Prevalence of venous thromboembolism among privately insured US adults
Boulet SL , Grosse SD , Hooper WC , Beckman MG , Atrash HK . Arch Intern Med 2010 170 (19) 1774-5 Venous thromboembolism (VTE) includes deep | vein thrombosis (DVT) and pulmonary embolism (PE); DVT refers to the formation of 1 or | more blood clots in a large vein, and PE results when a | portion of the blood clot breaks loose, travels through | the bloodstream, and partially or completely blocks a pulmonary artery.1 Venous thromboembolism is an important and growing public health concern; however, a national surveillance system for this condition has not been | established.2 Therefore, many of the current estimates of | VTE incidence were derived from geographically defined populations,3,4 single institutions,5 or hospital discharge databases.6 Hospital discharge data are particularly problematic because many patients are treated on | an outpatient basis.5 | Administrative data represent a potential source for | monitoring VTE trends in the absence of established public health surveillance systems. We used health insurance claims data from a large, privately insured US adult | population to estimate the prevalence of VTE during 2005 | through 2006 within that population. To account for the | potential for misclassification of DVT or PE diagnoses | in claims data, we also explored using different algorithms to calculate our estimates. |
The identification of children with adverse risk factor levels by body mass index cutoffs from 2 classification systems: the Bogalusa Heart Study
Freedman DS , Fulton JE , Dietz WH , Pan L , Nihiser AJ , Srinivasan SR , Berenson GS . Am J Clin Nutr 2010 92 (6) 1298-305 BACKGROUND: The cutoffs from the Centers for Disease Control and Prevention (CDC) growth charts and from the Cooper Institute (FitnessGram) are widely used to identify children who have a high body mass index (BMI). OBJECTIVE: We compared the abilities of these 2 systems to identify children who have adverse lipid concentrations and blood pressure measurements and the reliability (consistency) of each classification system over time (mean follow-up: 7 y). DESIGN: A cross-sectional analysis based on data from 22,896 examinations of 5- to 17-y-olds was conducted. Principal components analyses were used to summarize levels of the 5 risk factors, and likelihood ratios and the kappa statistic were used to compare the screening abilities of the 2 systems. Of these children, 3972 were included in longitudinal analyses. RESULTS: There were marked differences in the prevalence of a high FitnessGram BMI by age, with the prevalence among boys increasing from 2.5% to 21% between the ages of 5 and 11 y. The identification of adverse risk factors by the 2 systems was only fair (kappa = 0.25), but there was little difference in the abilities of the CDC and FitnessGram cutoffs to identify high-risk children. Longitudinal analyses, however, indicated that the agreement between initial and follow-up FitnessGram classifications was substantially lower than that based on CDC cutoffs (kappa = 0.28 compared with 0.49). CONCLUSIONS: The FitnessGram and CDC cutoffs have similar abilities to identify high-risk children. However, a high FitnessGram BMI is difficult to interpret because the reliability over time is low, and the prevalence increases markedly with age. |
Addressing mental health promotion in chronic disease prevention and health promotion
Perry GS , Presley-Cantrell LR , Dhingra SS . Am J Public Health 2010 100 (12) 2337-9 The World Health Organization (WHO) defines mental health as “not just the absence of mental disorder” but “as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”1(p2) Mental illness, on the other hand, is the “term that refers collectively to all diagnosable mental disorders” that are “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”2(p5) | Further, WHO has long defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity.”3(p100) Given these definitions, it should be clear that there is no health without mental health. |
Cancer statistics, 2010
Jemal A , Siegel R , Xu J , Ward E . CA Cancer J Clin 2010 60 (5) 277-300 Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data regarding cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,529,560 new cancer cases and 569,490 deaths from cancer are projected to occur in the United States in 2010. Overall cancer incidence rates decreased in the most recent time period in both men (1.3% per year from 2000 to 2006) and women (0.5% per year from 1998 to 2006), largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and 2 major cancer sites in women (breast and colorectum). This decrease occurred in all racial/ethnic groups in both men and women with the exception of American Indian/Alaska Native women, in whom rates were stable. Among men, death rates for all races combined decreased by 21.0% between 1990 and 2006, with decreases in lung, prostate, and colorectal cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2006 decreased by 12.3%, with decreases in breast and colorectal cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates translates to the avoidance of approximately 767,000 deaths from cancer over the 16-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, geographic area, and calendar year. Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment. |
Genetic characterization of clade B measles viruses isolated in Tunisia and Libya 2002-2009 and a proposed new subtype within the B3 genotype
Haddad-Boubaker S , Rezq M , Smeo MN , Ben Yahia A , Abudher A , Slim A , Ben Ghorbel M , Ahmed H , Rota P , Triki H . Virus Res 2010 153 (2) 258-64 Genetic characterization was conducted on 18 wild-type measles viruses, detected in Tunisia and Libya from 2002 to 2009. Sequence analysis of the 456 nucleotides in the carboxy terminus of the nucleoprotein (N) gene and the entire hemagglutinin (H) gene indicated that all isolates were in genotype B3. All of the viruses from 2002 to 2007 and some of the isolates from 2009 belonged to subtype B3.1. In contrast, 7 of the viruses isolated during 2008 and 2009 were quite divergent from all B3 isolates. The nucleotide sequences of the N gene of these 7 isolates differed from the sequences of the Ibadan and New York reference strain by an average of 3.1 and 4.4%, respectively. The H gene sequences differed by 1.1 and 2.6% with the same reference strains. This is the first report describing the genetic characteristics of measles viruses from clade B isolated in North Africa; the results suggest that these viruses represent a new subtype of genotype B3. |
Human papillomavirus infection and cytologic abnormalities of the anus and cervix among HIV-infected women in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (The SUN Study)
Kojic EM , Cu-Uvin S , Conley L , Bush T , Onyekwuluje J , Swan DC , Unger ER , Henry K , Hammer JH , Overton ET , Darragh TM , Palefsky JM , Vellozzi C , Patel P , Brooks JT . Sex Transm Dis 2010 38 (4) 253-9 BACKGROUND: Human papillomavirus (HPV) infection of the cervix and related abnormal cervical cytology in HIV-infected women has been well described. Little is known about anal HPV infection in HIV-infected women. METHODS: The SUN Study is a prospective cohort study of 700 HIV-infected patients including 167 women. At baseline, patients completed a behavioral questionnaire and provided, among other samples, cervical and anal swabs for HPV detection and genotyping and for cytologic examination. Here, we present the available baseline data on the 167 women in the SUN study. RESULTS: Baseline results were available for 120 women (median age: 38 years, 57% non-Hispanic black, median CD4 cell count 444.5 cells/mm), of whom, 77% were taking antiretroviral therapy. The prevalences in the anus and cervix of any HPV were 90% and 83%, respectively (P = 0.039), and of high-risk (HR) types 85% and 70%, respectively, (P = 0.001). There was no significant difference in the prevalences of abnormal cytology between the anus and cervix: 38% and 33%, respectively (P = 0.217). Although the presence of abnormal cervical cytology was associated with the presence of abnormal anal cytology (relative risk: 1.7, P = 0.024), its sensitivity (52.5%) and positive predictive value positive (45.6%) for identifying women with abnormal anal cytology were poor. A history of anal sex was not associated with anal HPV infection or abnormal anal cytology. CONCLUSIONS: In this cohort of HIV-infected women, anal HPV infection was more prevalent and diverse than cervical HPV infection. Anal cytologic abnormalities were as prevalent as cervical cytologic abnormalities, and although abnormal cervical cytology was predictive of abnormal anal cytology, results were not highly concordant. These data support the need for studies of anal cytologic screening of HIV-infected women. |
Injection drug use, HIV and the current response in selected low-income and middle-income countries
Bergenstrom AM , Abdul-Quader AS . AIDS 2010 24 Suppl 3 S20-9 Over half of the world's estimated opiate users reside in Asia, including an estimated 3.9 million injecting drug users (IDUs). Injection drug use is a significant factor in determining the course of HIV epidemics, particularly during the early stages of epidemics in Asian countries. Several countries report high HIV prevalence in this population and IDUs account for a large proportion of reported infections. The purpose of this review is to examine the current status of the epidemic, the availability and coverage of select interventions recommended by WHO, United Nations Office on Drugs and Crimes (UNODC) and United Nations Joint Programme on HIV/AIDS (UNAIDS), resource requirements for scaling-up harm reduction in Asia, gaps in the national response, barriers to implementation and recommendations for overcoming barriers to scaling up prevention, treatment and care services for IDUs in the region. |
Burden of typhoid and paratyphoid fever in a densely populated urban community, Dhaka, Bangladesh
Naheed A , Ram PK , Brooks WA , Hossain MA , Parsons MB , Talukder KA , Mintz E , Luby S , Breiman RF . Int J Infect Dis 2010 14 Suppl 3 e93-9 BACKGROUND: We conducted blood culture surveillance to estimate the incidence of typhoid and paratyphoid fever among urban slum residents in Dhaka, Bangladesh. METHODS: Between January 7, 2003 and January 6, 2004, participants were visited weekly to detect febrile illnesses. Blood cultures were obtained at the clinic from patients with fever (≥38 degrees C). Salmonella isolates were assayed for antimicrobial susceptibility. RESULTS: Forty Salmonella Typhi and eight Salmonella Paratyphi A were isolated from 961 blood cultures. The incidence of typhoid fever was 2.0 episodes/1000 person-years, with a higher incidence in children aged<5 years (10.5/1000 person-years) than in older persons (0.9/1000 person-years) (relative risk=12, 95% confidence interval (CI) 6.3-22.6). The incidence of paratyphoid fever was 0.4/1000 person-years without variation by age group. Sixteen S. Typhi isolates were multidrug-resistant (MDR). All S. Paratyphi isolates were pan-susceptible. The duration of fever among patients with an MDR S. Typhi infection was longer than among patients with non-MDR S. Typhi (16+/-8 vs. 11+/-4 days, p=0.02) and S. Paratyphi (10+/-2 days, p=0.04) infections. CONCLUSIONS: Typhoid fever is more common than paratyphoid fever in the urban Bangladeshi slum; children<5 years old have the highest incidence. Multidrug resistance is common in S. Typhi isolates and is associated with prolonged illness. Strategies for typhoid fever prevention in children aged<5 years in Bangladesh, including immunization, are needed. |
Comparison of engorged Culex quinquefasciatus collection and blood-feeding pattern among four mosquito collection methods in Puerto Barrios, Guatemala, 2007
Kent RJ , Gonzalez Reiche AS , Morales-Betoulle ME , Komar N . J Am Mosq Control Assoc 2010 26 (3) 332-336 Investigators have used a variety of techniques to sample resting, engorged mosquitoes for the purposes of studying mosquito blood-feeding behavior. However, evidence exists that mosquito blood-feeding patterns may vary according to collection method. Engorged mosquitoes were collected from rural and urban habitats after the 2007 dry (July) and wet (December) seasons in the Department of Izabal, Guatemala, with the use of Centers for Disease Control and Prevention (CDC) light traps, gravid traps, and aspiration from plastic pots and vegetation. We evaluated the utility of plastic pots as sampling tools for engorged Culex mosquitoes and compared Cx. quinquefasciatus blood host identities among collection methods. The array of vertebrate hosts supplying blood to Cx. quinquefasciatus did not differ significantly by method of collection. The density of engorged Cx. quinquefasciatus per trap-night was not significantly different between CDC light traps, gravid traps, and plastic pots; however, there was a significantly higher proportion of total mosquitoes that were engorged collected from pots than from either CDC light traps or gravid traps. |
Prevalence of Acanthamoeba spp. and other free-living amoebae in household water, Ohio, USA-1990-1992
Stockman LJ , Wright CJ , Visvesvara GS , Fields BS , Beach MJ . Parasitol Res 2010 108 (3) 621-7 Knowledge of the prevalence of free-living amoebae (FLA) in US household water can provide a focus for prevention of amoeba-associated illnesses. Household water samples from two Ohio counties, collected and examined for amoebae during 1990-1992, were used to describe the prevalence of Acanthamoeba and other FLA in a household setting. Amoebae were isolated and identified by morphologic features. A total of 2,454 samples from 467 households were examined. Amoebae were found in water samples of 371 (79%) households. Sites most likely to contain amoeba were shower heads (52%) and kitchen sprayers (50%). Species of Hartmannella, Acanthamoeba, or Vahlkampfia were most common. Detection was higher in biofilm swab samples than in water samples. Detection of FLA and Acanthamoeba, at 79% and 51%, respectively, exceed estimates that have been published in previous surveys of household sources. We believe FLA are commonplace inhabitants of household water in this sample as they are in the environment. |
A standardized health information system for refugee settings: rationale, challenges and the way forward
Haskew C , Spiegel P , Tomczyk B , Cornier N , Hering H . Bull World Health Organ 2010 88 (10) 792-4 The past 10 years have seen a significant increase in the amount of resources allocated to public health programmes for refugees.1 Increased funding and complex challenges in providing effective public health interventions in refugee settings have brought associated demands for better data and improved accountability. | In the past five years, the Office of the United Nations High Commissioner for Refugees (UNHCR) and its partners have developed and implemented a standardized health information system (HIS) in numerous countries to monitor camp-based refugee health programmes.2 The aim has been to improve the health status of refugees and other displaced persons through evidence-based policy formulation and better management of health programmes. At the end of 2009, a total of 17 operations in Africa, Asia and the Middle East were reporting into a standardized HIS using common tools and guidelines. The total population under surveillance was approximately 1.5 million refugees in 85 refugee camps across 24 different partners. |
Tracing the origins of Mycobacterium bovis tuberculosis in humans in the USA to cattle in Mexico using spoligotyping
Rodwell TC , Kapasi AJ , Moore M , Milian-Suazo F , Harris B , Guerrero LP , Moser K , Strathdee SA , Garfein RS . Int J Infect Dis 2010 14 Suppl 3 e129-35 OBJECTIVES: To compare genotypes of Mycobacterium bovis strains from humans in Southern California with genotypes of M. bovis strains in cattle in Mexico and the USA to explore the possible origins of human infections. METHODS: We conducted a descriptive analysis of M. bovis genotypes from a binational population of humans and cattle using spacer oligonucleotide typing (spoligotyping). RESULTS: One hundred six human M. bovis spoligotypes were compared to spoligotypes from 496 Mexican cattle and 219 US cattle. Twelve spoligotype patterns were identified among human cases and 126 spoligotype patterns were detected in cattle. Over 91% (97/106) of the human M. bovis isolates had spoligotypes that were identical to those found in Mexican cattle. Four human cases had spoligotypes that matched both cattle born in Mexico and in the USA. Nine human cases had spoligotypes that did not match cattle born in Mexico or the USA. CONCLUSIONS: Our data indicate that the population of M. bovis strains causing human TB disease in Southern California is closely related to the M. bovis strain population found in Mexican cattle and supports existing epidemiological evidence that human M. bovis disease in San Diego likely originated from Mexican cattle. |
US state alcohol sales compared to survey data, 1993-2006
Nelson DE , Naimi TS , Brewer RD , Roeber J . Addiction 2010 105 (9) 1589-96 AIMS: Assess long-term trends of the correlation between alcohol sales data and survey data. DESIGN: Analyses of state alcohol consumption data from the US Alcohol Epidemiologic Data System based on sales, tax receipts or alcohol shipments. Cross-sectional, state annual estimates of alcohol-related measures for adults from the US Behavioral Risk Factor Surveillance System using telephone surveys. SETTING: United States. Participants State alcohol tax authorities, alcohol vendors, alcohol industry (sales data) and randomly selected adults aged > or = 18 years 1993-2006 (survey data). MEASUREMENTS: State-level per capita annual alcohol consumption estimates from sales data. Self-reported alcohol consumption, current drinking, heavy drinking, binge drinking and alcohol-impaired driving from surveys. Correlation coefficients were calculated using linear regression models. FINDINGS: State survey estimates of consumption accounted for a median of 22% to 32% of state sales data across years. Nevertheless, state consumption estimates from both sources were strongly correlated with annual r-values ranging from 0.55-0.71. State sales data had moderate-to-strong correlations with survey estimates of current drinking, heavy drinking and binge drinking (range of r-values across years: 0.57-0.65; 0.33-0.70 and 0.45-0.61, respectively), but a weaker correlation with alcohol-impaired driving (range of r-values: 0.24-0.56). There were no trends in the magnitude of correlation coefficients. CONCLUSIONS: Although state surveys substantially underestimated alcohol consumption, the consistency of the strength of the association between sales consumption and survey data for most alcohol measures suggest both data sources continue to provide valuable information. These findings support and extend the distribution of consumption model and single distribution theory, suggesting that both sales and survey data are useful for monitoring population changes in alcohol use. |
Outbreak of acute gastroenteritis in young children with death due to rotavirus genotype G9 in Rio Branco, Brazilian Amazon region, 2005
Siqueira AA , Santelli AC , Alencar LR Jr , Dantas MP , Dimech CP , Carmo GM , Santos DA , Alves RM , Lucena MB , Morais M , Assis RM , Fialho A , Mascarenhas JD , Costa M , Linhares AC , Leite JP , Araujo WN , Hatch DL . Int J Infect Dis 2010 14 (10) e898-903 BACKGROUND: An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death. METHODS: Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%). CONCLUSIONS: Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil. |
The geography of heterosexual partnerships in Baltimore city adults
Gindi RM , Sifakis F , Sherman SG , Towe VL , Flynn C , Zenilman JM . Sex Transm Dis 2010 38 (4) 260-6 BACKGROUND: Human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk is determined in part by sexual network characteristics, which include spatial parameters. Geography and proximity of partner selection are important factors, which may explain neighborhood-level differences in HIV/STD morbidity. To study the effects of neighborhood factors on HIV/STD transmission in high-density urban areas, the geography of partner selection must be understood. METHODS: The Baltimore site of the National HIV Behavioral Surveillance system surveyed adults reporting one or more heterosexual partnerships. Spatial assortativity was defined as both partners residing in the same or adjacent census tracts and based on participant report. HIV core areas were defined as the census tracts in the top quartile for standardized HIV/AIDS case rates. RESULTS: Participants (n = 307) provided data on 776 recent sexual partnerships, and geographic information were obtained for 510 partnerships (66%). Almost half (47%) reported choosing spatially assortative partners. Participants who lived in high HIV-prevalence areas were more likely to choose spatially assortative partners than residents of lower prevalence areas after adjusting for partnership type, gender, and number of partners. Although this population exhibited assortative mixing in all types of partnerships, racial and age assortativities were not associated with choosing spatially assortative partners. CONCLUSIONS: Over 15 years ago, STD clinic patients in Baltimore were found to seek partners within close proximity. We confirm these results in a non-STD clinic population, indicating a continuing need for neighborhood approaches to intervention programs in urban areas. |
Improving the quality of industry and occupation data at a central cancer registry
Armenti KR , Celaya MO , Cherala S , Riddle B , Schumacher PK , Rees JR . Am J Ind Med 2010 53 (10) 995-1001 BACKGROUND: Central cancer registries are required to collect industry and occupation (I/O) information when available, but the data reported are often incomplete. METHODS: We audited the completeness of I/O data in the New Hampshire State Cancer Registry (NHSCR) database for diagnosis year 2005, and reviewed medical records for a convenience sample of 474 of these cases. We compared I/O data quality before and after a statewide registrar training session on occupationally related cancers. RESULTS: The original 2005 data contained both I/O data in 11.5% of cases, and lacked any I/O data in 74.5%. Corresponding figures for cases selected for audit were 15.2% and 77.2%, which improved to 54.2% and 11.8% after medical record review. After registrar training, 47% of reports contained both I/O data, and only 14.4% of cases lacked any I/O data. CONCLUSIONS: Statewide training to highlight the importance of I/O data is an effective method to improve I/O data quality. |
Commensal Escherichia coli isolate resistant to eight classes of antimicrobial agents in the United States
Krueger AL , Folster J , Medalla F , Joyce K , Perri MB , Johnson L , Zervos M , Whichard JM , Barzilay EJ . Foodborne Pathog Dis 2010 8 (2) 329-32 To increase understanding of community-acquired resistance, stool samples from 477 nonhospitalized persons in Maryland and Michigan, from 2004 to 2008, were screened for ceftriaxone resistance. Seven (1.5%) yielded ceftriaxone-resistant Escherichia coli; one isolate was resistant to all eight antimicrobial classes routinely tested: aminoglycosides, beta-lactam/beta-lactamase inhibitor combinations, cephems, penicillins, folate pathway inhibitors, phenicols, quinolones, and tetracyclines. The extensively resistant isolate was from a 50-year-old woman who denied antimicrobial use, hospitalization, or international travel within 6 months. Meat (beef, chicken, and pork) and eggs were consumed within 1 month before stool collection. Further studies are warranted to understand potential sources, including the food supply, of resistant E. coli. |
Reverse genetics generation of chimeric infectious Junin/Lassa virus is dependent on interaction of homologous glycoprotein stable signal peptide and G2 cytoplasmic domains.
Albarino CG , Bird BH , Chakrabarti AK , Dodd KA , White DM , Bergeron E , Shrivastava-Ranjan P , Nichol ST . J Virol 2010 85 (1) 112-22 The Arenaviridae are a diverse and globally distributed collection of viruses that are primarily maintained by rodent reservoirs. Junin virus (JUNV) and Lassa virus (LASV) can both cause significant outbreaks of severe and often fatal human disease throughout their respective endemic areas. In an effort to improve upon the existing live attenuated JUNV Candid 1 vaccine, we generated a genetically homogenous stock of this virus from cDNA copies of the virus S and L segments using a reverse genetics system. Further, these cDNAs were used in combination with LASV cDNAs to successfully generate two recombinant Candid1 JUNV/LASV chimeric viruses (via GPC envelope exchange). It was found that while the GPC extra-virion domains were readily exchangeable, homologous stable signal peptide (SSP) and G2 transmembrane and cytoplasmic tail domains were essential for correct GPC maturation and production of infectious chimeric viruses. The switching of the JUNV and LASV G1/G2 ectodomains within the Candid1 vaccine background did not alter the attenuated phenotype of the vaccine strain in a lethal mouse model. These recombinant chimeric viruses shed light on the fundamental requirements of arenavirus GPC maturation and may serve as a strategy for the development of bivalent JUNV and LASV vaccine candidates. |
Evidence-based classification of recommendations on use of genomic tests in clinical practice: dealing with insufficient evidence.
Khoury MJ , Coates RJ , Evans JP . Genet Med 2010 12 (11) 680-3 Numerous genomic tests continue to emerge as potential tools in the diagnosis, treatment, prognosis, and prevention for a wide variety of common human diseases. To date, most of these tests have "insufficient evidence" of clinical validity and utility for their use in clinical practice. Explicit and quantitative tools can be used in the evaluation of direct and indirect evidence on the utility of genomic tests. As suggested in an article in this month's issue by Veenstra et al., a recommendation matrix can be developed based on the amount of certainty of the evidence and the assessment of the risk-benefit profile. To supplement the current binary (up or down) evidence-based recommendation for use, it is worthwhile to explore all available data to develop a three-tier evidence-based recommendation classification of genomic tests ("use in practice," "promote informed decision-making," and "discourage use"). Promoting informed decision making may be a valuable recommendation for tests for which there is sufficient information on analytic and clinical validity and for which the risk/benefit analysis on clinical utility is promising but not definitive. This approach could provide interim guidance for clinical practice, while rigorous outcomes research is conducted to assess the impact of such tests on patients, families, and population health outcomes. |
Smoking characteristics of adults with selected lifetime mental illnesses: results from the 2007 National Health Interview Survey
McClave AK , McKnight-Eily LR , Davis SP , Dube SR . Am J Public Health 2010 100 (12) 2464-72 OBJECTIVES: We estimated smoking prevalence, frequency, intensity, and cessation attempts among US adults with selected diagnosed lifetime mental illnesses. METHODS: We used data from the 2007 National Health Interview Survey on 23393 noninstitutionalized US adults to obtain age-adjusted estimates of smoking prevalence, frequency, intensity, and cessation attempts for adults screened as having serious psychological distress and persons self-reporting bipolar disorder, schizophrenia, attention deficit disorder or hyperactivity, dementia, or phobias or fears. RESULTS: The age-adjusted smoking prevalence of adults with mental illness or serious psychological distress ranged from 34.3% (phobias or fears) to 59.1% (schizophrenia) compared with 18.3% of adults with no such illness. Smoking prevalence increased with the number of comorbid mental illnesses. Cessation attempts among persons with diagnosed mental illness or serious psychological distress were comparable to attempts among adults without mental illnesses or distress; however, lower quit ratios were observed among adults with these diagnoses, indicating lower success in quitting. CONCLUSIONS: The prevalence of current smoking was higher among persons with mental illnesses than among adults without mental illnesses. Our findings stress the need for prevention and cessation efforts targeting adults with mental illnesses. (Am J Public Health. Published online ahead of print October 21, 2010: e1-e9. doi:10.2105/AJPH.2009.188136). |
Prevalence and psychosocial correlates of current smoking among adolescent students in Thailand, 2005
McKnight-Eily L , Arrazola R , Merritt R , Malarcher A , Sirichotiratana N . Health Educ Behav 2010 37 (6) 863-78 This article examines the prevalence of current smoking and associated psychosocial correlates and whether these correlates differ by sex among adolescent students in Thailand. Data were analyzed from the Thailand Global Youth Tobacco Survey (GYTS), a school-based, cross-sectional survey conducted in 2005 and completed by Mathayom 1, 2, and 3 (U.S. seventh through ninth grades) students. Weighted prevalence estimates of the percentage of students who were current smokers (smoked on ≥1 day during the past 30 days) and noncurrent smokers were calculated for the sample and for each psychosocial variable. Separate logistic regression models were calculated for males and females to examine the independent association of the psychosocial correlates of current smoking. Significant correlates for both males and females included close peer smoking, secondhand smoke exposure, being offered a free cigarette by a tobacco industry representative, and belief that smoking is not harmful. These correlates are examined in the context of comprehensive tobacco control laws in Thailand. |
Online dietary supplement resources
Saldanha LG , Dwyer JT , Andrews KW , Bailey RL , Gahche JJ , Hardy CJ , Holden JM , Picciano MF , Roseland JM , Thomas PR , Wolf WR . J Am Diet Assoc 2010 110 (10) 1426, 1428, 1430-1 With the vast amount of information and resources on the Internet, it’s easy for individuals to look up information on dietary supplements. The difficulty for consumers and health professionals is identifying Web sites that provide reliable information. This article provides registered dietitians (RDs) and dietetic technicians, registered (DTRs) with examples of federal Web sites that contain accurate, reliable, and unbiased information on dietary supplements and examples of commercial Web sites that currently provide useful information on dietary supplements. | In 1994 the Dietary Supplement Health and Education Act (DSHEA) created a new category of foods called dietary supplements and defined them for regulatory purposes (1). DSHEA also fueled the growth of the dietary supplement industry that has increased more than five-fold since its passage; from around $4 billion in 1994 to 23.7 billion in 2008 (2). Currently, an estimated 4% of all dietary supplement sales are made through the Internet (2). Internet marketing and sales are in part responsible for the growth and development of the dietary supplement industry over the past decade. National survey data collected from 2003 to 2006 indicate that 53% of US adults report dietary supplement use (3). Consumers can easily find information about dietary supplement over the Internet and on social networking sites such as Twitter and Facebook, but its veracity is sometimes questionable. This is of concern because with the high prevalence of dietary supplement use, and easy access to information on the Internet, it is not surprising that many individuals may circumvent health professionals as a source of information and go directly to the Web for help. |
Knowledge and adoption of community mitigation efforts in Mexico during the 2009 H1N1 pandemic
Aburto NJ , Pevzner E , Lopez-Ridaura R , Rojas R , Lopez-Gatell H , Lazcano E , Hernandez-Avila M , Harrington TA . Am J Prev Med 2010 39 (5) 395-402 BACKGROUND: The public's ability and willingness to adopt community mitigation efforts during a pandemic are debated in the literature. PURPOSE: Awareness and adoption of community mitigation efforts in Mexico during the 2009 pandemic influenza A (H1N1) (pH1N1) outbreak were measured to evaluate if the population received, understood, and acted on public health messages. METHODS: A cross-sectional representative household survey in Mexico City; San Luis Potosi (high case ratio); and Queretaro (low case ratio) was conducted in May and June 2009. Accounting for the complex survey design, percentages and 95% CI for answers to all questions were generated and compared based on living inside or outside Mexico City, high versus low prevalence of infection in the community, and perceived severity and knowledge of the virus. RESULTS: Greater than 90% of respondents received community mitigation messages and adopted one or more community mitigation efforts. There were few differences among cities. Respondents reported high cost of masks, soaps, and gels as barriers to community mitigation-effort adoption. Nearly one fifth of respondents, disproportionally from the lower socioeconomic tertile, found some messages confusing. Half of all households reported a negative economic impact resulting from the outbreak. CONCLUSIONS: Mexico's community mitigation campaign reached the majority of the population in three surveyed cities. Confusion regarding messages and economic barriers to community mitigation-effort adoption were sometimes reported. |
A norovirus vaccine on the horizon?
Vinje J . J Infect Dis 2010 202 (11) 1623-5 Human noroviruses are the leading cause of epidemic gastroenteritis and an important cause of sporadic disease in humans of all ages in industrialized countries. Noroviruses are highly contagious, have a low infectious dose, and are persistent in the environment. These characteristics allow them to spread easily among individuals by direct contact, contaminated fomites (ie, environmental surfaces), and aerosol droplets. The ease of close contact transmission makes closed communities such as long-term care facilities, hospitals, military barracks, schools, and cruise ships especially vulnerable to outbreaks. Recent data also demonstrate that noroviruses are a leading cause of foodborne disease outbreaks in the United States [1, 2] and Europe [3]. Although norovirus infection is usually self-limiting and most people recover within a few days, norovirus gastroenteritis can be severe and sometimes fatal, especially among the very young, the elderly, the chronically ill, and immunocompromised individuals; norovirus gastroenteritis is also a frequent cause of hospitalization. Long-term effects of norovirus gastroenteritis, such as necrotizing enterocolitis, chronic diarrhea, and post-infectious irritable bowel syndrome, have been reported, but more data are needed to confirm a causal link with these conditions. |
Practice and child characteristics associated with influenza vaccine uptake in young children
Poehling KA , Fairbrother G , Zhu Y , Donauer S , Ambrose S , Edwards KM , Staat MA , Prill MM , Finelli L , Allred NJ , Bardenheier B , Szilagyi PG . Pediatrics 2010 126 (4) 665-73 OBJECTIVES: The objective of this study was to determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004-2005 influenza season, the first season for the universal influenza vaccination recommendation for all children who are aged 6 to 23 months. METHODS: Clinical and demographic data from randomly selected children who were aged 6 to 23 months were obtained by chart review from a community-based cohort study in 3 US counties. The proportion of children who were vaccinated by April 5, 2005, in each practice was obtained. For assessment of practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics that predicted complete influenza vaccination were determined by using multinomial logistic regression. RESULTS: Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children who were aged 6 to 23 months and were studied, 27% were completely vaccinated. The proportion of children who were completely vaccinated varied widely among practices (0%-71%). Most (87%) practices implemented ≥1 vaccination strategy. Complete influenza vaccination was associated with 3 practice characteristics: suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; with child characteristics of younger age, existing high-risk conditions, ≥6 well visits to the practice by 3 years of age, and any practice visit from October through January. CONCLUSIONS: Modifiable factors that were associated with increased influenza vaccination coverage included October to January practice visits and evening/weekend vaccine clinics. |
Adverse event reports following Japanese encephalitis vaccination in the United States, 1999-2009
Lindsey NP , Staples JE , Jones JF , Sevjar JJ , Griggs A , Iskander J , Miller ER , Fischer M . Vaccine 2010 29 (1) 58-64 We reviewed adverse events following receipt of inactivated mouse brain-derived Japanese encephalitis (JE) vaccine reported to the U.S. Vaccine Adverse Event Reporting System (VAERS) from 1999 to 2009. During this period, VAERS received 300 adverse event reports following JE vaccination (24 per 100,000 doses distributed); 106 (35%) were classified as hypersensitivity reactions (8.4 per 100,000 doses) and four (1%) were classified as neurologic events (0.3 per 100,000 doses). Twenty-three (8%) reports described serious adverse events (1.8 per 100,000 doses distributed). There were no reports of encephalitis, meningitis, or Guillain-Barre syndrome. As reported previously, hypersensitivity reactions were common among persons receiving inactivated mouse brain-derived JE vaccine. |
Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, 1990-2009
Moro PL , Broder K , Zheteyeva Y , Walton K , Rohan P , Sutherland A , Guh A , Haber P , Destefano F , Vellozzi C . Am J Obstet Gynecol 2010 204 (2) 146 e1-7 OBJECTIVE: The objective of the study was to characterize reports to the Vaccine Adverse Event Reporting System (VAERS) in pregnant women who received seasonal influenza vaccines to assess for potential vaccine safety concerns. STUDY DESIGN: We searched VAERS for reports of adverse events (AEs) in pregnant women who received trivalent inactivated influenza vaccine (TIV) from July 1, 1990 through June 30, 2009, or live attenuated influenza vaccine (LAIV) from July 1, 2003, through June 30, 2009. RESULTS: A total of 148 reports after TIV and 27 reports after LAIV were identified. Twenty TIV (13.5%) and 1 LAIV (4%) reports were classified as serious. No specific AEs were reported in 30 TIV (20.3%) and 16 LAIV (59%) reports. The most common pregnancy-specific AE was spontaneous abortion: 17 after TIV (11.5%) and 3 after LAIV (11%). The reporting rate of spontaneous abortion was 1.9 per million pregnant women vaccinated. CONCLUSION: No unusual patterns of pregnancy complications or fetal outcomes were observed in the VAERS reports of pregnant women after the administration of TIV or LAIV. |
Approaches to monitoring biological outcomes for HPV vaccination: challenges of early adopter countries
Wong CA , Saraiya M , Hariri S , Eckert L , Howlett RI , Markowitz LE , Brotherton JM , Sinka K , Martinez-Montanez OG , Kjaer SK , Dunne EF . Vaccine 2010 29 (5) 878-85 In this review, we describe plans to monitor the impact of human papillomavirus (HPV) vaccine on biologic outcomes in selected international areas (Australia, Canada, Mexico, the Nordic countries, Scotland, and the United States) that have adopted this vaccine. This summary of monitoring plans provides a background for discussing the challenges of vaccine monitoring in settings where resources and capacity may vary. A variety of approaches that depend on existing infrastructure and resources are planned or underway for monitoring HPV vaccine impact. Monitoring HPV vaccine impact on biologic outcomes is a complex and challenging task, but also plays an important role in documenting the benefit of vaccination, monitoring the progress of vaccination programs, and providing data to inform vaccination and disease prevention policies. |
Renal nitric oxide production in rat pregnancy: role of constitutive nitric oxide synthases
Smith CA , Santymire B , Erdely A , Venkat V , Losonczy G , Baylis C . Am J Physiol Renal Physiol 2010 299 (4) F830-6 Functional studies show that increased renal nitric oxide (NO) mediates the renal vasodilation and increased glomerular filtration rate that occur during normal pregnancy. We investigated whether changes in the constitutive NO synthases (NOS), endothelial (eNOS) and neuronal (nNOS), were associated with the increased renal NO production in normal midterm pregnancy in the rat. In kidneys from midterm pregnant (MP: 11-13 days gestation), late-term pregnant (LP: 18-20 days gestation), and similarly aged virgin (V) rats, transcript and protein abundance for eNOS and the nNOSalpha and nNOSbeta splice variants, as well as the rate of L-arginine-to-L-citrulline conversion, were determined as a measure of NOS activity. At MP, renal cortical abundance of the total eNOS protein and phosphorylated (Ser(1177)) eNOS was reduced, and L-arginine-to-L-citrulline conversion in the cortical membrane fraction was decreased; these declines were also seen in LP. There were no changes in the eNOS transcript. In contrast, L-arginine-to-L-citrulline conversion in the soluble fraction of renal cortex increased at MP and then declined at LP. This MP increase was ablated by S-methylthiocitrulline, a nNOS inhibitor. Using Western blotting, we did not detect a change in the protein abundance or transcript of the 160-kDa nNOSalpha, but protein abundance and transcript of the nNOSbeta were increased at MP in cortex. Collectively, these studies suggest that the soluble nNOSbeta is responsible for the increased renal cortical NO production during pregnancy. |
Mutations of an antibody binding energy hot spot on domain III of the dengue 2 envelope glycoprotein exploited for neutralization escape
Gromowski GD , Roehrig JT , Diamond MS , Lee JC , Pitcher TJ , Barrett AD . Virology 2010 407 (2) 237-46 Previous crystallographic studies have identified a total of 11 DENV-2 envelope protein domain III (ED3) residues (K305, F306, K307, V308, V309, K310, I312, Q325, P364, K388, and N390) that interacted, through both side- and main-chain contacts, with the Fab of a dengue virus (DENV) subcomplex-specific neutralizing monoclonal antibody (MAb) 1A1D-2 (Lok et al., 2008). Here, we used DENV-2 recombinant ED3 mutants of the MAb 1A1D-2 structural epitope residues to determine the functional epitope of this MAb. The side-chains of residues K307, K310 and I312 were determined to be functionally critical for MAb binding, and thus constitute a hot spot of binding energy for MAb 1A1D-2 on the DENV-2 ED3. Overall, these findings demonstrate that only a subset of the amino acid residue side-chains within the structural epitope of MAb 1A1D-2 define a functional epitope on the DENV-2 ED3 that is essential for MAb binding and neutralization escape. |
Exposure to cigarette smoke inhibits the pulmonary T cell response to influenza and Mycobacterium tuberculosis
Feng Y , Kong Y , Barnes PF , Huang FF , Klucar P , Wang X , Samten B , Sengupta M , Machona B , Donis R , Tvinnereim AR , Shams H . Infect Immun 2010 79 (1) 229-37 Smoking is associated with increased susceptibility to tuberculosis and influenza. However, little information is available on the mechanisms underlying this increased susceptibility. Mice were unexposed or exposed to cigarette smoke, and then infected with M. tuberculosis by aerosol or influenza A by intranasal infection. Some mice were given a DNA vaccine encoding an immunogenic M. tuberculosis protein. IFN-gamma production by T-cells from the lungs and spleens was measured. Cigarette smoke exposure inhibited lung T-cell production of interferon-gamma, during stimulation in vitro with anti-CD3, after vaccination with a construct expressing an immunogenic mycobacterial protein, and during infection with M. tuberculosis and influenza A virus in vivo. Reduced interferon-gamma production was mediated through decreased phosphorylation of transcription factors that positively regulate interferon-gamma expression. Cigarette smoke exposure increased the bacterial burden in mice infected with M. tuberculosis, and increased weight loss and mortality in mice infected with influenza virus. This study provides the first demonstration that cigarette smoke exposure directly inhibits the pulmonary T-cell response to M. tuberculosis and influenza virus in a physiologically relevant animal model, increasing susceptibility to both pathogens. |
Genomic signature-based identification of influenza A viruses using RT-PCR/electro-spray ionization mass spectrometry (ESI-MS) technology
Deyde VM , Sampath R , Garten RJ , Blair PJ , Myers CA , Massire C , Matthews H , Svoboda P , Reed MS , Pohl J , Klimov AI , Gubareva LV . PLoS One 2010 5 (10) e13293 BACKGROUND: The emergence and rapid spread of the 2009 H1N1 pandemic influenza A virus (H1N1pdm) in humans highlights the importance of enhancing the capability of existing influenza surveillance systems with tools for rapid identification of emerging and re-emerging viruses. One of the new approaches is the RT-PCR electrospray ionization mass spectrometry (RT-PCR/ESI-MS) technology, which is based on analysis of base composition (BC) of RT-PCR amplicons from influenza "core" genes. Combination of the BC signatures represents a "genomic print" of an influenza A virus. METHODOLOGY/PRINCIPAL FINDINGS: Here, 757 samples collected between 2006 and 2009 were tested, including 302 seasonal H1N1, 171 H3N2, 7 swine triple reassortants, and 277 H1N1pdm viruses. Of the 277 H1N1pdm samples, 209 were clinical specimens (throat, nasal and nasopharyngeal swabs, nasal washes, blood and sputum). BC signatures for the clinical specimen from one of the first cases of the 2009 pandemic, A/California/04/2009, confirmed it as an unusual, previously unrecognized influenza A virus, with "core" genes related to viruses of avian, human and swine origins. Subsequent analysis of additional 276 H1N1pdm samples revealed that they shared the genomic print of A/California/04/2009, which differed from those of North American swine triple reassortant viruses, seasonal H1N1 and H3N2 and other viruses tested. Moreover, this assay allowed distinction between "core" genes of co-circulating groups of seasonal H1N1, such as clades 2B, 2C, and their reassortants with dual antiviral resistance to adamantanes and oseltamivir. CONCLUSIONS/SIGNIFICANCE: The RT-PCR/ESI-MS assay is a broad range influenza identification tool that can be used directly on clinical specimens for rapid and accurate detection of influenza virus genes. The assay differentiates the H1N1pdm from seasonal and other nonhuman hosts viruses. Although not a diagnostic tool, this assay demonstrates its usefulness and robustness in influenza virus surveillance and detection of novel and unusual viruses with previously unseen genomic prints. |
Development of a multilocus sequence typing tool for Cryptosporidium muris and Cryptosporidium andersoni
Feng Y , Yang W , Ryan U , Zhang L , Kvac M , Koudela B , Modry D , Li N , Fayer R , Xiao L . J Clin Microbiol 2010 49 (1) 34-41 Although widely used in the characterization of the transmission of intestinal Cryptosporidium spp., genotyping tools are not available for C. muris and C. andersoni, two most common gastric Cryptosporidium spp. of mammals. In this study, we screened the C. muris whole genome sequencing data for microsatellite and minisatellite sequences. Among the 13 potential loci (six microsatellite and seven minisatellite loci) evaluated by PCR and DNA sequencing, four were eventually chosen. DNA sequence analyses of 27 C. muris and 17 C. andersoni DNA preparations showed the presence of 5-10 subtypes of C. muris and 1-4 subtypes of C. andersoni at each locus. Altogether, 11 C. muris and seven C. andersoni multilocus sequence typing (MLST) subtypes were detected among the 16 C. muris and 12 C. andersoni specimens successfully sequenced at all four loci. In all analyses, the C. muris isolate (TS03) originated from an East African mole rat differed significantly from other C. muris isolates, approaching the extent of genetic differences between C. muris and C. andersoni. Thus, a MLST technique was developed for high resolution typing of C. muris and C. andersoni. It should be useful in the characterization of the population genetics and transmission of gastric Cryptosporidium spp. |
Locomotion in restricted space: kinematic and electromyographic analysis of stoopwalking and crawling
Gallagher S , Pollard J , Porter WL . Gait Posture 2010 33 (1) 71-6 Stoopwalking and crawling are compulsory gait techniques in some occupational settings, as in low-seam coal mines (where vertical space may be less than 122cm). Nine participants, six males and three females (mean=35 years+17 SD), participated in a study examining kinematic and electromyographic (EMG) responses to natural cadence stoopwalking, four-point crawling (all fours), and two-point crawling (knees only). EMG data were collected from knee extensors and flexors, and a motion analysis system was used to obtain kinematic data. The average gait velocity for stoopwalking was 1.01 (+/-0.32)m/s with an average cadence of 112.8steps/min and stride length of 1.04m. Four-point crawling velocity averaged 0.50 (+/-0.20)m/s, with average cadence of 86.3steps/min and stride length of 0.69m. Two-point crawling exhibited the slowest velocity (0.32m/s) and shortest stride length (0.40m); however, cadence was greater than four-point crawling (96.8steps/min). EMG findings included prolonged contraction of both knee extensors and flexors (compared to normative data on normal walking), increased relative activity SD of the flexors (versus extensors) in two-point crawling, and decreased thigh muscle activity in four-point crawling. Interlimb coordination in four-point crawling trials indicated trot-like, no limb pairing, and near pace-like limb contact patterns. Presence or absence of kneepads had no impact on kinematic or EMG measures (p>0.05); however, subjects complained of discomfort without kneepads (especially in two-point crawling). Results of this study have implications for work performed in underground coal mines, as well as emergency or evacuation considerations. |
The occupational contribution to severe exacerbation of asthma
Henneberger PK , Mirabelli MC , Kogevinas M , Anto JM , Plana E , Dahlman-Hoglund A , Jarvis DL , Kromhout H , Lillienberg L , Norback D , Olivieri M , Radon K , Toren K , Urrutia I , Villani S , Zock JP . Eur Respir J 2010 36 (4) 743-50 The goal of this study was to identify occupational risk factors for severe exacerbation of asthma and estimate the extent to which occupation contributes to these events. The 966 participants were working adults with current asthma who participated in the follow-up phase of the European Community Respiratory Health Survey. Severe exacerbation of asthma was defined as self-reported unplanned care for asthma in the past 12 months. Occupations held in the same period were combined with a general population job-exposure matrix to assess occupational exposures. 74 participants reported having had at least one severe exacerbation event, for a 1-yr cumulative incidence of 7.7%. From regression models that controlled for confounders, the relative risk (RR) was statistically significant for low (RR 1.7, 95% CI 1.1-2.6) and high (RR 3.6, 95% CI 2.2-5.8) biological dust exposure, high mineral dust exposure (RR 1.8, 95% CI 1.02-3.2), and high gas and fumes exposure (RR 2.5, 95% CI 1.2-5.5). The summary category of high dust, gas, or fumes exposure had RR 3.1 (95% CI 1.9-5.1). Based on this RR, the population attributable risk was 14.7% among workers with current asthma. These results suggest occupation contributes to approximately one in seven cases of severe exacerbation of asthma in a working population, and various agents play a role. |
A pilot study on the association between job stress and repeated measures of immunological biomarkers in female nurses
Lee KM , Kang D , Yoon K , Kim SY , Kim H , Yoon HS , Trout DB , Hurrell JJ Jr . Int Arch Occup Environ Health 2010 83 (7) 779-89 OBJECTIVE: To evaluate the immunosuppressive effects of job stress in female nurses, an 8-month longitudinal study was conducted at a major university hospital. METHODS: Four groups of ten subjects each were constructed to represent high versus low objective stress and high versus low subjective stress based on their responses to a job stress questionnaire and objective stress ratings of the hospital's work units. Number of white blood cells (i.e., T cells, B cells, and natural killer cells), and lymphocytic proliferation to mitogens (concanavalin A, phytohemagglutinin, and pokeweed) and toxoid (tetanus) were measured by flow cytometry and radioimmunoassay. Serum levels of hydrocortisol, IL-1beta, IFN-gamma, and TNF-alpha, and salivary IgA were measured by enzyme-linked immunosorbent assay. The data were analyzed by repeated measures analysis of variance controlling for age and smoking. RESULTS: The level of white blood cells was lower among high objective stress group (median: 7,170/m(3); range: 5,386-10,057) compared with that among low objective stress group (8,063; 5,888-9,875) (P = 0.03), however, no other cellular blood variables were found to be significant. In terms of humoral immuno-biomarkers, the level of TNF-alpha was moderately lower among high objective stress group (1.7 ng/ml; 0.3-2.7) compared with that among low objective stress group (2.2; 0.5-3.5) (P = 0.07), whereas the level of total sIgA was significantly higher among higher objective stress group (72.9 end-point titer/mg/ml/min; 14.4-153.4) compared with that among low objective stress group (44.8; 9.9-123.8) (P = 0.02). CONCLUSION: The results of the study suggest that psychological job stress affects the levels of some immunological biomarkers in female nurses. |
Contact pressure study of N95 filtering face-piece respirators using finite element method
Lei Z , Yang J , Zhuang Z . Comput Aided Des Appl 2010 7 (6) 847-861 Respirators protect workers from hazardous airborne particles. It is important to evaluate respirator comfort and fit for all workers of diverse anthropometry as contact pressure plays a vital role. This paper presents the procedure and results of studying contact pressure of N95 filtering face-piece respirators (FFR) by using a finite element method. Finite element models of respirators and headforms have been improved based on a previous study. The headform model contains a skin layer, muscle layer, and bone layer. The whole facial area is divided into four parts (two areas for cheeks, one area for upper forehead, and one area for chin). Two N95 FFR models (one is one-size-fits-all and the other FFR has two sizes, i.e., small and medium/large) are used to simulate the interaction between the respirator and the headform. The results show that the respirator with two sizes provides better contact pressure distribution than the one-size-fits-all respirator. It has also been shown that the one-size-fits-all respirator works well for the large, medium, and short/wide headforms, but there are indications of potential leakages for the small and long/narrow headforms. For the respirator with two sizes, the medium/large size respirator works well for the large and long/narrow headforms, while the small size respirator works well for the medium, small, and short/wide headforms. The medium/large size respirator has potential leakages for the medium headform. Furthermore, the N95 FFR with two sizes has a more uniform pressure distribution than the one-size-fits-all respirator. Future studies are needed to validate these observations with human subjects. 2010 CAD Solutions, LLC. |
The impact of a national program to provide free mammograms to low-income, uninsured women on breast cancer mortality rates
Howard DH , Ekwueme DU , Gardner JG , Tangka FK , Li C , Miller JW . Cancer 2010 116 (19) 4456-62 BACKGROUND: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free or low-cost breast and cervical cancer screening to low-income, uninsured or underinsured women. The authors analyzed the impact of the NBCCEDP on breast cancer mortality rates. METHODS: The data consisted of observations for each state and year for the period from 1990 through 2004. The outcome variable was the breast cancer mortality rate for women ages 40 to 64 years. Independent variables included the proportion of women ages 40 to 64 years screened under NBCCEDP. The impact of screening intensity was estimated using least-squares regression with state and year fixed effects. RESULTS: In 2004, 1.2% of women ages 40 to 64 years were screened under NBCCEDP. The NBCCEDP screening rate was related significantly and negatively to breast cancer mortality in the same year. Results indicate that, for every 1000 women screened, there were 0.6 fewer deaths because of breast cancer among women ages 40 to 64 years. Changes in screening rates were unrelated to breast cancer mortality≥2 years in the future. CONCLUSIONS: In the current study, there was some evidence suggesting that the NBCCEDP led to a reduction in breast cancer mortality rates. However, the failure to detect an impact of screening on mortality rates in subsequent years suggests that caution is needed in interpreting these results as strong evidence in favor of the effectiveness of the NBCCEDP in reducing breast cancer mortality. |
Time for change: rethinking and reframing sexual health in the United States
Fenton KA . J Sex Med 2010 7 250-252 The data are both compelling and concerning. Each year more than 19 million sexually transmitted infections (STIs) are estimated to occur in the United States, with almost half of these infections occurring among young persons aged 15 to 24 years [1]. One in four women aged 14–19 years is infected with at least one STI [2], and there are an estimated 1.1 million Americans living with HIV, with over 55,000 new infections per year [3]. The annual direct and indirect costs associated with managing STIs, including HIV, are estimated at $15.9 billion per year [4,5]. One-half of all pregnancies in the United States are unintended [6], and rates of teenage pregnancies are again on the rise after a decade of relative stabilization [7]. There is growing concentration of adverse sexual and reproductive health outcomes among the economically disadvantaged or socially marginalized [8–9], challenging our work to achieve sustained improvements in health for all persons in the United States. Today, men who have sex with men (MSM) of all races, young people, African Americans, and Hispanic/Latinos bear a severe, pervasive, and disproportionate burden of many of these and other adverse health outcomes [10]. The enormity of the challenges appears daunting—it’s time for change. | It is time for us to question whether this status quo is either acceptable or just. While individual-level sexual risk behaviors are among the strongest predictors of STI acquisition, there is now a greater appreciation of the role of interpersonal, network, community, and societal level influences on the sexual health of individuals and communities [11]. As our understanding of the complex and dynamic interactions between these multi-layered determinants evolve, they challenge communities, practitioners, and policymakers to question long-held beliefs regarding the role and responsibilities of individuals, clinical, and public health services. Similarly, generational changes resulting from major demographic shifts in sexual attitudes and behaviors, combined with the global expansion of the internet; mobile technology; social networking; novel patterns of sexual mixing; globalization of sex work; and technological advances in preventive, diagnostic, and clinical services, suggest that simultaneous evolutions in our practice are required to remain relevant and effective in today’s society [12]. |
Fatal Clostridium sordellii infections after medical abortions
Meites E , Zane S , Gould C . N Engl J Med 2010 363 (14) 1382-3 Clostridial toxic shock is a rare and largely fatal syndrome among reproductive-age women. Six cases were reported after medical abortions between 2000 and 2007.1,2 We report two additional cases, bringing the current U.S. rate of fatal Clostridium sordellii and C. perfringens infections to 0.58 per 100,000 medical abortions.3 | In 2008, a 29-year-old white Hispanic woman (gravida 3, para 1, with diabetes) died 6 days after she began to receive 200 mg of oral mifepristone and 800 μg of vaginal misoprostol at 5 weeks of gestation, without prophylactic antibiotics. Her symptoms included severe abdominal cramping, vomiting, and diarrhea on day 4. She was hospitalized on day 5 with tachycardia, hemoconcentration (hematocrit, 58%), and leukocytosis (62,100 white cells per cubic millimeter), without fever. Exploratory laparotomy revealed copious greenish-brown peritoneal fluid and necrotic uterine and adnexal tissue; hysterectomy and bilateral salpingo-oophorectomy were performed. Refractory hypotension developed, and she died of sepsis with acute respiratory distress syndrome. The Infectious Disease Pathology Branch of the Centers for Disease Control and Prevention diagnosed clostridial infection by positive immunohistochemical staining of gram-positive bacilli in uterine tissue with necrotizing endometritis. C. sordellii was confirmed by means of polymerase-chain-reaction (PCR) assay. |
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