaluso M , Padian NS . Am J Epidemiol 2009 170 (7) 918-24 Challenges in the accurate measurement of sexual behavior in human immunodeficiency virus (HIV) prevention research are well documented and have prompted discussion about whether valid assessments are possible. Audio computer-assisted self-interviewing (ACASI) may increase the validity of self-reported behavioral data. In 2006-2007, Zimbabwean women participated in a randomized, cross-sectional study that compared self-reports of recent vaginal sex and condom use collected through ACASI or face-to-face interviewing (FTFI) with a validated objective biomarker of recent semen exposure (prostate-specific antigen (PSA) levels). Of 910 study participants, 196 (21.5%) tested positive for PSA, an indication of semen exposure during the previous 2 days. Of these 196 participants, 23 (11.7%) reported no sex in the previous 2 days, with no difference in reported sexual activity between interview modes (12.5% ACASI vs. 10.9% FTFI; Fisher's exact test: P = 0.72). In addition, 71 PSA-positive participants (36.2%) reported condom-protected vaginal sex only; their reports also indicated no difference between interview modes (33.7% ACASI vs. 39.1% FTFI; P = 0.26). Only 52% of PSA-positive participants reported unprotected sex during the previous 2 days. Self-report was a poor predictor of recent sexual activity and condom use in this study, regardless of interview mode, providing evidence that such data should be interpreted cautiously. |
Detection of all four human metapneumovirus subtypes in nasopharyngeal specimens from children with respiratory disease in Uberlandia, Brazil
Carneiro BM , Yokosawa J , Arbiza J , Costa LF , Mirazo S , Nepomuceno LL , Oliveira TF , Goulart LR , Vieira CU , Freitas GR , Paula NT , Queiroz DA . J Med Virol 2009 81 (10) 1814-8 The human metapneumovirus (hMPV) is a pathogen of the respiratory tract identified first in the Netherlands in 2001 and since then it has been detected worldwide. The purpose of this study was to identify and characterize hMPV in samples collected from children <5 years presenting with acute respiratory disease (ARD) seen at a public hospital in Uberlandia, in Southeastern Brazil. One hundred fourteen nasopharyngeal aspirates (NPAs) samples that were negative for the presence of nine other respiratory viruses were tested by reverse transcription polymerase chain reaction (RT-PCR) for the presence of hMPV RNA. Fourteen out of 114 (12.3%) samples were positive for presence of hMPV RNA. PCR products, obtained by the amplification of partial nucleotide sequence of gene N, were sequenced and compared with sequences deposited in GenBank. Sequences from eight samples were obtained and all four subtypes were identified. Also, the recently proposed sublineages "a" and "b" of subtype A2 were found; mean age was 21 months old; upper respiratory tract infection (URTI) was the most common clinical symptom; the virus was detected in samples collected from March to November, a period that corresponds to late summer to mid-spring in Brazil. This is the first study to describe the circulation of all hMPV subtypes in Minas Gerais state. |
Youth assets and sexual risk behavior: differences between male and female adolescents
Mueller T , Gavin L , Oman R , Vesely S , Aspy C , Tolma E , Rodine S . Health Educ Behav 2009 37 (3) 343-56 Youth internal assets and external resources are protective factors that can help youth avoid potentially harmful behaviors. This study investigates how the relationship between youth assets or resources and two sexual risk behaviors (ever had sex and birth control use) varied by gender. Data were collected through in-home interviews from parent-adolescent dyads, including 1,219 females and 1,116 males. Important differences exist between male and female adolescents. Females with the nonparental role models or the family communication resource were more likely to report never having had sexual intercourse than were females without the resources. Among males, the aspirations for the future and responsible choices assets were associated with never having had sexual intercourse. Males and females had two assets or resources in common that were protective of never having had sex: peer role models and use of time (religion). Considering which youth assets and resources are more likely to positively influence sexual behaviors of males and females may be important when planning prevention programs with youth. |
H1N1 vaccine safety monitoring: beyond background rates
Destefano F , Tokars J . Lancet 2009 375 (9721) 1146-7 Since its emergence early this year, the H1N1 2009 influenza A virus has achieved pandemic proportions. Vaccines have been produced by several manufacturers and mass-vaccination campaigns are underway in the USA and several other countries. Scrutiny of the safety of H1N1 vaccines is expected to be intense. With potentially hundreds of millions of people being vaccinated, adverse events will inevitably occur in some recently vaccinated people and the question will arise as to whether the vaccine was causative. | In The Lancet today, Steven Black and colleagues1 estimate the expected background rates of occurrence of several health conditions. The authors obtained rates from the literature and also from computerised health databases in several countries. They show that when millions of people are vaccinated, even rare health conditions can be expected to occur coincidentally shortly after vaccination. For example, among 10 million vaccinees, it can be predicted that about 22 will develop Guillain-Barré syndrome within 6 weeks of vaccination even if the vaccine does not increase the risk of the syndrome. Knowledge that this number of events would have occurred regardless of whether or not the individuals were vaccinated will be extremely important in providing an appropriate context in which to interpret adverse events after immunisation. |
A system for recording high fidelity cough sound and airflow characteristics
Goldsmith WT , Mahmoud AM , Reynolds JS , McKinney WG , Afshari AA , Abaza AA , Frazer DG . Ann Biomed Eng 2009 38 (2) 469-77 Cough is considered an early sign of many respiratory diseases. Recently, there has been increased interest in measuring, analyzing, and characterizing the acoustical properties of a cough. In most cases the main focus of those studies was to distinguish between involuntary coughs and ambient sounds over a specified time period. The objective of this study was to develop a system to measure high fidelity voluntary cough sounds to detect lung diseases. To further augment the analysis capability of the system, a non-invasive flow measurement was also incorporated into the design. One of the main design considerations was to increase the fidelity of the recorded sound characteristics by increasing the signal to noise ratio of cough sounds and to minimize acoustical reflections from the environment. To accomplish this goal, a system was designed with a mouthpiece connected to a cylindrical tube. A microphone was attached near the mouthpiece so that its diaphragm was tangent to the inner surface of the cylinder. A pneumotach at the end of the tube measured the airflow generated by the cough. The system was terminated with an exponential horn to minimize sound reflections. Custom software was developed to read, process, display, record, and analyze cough sound and airflow characteristics. The system was optimized by comparing acoustical reflections and total signal to background noise ratios across different designs. Cough measurements were also collected from volunteer subjects to assess the viability of the system. Results indicate that analysis of cough characteristics has the potential to detect lung disease. |
Assessment of radionuclide databases in CAP88 mainframe version 1.0 and Windows-based version 3.0
LaBone ED , Farfan EB , Lee PL , Jannik GT , Donnelly EH , Foley TQ . Health Phys 2009 97 (3) 242-7 In this study the radionuclide databases for two versions of the Clean Air Act Assessment Package-1988 (CAP88) computer model were assessed in detail. CAP88 estimates radiation dose and the risk of health effects to human populations from radionuclide emissions to air. This program is used by several U.S. Department of Energy (DOE) facilities to comply with National Emission Standards for Hazardous Air Pollutants regulations. CAP88 Mainframe, referred to as version 1.0 on the U.S. Environmental Protection Agency Web site (http://www.epa.gov/radiation/assessment/CAP88/), was the very first CAP88 version released in 1988. Some DOE facilities including the Savannah River Site still employ this version (1.0) while others use the more user-friendly personal computer Windows-based version 3.0 released in December 2007. Version 1.0 uses the program RADRISK based on International Commission on Radiological Protection Publication 30 as its radionuclide database. Version 3.0 uses half-life, dose, and risk factor values based on Federal Guidance Report 13. Differences in these values could cause different results for the same input exposure data (same scenario), depending on which version of CAP88 is used. Consequently, the differences between the two versions are being assessed in detail at Savannah River National Laboratory. The version 1.0 and 3.0 database files contain 496 and 838 radionuclides, respectively, and though one would expect the newer version to include all the 496 radionuclides, 35 radionuclides are listed in version 1.0 that are not included in version 3.0. The majority of these has either extremely short or long half-lives or is no longer in production; however, some of the short-lived radionuclides might produce progeny of great interest at DOE sites. In addition, 122 radionuclides were found to have different half-lives in the two versions, with 21 over 3 percent different and 12 over 10 percent different. |
Lagos bat virus virulence in mice inoculated by the peripheral route
Markotter W , Kuzmin IV , Rupprecht CE , Nel LH . Epidemiol Infect 2009 137 (8) 1155-62 Lagos bat virus (LBV) constitutes genotype (gt) 2 in the Lyssavirus genus. In contrast to the gt1 lyssavirus, rabies virus (RABV), LBV was reported to have markedly reduced levels of peripheral pathogenicity. However, this opinion was based on a study of one isolate of LBV only and the reduction in pathogenicity was essentially attributed to the amino-acid substitution at position 333 of glycoprotein ectodomain. In the present study we have demonstrated that peripheral pathogenicity of representatives of LBV in a murine model is as high as that of RABV. Comparison of amino-acid substitutions among the viral glycoproteins, demonstrated significant differences within two antigenic sites between different phylogenetic lineages of LBV. Such molecular variability potentially contributes to differences in peripheral pathogenicity of lyssaviruses. |
A New World primate deficient in tetherin-mediated restriction of human immunodeficiency virus type 1
Wong SK , Connole M , Sullivan JS , Choe H , Carville A , Farzan M . J Virol 2009 83 (17) 8771-80 Human immunodeficiency virus type 1 (HIV-1) does not replicate in primary cells of New World primates. To better understand this restriction, we expressed owl monkey (Aotus nancymaae) CD4 and CXCR4 in the owl monkey kidney cell line, OMK. An HIV-1 variant modified to evade the owl monkey restriction factor TRIM-cyp replicated efficiently in these cells but could not replicate in primary A. nancymaae CD4-positive T cells. To understand this difference, we examined APOBEC3G and tetherin orthologs from OMK cells and primary A. nancymaae cells. We observed that OMK cells expressed substantially lower levels of APOBEC3G than did A. nancymaae cells. A. nancymaae, but not marmoset (Callithrix jacchus), APOBEC3G was partially downregulated by HIV-1 vif and reduced but did not abolish HIV-1 replication when stably expressed in OMK cells. The functional difference between A. nancymaae and marmoset APOBEC3Gs mapped to residue 128, previously shown to distinguish African green monkey from human APOBEC3G. We also characterized tetherin orthologs from OMK and A. nancymaae cells. The A. nancymaae tetherin ortholog, but not OMK tetherin, prevented HIV-1 release. Alteration of threonine 181 of OMK tetherin rescued its function and its efficient N glycosylation. All alleles of Aotus lemurinus griseimembra examined, but none of A. nancymaae or Aotus vociferans, encoded this nonfunctional tetherin ortholog. Our data indicate that HIV-1 replication in owl monkeys is not restricted at entry but can be limited by APOBEC3G and tetherin. Further, A. lemurinus griseimembra does not restrict HIV-1 replication via tetherin, a property likely useful for the study of tetherin-restricted viruses. |
Aspergillus terreus accessory conidia are unique in surface architecture, cell wall composition and germination kinetics
Deak E , Wilson SD , White E , Carr JH , Balajee SA . PLoS One 2009 4 (10) e7673 Infection with Aspergillus terreus is more likely to result in invasive, disseminated disease when compared to other Aspergillus species; importantly this species appears to be less susceptible to the antifungal drug amphotericin B. Unique to this species is the ability to produce specialized structures denoted as accessory conidia (AC) directly on hyphae both in vitro and in vivo. With the hypothesis that production of AC by A. terreus may enhance virulence of this organism, we analyzed the phenotype, structure and metabolic potential of these conidia. Comparison of A. terreus phialidic conidia (conidia that arise from conidiophores, PC) and AC architecture by electron microscopy revealed distinct morphological differences between the two conidial forms; AC have a smoother, thicker outer cell surface with no apparent pigment-like layer. Further, AC germinated rapidly, had enhanced adherence to microspheres, and were metabolically more active compared to PC. Additionally, AC contained less cell membrane ergosterol, which correlated with decreased susceptibility to AMB as determined using a flow cytometry based analysis. Furthermore, AC exhibited surface patches of beta1-3 glucan, suggestive of attachment scarring. Collectively, the findings of this study suggest a possible role for AC in A. terreus pathogenesis. |
Changes in asthma-like responses after extended removal from exposure to trimellitic anhydride in the Brown Norway rat model
Zhang XD , Hubbs AF , Siegel PD . Clin Exp Allergy 2009 39 (11) 1746-53 BACKGROUND: Organic acid anhydride-induced occupational asthma is considered to be IgE-mediated. Airway and skin exposure are the two main routes of sensitization in the work place. Recently we developed an allergic asthmatic Brown Norway rat model sensitized by dermal exposure to trimellitic anhydride (TMA) using an occlusion patch application. OBJECTIVES: The objectives of this study were (1) to develop a model of non-occluded dermal exposure leading to allergic sensitization and (2) to examine the effect of extended removal from exposure on persistence of both specific IgE and TMA aerosol-induced airway responses in this model. METHODS: TMA powder (4 or 40 mg) was applied, unoccluded, to the skin of rats for 4 h, once/week for 4 weeks. Rats were given a 10-min aerosol challenge to 40 mg/m(3) TMA 2 weeks after the last dermal exposure (day 35). Another group was challenged on day 35 and again 18-24 months later. Respiratory enhanced pause (Penh), pulmonary histopathology and inflammation and specific IgE titres were measured. RESULTS: Rats produced dose-dependent specific IgE titres after exposure and developed early-phase (EAR) and late-phase airway responses (LAR) after airway challenge to TMA aerosol as well as airway eosinophilic inflammation. Specific airway responses were still manifested after a second TMA airway challenge given 18-24 months following the initial airway challenge. While persistent, airway inflammation, specific IgE and EAR were significantly attenuated following the second TMA challenge. LAR remained robust at 18-24 months and was not significantly different from the response on day 35. CONCLUSIONS: These results demonstrate the persistence of chemical sensitization and further suggest that IgE is not essential for LAR. |
Computer controlled multi-walled carbon nanotube inhalation exposure system
McKinney W , Chen B , Frazer D . Inhal Toxicol 2009 21 (12) 1053-61 Inhalation exposure systems are necessary tools for determining the dose-response relationship of inhaled toxicants under a variety of exposure conditions. The objective of this project was to develop an automated computer controlled system to expose small laboratory animals to precise concentrations of airborne multi-walled carbon nanotubes (MWCNT). An aerosol generator was developed which was capable of suspending a respirable fraction of multi-walled carbon nanotubes from bulk material. The output of the generator was used to expose small laboratory animals to constant aerosol concentrations up to 12 mg/m(3). Particle distribution and morphology of the MWCNT aerosol delivered to the exposure chamber were measured and compared to samples previously taken from air inside a facility that produces MWCNT. The comparison showed the MWCNT generator was producing particles similar in size and shape to those found in a work environment. The inhalation exposure system combined air flow controllers, particle monitors, data acquisition devices, and custom software with automatic feedback control to achieve constant and repeatable exposure chamber temperature, relative humidity, pressure, aerosol concentration, and particle size distribution. The automatic control algorithm was capable of maintaining the mean aerosol concentration to within 0.1 mg/m(3) of the selected target value, and it could reach 95% of the target value in less than 10 minutes during the start-up of an inhalation exposure. One of the major advantages of this system was that once the exposure parameters were selected, a minimum amount of operator intervention was required over the exposure period. |
Detection of antiviral resistance and genetic lineage markers in influenza B virus neuraminidase using pyrosequencing
Sheu TG , Deyde VM , Garten RJ , Klimov AI , Gubareva LV . Antiviral Res 2009 85 (2) 354-60 We report here the design of a pyrosequencing approach for the detection of molecular markers of resistance to the neuraminidase inhibitors zanamivir and oseltamivir in influenza viruses of type B. Primers were designed to analyze the sequences at eight amino acid positions E119, R152, D198, I222, S250, H274, R371, and G402 (universal A/N2 numbering) in the neuraminidase (NA) which have been previously found to be associated with resistance or reduced susceptibility to oseltamivir and/or zanamivir in the NA inhibition assay. In addition, the designed primers could be utilized to the distinguish between the NAs of influenza B viruses from the two major lineages (Victoria and Yamagata) that have co-circulated globally in recent years, thus providing a valuable tool for virus strain surveillance. |
Dried tube specimens: a simple and cost-effective method for preparation of HIV proficiency testing panels and quality control materials for use in resource-limited settings
Parekh BS , Anyanwu J , Patel H , Downer M , Kalou M , Gichimu C , Keipkerich BS , Clement N , Omondi M , Mayer O , Ou CY , Nkengasong JN . J Virol Methods 2009 163 (2) 295-300 HIV testing has rapidly expanded worldwide, but proficiency testing (PT) programs to monitor and improve the quality of testing are often lacking in resource-limited settings (RLS). Traditional PT programs and quality control reagents use serum/plasma specimens requiring stringent conditions for storage and transportation. A novel, simple and easy to use approach, based on dried tube specimens (DTS), was developed that can help monitor the quality of HIV antibody testing in RLS. DTS were prepared by drying 20mul of specimen overnight at room temperature. The addition of a green dye (0.1%) made the DTS pellets visible without affecting the test results. Before testing, the DTS were rehydrated with 200mul of PBS/Tween buffer. A panel of 303 DTS samples (135 HIV positive and 168 negative) was evaluated with two rapid tests. Sensitivity and specificity with the Determine HIV-1/2 test were 99.3% and 99.4%, respectively, and with OraQuick were 98.5% and 100%, respectively. Stability studies showed that HIV-specific antibodies in the DTS specimens were stable at 4 degrees and 25 degrees for 4 weeks, with only marginal decline at 37 degrees and 45 degrees C over 4 weeks. The DTS-based PT program was piloted successfully in 24 testing sites in Kenya. Results demonstrate that the DTS is a simple to use, practical method to prepare and distribute PT panels and quality control specimens to monitor HIV testing practices in RLS. |
Maternal nutrient intake and risks for transverse and longitudinal limb deficiencies: data from the National Birth Defects Prevention Study, 1997-2003
Robitaille J , Carmichael SL , Shaw GM , Olney RS , National Birth Defects Prevention Study . Birth Defects Res A Clin Mol Teratol 2009 85 (9) 773-9 BACKGROUND: The association between periconceptional intake of supplements containing folic acid with specific subtypes of limb deficiencies has been inconsistent. The objective was to investigate whether intake of nutrients involved in one-carbon metabolism (folate, vitamin B(6), vitamin B(12), riboflavin, choline, betaine, zinc, and methionine) through diet alone or in combination with a supplement containing folic acid influenced the risk for transverse limb deficiency (TLD) and longitudinal limb deficiency (LLD). METHODS: We analyzed 1997-2003 data from the National Birth Defects Prevention Study and included 324 case infants with TLD, 158 case infants with LLD, and 4982 nonmalformed control infants. A food frequency questionnaire was used to estimate nutrient intakes. Use of supplements containing folic acid 1 month before through 2 months after conception was recorded. RESULTS: Use of a supplement containing folic acid was not associated with LLD or TLD. For nonsupplement users, within (1) the lowest quartile of dietary folate intake or vitamin B(6) intake, adjusted odds ratios (aORs) for LLD were, respectively, 3.86 (95% confidence interval [CI]: 1.08-13.78) and 4.36 (95% CI: 0.93-20.48); and (2) the lowest quartile for riboflavin intake, the aOR for TLD was 2.94 (95% CI: 1.04-8.32). For supplement users within the lowest quartile of folate intake or riboflavin intake, the aORs for TLD were, respectively, 1.52 (95% CI: 0.91-2.54) and 1.54 (95% CI: 1.00-2.37). CONCLUSIONS: TLD and LLD were not associated with supplement use, but TLD was associated with low intakes of riboflavin from diet. |
Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study
Crider KS , Cleves MA , Reefhuis J , Berry RJ , Hobbs CA , Hu DJ . Arch Pediatr Adolesc Med 2009 163 (11) 978-85 OBJECTIVE: To estimate the association between antibacterial medications and selected birth defects. DESIGN, SETTING, AND PARTICIPANTS: Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941). MAIN EXPOSURE: Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester). MAIN OUTCOME MEASURE: Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders. RESULTS: The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect). CONCLUSIONS: Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny. |
Are birth defects among Hispanics related to maternal nativity or number of years lived in the United States?
Ramadhani T , Short V , Canfield MA , Waller DK , Correa A , Royle M , Scheuerle A , National Birth Defects Prevention Study . Birth Defects Res A Clin Mol Teratol 2009 85 (9) 755-63 BACKGROUND: Literature on the risk of birth defects among foreign- versus U.S.-born Hispanics is limited or inconsistent. We examined the association between country of birth, immigration patterns, and birth defects among Hispanic mothers. METHODS: We used data from the National Birth Defects Prevention Study and calculated odds ratios (ORs) and 95% confidence intervals and assessed the relationship between mothers' country of birth, years lived in the United States, and birth defects among 575 foreign-born compared to 539 U.S.-born Hispanic mothers. RESULTS: Hispanic mothers born in Mexico/Central America were more likely to deliver babies with spina bifida (OR = 1.53) than their U.S.-born counterparts. Also, mothers born in Mexico/Central America or who were recent United States immigrants (< or =5 years) were less likely to deliver babies with all atrial septal defects combined, all septal defects combined, or atrial septal defect, secundum type. However, Hispanic foreign-born mothers who lived in the United States for >5 years were more likely to deliver babies with all neural tube defects combined (OR = 1.42), spina bifida (OR = 1.89), and longitudinal limb defects (OR = 2.34). Foreign-born mothers, regardless of their number of years lived in the United States, were more likely to deliver babies with anotia or microtia. CONCLUSIONS: Depending on the type of birth defect, foreign-born Hispanic mothers might be at higher or lower risk of delivering babies with the defects. The differences might reflect variations in predisposition, cultural norms, behavioral characteristics, and/or ascertainment of the birth defects. |
The co-occurrence of autism and birth defects: prevalence and risk in a population-based cohort
Schendel DE , Autry A , Wines R , Moore C . Dev Med Child Neurol 2009 51 (10) 779-86 AIM: To estimate the prevalence of major birth defects among children with autism, the prevalence of autism in children with birth defects, and the risk for autism associated with having birth defects. METHOD: Retrospective cohort including all children born in Atlanta, GA, USA, 1986 to 1993, who survived to age 3 years and were identified through Georgia vital records. Children with autism and other developmental disabilities residing in Atlanta at ages 3 to 10 years in 1996 were identified through the Metropolitan Atlanta Developmental Disabilities Surveillance Program. Children with major birth defects through age 6 years were identified by the Metropolitan Atlanta Congenital Defects Program. RESULTS: Birth defects were found among 6% of children with autism (total n=617; 488 males, 129 females) and was associated with a near twofold increased risk for autism overall. However, the risk magnitude and statistical significance varied by type of birth defect. With any type of birth defect, the risk for autism accompanied by intellectual disability or other developmental disabilities was typically higher than the risk for autism alone. A 6:1 to 8:1 male bias was observed among children with autism and a birth defect. INTERPRETATION: Investigation of the association between autism and birth defects is warranted, especially for the role of birth defects in autism among sex-specific or autism subgroups. |
Congenital trypanosoma cruzi transmission in Santa Cruz, Bolivia
Bern C , Verastegui M , Gilman RH , Lafuente C , Galdos-Cardenas G , Calderon M , Pacori J , Del Carmen Abastoflor M , Aparicio H , Brady MF , Ferrufino L , Angulo N , Marcus S , Sterling C , Maguire JH . Clin Infect Dis 2009 49 (11) 1667-74 BACKGROUND: We conducted a study of congenital Trypanosoma cruzi infection in Santa Cruz, Bolivia. Our objective was to apply new tools to identify weak points in current screening algorithms, and find ways to improve them. METHODS: Women presenting for delivery were screened by rapid and conventional serological tests. For infants of infected mothers, blood specimens obtained on days 0, 7, 21, 30, 90, 180, and 270 were concentrated and examined microscopically; serological tests were performed for the day 90, 180, and 270 specimens. Maternal and infant specimens, including umbilical tissue, were tested by polymerase chain reaction (PCR) targeting the kinetoplast minicircle and by quantitative PCR. RESULTS: Of 530 women, 154 (29%) were seropositive. Ten infants had congenital T. cruzi infection. Only 4 infants had positive results of microscopy evaluation in the first month, and none had positive cord blood microscopy results. PCR results were positive for 6 (67%) of 9 cord blood and 7 (87.5%) of 8 umbilical tissue specimens. PCR-positive women were more likely to transmit T. cruzi than were seropositive women with negative PCR results ([Formula: see text]). Parasite loads determined by quantitative PCR were higher for mothers of infected infants than for seropositive mothers of uninfected infants ([Formula: see text]). Despite intensive efforts, only 58% of at-risk infants had a month 9 specimen collected. CONCLUSIONS: On the basis of the low sensitivity of microscopy in cord blood and high rate of loss to follow-up, we estimate that current screening programs miss one-half of all infected infants. Molecular techniques may improve early detection. |
Photo quiz: Who is this man? Henry Rose Carter
Schultz MG . Emerg Infect Dis 2009 15 (10) 1681-4 He discovered the extrinsic incubation period of yellow fever. |
Occupational toxicology of nickel and nickel compounds
Zhao J , Shi X , Castranova V , Ding M . J Environ Pathol Toxicol Oncol 2009 28 (3) 177-208 Nickel and nickel compounds are widely used in industry. The high consumption of nickel products inevitably leads to occupational and environmental pollution. In occupational settings, exposure to nickel and nickel compounds occurs primarily during nickel refining, electroplating, and welding. The most common airborne exposures to nickel in the workplace are to insoluble nickel species, such as metallic nickel, nickel sulfide, and nickel oxides from dusts and fumes. The chemical and physical properties of nickel and nickel compounds strongly influence their bioavailability and toxicity. The lung and the skin are the principal target organs upon occupational exposure. inhalation exposure is a primary route for nickel-induced toxicity in the workplace. The most important adverse health effects due to occupational exposure to nickel and its compounds are skin allergies, lung fibrosis, and lung cancer. The exact mechanisms of nickel-induced carcinogenesis are not clear. This review summarizes the current knowledge on occupational toxicology of nickel and its compounds. The subtopics include: chemical and physical properties, uses, occupational exposures, occupational exposure limits, toxicokinetics, biological monitoring, acute toxicity, chronic toxicity, genotoxicity, reproductive toxicity, carcinogenicity, molecular mechanisms of carcinogenesis, and gaps in knowledge. |
Shelley Davis: public health advocate at the service of the farmworker
Baron S , Liebman AK , Ruiz V , Steege AL . Am J Public Health 2009 99 S505-S507 SHELLEY DAVIS MADE important contributions to civil rights, public health, and social justice, but, above all, she was a tireless advocate at the service of farmworkers. During her thirty-year career she fought in every available forum—federal and state courts, administrative agencies, state and federal legislatures, and the court of public opinion—over many issues, but especially over occupational health, environmental justice, child labor, and the rights of Latino and indigenous farmworkers. On Shelley Davis' CaringBridge Web site, Arturo S. Rodriguez, president of the United Farm Workers, wrote of her, “She is driven by an intense desire to ensure that the people who harvest the food we eat not be forced to sacrifice their health in the process.” | Davis, recognized and respected by allies and adversaries alike as a brilliant strategist in the area of social policy, was a masterful attorney who authored extraordinarily well-written and well-argued briefs. She was perhaps best known to her colleagues as an indefatigable and tenacious fighter for justice whose irrepressible optimism inspired others to join in her cause. Davis consistently fought to defend farmworkers, whether the matter was wage theft, pesticides, or HIV/AIDS. She was an authority not only on the law but also on public health issues. Davis was a bilingual (English and Spanish) activist personally involved with workers' lives and concerns. Her collaborator Nargess Shadbeh remembers that, in the field, Davis's first request was always, “Let's go to the labor camps so we can talk to the workers.” |
Alice Hamilton (1869-1970): mother of US occupational medicine
Baron SL , Brown TM . Am J Public Health 2009 99 S548 ALICE HAMILTON, OFTEN referred to as the mother of US occupational medicine, was also one of a pioneering group of young women who formed part of Jane Addam's Hull House at the turn of the 20th century. Born in New York City and raised in Fort Wayne, Indiana, Hamilton earned her medical degree at the University of Michigan in 1893. Following internships in Minneapolis, Minnesota, and Boston, Massachusetts, she studied bacteriology and pathology in Germany and then at Johns Hopkins University in Baltimore, Maryland. She moved to Chicago in 1897 where she was appointed professor of pathology at the Women's Medical School of Northwestern University.1(p1–10) | While happy to find a professional position in her field, she was most excited about the opportunity to become part of Jane Addam's new settlement movement. Her life at Hull House exposed her to many of the leading progressive era activists and social reformers including Florence Kelley, the socialist, who fought against child labor and for the 8-hour workday. In her autobiography, Hamilton wrote, “In settlement life it is impossible not to see how deep and fundamental are the inequalities in our democratic country.”2(p75) While living among the working class immigrant communities of Chicago, Illinois, she heard about their deplorable working conditions and she began reading studies by European occupational medicine researchers. When she asked US authorities about the existence of industrial poisoning she was assured that the European findings could not apply to American workers who “were so much better paid, their standard of living was so much higher, and the factories they worked in so much finer than the Europeans.”2(p115) Alice Hamilton's training in pathology, combined with her intimate knowledge of working class life, and her ideals of social reform made her the spearhead of the occupational safety and health movement in the United States.3 |
A clustering of immune-mediated polyradiculoneuropathy among swine abattoir workers exposed to aerosolized porcine brains, Indiana, United States
Adjemian JZ , Howell J , Holzbauer S , Harris J , Recuenco S , McQuiston J , Chester T , Lynfield R , Devries A , Belay E , Sejvar J . Int J Occup Environ Health 2009 15 (4) 331-8 In November 2007 a novel neuropathy, immune-mediated polyradiculoneuropathy (IP), was identified among workers at a Minnesota swine abattoir where a unique compressed air technique was used to remove porcine brains. An epidemiologic investigation at another abattoir in Indiana that also uses this process was launched to evaluate workers self-reporting neurologic illness compatible with IP. A nested case-control study was performed to identify cases and risk factors. Six confirmed, one probable, and three possible IP cases were detected. IP cases were 28-52 years old, of Latino origin, and 62.5% female. Onset dates ranged from April 2005-December 2007; 60% were hospitalized. IP cases at this plant were similar in clinical presentation and exposure risks to those detected in Minnesota. Swine abattoirs using similar brain extraction methods should discontinue this process. |
Increased bladder cancer risk among workers exposed to o-toluidine and aniline: a reanalysis
Carreon T , Hein MJ , Viet SM , Hanley KW , Ruder AM , Ward EM . Occup Environ Med 2009 67 (5) 348-50 INTRODUCTION: In 1991, the U.S. National Institute for Occupational Safety and Health (NIOSH) reported an increased bladder cancer risk in a cohort of 1749 workers potentially exposed to o-toluidine and aniline at a chemical manufacturing plant. Additional information showed that workers in certain departments had been misclassified regarding o-toluidine exposure; therefore, we conducted a reanalysis of the data using updated exposure categories. METHODS: We updated exposure categories based on information ascertained during a plant walkthrough, documents on file at the plant, interviews with current and former employees, and answers provided by company and union officials on specific questions. Bladder cancer incidence was determined through 31 December 1988 and mortality through 31 December 1994. RESULTS: Thirteen cases of bladder cancer were observed, versus 3.57 expected (New York State rates excluding New York City) [standardized incidence ratio (SIR) 3.64, 95% confidence interval (CI) 1.94-6.23]. Among workers classified as definitely exposed, increasing risks were observed for longer duration of employment [for ≥10 years, standardized rate ratio (SRR) 6.07, 95% CI 0.77-48.17] and time since first employment in the exposed departments (for ≥20 years, SRR 3.39, 95% CI 0.40-29.03). One bladder cancer death was observed among those definitely exposed. CONCLUSION: These findings are comparable to the results reported earlier by NIOSH, and confirm that workers in this plant have an increased risk of bladder cancer. |
Effects of age and glutathione levels on oxidative stress in rats after chronic exposure to stretch-shortening contractions
Hollander MS , Baker BA , Ensey J , Kashon ML , Cutlip RG . Eur J Appl Physiol 2009 108 (3) 589-97 We investigated effects of age and glutathione synthesis inhibition on the oxidative stress status of tibialis anterior muscles from young and old Fisher 344 x Brown Norway male rats after chronic administration of stretch-shortening contractions. Oral supplementation of L: -buthionine-(S,R)-sulfoximine (BSO) inhibited glutathione synthesis. Dorsiflexor muscles in the hindlimb were exposed to 80 maximal stretch-shortening contractions (SSCs) three times per week for 4.5 weeks. We measured malondialdehyde, hydrogen peroxide (H(2)O(2)), and free isoprostanes to determine oxidative stress. Glutathione peroxidase activity was measured as an indicator of H(2)O(2) scavenging. Glutathione measurements confirmed the effectiveness of BSO treatment. In young rats, the SSC exposure protocol prevented oxidative stress and enhanced H(2)O(2) scavenging. In old rats, malondialdehyde was increased in the exposed muscle and a BSO-induced increase in H(2)O(2) was not alleviated with SSC exposure as seen in young rats. In addition, glutathione peroxidase activity and total glutathione were increased in old rats relative to their young counterparts. All comparisons were significant at the 0.05 level. Overall, BSO administration was effective in decreasing total glutathione levels and increasing H(2)O(2) levels in old and young rats exposed to SSCs. In addition, effects of chronic exposure to high-force resistive loading SSCs in active muscle from old animals are: (1) antioxidant capacity is enhanced similar to what is seen with endurance training and (2) oxidative stress is increased, probably as a consequence of the enhanced vulnerability due to aging. |
Effects of glutathione depletion and age on skeletal muscle performance and morphology following chronic stretch-shortening contraction exposure
Baker BA , Hollander MS , Kashon ML , Cutlip RG . Eur J Appl Physiol 2009 108 (3) 619-30 The involvement of glutathione in the response of skeletal muscle following repetitive, high-intensity mechanical loading is not known. We examined the influence of a glutathione antagonist [L: -Buthionine Sulfoximine (BSO)] had on the adaptability of skeletal muscle during chronic mechanical loading via stretch-shortening contractions (SSCs) in young and old rats. Left dorsiflexor muscles of young (12 weeks, N = 16) and old (30 months, N = 16), vehicle- and BSO-treated rats were exposed three times per week for 4.5-weeks to a protocol of 80 maximal SSCs per exposure in vivo. Skeletal muscle response to the SSC exposure was characterized by muscle performance, as well as muscle wet-weight and quantitative morphological analyses following the exposure period. Results reveal that generally, muscle performance increased in the young rats only following chronic SSC exposure. BSO treatment had no effect on muscle performance or morphology following the chronic SSC exposure in old rats. Muscle wet-weight was increased following exposure compared with the contra-lateral control limb, irrespective of age (p < 0.05). Muscle cross-sectional area increased approximately 20% with SSC loading in the young, vehicle rats, while increasing approximately 10% with SSC loading in old, vehicle rats compared with control rat muscle. No degenerative myofibers were noted in either age group, but edema were increased as a result of aging (p < 0.05). We conclude that our results indicate that glutathione depletion does not adversely affect muscle performance or morphology in old rats. Nevertheless, we continue to show that aging negatively influences performance and morphology following chronic SSC exposure. |
Achieving recognition that mental health is part of the mission of CDC
Safran MA . Psychiatr Serv 2009 60 (11) 1532-4 For much of its history the U.S. Centers for Disease Control and Prevention (CDC) considered mental health to be outside of its mission. That assumption persisted even after CDC became a leading public health agency and began to face important mental health issues. This narrative describes how the organizational paradigm indicating that mental health was not mission related was challenged and superseded by a new paradigm recognizing mental health as part of CDC's public health mission. Even after the CDC Mental Health Work Group's establishment in 2000, CDC took eight more years to overcome powerful remnants of the old paradigm that had for so long excluded, minimized, or discouraged attention to mental health. The CDC Mental Health Work Group led the agency's mental health efforts without funding or dedicated staffing but with more than 100 CDC professionals from multiple disciplines and centers serving as voluntary members, in addition to their other CDC responsibilities. |
The contribution of family planning towards the prevention of vertical HIV transmission in Uganda
Hladik W , Stover J , Esiru G , Harper M , Tappero J . PLoS One 2009 4 (11) e7691 BACKGROUND: Uganda has one of the highest total fertility rates (TFR) worldwide. We compared the effects of antiretroviral (ARV) prophylaxis for the prevention of mother-to-child HIV transmission (PMTCT) to that of existing family planning (FP) use and estimated the burden of pediatric HIV disease due to unwanted fertility. METHODOLOGY/PRINCIPAL FINDINGS: Using the demographic software Spectrum, a baseline mathematical projection to estimate the current pediatric HIV burden in Uganda was compared to three hypothetical projections: 1) without ARV-PMTCT (to estimate the effect of ARV-PMTCT), 2) without contraception (effect of existing FP use), 3) without unwanted fertility (effect of unmet FP needs). Key input parameters included HIV prevalence, ARV-PMTCT uptake, MTCT probabilities, and TFR. We estimate that in 2007, an estimated 25,000 vertical infections and 17,000 pediatric AIDS deaths occurred (baseline projection). Existing ARV-PMTCT likely averted 8.1% of infections and 8.5% of deaths. FP use likely averted 19.7% of infections and 13.1% of deaths. Unwanted fertility accounted for 21.3% of infections and 13.4% of deaths. During 2008-2012, an estimated 131,000 vertical infections and 71,000 pediatric AIDS deaths will occur. The projected scale up of ARV-PMTCT (from 39%-57%) may avert 18.1% of infections and 24.5% of deaths. Projected FP use may avert 21.6% of infections and 18.5% of deaths. Unwanted fertility will account for 24.5% of infections and 19.8% of deaths. CONCLUSIONS: Existing FP use contributes as much or more than ARV-PMTCT in mitigating pediatric HIV in Uganda. Expanding FP services can substantially contribute towards PMTCT. |
Integrating reproductive health into HIV care of women in the United States: it is time
Burr CK , Fry RS , Weber S , Armas-Kolostroubis LN , Lampe MA . AIDS 2009 23 (14) 1928-30 Twenty-five years into the HIV/AIDS epidemic, we are at a crossroads in caring for HIV-infected women in the USA. Integrating comprehensive reproductive health and family planning services with HIV care for women in our care holds the promise of having healthier families and is an important element in moving toward the elimination of perinatal transmission of HIV. We are writing to give a voice to recommendations made by two expert panels of HIV clinicians and women's health experts in the USA who met in 2008 to discuss how to perform this feat of integrating reproductive health and HIV care. | Childbearing continues to be an important part of the lives of many of our patients, both female and male, living with HIV infection. Approximately, 8000 HIV-infected women give birth per year in the USA [1]. About one-third of HIV-infected women state that they want to have a child in the future [2]. A great deal of stigma still exists toward HIV-infected women and couples who want to get pregnant, especially from their healthcare providers. Women with HIV, particularly perinatally infected women now of reproductive age, come to motherhood with significant psychosocial as well as medical challenges. The small body of existing data tells us that that both HIV discordant and concordant couples have complex experiences, including making decisions about unprotected sex with the intention to conceive, shifting responsibility for condom use as relationships progress, and insufficient knowledge about how to reduce partner transmission risk in relation to childbearing [3]. |
Active cigarette smoking, secondhand smoke exposure at work and home, and self-rated health
Nakata A , Takahashi M , Swanson NG , Ikeda T , Hojou M . Public Health 2009 123 (10) 650-6 OBJECTIVES: Although active smoking has been reported to be associated with poor self-rated health (SRH), its association with secondhand smoke (SHS) is not well understood. STUDY DESIGN: A cross-sectional study was conducted to examine the association of active smoking and SHS exposure with SRH. METHODS: A total of 2558 workers (1899 men and 689 women), aged 16-83 (mean 45) years, in 296 small and medium-sized enterprises were surveyed by means of a self-administered questionnaire. Smoking status and exposure levels to SHS (no, occasional or regular) among lifetime non-smokers were assessed separately at work and at home. SRH was assessed with the question: How would you describe your health during the past 1-year period (very poor, poor, good, very good)? SRH was dichotomized into suboptimal (poor, very poor) and optimal (good, very good). Odds ratios (ORs) with 95% confidence intervals (CIs) for reporting suboptimal vs optimal SRH according to smoking status and smoke exposure were calculated. RESULTS: Current heavy smokers (20+ cigarettes/day) had a significantly increased suboptimal SRH than lifetime non-smokers after adjusting for sociodemographic, lifestyle, physical and occupational factors (OR 1.34, 95% CI 1.06-1.69). Similarly, lifetime non-smokers occasionally exposed to SHS at work alone had worse SRH than their unexposed counterparts (OR 1.50, 95% CI 1.02-2.11). In contrast, lifetime non-smokers exposed at home alone had no significant increase in suboptimal SRH. CONCLUSIONS: The present study indicates an increase in suboptimal SRH among current heavy smokers, and suggests that SHS exposure at work is a possible risk factor for non-smokers. Whether or not the association is causal, control of smoking at work may protect workers from developing future health conditions. |
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