Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the look AHEAD trial
Wing RR , Bahnson JL , Bray GA , Clark JM , Coday M , Egan C , Espeland MA , Foreyt JP , Gregg EW , Goldman V , Haffner SM , Hazuda H , Hill JO , Horton ES , Hubbard VS , Jakicic J , Jeffery RW , Johnson KC , Kahn S , Killean T , Kitabchi AE , Lewis CE , Manus C , Maschak-Carey BJ , Michaels S , Montez M , Montgomery B , Nathan DM , Patricio J , Peters A , Pi-Sunyer X , Pownall H , Reboussin D , Rejeski WJ , Rubin R , Safford M , Skarphol T , Van Dorsten B , Wadden TA , Wagenknecht L , Wesche-Thobaben J , West DS , Williamson D , Yanovski SZ . Arch Intern Med 2010 170 (17) (17) 1566-1575 BACKGROUND: Lifestyle interventions produce shortterm improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study. METHODS: The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment. RESULTS: Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (-6.15% vs -0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A1c level (-0.36% vs -0.09%; P < .001), systolic (-5.33 vs -2.97 mm Hg; P < .001) and diastolic (-2.92 vs -2.48 mm Hg; P=.01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (-25.56 vs -19.75 mg/dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (-11.27 vs -12.84 mg/dL; P=.009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A1c levels, systolic blood pressure, and highdensity lipoprotein cholesterol levels. CONCLUSIONS: Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemic control, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial. TRIAL REGISTRATION: clinicaltrials.gov IDENTIFIER: NCT00017953 2010 American Medical Association. All rights reserved. |
Association of CKD with disability in the United States
Plantinga LC , Johansen K , Crews DC , Shahinian VB , Robinson BM , Saran R , Burrows NR , Williams DE , Powe NR . Am J Kidney Dis 2010 57 (2) 212-27 BACKGROUND: Little is known about disability in early-stage chronic kidney disease (CKD). STUDY DESIGN: Cross-sectional national survey (National Health and Nutrition Examination Survey 1999-2006). SETTING & PARTICIPANTS: Community-based survey of 16,011 noninstitutionalized US civilian adults (aged ≥20 years). PREDICTOR: CKD, categorized as no CKD, stages 1 and 2 (albuminuria and estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m(2)), and stages 3 and 4 (eGFR, 15-59 mL/min/1.73 m(2)). OUTCOME: Self-reported disability, defined by limitations in working, walking, and cognition and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. MEASUREMENTS: Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed using a standardized questionnaire. RESULTS: Age-adjusted prevalence of reported limitations generally was significantly greater with CKD: for example, difficulty with ADL was reported by 17.6%, 24.7%, and 23.9% of older (≥65 years) and 6.8%, 11.9%, and 11.0% of younger (20-64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD also was associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly in older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance no longer was achieved. LIMITATIONS: Inability to establish causality and possible unmeasured confounding. CONCLUSION: CKD is associated with a higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association. |
Therapeutic targeting of respiratory syncytial virus G-protein
Kauvar LM , Harcourt JL , Haynes LM , Tripp RA . Immunotherapy 2010 2 (5) 655-61 Respiratory syncytial virus (RSV) is a leading cause of pneumonia and bronchiolitis in infants and young children and an important pathogen of the elderly and immune suppressed. The only intervention currently available is a monoclonal antibody against the RSV fusion protein, which has shown utility as a prophylactic for high-risk premature infants, but which has not shown postinfection therapeutic efficacy in the specific RSV-infected populations studied. Thus, for the major susceptible populations, there remains a great need for effective treatment. Recent results support monoclonal antibody targeting of the RSV G-protein for therapeutic use. This objective encompasses a dual mechanism: reduction in the ability of RSV G-protein to distort the host innate immune response, and direct complement-mediated antiviral activity. |
Two clusters of HIV-1 infection, rural Idaho, USA, 2008
Nett RJ , Bartschi JL , Ellis GM , Hachey DM , Frenkel LM , Roscoe JC , Carter KK , Hahn CG . Emerg Infect Dis 2010 16 (11) 1807-9 Prevalence of HIV-1 infection in rural areas of the United States has been increasing (1). During 2003–2007, an average of 30 (range 24–42) cases of new HIV-1 infection diagnoses per year among Idaho residents were reported. Of the 152 reported cases during this period, 54 (36%) were related to a person living in a rural area of <75,000 residents and a 60-minute drive from an urban area (2). Of these 54 cases, 19 (35%) were in men who have sex with men (MSM), 5 (9%) were in injection drug users (IDU), and 2 (4%) were in those in both categories. | In March 2008, a cluster of newly identified HIV-1 infections that included 5 cases (cluster A) in a rural southeastern Idaho city (city A) was reported to the Idaho Department of Health and Welfare. Two patients were men and the median age was 26 years (range 18–32 years). One patient was an IDU (Table). Through epidemiologic investigation, 3 additional patients were suspected to be IDUs, but confirmation was not practicable. All reported methamphetamine use. One man and 2 women reported both male and female sex partners. |
Multicity HIV seroprevalence in street youth, Ukraine
Robbins CL , Zapata L , Kissin DM , Shevchenko N , Yorick R , Skipalska H , Finnerty E , Ornstein T , Marchbanks PA , Jamieson DJ , Hillis SD . Int J STD AIDS 2010 21 (7) 489-96 We conducted the first systematic, community-based, multicity assessment outside the USA of HIV seroprevalence, risk factors and linkage into clinical services among 929 street youth. After city-wide mapping, we used time-location sampling and randomly selected 74 venues in Odesa, Kyiv and Donetsk, Ukraine. Rapid HIV testing with post-test counselling was offered to all eligible youths aged 15-24 years. Overall, 18.4% (95% confidence interval 16.2-20.2) were HIV positive and 85% had previously unknown status. Rates were identical by sex. Subgroups with highest rates included orphans (26%), youths with histories of exchanging sex (35%), sexually transmitted infections (STIs) (37%), injection drug use (IDU) (42%) and needle sharing (49%). Independent predictors, similar across age groups and city, included being orphaned, time on the street, history of anal sex, STIs, exchanging sex, any drug use, IDU and needle sharing. Two-thirds (68%) of HIV-positive youths were linked to services. This high-risk population has many immediate needs. |
Outcomes of multidrug-resistant tuberculosis among binational cases in El Paso, Texas
Ferrer G , Acuna-Villaorduna C , Escobedo M , Vlasich E , Rivera M . Am J Trop Med Hyg 2010 83 (5) 1056-8 In the United States, multidrug-resistant tuberculosis (MDR-TB) is more commonly seen among foreign-born patients. We report outcomes for 46 patients with MDR-TB who were born in Mexico and treated along the United States-Mexico border. According to our definition, 30 were cured, 3 showed treatment failure, 3 died, and 10 abandoned treatment. Multidrug-resistant tuberculosis can be successfully treated on an ambulatory basis. |
Pre- and post-conjugate vaccine epidemiology of pneumococcal serotype 6C invasive disease and carriage within Navajo and White Mountain Apache communities
Millar EV , Pimenta FC , Roundtree A , Jackson D , Carvalho MD , Perilla MJ , Reid R , Santosham M , Whitney CG , Beall BW , O'Brien KL . Clin Infect Dis 2010 51 (11) 1258-65 BACKGROUND: A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. METHODS: We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. RESULTS: A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1%) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95% confidence interval, 0.03-0.9), 0.7 (95% confidence interval, 0.2-1.3), and 1.5 (95% confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively ([Formula: see text]). In the routine vaccination era, 76% of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42% to 61% to 94% in the prevaccine, early vaccine, and routine vaccination eras, respectively. CONCLUSION: In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted. |
Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission
Simmerman JM , Suntarattiwong P , Levy J , Gibbons RV , Cruz C , Shaman J , Jarman RG , Chotpitayasunondh T . Clin Infect Dis 2010 51 (9) 1053-61 BACKGROUND: Rational infection control guidance requires an improved understanding of influenza transmission. We studied households with an influenza-infected child to measure the prevalence of influenza contamination, the effect of hand washing, and associations with humidity and temperature. METHODOLOGY: We identified children with influenza and randomly assigned their households to hand washing and control arms. Six common household surfaces and the fingertips of the index patient and symptomatic family members were swabbed. Specimens were tested by real-time reverse-transcription polymerase chain reaction (rRT-PCR), and specimens with positive results were placed on cell culture. A handheld psychrometer measured meteorological data. RESULTS: Sixteen (17.8%) of 90 households had influenza A-positive surfaces by rRT-PCR, but no viruses could be cultured. The fingertips of 15 (16.6%) of the index patients had results positive for influenza A, and 1 virus was cultured. Index patients with seasonal influenza infections shed more virus than did patients with pandemic influenza infection. Control households had a higher prevalence of surface contamination (11 [24.4%] of 45) than did hand washing households (5 [11.1%] of 45); prevalence risk difference (PRD), 13.3%; [95% confidence interval {CI}, -2.2% to 28.9%]; P = .09). Households in which the age of the index patient was ≤8 years had a significantly higher prevalence of contamination (PRD ,19.1%; 95% CI, 5.3% -32.9%; P = .02). Within the strata of households with secondary infections, an effect of lower absolute humidity is suggested (P = .07). CONCLUSIONS: We documented influenza virus RNA contamination on household surfaces and on the fingertips of ill children. Homes with younger children were more likely than homes of older children to have contaminated surfaces. Lower absolute humidity favors surface contamination in households with multiple infections. Increased hand washing can reduce influenza contamination in the home. |
International Conference on Emerging Infectious Diseases, 2010
Marano N , Smith TL , Hajjeh RA , McDonald M , Bridges CB , Martin SA , Chorba T . Emerg Infect Dis 2010 16 (11) e1 The seventh International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta, Georgia, USA, July 11-14, 2010. The conference goal was to bring together public health professionals to encourage exchange of scientific and public health information on global emerging infectious disease issues. The conference was organized by the Centers for Disease Control and Prevention (CDC), American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization; additional support was provided by 40 other multidisciplinary public health partners. |
The 2009 pandemic H1N1 and triple ressortant swine H1N1 influenza viruses replicate efficiently but elicit an attenuated inflammatory response in polarized human bronchial epithelial cells
Zeng H , Pappas C , Katz JM , Tumpey TM . J Virol 2010 85 (2) 686-96 The pandemic H1N1 virus of 2009 (2009 H1N1) produced a spectrum of disease ranging from mild to severe illness and death. Respiratory symptoms were frequently associated with virus infection with relatively high rate of gastrointestinal symptoms reported. To better understand 2009 H1N1 virus pathogenesis in humans, we studied virus and host responses following infection of two cell types: polarized bronchial and pharyngeal epithelial cells which exhibit many features of the human airway epithelium, and colon epithelial cells to serve as a human intestinal cell model. Selected 2009 H1N1 viruses were compared to both a seasonal H1N1 virus and triple-reassortant swine H1N1 influenza viruses that have circulated among North American pigs preceding the 2009 pandemic. All H1N1 viruses replicated productively in airway cells, however in contrast to seasonal H1N1 virus, infection with the 2009 H1N1 and triple-reassortant swine H1N1 viruses resulted in an attenuated inflammatory response, weaker interferon response and reduced cell death. Additionally, the H1N1 viruses of swine origin replicated less efficiently at the temperature of the human proximal airways (33 degrees C). We also observed that the 2009 H1N1 viruses replicated to significantly higher titers than seasonal H1N1 virus in polarized colon epitheilal cells. These studies reveal that in comparison to seasonal influenza virus, H1N1 viruses of swine origin poorly activate multiple aspects of the human innate response which may contribute to the virulence of these viruses. In addition, their less efficient replication at human upper airway temperatures has implications for the understanding of pandemic H1N1 virus adaptation to humans. |
Accuracy of clinical diagnosis of bacterial vaginosis by human immunodeficiency virus infection status
Gallo MF , Jamieson DJ , Cu-Uvin S , Rompalo A , Klein RS , Sobel JD . Sex Transm Dis 2010 38 (4) 270-4 OBJECTIVE: To assess the accuracy of clinical diagnosis of bacterial vaginosis (BV) by using Amsel criteria, overall and by human immunodeficiency virus (HIV) infection status. METHODS: Women with HIV, or at risk for HIV, participated in the HIV Epidemiology Research Study, a prospective study conducted in 4 US sites. At enrollment and follow-up visits, scheduled at 6-month intervals for ≤5 years, participants received gynecologic examinations, had specimens collected, and underwent standardized interviews. We used McNemar test statistic to evaluate agreement between Amsel criteria and Nugent scoring. Using Nugent scoring as the reference standard, we calculated sensitivity and specificity for Amsel criteria and for 3 other classifications of clinical BV. Our results are based on data collected from 9140 study visits by 862 HIV-infected women and 421 HIV-uninfected women. RESULTS: Amsel criteria and Nugent scoring did not agree in the classification of BV cases (P < 0.01). Amsel criteria had poor sensitivity (60%; 95% confidence interval, 58%-61%) and specificity (90%; 95% confidence interval, 89%-91%) with wide differences in test properties by study site. We found no differences in diagnosing BV by HIV infection status. CONCLUSIONS: The under- and overdiagnosing of BV clinically suggests that the accuracy of Amsel criteria for routine screening of asymptomatic women might be lower than previous estimates; that clinicians need more rigorous training to apply subjective Amsel criteria accurately; or that wide heterogeneity in cases might prevent agreement between clinical and laboratory diagnoses, with future research needed to better understand the criteria or morphotypes associated with specific adverse outcomes. |
Primary health care in community health centers and comparison with office-based practice
Hing E , Hooker RS , Ashman JJ . J Community Health 2010 36 (3) 406-13 We examine the roles of nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (CNMs) in community health centers (CHCs). We also compare primary care physicians in CHCs with office-based physicians. Estimates are from the National Ambulatory Medical Care Survey, a nationally representative annual survey of nonfederal, office-based patient care physicians and their visits. Analysis of primary care delivery in CHCs and office-based practices are based on 1,434 providers and their visits (n = 32,300). During 2006-2007, on average, physicians comprised 70% of CHC clinicians, with NPs (20%), PAs (9%), and CNMs (1%) making up the remainder. PAs, NPs, and CNMs provided care in almost a third of CHC primary care visits; 87% of visits to these CHC providers were independent of physicians. Types of patients seen by clinicians suggest a division of labor in caring for CHC patients. NPs and PAs were more likely than physicians to report providing health education services. There were no other differences among services examined. Office-based physicians were less likely to work alongside PAs/NPs/CNMs than CHC physicians. CHC staffing is contingent on a variety of providers. CHC staffing patterns may serve as models of primary care staffing for office practices as demand for primary care services nationwide increases. |
Prevalence and genetic diversity of Bartonella detected in different tissues of small mammals of Nepal
Gundi VA , Kosoy MY , Myint KS , Shrestha SK , Shrestha MP , Pavlin JA , Gibbons RV . Appl Environ Microbiol 2010 76 (24) 8247-54 Bartonellae were detected in a total of 152 out of 642 (23.7%) tissues from 108/223 (48.4%) small mammals trapped in several urban areas of Nepal. Based on rpoB- and gltA-sequence analysis, genotypes belonging to seven known Bartonella species and five genotypes not belonging to previously known species were identified in these animals. |
The risk of West Nile Virus infection is associated with combined sewer overflow streams in urban Atlanta, Georgia, USA
Vazquez-Prokopec GM , Vanden Eng JL , Kelly R , Mead DG , Kolhe P , Howgate J , Kitron U , Burkot TR . Environ Health Perspect 2010 118 (10) 1382-8 BACKGROUND: At present, the factors favoring transmission and amplification of West Nile Virus (WNV) within urban environments are poorly understood. In urban Atlanta, Georgia, the highly polluted waters of streams affected by combined sewer overflow (CSO) represent significant habitats for the WNV mosquito vector Culex quinquefasciatus. However, their contribution to the risk of WNV infection in humans and birds remains unclear. OBJECTIVES: Our goals were to describe and quantify the spatial distribution of WNV infection in mosquitoes, humans, and corvids, such as blue jays and American crows that are particularly susceptible to WNV infection, and to assess the relationship between WNV infection and proximity to CSO-affected streams in the city of Atlanta, Georgia. MATERIALS & METHODS: We applied spatial statistics to human, corvid, and mosquito WNV surveillance data from 2001 through 2007. Multimodel analysis was used to estimate associations of WNV infection in Cx. quinquefasciatus, humans, and dead corvids with selected risk factors including distance to CSO streams and catch basins, land cover, median household income, and housing characteristics. RESULTS: We found that WNV infection in mosquitoes, corvids, and humans was spatially clustered and statistically associated with CSO-affected streams. WNV infection in Cx. quinquefasciatus was significantly higher in CSO compared with non-CSO streams, and WNV infection rates among humans and corvids were significantly associated with proximity to CSO-affected streams, the extent of tree cover, and median household income. CONCLUSIONS: Our study strongly suggests that CSO-affected streams are significant sources of Cx. quinquefasciatus mosquitoes that may facilitate WNV transmission to humans within urban environments. Our findings may have direct implications for the surveillance and control of WNV in other urban centers that continue to use CSO systems as a waste management practice. |
Urban form and extreme heat events: are sprawling cities more vulnerable to climate change than compact cities?
Stone B , Hess JJ , Frumkin H . Environ Health Perspect 2010 118 (10) 1425-1428 BACKGROUND: Extreme heat events (EHEs) are increasing in frequency in large U.S. cities and are responsible for a greater annual number of climate-related fatalities, on average, than any other form of extreme weather. In addition, low-density, sprawling patterns of urban development have been associated with enhanced surface temperatures in urbanized areas. OBJECTIVES: In this study. we examined the association between urban form at the level of the metropolitan region and the frequency of EHEs over a five-decade period. METHODS: We employed a widely published sprawl index to measure the association between urban form in 2000 and the mean annual rate of change in EHEs between 1956 and 2005. RESULTS: We found that the rate of increase in the annual number of EHEs between 1956 and 2005 in the most sprawling metropolitan regions was more than double the rate of increase observed in the most compact metropolitan regions. CONCLUSIONS: The design and management of land use in metropolitan regions may offer an important tool for adapting to the heat-related health effects associated with ongoing climate change. |
Nitrates in drinking water and methemoglobin levels in pregnancy: a longitudinal study
Manassaram DM , Backer LC , Messing R , Fleming LE , Luke B , Monteilh CP . Environ Health 2010 9 60 BACKGROUND: Private water systems are more likely to have nitrate levels above the maximum contaminant level (MCL). Pregnant women are considered vulnerable to the effects of exposure to high levels of nitrates in drinking water due to their altered physiological states. The level of methemoglobin in the blood is the biomarker often used in research for assessing exposure to nitrates. The objective of this study was to assess methemoglobin levels and examine how various factors affected methemoglobin levels during pregnancy. We also examined whether differences in water use practices existed among pregnant women based on household drinking water source of private vs. public supply. METHODS: A longitudinal study of 357 pregnant women was conducted. Longitudinal regression models were used to examine changes and predictors of the change in methemoglobin levels over the period of gestation. RESULTS: Pregnant women showed a decrease in methemoglobin levels with increasing gestation although <1% had levels above the physiologic normal of 2% methemoglobin, regardless of the source of their drinking water. The multivariable analyses did not show a statistically significant association between methemoglobin levels and the estimated nitrate intake from tap water among pregnant women around 36 weeks gestation (beta = 0.046, p = 0.986). Four women had tap water nitrate levels above the MCL of 10 mg/L. At enrollment, a greater proportion of women who reported using water treatment devices were private wells users (66%) compared to public system users (46%) (p < 0.0001). Also, a greater proportion of private well users (27%) compared to public system users (13%) were using devices capable of removing nitrate from water (p < 0.0001). CONCLUSION: Pregnant women potentially exposed to nitrate levels primarily below the MCL for drinking water were unlikely to show methemoglobin levels above the physiologic normal. Water use practices such as the use of treatment devices to remove nitrates varied according to water source and should be considered in the assessment of exposure to nitrates in future studies. |
Polybrominated diphenyl ether (PBDE) flame retardants and thyroid hormone during pregnancy
Chevrier J , Harley KG , Bradman A , Gharbi M , Sjodin A , Eskenazi B . Environ Health Perspect 2010 118 (10) 1444-9 BACKGROUND: Human exposure to polybrominated diphenyl ether (PBDE) flame retardants has increased exponentially over the last three decades. Animal and human studies suggest that PBDEs may disrupt thyroid function. Although thyroid hormone (TH) of maternal origin plays an essential role in normal fetal brain development, there is a paucity of human data regarding associations between exposure to PBDEs and maternal TH levels during pregnancy. OBJECTIVES: Our goal was to determine whether PBDE serum concentrations are associated with TH levels in pregnant women. METHODS: We measured the concentration of 10 PBDE congeners, free thyroxine (T4), total T4, and thyroid-stimulating hormone (TSH) in 270 pregnant women around the 27th week of gestation. RESULTS: Serum concentrations of individual PBDE congeners with detection frequencies > 50% (BDEs 28, 47, 99, 100, and 153) and their sum (SigmaPBDEs) were inversely associated with TSH levels. Decreases in TSH ranged between 10.9% [95% confidence interval (CI), -20.6 to 0.0] and 18.7% (95% CI, -29.2 to -4.5) for every 10-fold increase in the concentration of individual congeners. Odds of subclinical hyperthyroidism (low TSH but normal T4) were also significantly elevated in participants in the highest quartile of SigmaPBDEs and BDEs 100 and 153 relative to those in the first quartile. Associations between PBDEs and free and total T4 were not statistically significant. Results were not substantially altered after the removal of outliers and were independent of the method used to adjust for blood lipid levels and to express SigmaPBDEs. CONCLUSIONS: Results suggest that exposure to PBDEs is associated with lower TSH during pregnancy. Findings may have implications for maternal health and fetal development. |
The landscape of international event-based biosurveillance
Hartley DM , Nelson NP , Walters R , Arthur R , Yangarber R , Madoff L , Linge JP , Mawudeku A , Collier N , Brownstein JS , Thinus G , Lightfoot N . Emerg Health Threats J 2010 3 e3 Event-based biosurveillance is a scientific discipline in which diverse sources of data, many of which are available from the Internet, are characterized prospectively to provide information on infectious disease events. Biosurveillance complements traditional public health surveillance to provide both early warning of infectious disease events as well as situational awareness. The Global Health Security Action Group (GHSAG) of the Global Health Security Initiative is developing a biosurveillance capability that integrates and leverages component systems from member nations. This work discusses these biosurveillance systems and identifies needed future studies. |
A new method to estimate mortality in crisis-affected and resource-poor settings: validation study
Roberts B , Morgan OW , Sultani MG , Nyasulu P , Rwebangila S , Myatt M , Sondorp E , Chandramohan D , Checchi F . Int J Epidemiol 2010 39 (6) 1584-96 BACKGROUND: Data on mortality rates are crucial to guide health interventions in crisis-affected and resource-poor settings. The methods currently available to collect mortality data in such settings feature important methodological limitations. We developed and validated a new method to provide near real-time mortality estimates in such settings. METHODS: We selected four study sites: Kabul, Afghanistan; Mae La refugee camp, Thailand; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We recorded information about all deaths in a 60-day period by asking key community informants and decedents' next of kin to refer interviewers to bereaved households. We used the total number of deaths and population estimates to calculate mortality rates for 60- and 30-day periods. For validation we compared these rates with a best estimate of mortality using capture-recapture analysis with two further independent lists of deaths. RESULTS: The population covered by the new method was 76,476 persons in Kabul, 43,794 in Mae La camp, 54,418 in Chiradzulu District and 80,136 in the Tanzania camps. The informant method showed moderate sensitivity (55.0% in Kabul, 64.0% in Mae La, 72.5% in Chiradzulu and 67.7% in Tanzania), but performed better than the active surveillance system in the Tanzania refugee camps. CONCLUSIONS: The informant method currently features moderate sensitivity for accurately assessing mortality, but warrants further development, particularly considering its advantages over current options (ease of implementation and analysis and near-real estimates of mortality rates). Strategies should be tested to improve the performance of the informant method. |
Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007-2008
Tsang CA , Anderson SM , Imholte SB , Erhart LM , Chen S , Park BJ , Christ C , Komatsu KK , Chiller T , Sunenshine RH . Emerg Infect Dis 2010 16 (11) 1738-44 Coccidioidomycosis is endemic to the southwestern United States; 60% of nationally reported cases occur in Arizona. Although the Council of State and Territorial Epidemiologists case definition for coccidioidomycosis requires laboratory and clinical criteria, Arizona uses only laboratory criteria. To validate this case definition and characterize the effects of coccidioidomycosis in Arizona, we interviewed every tenth case-patient with coccidioidomycosis reported during January 2007-February 2008. Of 493 patients interviewed, 44% visited the emergency department, and 41% were hospitalized. Symptoms lasted a median of 120 days. Persons aware of coccidioidomycosis before seeking healthcare were more likely to receive an earlier diagnosis than those unaware of the disease (p = 0.04) and to request testing for Coccidioides spp. (p = 0.05). These findings warrant greater public and provider education. Ninety-five percent of patients interviewed met the Council of State and Territorial Epidemiologists clinical case definition, validating the Arizona laboratory-based case definition for surveillance in a coccidiodomycosis-endemic area. |
Comparison of survey methods in norovirus outbreak investigation, Oregon, USA, 2009
Oh JY , Bancroft JE , Cunningham MC , Keene WE , Lyss SB , Cieslak PR , Hedberg K . Emerg Infect Dis 2010 16 (11) 1773-6 We compared data from an Internet-based survey and a telephone-based survey during a 2009 norovirus outbreak in Oregon. Survey initiation, timeliness of response, and attack rates were comparable, but participants were less likely to complete Internet questions. Internet-based surveys permit efficient data collection but should be designed to maximize complete responses. |
Use of genomic profiling to assess risk for cardiovascular disease and identify individualized prevention strategies--a targeted evidence-based review.
Palomaki GE , Melillo S , Neveux L , Douglas MP , Dotson WD , Janssens AC , Balkite EA , Bradley LA . Genet Med 2010 12 (12) 772-84 PURPOSE: To address the key question of whether using available "cardiogenomic profiles" leads to improved health outcomes (e.g., reduction in rates of myocardial infarction and stroke) and whether these profiles help in making medical or personal decisions. METHODS: A targeted evidence-based review based on published Evaluation of Genomic Applications in Practice and Prevention methodologies. RESULTS: No study addressed the overarching question directly. Evidence for the analytic validity of genomic profiles was inadequate for most genes (scale: convincing, adequate, and inadequate), but based on gray data, the analytic sensitivity and specificity might be adequate. For the 29 candidate genes (58 separate associations reviewed), the credibility of evidence for clinical validity was weak (34 associations) to moderate (23 associations), based on limited evidence, potential biases, and/or variability between included studies. The association of 9p21 variants with heart disease had strong credibility with odds ratios of 0.80 (95% confidence interval: 0.77-0.82) and 1.25 (95% confidence interval: 1.21-1.30), respectively, for individuals with no, or two, at-risk alleles versus those with one at-risk allele. Using a multiplicative model, we combined information from 24 markers predicting heart disease and from 13 markers for stroke. The areas under the curves (64.7% and 55.2%, respectively), and overall screening performance (detection rates of 24% and 14% at a 10% false-positive rate, respectively) do not warrant use as stand-alone tests. CONCLUSION: Even if genomic markers were independent of traditional risk factors, reports indicate that cardiovascular disease risk reclassification would be small. Improvement in health could occur with earlier initiation or higher adherence to medical or behavioral interventions, but no prospective studies documented such improvements (clinical utility). |
Novel risk factors associated with hepatitis E virus infection in a large outbreak in northern Uganda: results from a case-control study and environmental analysis
Howard CM , Handzel T , Hill VR , Grytdal SP , Blanton C , Kamili S , Drobeniuc J , Hu D , Teshale E . Am J Trop Med Hyg 2010 83 (5) 1170-3 An outbreak of hepatitis E virus (HEV) began in October 2007 in northern Uganda. To determine risk factors and sources for ongoing transmission, we conducted both a case-control study and an environmental investigation. A case patient was defined as having serologic evidence of HEV infection, whereas controls were seronegative. We identified risk factors for infection by univariable and multivariable analyses using conditional logistic regression. Several water sources were tested for HEV RNA. Among 112 cases and 145 controls, storage of drinking water in large-mouthed vessels (adjusted odds ratios [AOR] = 2.83; 95% confidence interval [CI] = 1.16-6.94) and washing hands in a group basin (AOR = 1.90; 95% CI = 1.07-3.38) were associated with HEV infection. HEV RNA was detected from communal hand-rinse and surface-water samples. The epidemiologic and environmental water-testing results suggest that household-level factors played an important role in the transmission of HEV-modalities that have been previously underappreciated. |
Rapid scale-up of long-lasting insecticide-treated bed nets through integration into the national immunization program during Child Health Week in Togo, 2004
Wolkon A , Vanden Eng JL , Morgah K , Eliades MJ , Thwing J , Terlouw DJ , Takpa V , Dare A , Sodahlon YK , Doumanou Y , Hightower AW , Lama M , Thawani N , Slutsker L , Hawley WA . Am J Trop Med Hyg 2010 83 (5) 1014-9 In December 2004, Togo was the first country to conduct a nationwide free insecticide-treated net (ITN) distribution as part of its National Integrated Child Health Campaign. Community-based cross-sectional surveys were conducted one and nine months post-campaign as part of a multidisciplinary evaluation of the nationwide distribution of ITNs to children 9-59 months of age to evaluate ITN ownership, equity, and use. Our results demonstrated that at one month post-campaign, 93.1% of all eligible children received an ITN. Household ITN ownership and equity increased significantly post-campaign. Nine months post-campaign, 78.6% of households with a child eligible to participate in the campaign retained at least one campaign net. Use by eligible children was 43.5% at one month post-campaign (during the dry season) and 52.9% at nine months post-campaign (during the rainy season). Household ownership of at least one ITN increased from 8.0% pre-campaign to 62.5% one month post-campaign. Together, these findings demonstrate that in this setting, increased household ITN ownership, equity, and retention can be achieved on a national scale through free ITN distribution during an integrated campaign. |
Investigation of increased rates of isolation of bacillus species
Meites E , Taur Y , Marino L , Schaefer M , Eagan J , Jensen B , Williams M , Kamboj M , Srinivasan A . Infect Control Hosp Epidemiol 2010 31 (12) 1257-63 BACKGROUND: In 2007-2008, several US hospitals reported summertime increases in the number of clinical blood cultures positive for Bacillus species, which are common environmental bacteria. OBJECTIVE: To investigate increased rates of isolation of Bacillus species from blood cultures, identify risk factors, and recommend control strategies. DESIGN: Survey and case-control study. SETTING: Multiple hospitals, including a cancer center. METHODS: We surveyed 24 facilities that reported increases. We also conducted a field investigation at a hospital with a high rate, reviewing charts, collecting clinical and environmental isolates, and observing infection control procedures. A case-control study compared inpatient case patients who had any blood culture positive for Bacillus with unmatched control patients who had a blood culture with no growth during June-August 2008. RESULTS: Among surveyed facilities, mean monthly rates rose from 25 to a peak of 75 Bacillus-positive blood cultures per 10,000 blood cultures performed during the period June-August. At the hospital where the case-control investigation was conducted, for most case patients (75%), the Bacillus-positive blood cultures represented contamination or device colonization rather than infection. We enrolled 48 case patients and 48 control patients; in multivariate analysis, only central venous access device use was significantly associated with case status (odds ratio, 14.0; [Formula: see text]). Laboratory testing identified at least 12 different Bacillus species (non-anthracis) among the isolates. Observation of infection control procedures revealed variability in central line care and blood sample collection techniques. CONCLUSIONS: Periodic increases in the environmental load of Bacillus species may occur in hospitals. Our investigation indicated that at one facility, these increases likely represented a pseudo-outbreak of Bacillus species colonizing central venous lines or their accessories, such as needleless connector devices. Vigilant attention should be paid to infection control practices when collecting blood samples for culture, to minimize the risk of contamination by environmental microorganisms. |
Disinfection and sterilization of prion-contaminated medical instruments
Belay ED , Schonberger LB , Brown P , Priola SA , Chesebro B , Will RG , Asher DM . Infect Control Hosp Epidemiol 2010 31 (12) 1304-6 In the February 2010 issue of the journal, | under "SHEA Guideline," Rutala and Weber1 | recommended | sterilization options for decontaminating neurosurgical instruments exposed to the infectious agents of transmissible | spongiform encephalopathies (TSE agents; prions). The recommendations of Rutala and Weber1 | are contrary to those | endorsed by many other experts in the field, including authors | of some studies cited in their article. Conflicting TSE decontamination protocols have been proposed in the past because | of concerns about the unusual resistance of infectivity to | conventional sterilization methods, the paucity of appropriate | laboratory and epidemiologic data, and the difficulties associated with conducting inactivation studies more relevant | to clinical settings. To address the inconsistent recommendations, the World Health Organization (WHO), in 1999, | convened an international consultation of prominent prion | disease researchers, including experts in agent inactivation, | biology, and epidemiology.2 | The consultation offered various | options appropriate for hospitals in developed and developing | countries, with a consensus recommendation to inactivate | prions, whenever possible, by means of immersion in 1-2 N | NaOH, followed by heating in a gravity displacement autoclave at 121°C for 30 minutes and cleaning and sterilization | by conventional means. Rutala and Weber's1 | option 1—initially cleaning the instruments and then autoclaving at 134°C | for 18 minutes—was viewed by the WHO consultants as the | least effective procedure and was accompanied by a warning | that it was likely to leave residual infectivity in some circumstances and should be used only in those clinical situations | where limited resources preclude using more stringent | options.2 |
Adverse events following trivalent inactivated influenza vaccination in children: analysis of the Vaccine Adverse Event Reporting System
Muhammad RD , Haber P , Broder KR , Leroy Z , Ball R , Braun MM , Davis RL , McMahon AW . Pediatr Infect Dis J 2010 30 (1) e1-8 BACKGROUND: The Advisory Committee on Immunization Practices' recommendations for influenza vaccination of children have expanded from the long-standing recommendation to vaccinate high-risk children aged ≥6 months, to vaccinating all 6- to 23-month-olds (2004), 2- to 4-year-olds (2006), and 5- to 18-year-olds (2008). OBJECTIVE: To identify new or unexpected adverse events (AEs) after trivalent inactivated vaccine (TIV) in children. METHODS: We analyzed reports after TIV to the Vaccine Adverse Event Reporting System from 1990-2006 in children aged 2 to 17 years, and from the 2008-2009 influenza season in children aged 5 to 17 years. Empiric Bayesian data mining techniques were used to identify new or unexpected AEs during 1990-2006. RESULTS: During 1990-2006, the Vaccine Adverse Event Reporting System received 2054 reports of children aged 2 to 17 years with a peak in the 2003-2004 influenza season. In 2008-2009, 506 reports describing 5 to 17 year olds were received. The serious reports of tests performed after TIV were approximately 10% of all reports from 2001-2006, and 6% of the reports in the 2008-2009 season. Data mining showed an increased proportion of medication errors and Guillain Barre Syndrome (GBS). The findings of GBS could not be interpreted as causally related to vaccination. Among 201 reports of medication error, 94% had no AE reported other than the medication error itself. CONCLUSION: In this analysis, we found no unexpected AEs. Our review of medication error and GBS reports suggests that ongoing monitoring in these areas is appropriate. |
Decline in rotavirus hospitalizations and health care visits for childhood diarrhea following rotavirus vaccination in El Salvador
Yen C , Armero Guardado JA , Alberto P , Rodriguez Araujo DS , Mena C , Cuellar E , Nolasco JB , De Oliveira LH , Pastor D , Tate JE , Parashar UD , Patel M . Pediatr Infect Dis J 2010 30 S6-S10 BACKGROUND: A recent postlicensure study from El Salvador showed that the monovalent rotavirus vaccine conferred 76% protection against rotavirus hospitalizations. We further examined the impact of rotavirus vaccination on the national burden of childhood diarrhea to help assess the total public health benefits of vaccination. METHODS: We compared all-cause diarrhea and rotavirus-specific hospitalization rates during prevaccine year 2006, with postvaccine years 2008 and 2009 in children <5 years of age from 7 sentinel surveillance hospitals. We also compared annual rates of diarrhea-related healthcare events during prevaccine years 2005 and 2006 with postvaccine years 2008 and 2009 to examine the national burden of healthcare utilization for all-cause diarrhea. RESULTS: Among sentinel surveillance hospitals, rotavirus hospitalization rates among children <5 years of age declined by 81% (95% confidence interval [CI]: 78%-84%) in 2008 when 2-dose rotavirus vaccine coverage was 50% among infants <1 year; the decline was 69% (95% CI: 65%-73%) in 2009 when 2-dose vaccine coverage was 61% among infants <1 year, compared with 2006. The greatest declines were observed in children ≤1 year of age, although sizeable reductions were also observed among children ≥2 years in 2008. National diarrhea-related healthcare visits during rotavirus season decreased by 48% (95% CI: 47%-48%) in 2008 and by 35% (95% CI: 34%-35%) in 2009 compared with the mean rate from the 2005 and 2006 rotavirus seasons. CONCLUSIONS: Rotavirus vaccination had a substantial public health impact on rotavirus disease and overall diarrhea events in El Salvador. Important age-related changes in diarrheal incidence emphasize the need for ongoing rotavirus surveillance after vaccine introduction. |
Attention-deficit/hyperactivity disorder, conduct disorder, and young adult intimate partner violence
Fang X , Massetti GM , Ouyang L , Grosse SD , Mercy JA . Arch Gen Psychiatry 2010 67 (11) 1179-86 CONTEXT: Studies based on clinical samples suggest a connection between childhood attention-deficit/hyperactivity disorder (ADHD) and later intimate partner violence (IPV) perpetration. OBJECTIVE: To examine the association between retrospectively reported childhood ADHD and conduct disorder (CD) symptoms and the perpetration of physical IPV in a population-based sample of young adults. DESIGN, SETTING, AND PARTICIPANTS: The study population consisted of 11 238 participants (mean [SD] age, 22.0 [1.7] years) in the National Longitudinal Study of Adolescent Health. Multinomial logistic regressions and propensity score matching were used to analyze the relationships of IPV with symptoms of ADHD domains (hyperactive/impulsive and inattentive) and symptoms of CD as well as with ADHD and CD dichotomized on the basis of symptom criteria. MAIN OUTCOME MEASURES: Respondents' answers to the 2 questions in the wave III survey reflecting perpetration of physical violence toward a partner were used to define IPV perpetration. Intimate partner violence perpetration resulting in injury or not was assessed with a follow-up question. RESULTS: Conduct disorder significantly predicted IPV perpetration both with and without injury. Controlling for CD and hyperactivity/impulsivity, inattention independently predicted young adult IPV perpetration without injury. Controlling for inattention and CD, no significant relationship between hyperactivity/impulsivity and IPV perpetration without injury was found. Results were different regarding IPV perpetration resulting in injury. Hyperactivity/impulsivity, but not inattention, independently predicted IPV perpetration resulting in injury. In categorical analyses, CD predicted both types of IPV, and ADHD significantly predicted IPV perpetration resulting in injury but did not significantly predict IPV perpetration without injury. CONCLUSIONS: Conduct disorder is consistently associated with violence in intimate relationships. Controlling for CD, there is also an association between ADHD and IPV. Results suggest the need for services and treatment strategies that specifically address the risks for violence and promote healthy intimate relationships for youths with CD and ADHD. |
Rapid drug susceptibility testing with a molecular beacon assay is associated with earlier diagnosis and treatment of multidrug-resistant tuberculosis in California
Banerjee R , Allen J , Lin SY , Westenhouse J , Desmond E , Schecter GF , Scott C , Raftery A , Mase S , Watt JP , Flood J . J Clin Microbiol 2010 48 (10) 3779-81 To assess the clinical impact of a molecular beacon (MB) assay that detects multidrug-resistant tuberculosis (MDR TB), we retrospectively reviewed records of 127 MDR TB patients with and without MB testing between 2004 and 2007. Use of the MB assay reduced the time to detection and treatment of MDR TB. |
Toward excellence in testosterone testing: a consensus statement
Rosner W , Vesper H . J Clin Endocrinol Metab 2010 95 (10) 4542-8 BACKGROUND: Testosterone assays are widely used. However, deficiencies in these assays limit their broad and effective implementation and threaten the health of those patients whose medical care relies upon its accurate measurement. Furthermore, the translation of research findings into information useful for patient care, such as new evidence-based clinical guidelines, is not possible unless both research and clinical assays are held to higher standards than are currently required. A group of concerned stakeholders was convened to address this problem. METHODS: Representatives of multiple professional societies, government, and industry, having a stake in ensuring that testosterone levels are measured accurately and reliably, met to identify goals, objectives, and actions necessary to bring about the standardization of assays for testosterone. RESULTS: To ensure highly accurate testosterone testing that will result in improved diagnosis, treatment, and prevention of disease through the use of standardized assays, a series of recommendations were agreed upon. The recommendations included the following: technical improvements for assay standardization; education of health care providers, patients, and all others concerned with testosterone testing; plans to encourage all concerned journals, government agencies, and health insurance companies to support this effort; and encouragement to manufacturers to develop better and more cost effective assays. CONCLUSION: A preliminary timeline was set out to implement the recommendations of the Group. |
Plasmid-mediated quinolone resistance among non-Typhi Salmonella enterica isolates, USA
Sjolund-Karlsson M , Howie R , Rickert R , Krueger A , Tran TT , Zhao S , Ball T , Haro J , Pecic G , Joyce K , Fedorka-Cray PJ , Whichard JM , McDermott PF . Emerg Infect Dis 2010 16 (11) 1789-91 We determined the prevalence of plasmid-mediated quinolone resistance mechanisms among non-Typhi Salmonella spp. isolated from humans, food animals, and retail meat in the United States in 2007. Six isolates collected from humans harbored aac(6')Ib-cr or a qnr gene. Most prevalent was qnrS1. No animal or retail meat isolates harbored a plasmid-mediated mechanism. |
ELISpot detection of mumps-specific antibody secreting B-cells as an alternative method of laboratory diagnosis
Latner DR , McGrew M , Williams N , Lowe L , Werman R , Warnock E , Gallagher K , Doyle P , Smole S , Lett S , Cocoros N , Demaria A , Konomi R , Brown CJ , Rota PA , Bellini WJ , Hickman CJ . Clin Vaccine Immunol 2010 18 (1) 35-42 Although high measles, mumps, and rubella (MMR) vaccination coverage has been successful in dramatically reducing mumps disease in the United States, mumps (re)infections occasionally occur in individuals who have been either previously vaccinated or naturally infected. Standard diagnostics that detect virus or virus-specific antibody are dependable for confirming primary mumps infection in immunologically naive persons, but these methods perform inconsistently on individuals with prior immune exposure. We hypothesized that detection of activated mumps-specific Antibody-Secreting B-Cells (ASC) by ELISpot could be used as a more reliable diagnostic. To test this, a time-course of virus-specific ASC responses was measured by ELISpot following MMR vaccination of 16 previously vaccinated or naturally exposed adult volunteers. Mumps-specific ASC were detectable in 68% of these individuals at some point during the first 3 weeks following re-vaccination. In addition, mumps-specific ASC were detected in 7/7 previously vaccinated individuals who recently had been infected as part of a confirmed mumps outbreak. These data suggest that ELISpot detection of mumps-specific ASC has the potential for use as an alternative method of diagnosis when suspect cases cannot be confirmed by detection of IgM or virus. In addition, it was determined that mumps-specific memory B-cells are detected at a much lower frequency than measles or rubella-specific cells, suggesting that mumps infection may not generate robust B-cell memory. |
Evaluation of three commercially available Japanese encephalitis virus IgM enzyme-linked immunosorbent assays
Robinson JS , Featherstone D , Vasanthapuram R , Biggerstaff BJ , Desai A , Ramamurty N , Chowdhury AH , Sandhu HS , Cavallaro KF , Johnson BW . Am J Trop Med Hyg 2010 83 (5) 1146-1155 We evaluated performance of three commercial Japanese encephalitis virus (JEV) IgM antibody capture enzyme-linked immunosorbent assay (MAC ELISA) kits with a panel of serological specimens collected during a surveillance project of acute encephalitis syndrome in India and acute meningitis and encephalitis syndrome in Bangladesh. The serum and cerebral spinal fluid specimens had been referred to the Centers for Disease Control and Prevention (CDC) for confirmatory testing. The CDC results and specimen classifications were considered the reference standard. All three commercial kits had high specificity (95-99.5%), but low sensitivities, ranging from 17-57%, with both serum and cerebrospinal fluid samples. Specific factors contributing to low sensitivity compared with the CDC ELISA could not be determined through further analysis of the limits and dilution end points of IgM detection. |
Guidelines for the laboratory diagnosis of mycoplasma genitalium infections in East European countries
Shipitsyna E , Savicheva A , Solokovskiy E , Ballard RC , Domeika M , Unemo M , Jensen JS . Acta Derm Venereol 2010 90 (5) 461-7 The present guidelines aim to provide comprehensive information regarding laboratory diagnosis of Mycoplasma genitalium infections in East European countries. These guidelines are intended primarily for laboratory professionals testing specimens from patients at sexual health care clinics, but may also be useful for community-based screening programmes. Diagnosis of M. genitalium infection is performed exclusively using nucleic acid amplification tests (NAATs), owing to the poor and slow growth of the bacterium in culture. Because no internationally validated and approved commercial NAAT for M. genitalium detection is presently available, it is necessary that laboratories performing M. genitalium diagnostics not only carefully evaluate and validate their in-house PCRs before using them routinely, but also use comprehensive internal controls and take part in external quality assessment programmes. The guidelines were elaborated as a consensus document of the Eastern European Sexual and Reproductive Health (EE SRH) Network, and comprise one element of a series of guidelines aimed at optimizing, standardizing, and providing guidance on quality laboratory testing for reproductive tract infections. |
The international circumpolar surveillance interlaboratory quality control program for Streptococcus pneumoniae, 1999 - 2008
Reasonover A , Zulz T , Bruce MG , Bruden D , Jette L , Kaltoft M , Lambertsen L , Parkinson A , Rudolph K , Lovgren M . J Clin Microbiol 2010 49 (1) 138-43 The International Circumpolar Surveillance (ICS) Project was initiated in 1999 to conduct population-based surveillance for invasive pneumococcal disease in select regions of the Arctic. An inter-laboratory quality control (QC) program for pneumococcal serotyping and antibiotic susceptibility testing was incorporated into ICS by reference laboratories in Northern Canada (Laboratoire de Sante Publique du Quebec (LSPQ) in Sainte-Anne de Bellevue, Quebec, National Centre for Streptococcus (NCS) in Edmonton, Alberta) and Alaska (Arctic Investigations Program, (AIP). The World Health Organization's Collaborating Centre for Reference and Research on Pneumococci at Statens Serum Institute (SSI) in Copenhagen, Denmark, joined the QC Program in 2004. The Iceland Reference Laboratory (IRL) in Reykjavik joined the QC Program in 2006, but due to low sample sizes data from IRL are not included in this report. From 1999 through 2008, 190 isolates were distributed among four laboratories (AIP, NCS, LSPQ, and SSI). The overall serotype concordance was 95.8%, and overall serogroup concordance was 97.4%. The overall modal MIC concordance for testing by broth microdilution (BMD) and agar dilution was >96% for all the antibiotics except for erythromycin (92.1%) and clindamycin (89.5%). MIC comparisons between the Etest(R) and broth microdilution (BMD) resulted in lower concordance for erythromycin (73.9%), clindamycin (65.5%), and trimethoprim-sulfamethoxazole (80%); however categorical concordance (susceptible, resistant) remained high at 98.6%, 89.1%, and 90.9%, respectively. Our data demonstrate a high correlation of serotyping and antimicrobial susceptibility testing results between four participating laboratories. |
Assessing the toxic effects of ethylene glycol ethers using Quantitative Structure Toxicity Relationship models
Ruiz P , Mumtaz M , Gombar V . Toxicol Appl Pharmacol 2010 254 (2) 198-205 Experimental determination of toxicity profiles consumes a great deal of time, money, and other resources. Consequently, businesses, societies, and regulators strive for reliable alternatives such as Quantitative Structure Toxicity Relationship (QSTR) models to fill gaps in toxicity profiles of compounds of concern to human health. The use of glycol ethers and their health effects have recently attracted the attention of international organizations such as the World Health Organization (WHO). The board members of Concise International Chemical Assessment Documents (CICAD) recently identified inadequate testing as well as gaps in toxicity profiles of ethylene glycol mono-n-alkyl ethers (EGEs). The CICAD board requested the ATSDR Computational Toxicology and Methods Development Laboratory to conduct QSTR assessments of certain specific toxicity endpoints for these chemicals. In order to evaluate the potential health effects of EGEs, CICAD proposed a critical QSTR analysis of the mutagenicity, carcinogenicity, and developmental effects of EGEs and other selected chemicals. We report here results of the application of QSTRs to assess rodent carcinogenicity, mutagenicity, and developmental toxicity of four EGEs: 2-methoxyethanol, 2-ethoxyethanol, 2-propoxyethanol, and 2-butoxyethanol and their metabolites. Neither mutagenicity nor carcinogenicity is indicated for the parent compounds, but these compounds are predicted to be developmental toxicants. The predicted toxicity effects were subjected to reverse QSTR (rQSTR) analysis to identify structural attributes that may be the main drivers of the developmental toxicity potential of these compounds. |
Comparison of 3 infrared thermal detection systems and self-report for mass fever screening
Nguyen AV , Cohen NJ , Lipman H , Brown CM , Molinari NA , Jackson WL , Kirking H , Szymanowski P , Wilson TW , Salhi BA , Roberts RR , Stryker DW , Fishbein DB . Emerg Infect Dis 2010 16 (11) 1710-7 Despite limited evidence regarding their utility, infrared thermal detection systems (ITDS) are increasingly being used for mass fever detection. We compared temperature measurements for 3 ITDS (FLIR ThermoVision A20M [FLIR Systems Inc., Boston, MA, USA], OptoTherm Thermoscreen [OptoTherm Thermal Imaging Systems and Infrared Cameras Inc., Sewickley, PA, USA], and Wahl Fever Alert Imager HSI2000S [Wahl Instruments Inc., Asheville, NC, USA]) with oral temperatures (≥ 100 degrees F = confirmed fever) and self-reported fever. Of 2,873 patients enrolled, 476 (16.6%) reported a fever, and 64 (2.2%) had a confirmed fever. Self-reported fever had a sensitivity of 75.0%, specificity 84.7%, and positive predictive value 10.1%. At optimal cutoff values for detecting fever, temperature measurements by OptoTherm and FLIR had greater sensitivity (91.0% and 90.0%, respectively) and specificity (86.0% and 80.0%, respectively) than did self-reports. Correlations between ITDS and oral temperatures were similar for OptoTherm (rho = 0.43) and FLIR (rho = 0.42) but significantly lower for Wahl (rho = 0.14; p < 0.001). When compared with oral temperatures, 2 systems (OptoTherm and FLIR) were reasonably accurate for detecting fever and predicted fever better than self-reports. |
Comparison of detection methods for heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) using population analysis profile as the reference method
Satola SW , Farley MM , Anderson KF , Patel JB . J Clin Microbiol 2010 49 (1) 177-83 Staphylococcus aureus clinical isolates with vancomycin MICs of 2 mug/mL have been associated with vancomycin therapeutic failure and the heteroresistant vancomycin-intermediate S. aureus (hVISA) phenotype. Population analysis profile (PAP) with an area under the curve (AUC) ratio of ≥ 0.9 compared to hVISA strain Mu3 is most often used for determining hVISA, but it is time consuming and labor-intensive. A collection of 140 MRSA blood isolates with vancomycin MICs of 2 mug/mL by reference broth microdilution and screened for hVISA using PAP-AUC (21/140 [15%] hVISA) were tested by additional methods to detect hVISA. Methods included: 1) Etest macromethod using vancomycin and teicoplanin test strips, Brain Heart Infusion (BHI) agar and a 2.0 McFarland inoculum; 2) Etest GRD using vancomycin-teicoplanin double-sided gradient test strips on Mueller Hinton Agar (MHA) with 5% sheep's blood and 0.5 McFarland inoculum; and 3) BHI screen agar plates containing 4mug/mL vancomcyin and 16 g/L casein using 0.5 and 2.0 McFarland inocula. Each method was evaluated using PAP-AUC as the reference method. The sensitivity of each method for detecting hVISA was higher when read at 48 h. Etest macromethod was 57% sensitive and 96% specific, Etest GRD was 57% sensitive and 97% specific, BHI screen agar was 90% sensitive and 95% specific with 0.5 McFarland inoculum and 100% sensitive and 68% specific with 2.0 McFarland inoculum. BHI screen agar with 4 mug/mL vancomycin and casein and 0.5 McFarland inoculum had the best sensitivity and specificity combination, was easy to perform and may be useful for clinical detection of hVISA. |
Distribution and persistence of pleural penetrations by multi-walled carbon nanotubes
Mercer RR , Hubbs AF , Scabilloni JF , Wang L , Battelli LA , Schwegler-Berry D , Castranova V , Porter DW . Part Fibre Toxicol 2010 7 28 BACKGROUND: Multi-walled carbon nanotubes (MWCNT) are new manufactured nanomaterials with a wide spectrum of commercial applications. The durability and fiber-like dimensions (mean length 3.9 mum long x 49 nm diameter) of MWCNT suggest that these fibers may migrate to and have toxicity within the pleural region. To address whether the pleura received a significant and persistent exposure, C57BL/6J mice were exposed by pharyngeal aspiration to 10, 20, 40 and 80 mug MWCNT or vehicle and the distribution of MWCNT penetrations determined at 1, 7, 28 and 56 days after exposure. Following lung fixation and sectioning, morphometric methods were used to determine the distribution of MWCNT and the number of MWCNT fiber penetrations of three barriers: alveolar epithelium (alveolar penetrations), the alveolar epithelium immediately adjacent to the pleura (subpleural tissue), and visceral pleural surface (intrapleural space). RESULTS: At 1 day 18%, 81.6% and 0.6% of the MWCNT lung burden was in the airway, the alveolar, and the subpleural regions, respectively. There was an initial, high density of penetrations into the subpleural tissue and the intrapleural space one day following aspiration which appeared to decrease due to clearance by alveolar macrophages and/or lymphatics by day 7. However, the density of penetrations increased to steady state levels in the subpleural tissue and intrapleural from day 28 - 56. At day 56 approximately 1 in every 400 fiber penetrations was in either the subpleural tissue or intrapleural space. Numerous penetrations into macrophages in the alveolar airspaces throughout the lungs were demonstrated at all times but are not included in the counts presented. CONCLUSIONS: The results document that MWCNT penetrations of alveolar macrophages, the alveolar wall, and visceral pleura are both frequent and sustained. In addition, the findings demonstrate the need to investigate the chronic toxicity of MWCNT at these sites. |
Outbreak of beriberi in an Indian population of the upper Amazon region, Roraima State, Brazil, 2008
Cerroni MP , Barrado JC , Nobrega AA , Lins AB , da Silva IP , Mangueira RR , da Cruz RH , Mendes SM , Sobel J . Am J Trop Med Hyg 2010 83 (5) 1093-1097 Edema, parasthesias, and paresis affected 10 residents of an Indian community in Roraima state; three died. Mining with mercury occurs locally; caxiri, a traditional alcoholic drink, is consumed daily. We conducted a 1:2 unmatched case-control study; a case was an Indian from Uiramuta county (population of 9,127) who presented ≥ 1 of lower extremity edema, paresthesias, paresis, or weakness. Controls were asymptomatic Indians randomly selected from the population. We identified 90 cases (prevalence of 1%) and 180 controls; all were enrolled. Among cases, 79% were male, and the median age was 31 years. Ethnicity was Macuxi, and 49% had income. Cases had lower extremity edema (85%), upper extremity paresthesias (84%), and lower extremity weakness and pain (78%). Risk factors were male sex (odds ratio [OR] = 6.8; P < 0.001), age 31-40 years (OR = 5.63; P < 0.001), and consumption of caxiri (OR = 2.7; P < 0.003). Mercury exposure was not a risk. Thiamine therapy produced complete rapid clinical recovery in all cases, confirming the diagnosis of beriberi. We recommend surveillance, thiamine supplementation, and nutritional intervention. |
Understanding workplace processes and factors that determine exposures to engineered nanomaterials
Woskie SR , Bello D , Virji MA , Stefaniak AB . Int J Occup Environ Health 2010 16 (4) 365-77 There is a critical need to understand the factors that influence engineered nannomaterial (ENM) exposures in the workplace. Such an understanding would aid in: identifying and prioritizing control measures; targeting future exposure measurements; and predicting worker exposures for work scenarios. This information could also be used in epidemiological studies. We propose a multitiered model in which information on exposure factors can be obtained at the macrolevel (examining differences in exposures between differenct ENM sectors or product types); the midlevel (examining differences in exposures between workplaces within the same ENM sector or product type); and the microlevel (examining differences in exposure between tasks or between ENM types during the same task). Further, within the microlevel, potential exposure factors are defined by a source-receptor model. We recommend that auxiliary data be collected systematically, along with exposure measurements, to enable analysis of exposure factors as well as the pooling of data across studies. |
Wood dust sampling: field evaluation of personal samplers when large particles are present
Lee T , Harper M , Slaven JE , Lee K , Rando RJ , Maples EH . Ann Occup Hyg 2010 55 (2) 180-91 Recent recommendations for wood dust sampling include sampling according to the inhalable convention of International Organization for Standardization (ISO) 7708 (1995) Air quality-particle size fraction definitions for health-related sampling. However, a specific sampling device is not mandated, and while several samplers have laboratory performance approaching theoretical for an 'inhalable' sampler, the best choice of sampler for wood dust is not clear. A side-by-side field study was considered the most practical test of samplers as laboratory performance tests consider overall performance based on a wider range of particle sizes than are commonly encountered in the wood products industry. Seven companies in the wood products industry of the Southeast USA (MS, KY, AL, and WV) participated in this study. The products included hardwood flooring, engineered hardwood flooring, door skins, shutter blinds, kitchen cabinets, plywood, and veneer. The samplers selected were 37-mm closed-face cassette with ACCU-CAP, Button, CIP10-I, GSP, and Institute of Occupational Medicine. Approximately 30 of each possible pairwise combination of samplers were collected as personal sample sets. Paired samplers of the same type were used to calculate environmental variance that was then used to determine the number of pairs of samples necessary to detect any difference at a specified level of confidence. Total valid sample number was 888 (444 valid pairs). The mass concentration of wood dust ranged from 0.02 to 195 mg m(-3). Geometric mean (geometric standard deviation) and arithmetic mean (standard deviation) of wood dust were 0.98 mg m(-3) (3.06) and 2.12 mg m(-3) (7.74), respectively. One percent of the samples exceeded 15 mg m(-3), 6% exceeded 5 mg m(-3), and 48% exceeded 1 mg m(-3). The number of collected pairs is generally appropriate to detect a 35% difference when outliers (negative mass loadings) are removed. Statistical evaluation of the nonsimilar sampler pair results produced a finding of no significant difference between any pairing of sampler type. A practical consideration for sampling in the USA is that the ACCU-CAP is similar to the sampler currently used by the Occupational Safety and Health Administration for purposes of demonstrating compliance with its permissible exposure limit for wood dust, which is the same as for Particles Not Otherwise Regulated, also known as inert dust or nuisance dust (Method PV2121). |
Lack of respiratory improvement following remediation of a water-damaged office building
Iossifova YY , Cox-Ganser JM , Park JH , White SK , Kreiss K . Am J Ind Med 2010 54 (4) 269-77 BACKGROUND: Damp buildings are commonly remediated without removing employees or ongoing medical surveillance. METHODS: We examined paired pulmonary function and questionnaire data from 2002 and 2005 for 97 employees in a water-damaged building during ongoing but incomplete remediation. RESULTS: We observed no overall improvement in respiratory health, as reflected in symptom scores, overall medication use, spirometry abnormalities, or sick leave. Four employees went from borderline bronchial hyperresponsiveness to bronchial hyperresponsiveness; six developed abnormal spirometry; three more reported post-occupancy current asthma, and four hypersensitivity pneumonitis. The number of participants without lower respiratory symptoms decreased from 27 in 2002 to 20 in 2005. Respiratory cases relocated in the building had a decrease in medication use and sick leave in 2005. CONCLUSIONS: During dampness remediation, relocation may be health protective and prevent incident building-related respiratory cases. Without relocation of entire workforces, medical surveillance is advisable for secondary prevention of existing building-related disease. Am. J. Ind. Med. (c) 2010 Wiley-Liss, Inc. |
Noise control solutions for indoor firing ranges
Kardous CA , Murphy WJ . Noise Control Eng J 2010 58 (4) 345-356 Peak sound pressure level measurements conducted at indoor firing ranges ranged from 157-168 decibels (dB). Exposure to high-intensity impulsive noise during target shooting at indoor firing ranges has been identified as a significant contributor to noise-induced hearing loss among shooters. In addition, firing ranges that are constructed with adjacent areas or housed within a larger building structure require minimal sound transmission to occur outside the firing range. Several principles of noise control engineering can be applied to improve the absorption of impulse noise inside the firing ranges and limit the transmission of such impulses to adjacent areas and spaces. Although little can be done to control the direct exposure of shooters to the firing of their own firearms, several noise control solutions are presented to reduce the secondary exposure off reflected surfaces and from other shooters. This paper will provide a general overview of noise control solutions aimed to improve sound absorption inside the firing range and reduce the transmission of airborne and structuralborne sounds to adjacent areas and facilities. 2010 Institute of Noise Control Engineering. |
Occupational lung cancer in US women, 1984-1998
Robinson CF , Sullivan PA , Li J , Walker JT . Am J Ind Med 2010 54 (2) 102-17 BACKGROUND: Lung cancer is the leading cause of cancer death in US women, accounting for 72,130 deaths in 2006. In addition to smoking cessation, further reduction of the burden of lung cancer mortality can be made by preventing exposure to occupational lung carcinogens. Data for occupational exposures and health outcomes of US working women are limited. METHODS: Population-based mortality data for 4,570,711 women who died between 1984 and 1998 in 27 US States were used to evaluate lung cancer proportionate mortality over time by the usual occupation and industry reported on death certificates. Lung cancer proportionate mortality ratios were adjusted for smoking, using data from the National Health Interview Survey (NHIS) and the American Cancer Society's Cancer Prevention Study II. RESULTS: Analyses revealed that 194,382 white, 18,225 Black and 1,515 Hispanic women died 1984-1998 with lung cancer reported as the underlying cause of death. Following adjustment for smoking, significant excess proportionate lung cancer mortality was observed among US women working in the US manufacturing; transportation; retail trade; agriculture, forestry, and fishing; and nursing/personal care industries. Women employed in precision production, technical, managerial, professional specialty, and administrative occupations experienced some of the highest significantly excess proportionate lung cancer mortality during 1984-1998. CONCLUSIONS: The results of our study point to significantly elevated risks for lung cancer after adjustment for smoking among women in several occupations and industries. Because 6-17% of lung cancer in US males is attributable to known exposures to occupational carcinogens, and since synergistic interactions between cigarette smoke and other occupational lung carcinogens have been noted, it is important to continue research into the effects of occupational exposures on working men and women. Am. J. Ind. Med. (c) 2010 Wiley-Liss, Inc. |
Effectiveness of a custom-fitted flange and local exhaust ventilation (LEV) system in controlling the release of nanoscale metal oxide particulates during reactor cleanout operations
Methner MM . Int J Occup Environ Health 2010 16 (4) 475-87 As the nanotechnology industry expands, facilities engaged in the production and use of engineered nanoscale materials (ENMs) are challenged with determining whether their processes pose a risk for worker inhalation exposure. Although there are neither regulatory exposure limits specific to ENMs nor validated measurement standards for nanomaterials in the workplace, many facilities opt to be proactive in managing uncharacterized ENMs by reducing or eliminating the potential for exposure by controlling their release into the workplace atmosphere. A field study was conducted to evaluate the effectiveness of a portable, HEPA-filtered, local exhaust ventilation system equipped with a custom-fitted flange for controlling the emission of engineered nanoscale metal oxide particulates during reactor cleanout operations. On the basis of the findings of this study, it appears that a properly designed LEV system, coupled with good work practices can be highly effective in controlling nanoscale material emissions during processes of this type. |
Endothelial function, a biomarker of subclinical cardiovascular disease, in urban police officers
Joseph PN , Violanti JM , Donahue R , Andrew ME , Trevisan M , Burchfiel CM , Dorn J . J Occup Environ Med 2010 52 (10) 1004-8 OBJECTIVE: Police officers were hypothesized to have decreased endothelial function, measured by brachial artery flow-mediated dilation (FMD). METHODS: We compared FMD in police officers (n = 261) and a population sample of men and women (n = 229), all from the same geographical region and free of clinical cardiovascular disease (CVD). RESULTS: Compared with the population sample, police officers had significantly increased age-adjusted CVD risk factors (systolic and diastolic blood pressure, total cholesterol, smoking prevalence, and alcohol consumption). Police officers exhibited lower mean FMD after adjustment for age, gender, and traditional CVD risk factors among those aged 55 years or younger (%dilation: police = 5.49%, population = 6.49%; P = 0.04). CONCLUSIONS: Police officers exhibited decreased endothelial function (lower FMD) compared with the civilian sample, which was not fully explained by traditional CVD risk factors, suggesting that other pathways may contribute to increased CVD risk in law enforcement work. |
Evaluation of antineoplastic drug exposure of health care workers at three university-based U.S. cancer centers
Connor TH , DeBord DG , Pretty JR , Oliver MS , Roth TS , Lees PS , Krieg EF Jr , Rogers B , Escalante CP , Toennis CA , Clark JC , Johnson BC , McDiarmid MA . J Occup Environ Med 2010 52 (10) 1019-27 OBJECTIVE: This study evaluated health care worker exposure to antineoplastic drugs. METHODS: A cross-sectional study examined environmental samples from pharmacy and nursing areas. A 6-week diary documented tasks involving those drugs. Urine was analyzed for two specific drugs, and blood samples were analyzed by the comet assay. RESULTS: Sixty-eight exposed and 53 nonexposed workers were studied. Exposed workers recorded 10,000 drug-handling events during the 6-week period. Sixty percent of wipe samples were positive for at least one of the five drugs measured. Cyclophosphamide was most commonly detected, followed by 5-fluorouracil. Three of the 68 urine samples were positive for one drug. No genetic damage was detected in exposed workers using the comet assay. CONCLUSIONS: Despite following recommended safe-handling practices, workplace contamination with antineoplastic drugs in pharmacy and nursing areas continues at these locations. |
Evaluation of the COSHH essentials model with a mixture of organic chemicals at a medium-sized paint producer
Lee EG , Slaven J , Bowen RB , Harper M . Ann Occup Hyg 2010 55 (1) 16-29 The Control of Substances Hazardous to Health (COSHH) Essentials model was evaluated using full-shift exposure measurements of five chemical components in a mixture [acetone, ethylbenzene, methyl ethyl ketone, toluene, and xylenes] at a medium-sized plant producing paint materials. Two tasks, batch-making and bucket-washing, were examined. Varying levels of control were already established in both tasks and the average exposures of individual chemicals were considerably lower than the regulatory and advisory 8-h standards. The average exposure fractions using the additive mixture formula were also less than unity (batch-making: 0.25, bucket-washing: 0.56) indicating the mixture of chemicals did not exceed the combined occupational exposure limit (OEL). The paper version of the COSHH Essentials model was used to calculate a predicted exposure range (PER) for each chemical according to different levels of control. The estimated PERs of the tested chemicals for both tasks did not show consistent agreement with exposure measurements when the comparison was made for each control method and this is believed to be because of the considerably different volatilities of the chemicals. Given the combination of health hazard and exposure potential components, the COSHH Essentials model recommended a control approach 'special advice' for both tasks, based on the potential reproductive hazard ascribed to toluene. This would not have been the same conclusion if some other chemical had been substituted (for example styrene, which has the same threshold limit value as toluene). Nevertheless, it was special advice, which had led to the combination of hygienic procedures in place at this plant. The probability of the combined exposure fractions exceeding unity was 0.0002 for the batch-making task indicating that the employees performing this task were most likely well protected below the OELs. Although the employees involved in the bucket-washing task had greater potential to exceed the threshold limit value of the mixture (P > 1 = 0.2375), the expected personal exposure after adjusting for the assigned protection factor for the respirators in use would be considerably lower (P > 1 = 0.0161). Thus, our findings suggested that the COSHH essentials model worked reasonably well for the volatile organic chemicals at the plant. However, it was difficult to override the reproductive hazard even though it was meant to be possible in principle. Further, it became apparent that an input of existing controls, which is not possible in the web-based model, may have allowed the model be more widely applicable. The experience of using the web-based COSHH Essentials model generated some suggestions to provide a more user-friendly tool to the model users who do not have expertise in occupational hygiene. |
Human and environmental exposure assessment for nanomaterials: an introduction to this issue
Murashov V . Int J Occup Environ Health 2010 16 (4) 363-4 Determining whether a material or substance poses risk to human health depends on knowing not only the potential toxic characteristics of the material, but also the characteristics of exposure. To what concentrations are workers and general population exposed, for how long, and in what ways? Exposure assessment is particularly vital to answer the question of whether nanomaterials pose work-related health risks. Because of the relative newness of nanotechnology, as well as technical issues regarding metrics, availability of instrumentations, and questions about proprietary information, very little data on exposure to nanomaterials have been reported in teh scientific literature. At this stage, measuring or determining risk becomes a little like trying to solve mystery when major clues are missing. Scientists and engineers face this challenge even as the market for nanotechnology grows, and at the same time, there is increasing demand from diverse parties for guidance to underpin its responsible development. |
Biodynamics of the human body under whole-body vibration: synthesis of the reported data
Rakheja S , Dong RG , Patra S , Boileau PE , Marcotte P , Warren C . Int J Ind Ergon 2010 40 (6) 710-732 Identification of most probable ranges of biodynamic responses of the human body exposed to whole-body vibration is essential for developing effective integrated human-machine system design tools, improved vibration mitigation devices and frequency-weighting for exposure assessment. The international standard, ISO-5982 (2001), defines such ranges for very limited conditions, namely for body seated without a back support and exposed to vertical vibration. The reported data on biodynamic responses of the seated and standing human body exposed to whole-body vibration along different directions and the associated experimental conditions are systematically reviewed in an attempt to identify datasets that are likely to represent comparable and practical postural and exposure conditions. Syntheses of datasets, selected on the basis of a set of criterion, are performed to identify the most probable ranges of biodynamic responses of the human body to whole-body vibration. These include the driving-point biodynamic responses of the body seated with and without a back support while exposed to fore-aft, lateral and vertical vibration and those of the standing body to vertical vibration, and seat-to-head vibration transmissibility of the seated body. The proposed ranges are expected to serve as reasonable target functions in various applications involving coupled human-system dynamics in the design process, and potentially for developing better frequency-weightings for exposure assessments. Relevance to the industry: Identification of most probable biodynamic responses of the seated and standing human body exposed to whole-body vibration is essential for developing anthropodynamic manikins, integrated human-machine system design tools for improved vibration mitigation devices and frequency-weighting for exposure assessment. This study derives ranges of biodynamic responses of the body seated with and without the back support, and those of the standing body. The ranges would serve as the target response functions for: (i) designs of anthropodynamic manikins for assessment of vibration isolation effectiveness of coupled seat-occupant system; (ii) development of human body models, which are vital for quantifying the vibration-induced stresses in different joints and for deriving integrated human-machine system design tools; and (iii) identification of alternate frequency weightings for assessment of vibration exposure. 2010 Elsevier B.V. |
Characterization of exposures to nanoscale particles and fibers during solid core drilling of hybrid carbon nanotube advanced composites
Bello D , Wardle BL , Zhang J , Yamamoto N , Santeufemio C , Hallock M , Virji MA . Int J Occup Environ Health 2010 16 (4) 434-50 This work investigated exposures to nanoparticles and nanofibers during solid core drilling of two types of advanced carbon nanotube (CNT)-hybrid composites: (1) reinforced plastic hybrid laminates (alumina fibers and CNT); and (2) graphite-epoxy composites (carbon fibers and CNT). Mutliple real-time instruments were used to characterize the size distribution (5.6 nm to 20 μm), number and mass concentration, particle-bound polyaromatic hydrocarbons (b-PAHs), and surface area of airborne particles at the source and breathing zone. Time-integrated samples included grids for electron microscopy characterization of particle morphology and size resolved (2 nm to 20 μm) samples forthe quantification of metals. Several new important findings herein include generation of airborne clusters of CNTs not seen during saw-cutting of similar composites, fewer nanofibers and respirable fibers released, similarly high exposures to nanoparticles with less dependence on the composite thickness, and ultrafine (< 5 nm) aerosol originating from thermal degradation of the composite material. |
The impact of an emergency hiring plan on the shortage and distribution of nurses in Kenya: the importance of information systems
Gross JM , Riley PL , Rakuom C , Willy R , Kamenju A , Oywer E , Wambua D , Waudo A , Rogers MF . Bull World Health Organ 2010 88 (11) 824-830 OBJECTIVE: To analyse the effect of Kenya’s Emergency Hiring Plan for nurses on their inequitable distribution in rural and underserved areas. | METHODS: We used data from the Kenya Health Workforce Informatics System on the nursing workforce to determine the effect of the Emergency Hiring Plan on nurse shortages and maldistribution. The total number of nurses, the number of nurses per 100,000 population and the opening of previously closed or new heath facilities were recorded. FINDINGS: Of the 18,181 nurses employed in Kenya’s public sector in 2009, 1836 (10%) had been recruited since 2005 through the Emergency Hiring Plan. Nursing staff increased by 7% in hospitals, 13% in health centres and 15% in dispensaries. North Eastern province, which includes some of the most remote areas, benefited most: the number of nurses per 100,000 population increased by 37%. The next greatest increase was in Nyanza province, which has the highest prevalence of HIV infection in Kenya. Emergency Hiring Plan nurses enabled the number of functioning public health facilities to increase by 29%. By February 2010, 94% of the nurses hired under pre-recruitment absorption agreements had entered the civil service. CONCLUSION: The Emergency Hiring Plan for nurses significantly increased health services in Kenya’s rural and underserved areas over the short term. Preliminary indicators of sustainability are promising, as most nurses hired are now civil servants. However, continued monitoring will be necessary over the long term to evaluate future nurse retention. The accurate workforce data provided by the Kenya Health Workforce Informatics System were essential for evaluating the effect of the Emergency Hiring Plan. |
Are standing order programs associated with influenza vaccination? - NNHS, 2004
Bardenheier BH , Shefer AM , Lu PJ , Remsburg RE , Marsteller JA . J Am Med Dir Assoc 2010 11 (9) 654-61 BACKGROUND: Influenza vaccination coverage among nursing home residents has consistently been reported well below the Healthy People goals. We sought to determine if standing order programs (SOPs) in long-term care facilities are associated with greater influenza vaccination coverage among residents. METHODS: The National Nursing Home Survey (2004) is cross-sectional. A total of 1152 US long-term care facilities were systematically sampled with probability proportional to number of beds. A total of 11,939 people aged 65 years or older residing in sampled long-term care facilities between August and December 2004 were randomly sampled. Influenza vaccination coverage of residents was obtained from facility records. Facility's immunization program included standing orders versus other (preprinted admission order, advance physician order, personal physician order, and no program). Multinomial logistic regression was used to examine the relationship between type of influenza immunization program and receipt of vaccination, adjusted for resident and facility confounders. RESULTS: The proportion of residents aged 65 years or older who received influenza vaccination was 64%; 41% of residents lived in a facility with an SOP. Influenza vaccination coverage among residents residing in facilities with standing orders was 68% compared with 59% to 63% of residents in facilities with other program types. Logistic regression showed that standing order programs were independently associated with greater influenza vaccination coverage (66.7% versus 62.0%, P < .01). CONCLUSION: This study indicates that residents in long-term care facilities having standing order programs for influenza were more likely to be immunized. More research needs to be done to understand how to facilitate adoption of these programs. |
The spectrum of haemostatic characteristics of women with unexplained menorrhagia
Miller CH , Philipp CS , Stein SF , Kouides PA , Lukes AS , Heit JA , Byams VR , Dowling NF , Kulkarni R . Haemophilia 2010 17 (1) e223-9 SUMMARY: While an estimated 13% of women with unexplained menorrhagia have von Willebrand disease (VWD), the frequency of other potential bleeding disorders has been uncertain. This study describes the relatively wide range of laboratory characteristics of women with unexplained menorrhagia and presents issues affecting diagnosis in this population. Women with pictorial blood assessment chart (PBAC) score >100 were identified at six U.S. sites and asked to remain drug free for 10 days prior to testing. Blood was collected on one of the first four menstrual cycle days and tested at a central laboratory for procoagulant factors, VWD and fibrinolytic factors. Platelet function testing by PFA-100((R)) (PFA) and platelet aggregation with ATP release (PAGG/ATPR) were performed locally using standardized methods. Among 232 subjects, a laboratory abnormality was found in 170 (73.3%), including 124 of 182 White (68.1%) and 34 of 37 Black (91.9%) subjects; 6.0% had VWD, 56.0% had abnormal PAGG/ATPR, 4.7% had a non-VWD coagulation defect (NVCD) and 6.5% had an abnormal PFA only. AGG/ATPR was reduced in 58.9% of subjects, with multiple agonists in 28.6%, a single agonist in 6.1% and ristocetin alone in 24.2%. Frequencies of PAGG/ATPR defects varied by study site and race; frequencies of VWD and NVCD were similar. Laboratory abnormalities of haemostasis, especially platelet function defects, were common among women with unexplained menorrhagia across multiple U.S. sites. To what degree these abnormalities are clinically significant requires further study. |
What does "occupation" represent as an indicator of socioeconomic status?: Exploring occupational prestige and health
Fujishiro K , Xu J , Gong F . Soc Sci Med 2010 71 (12) 2100-7 The association between socioeconomic status (SES) and health has been widely documented. However, the role of occupation in this association is not clear because occupation is less often used than income and education as an indicator of SES, especially in the United States. This may be caused by the ambiguity in what occupation represents: both health-enhancing resources (e.g., self-affirmation) and health-damaging hazards (e.g., job stress). SES has two aspects: resources and status. While income and education represent resources and imply status, occupational prestige is an explicit indicator of the social status afforded by one's occupation. Using data from the US General Social Survey in 2002 and 2006 (n = 3151), we examine whether occupational prestige has a significant association with self-rated health independent from other SES indicators (income, education), occupational categories (e.g., managerial, professional, technical, service), and previously established work-related health determinants (job strain, work place social support, job satisfaction). After all covariates were included in the multiple logistic regression model, higher occupational prestige was associated with lower odds of reporting poor/fair self-rated health. We discuss potential mechanisms through which occupational prestige may impact health. Our findings not only suggest multiple ways that occupation is associated with health, but also highlight the utility of occupational prestige as an SES indicator that explicitly represents social standing. |
Does switching to reduced ignition propensity cigarettes alter smoking behavior or exposure to tobacco smoke constituents?
O'Connor RJ , Rees VW , Norton KJ , Cummings KM , Connolly GN , Alpert HR , Sjodin A , Romanoff L , Li Z , June KM , Giovino GA . Nicotine Tob Res 2010 12 (10) 1011-8 INTRODUCTION: Since 2004, several jurisdictions have mandated that cigarettes show reduced ignition propensity (RIP) in laboratory testing. RIP cigarettes may limit fires caused by smoldering cigarettes, reducing fire-related deaths and injury. However, some evidence suggests that RIP cigarettes emit more carbon monoxide and polycyclic aromatic hydrocarbons, and smokers may alter their smoking patterns in response to RIP cigarettes. Both of these could increase smokers' exposures to harmful constituents in cigarettes. METHODS: An 18-day switching study with a comparison group was conducted in Boston, MA (N = 77), and Buffalo, NY (N = 83), in 2006-2007. Current daily smokers completed 4 laboratory visits and two 48-hr field data collections. After a 4-day baseline, Boston participants switched to RIP cigarettes for 14 days, whereas Buffalo participants smoked RIP cigarettes throughout. Outcome measures included cigarettes smoked per day; smoking topography; salivary cotinine; breath CO; and hydroxylated metabolites of pyrene, naphthalene, phenanthrene, and fluorene. Because the groups differed demographically, analyses adjusted for race, age, and sex. RESULTS: We observed no significant changes in smoking topography or CO exposure among participants who switched to RIP cigarettes. Cigarette use decreased significantly in the switched group (37.7 cigarettes/48 hr vs. 32.6 cigarettes/48 hr, p = .031), while hydroxyphenanthrenes increased significantly (555 ng/g creatinine vs. 669 ng/g creatinine, p = .007). No other biomarkers were significantly affected. DISCUSSION: Small increases in exposure to phenanthrene among smokers who switched to RIP versions were observed, while other exposures and smoking topography were not significantly affected. Toxicological implications of these findings are unclear. These findings should be weighed against the potential public health benefits of adopting RIP design standards for cigarette products. |
Pulmonary idiopathic alveolar ossification in a raccoon (Procyon lotor)
Hamir AN , Rupprecht CE . J Am Assoc Lab Anim Sci 2010 49 (5) 642-3 Here we describe gross and histopathologic findings in a laboratory-confined adult male raccoon (Procyon lotor) with microscopic ossified areas in pulmonary alveoli. At the time of necropsy, gross lesions were present in the kidneys and in one thyroid gland. Noteworthy microscopic findings included multifocal foci of osseous tissue within the alveoli of the lungs, bilateral thyroid adenomas, pancreatic islet cell amyloidosis, cortical kidney infarcts, cystic adenomatous hyperplasia of urinary bladder, and mineralizations (psommama bodies) of small blood vessels of meninges and choroid plexus. Pulmonary ossification in raccoons has not been reported previously. The other histopathologic lesions have been documented to occur as incidental findings in raccoons and do not appear to have any apparent association with the formation of osseous foci in the lungs of the animal described. |
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