High diabetes prevalence among tuberculosis cases in Kerala, India
Balakrishnan S , Vijayan S , Nair S , Subramoniapillai J , Mrithyunjayan S , Wilson N , Satyanarayana S , Dewan PK , Kumar AM , Karthickeyan D , Willis M , Harries AD , Nair SA . PLoS One 2012 7 (10) e46502 BACKGROUND: While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM. METHODOLOGY/PRINCIPAL FINDINGS: A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control. CONCLUSIONS/SIGNIFICANCE: Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research. |
High one year mortality in adults with sickle cell disease and end-stage renal disease
McClellan AC , Luthi JC , Lynch JR , Soucie JM , Kulkarni R , Guasch A , Huff ED , Gilbertson D , McClellan WM , Debaun MR . Br J Haematol 2012 159 (3) 360-7 Adequate pre-dialysis care reduces mortality among end-stage renal disease (ESRD) patients. We tested the hypothesis that individuals with ESRD due to sickle cell disease (SCD-ESRD) receiving pre-ESRD care have lower mortality compared to individuals without pre-ESRD care. We examined the association between mortality and pre-ESRD care in incident SCD-ESRD patients who started haemodialysis between 1 June, 2005 and 31 May, 2009 using data provided by the Centers for Medicare and Medicaid Services (CMS). SCD-ESRD was reported for 410 (0.1%) of 442 017 patients. One year after starting dialysis, 108 (26.3%) patients with incident ESRD attributed to SCD died; the hazard ratio (HR) for mortality among patients with SCD-ESRD compared to those without SCD as the primary cause of renal failure was 2.80 (95% confidence interval [CI] 2.31-3.38). Patients with SCD-ESRD receiving pre-dialysis nephrology care had a lower death rate than those with SCD-ESRD who did not receive pre-dialysis nephrology care (HR = 0.67, 95% CI 0.45-0.99). The one-year mortality rate following an ESRD diagnosis was almost three times higher in individuals with SCD when compared to those without SCD but with ESRD and could be attenuated by pre-dialysis nephrology care. |
Characteristics of adults with serious mental illness in the United States household population in 2007
Pratt LA . Psychiatr Serv 2012 63 (10) 1042-6 OBJECTIVE: This study described the epidemiology of serious mental illness in the adult household population. METHODS: Data from the 2007 National Health Interview Survey of 23,393 adult respondents were used. Serious mental illness was defined when respondents reported that a health professional had told them that they had schizophrenia, bipolar disorder, mania, or psychosis. Sociodemographic and health characteristics, health care utilization, and participation in government assistance programs among adults with and without serious mental illness were compared. RESULTS: Over 2% of adults reported having received a diagnosis of serious mental illness. Thirty-five percent of adults with serious mental illness had a history of homelessness or of having been in jail. Fewer than two-thirds of adults with serious mental illness had seen a mental health professional in the past year. CONCLUSIONS: Adults with serious mental illness were socially disadvantaged and had worse health compared with adults without serious mental illness. |
Risk factors associated with tuberculosis infection among health care workers in Inner Mongolia, China
He GX , Wang LX , Chai SJ , Klena JD , Cheng SM , Ren YL , Ren LP , Gao F , Li YY , He GM , Li JB , Wang Y , Rao C , Varma JK . Int J Tuberc Lung Dis 2012 16 (11) 1485-91 SETTING: Health care workers (HCWs) are at increased risk for tuberculosis (TB) infection. In China, surveys examining TB infection among HCWs have not studied general health care facilities, compared tuberculin tests conducted using local protocols against an internationally accepted test or characterised risk factors. OBJECTIVE: To measure the prevalence of and risk factors for TB infection among HCWs in Inner Mongolia, China. DESIGN: Between April and August 2010, we administered QuantiFERON(R)-TB Gold In-Tube (QFT-GIT) tests, skin tests using Chinese tuberculin (TST) and surveys among HCWs at an infectious diseases hospital and a general medical hospital. We assessed whether demographic characteristics, personal exposure and work exposure were associated with QFT-GIT and TST positivity, and assessed agreement between test results. RESULTS: Of 999 HCWs, 683 (68%) were QFT-GIT-positive, which was associated with greater age, longer HCW career, TB disease in a co-worker and greater daily patient exposure using multivariable analysis. TST reactions ≥5 mm occurred in 69% of the HCWs; agreement between test results was low ( 0.22). CONCLUSIONS: The prevalence of TB infection among HCWs in Inner Mongolia is high; infection was associated with occupational exposure. Results from locally conducted TST are difficult to interpret. In China, TB infection control in health care facilities should be strengthened. |
Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya
Van't Hoog AH , Williamson J , Sewe M , Mboya P , Odeny LO , Agaya JA , Amolloh M , Borgdorff MW , Laserson KF . Int J Tuberc Lung Dis 2012 16 (12) 1649-56 OBJECTIVES: To evaluate excess mortality and risk factors for death during anti-tuberculosis treatment in Western Kenya. METHODS: We abstracted surveillance data and compared mortality rates during anti-tuberculosis treatment with all-cause mortality from a health and demographic surveillance population to obtain standardised mortality ratios (SMRs). Risk factors for excess mortality were obtained using a relative survival model, and for death during treatment using a proportional hazards regression model. RESULTS: The crude mortality rate during anti-tuberculosis treatment was 18.0 (95%CI 16.8-19.2) per 100 person-years. The age and sex SMR was 8.8 (95%CI 8.2-9.4). Excess mortality was greater in human immunodeficiency virus (HIV) positive TB patients (excess hazard ratio [eHR] 2.1, 95%CI 1.5-3.1), and lower in patients who were female or started treatment in a later year. Mortality was high in patients with unknown HIV status (HR 2.9, 95%CI 2.2-3.8) or, if HIV-positive, not on antiretroviral treatment (ART; HR 3.3, 95%CI 2.5-4.5) or not known to be on ART (HR 2.8, 95%CI 2.1-3.7). The attributable fraction of incomplete uptake of HIV testing and ART on mortality was 31% (95%CI 15-45) compared to HIV-positive patients on ART. CONCLUSION: Increasing the uptake of HIV testing and ART would further reduce mortality during anti-tuberculosis treatment by an estimated 31%. |
Treatment with neuraminidase inhibitors for critically ill patients with influenza A (H1N1)pdm09
Louie JK , Yang S , Acosta M , Yen C , Samuel MC , Schechter R , Guevara H , Uyeki TM . Clin Infect Dis 2012 55 (9) 1198-204 BACKGROUND: Neuraminidase inhibitor (NAI) antiviral drugs can shorten the duration of uncomplicated influenza when administered early (<48 hours after illness onset) to otherwise healthy outpatients, but the optimal timing of effective therapy for critically ill patients is not well established. METHODS: We analyzed California surveillance data to characterize the outcomes of patients in intensive care units (ICUs) treated with NAIs for influenza A(H1N1)pdm09 (pH1N1). Demographic and clinical data were abstracted from medical records, using standardized case report forms. RESULTS: From 3 April 2009 through 10 August 2010, 1950 pH1N1 cases hospitalized in ICUs were reported. Of 1859 (95%) with information available, 1676 (90%) received NAI treatment, and 183 (10%) did not. The median age was 37 years (range, 1 week-93 years), 1473 (79%) had ≥1 comorbidity, and 492 (26%) died. The median time from symptom onset to starting NAI treatment was 4 days (range, 0-52 days). NAI treatment was associated with survival: 107 of 183 untreated case patients (58%) survived, compared with 1260 of 1676 treated case patients (75%; P ≤ .0001). There was a trend toward improved survival for those treated earliest (P < .0001). Treatment initiated within 5 days after symptom onset was associated with improved survival compared to those never treated (P < .05). CONCLUSIONS: NAI treatment of critically ill pH1N1 patients improves survival. While earlier treatment conveyed the most benefit, patients who started treatment up to 5 days after symptom onset also were more likely to survive. Further research is needed about whether starting NAI treatment >5 days after symptom onset may also convey benefit. |
Tuberculosis mortality: death from a curable disease, Connecticut, 2007-2009
Kattan JA , Sosa LE , Lobato MN . Int J Tuberc Lung Dis 2012 16 (12) 1657-62 SETTING: Health Department Tuberculosis (TB) Control program, Connecticut, United States. OBJECTIVE: 1) To assess TB-relatedness of deaths and missed opportunities among Connecticut patients who died with TB, and 2) to identify factors associated with death. DESIGN: The study population consisted of all persons diagnosed with TB and reported to the Connecticut TB Control Program during 2007-2009. TB Control Program records, medical records, autopsy reports and death certificates of decedents were reviewed. A tool was used to categorize TB-relatedness of deaths and identify missed opportunities in diagnosis and medical treatment among TB-related deaths. Surveillance data regarding TB survivors were used for comparison to identify factors associated with death. RESULTS: During 2007-2009, 20/300 (7%) persons with TB died; 14 (70%) decedents had at least one medical comorbidity and 17 (85%) deaths were TB-related. Among patients who had a TB-related death, 16 (94%) had ≥1 missed opportunity identified. Excess alcohol use (risk ratio [RR] 4.4, 95% confidence interval [CI] 1.8-11.0) and age > 64 years (RR 5.7, 95%CI 2.5-13.1) were associated with death. CONCLUSIONS: The majority of deaths among Connecticut TB patients were TB-related. Missed opportunities were common. Excess alcohol use and older age might indicate a need for monitoring to prevent death. |
Mortality, severe acute respiratory infection, and influenza-like illness associated with influenza A(H1N1)pdm09 in Argentina, 2009
Azziz-Baumgartner E , Cabrera AM , Chang L , Calli R , Kusznierz G , Baez C , Yedlin P , Zamora AM , Cuezzo R , Sarrouf EB , Uboldi A , Herrmann J , Zerbini E , Uez O , Rico Cordeiro PO , Chavez P , Han G , Antman J , Coronado F , Bresee J , Kosacoff M , Widdowson MA , Echenique H . PLoS One 2012 7 (10) e47540 INTRODUCTION: While there is much information about the burden of influenza A(H1N1)pdm09 in North America, little data exist on its burden in South America. METHODS: During April to December 2009, we actively searched for persons with severe acute respiratory infection and influenza-like illness (ILI) in three sentinel cities. A proportion of case-patients provided swabs for influenza testing. We estimated the number of case-patients that would have tested positive for influenza by multiplying the number of untested case-patients by the proportion who tested positive. We estimated rates by dividing the estimated number of case-patients by the census population after adjusting for the proportion of case-patients with missing illness onset information and ILI case-patients who visited physicians multiple times for one illness event. RESULTS: We estimated that the influenza A(H1N1)pdm09 mortality rate per 100,000 person-years (py) ranged from 1.5 among persons aged 5-44 years to 5.6 among persons aged ≥65 years. A(H1N1)pdm09 hospitalization rates per 100,000 py ranged between 26.9 among children aged <5 years to 41.8 among persons aged ≥65 years. Influenza A(H1N1)pdm09 ILI rates per 100 py ranged between 1.6 among children aged <5 to 17.1 among persons aged 45-64 years. While 9 (53%) of 17 influenza A(H1N1)pdm09 decedents with available data had obesity and 7 (17%) of 40 had diabetes, less than 4% of surviving influenza A(H1N1)pdm09 case-patients had these pre-existing conditions (p≤0.001). CONCLUSION: Influenza A(H1N1)pdm09 caused a similar burden of disease in Argentina as in other countries. Such disease burden suggests the potential value of timely influenza vaccinations. |
Patterns of measles transmission among airplane travelers
Edelson PJ . Travel Med Infect Dis 2012 10 230-5 With advanced air handling systems on modern aircraft and the high level of measles immunity in many countries, measles infection in air travelers may be considered a low-risk event. However, introduction of measles into countries where transmission has been controlled or eliminated can have substantial consequences both for the use of public health resources and for those still susceptible. In an effort to balance the relatively low likelihood of disease transmission among largely immune travelers and the risk to the public health of the occurrence of secondary cases resulting from importations, criteria in the United States for contact investigations for measles exposures consider contacts to be those passengers who are seated within 2 rows of the index case. However, recent work has shown that cabin air flow may not be as reliable a barrier to the spread of measles virus as previously believed. Along with these new studies, several reports have described measles developing after travel in passengers seated some distance from the index case. To understand better the potential for measles virus to spread on an airplane, reports of apparent secondary cases occurring in co-travelers of passengers with infectious cases of measles were reviewed. Medline was searched for articles in all languages from 1946 to week 1 of March 2012, using the search terms "measles [human] or rubeola" and ("aircraft" or "airplane" or "aeroplane" or "aviation" or "travel" or "traveler" or "traveller"); 45 citations were returned. Embase was searched from 1988 to week 11 2012, using the same search strategy; 95 citations were returned. Papers were included in this review if they reported secondary cases of measles occurring in persons traveling on an airplane on which a person or persons with measles also flew, and which included the seating location of both the index case(s) and the secondary case(s) on the plane. Nine reports, including 13 index cases and 23 apparent secondary cases on 10 flights, were identified in which transmission on board the aircraft appeared likely and which included seating information for both the index (primary) and secondary cases. Separation between index and secondary cases ranged from adjacent seats to 17 rows, with a median of 6 rows. Three flights had more than one index case aboard. Based on previously published data, it is not possible to say how unusual cases of measles transmission among air travelers beyond the usual zone of contact investigation (the row the index case sat in and 2 rows ahead of or behind that row) may be. The fact that several flights had more than one infectious case aboard and that all but two index cases were in the prodromal phase may be of importance in understanding the wider spread described in several of the reviewed reports. Although the pattern of cabin air flow typical of modern commercial aircraft has been considered highly effective in limiting the airborne spread of microorganisms, concerns have been raised about relying on the operation of these systems to determine exposure risk, as turbulence in the cabin air stream is generated when passengers and crew are aboard, allowing the transmission of infectious agents over many rows. Additionally, the characteristics of some index cases may reflect a greater likelihood of disease transmission. Investigators should continue to examine carefully both aircraft and index-case factors that may influence disease transmission and could serve as indicators on a case-by-case basis to include a broader group of travelers in a contact investigation. |
Effect of hormonal contraceptive methods on HIV disease progression: a systematic review
Phillips SJ , Curtis KM , Polis CB . AIDS 2012 27 (5) 787-94 OBJECTIVE: Systematically assess from the literature whether women living with HIV who use hormonal contraception are at increased risk of HIV disease progression compared with those who do not use hormonal contraception. METHODS: We searched PUBMED and EMBASE for articles published in peer-reviewed journals through December 15, 2011 for evidence relevant to all hormonal contraceptive methods and HIV disease progression. RESULTS: Twelve reports of eleven studies met inclusion criteria. One randomized controlled trial (RCT) found increased risk for the composite outcome of a reduced CD4 count or death among hormonal contraceptive users when compared with copper IUD users. Ten cohort studies reported no increased risk for HIV disease progression (as measured by mortality, time to a CD4 count below 200, time to initiation of antiretroviral therapy, an increase in HIV-RNA viral load, or a decrease in CD4 count) among women who used hormonal contraception compared with those who did not. CONCLUSIONS: The preponderance of evidence indicates that HIV-positive women can use hormonal contraceptive methods without concerns related to HIV disease progression. Cohort studies consistently found no association between hormonal contraceptive use and HIV disease progression compared with nonuse of hormonal contraceptives. One RCT found that hormonal contraceptive use was associated with increased risk of HIV disease progression when compared with IUD use, but this study had important methodological shortcomings. Prevention of unintended pregnancy among women living with HIV remains a public health priority to safeguard women's and infants' health and to prevent mother-to-child transmission of HIV. |
Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru
Shin SS , Asencios L , Yagui M , Yale G , Suarez C , Bayona J , Bonilla C , Jave O , Contreras CC , Atwood S , Blaya JA , Ershova J , Cegielski JP . Int J Tuberc Lung Dis 2012 16 (11) 1538-43 SETTING: Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru. OBJECTIVE: Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods. DESIGN: From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death. RESULTS: Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST. NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56-0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01-1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31-0.90). CONCLUSION: Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups. |
Infectious disease burden and vaccination needs among asylees versus refugees -- District of Columbia
Chai SJ , Davies-Cole J , Cookson ST . Clin Infect Dis 2012 56 (5) 652-8 BACKGROUND: Unlike US-bound refugees, asylum seekers (asylees) apply for asylum while residing in the United States and are not provided a medical screening. Infectious disease burden and vaccination needs have not been described among US asylees. METHODS: We conducted a retrospective cohort study of 630 asylees and 151 refugees referred to the District of Columbia (DC) Department of Health screening program for an initial US medical screening during September 2003-August 2007. We assessed the prevalence of latent tuberculosis infection (tuberculin skin test reactivity ≥10mm), human immunodeficiency virus (HIV) and hepatitis B seropositivity, intestinal parasite test positivity, need for vaccinations, and time from date of US arrival to receipt of screening. RESULTS: Asylees in DC had a similar prevalence as refugees of latent tuberculosis infection (39% versus 38%, respectively, P=.83), pathogenic intestinal parasites (4% versus 2%, P=.36), and need for adult vaccinations (80% versus 80%, P=.95). Asylees were screened significantly later after US arrival compared with refugees (55 weeks versus 1 week; P<.001). Asylees had higher prevalence of latent tuberculosis infection, hepatitis B and HIV seropositivity, and child and adult vaccination needs than the US population (P<.001). CONCLUSIONS: This first study of the infectious disease concerns of a US asylee population suggests that in DC, asylees have similar infectious disease burden and prevention needs as refugees and should be screened with the same urgency. Because applicants for US asylum are not linked to prompt medical screenings, DC asylees are typically screened much later, placing them and US communities at risk. |
Using intervention mapping as a participatory strategy: development of a cervical cancer screening intervention for Hispanic women
Byrd TL , Wilson KM , Smith JL , Heckert A , Orians CE , Vernon SW , Fernandez-Esquer ME , Fernandez ME . Health Educ Behav 2012 39 (5) 603-11 Cervical cancer is preventable with treatment of precancerous lesions and treatable at early stages. Hispanics have higher rates of cervical cancer and lower rates of screening. Ayndando a las Mujeres con Informaccion, Guia, y Amor para su Salud (AMIGAS) is an intervention to increase cervical cancer screening in U.S. women of Mexican origin. AMIGAS was developed with the participation of the community using intervention mapping (IM). Following the IM process, the authors completed a needs assessment, development of program objectives, selection of intervention methods and strategies, and program design. A benefit of IM is its linkage with community-based participatory research as it includes engagement of community members to identify and refine priority areas. The success of this strategy suggests it a useful tool for other populations. The resulting intervention program is currently being tested for efficacy and cost-effectiveness in three sites: El Paso, Texas; Houston, Texas; and Yakima, Washington. |
The association of statin use with peripheral neuropathy in the US population 40 years of age or older
Tierney EF , Thurman DJ , Beckles GL , Cadwell BL . J Diabetes 2012 5 (2) 207-15 BACKGROUND: Peripheral neuropathy is a serious complication of diabetes and several conditions that may lead to loss of lower extremity function and even amputations. Since their introduction, the use of statin drugs has increased dramatically. Recent reports suggest a role for statins in the development of peripheral neuropathy. Our aims in this study were to assess the association between statin use and peripheral neuropathy and to determine whether this association varied by diabetes status. METHOD: We used the lower extremity examination supplement in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). RESULTS: Overall prevalence of statin use was 15%, and the prevalence of peripheral neuropathy was 14.9%. The prevalence of peripheral neuropathy was significantly higher among those who used statins compared to those who did not (23.5% vs. 13.5%; p < 0.01). In multivariate logistic regression, statin use (Adj. OR 1.3, 95% CI 1.1-1.6, Wald p-value 0.04) was significantly associated with peripheral neuropathy, controlling for diabetes status, age, gender, race, height, weight, blood lead levels, poverty, glycohemoglobin, use of vitamin B, alcohol abuse, hypertension, and non-HDL cholesterol. Diabetes status, age, gender, height, weight, blood lead levels, poverty, and glycohemoglobin were also significantly associated with peripheral neuropathy. We found no effect modification between statin use and diabetes status, race, gender, age, vitamin B12, blood lead levels, or alcohol abuse. CONCLUSIONS: In this cross-sectional study, we found a modest association between peripheral neuropathy and statin use. Prospective studies are required to determine the causal direction. (Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Exposures to endocrine-disrupting chemicals and age of menarche in adolescent girls in NHANES (2003-2008)
Buttke DE , Sircar K , Martin C . Environ Health Perspect 2012 120 (11) 1613-8 BACKGROUND: The observed age of menarche has fallen, which may have important adverse social and health consequences. Increased exposure to endocrine-disrupting compounds (EDCs) has been associated with adverse reproductive outcomes. OBJECTIVE: Our objective was to assess the relationship between EDC exposure and the age of menarche in adolescent girls. METHODS: We used data from female participants 12-16 years of age who had completed the reproductive health questionnaire and laboratory examination for the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) for years 2003-2008 (2005-2008 for analyses of phthalates and parabens). Exposures were assessed based on creatinine-corrected natural log urine concentrations of selected environmental chemicals and metabolites found in at least 75% of samples in our study sample. We used Cox proportional hazards analysis in SAS 9.2 survey procedures to estimate associations after accounting for censored data among participants who had not reached menarche. We evaluated body mass index (BMI; kilograms per meter squared), family income-to-poverty ratio, race/ethnicity, mother's smoking status during pregnancy, and birth weight as potential confounders. RESULTS: The weighted mean age of menarche was 12.0 years of age. Among 440 girls with both reproductive health and laboratory data, after accounting for BMI and race/ethnicity, we found that 2,5-dichlorophenol (2,5-DCP) and summed environmental phenols (2,5-DCP and 2,4-DCP) were inversely associated with age of menarche [hazard ratios of 1.10; 95% confidence interval (CI): 1.01, 1.19 and 1.09; 95% CI: 1.01, 1.19, respectively]. Other exposures (total parabens, bisphenol A, triclosan, benzophenone-3, total phthalates, and 2,4-DCP) were not significantly associated with age of menarche. CONCLUSIONS: Our findings suggest an association between 2,5-DCP, a potential EDC, and earlier age of menarche in the general U.S. population. |
Testing the feasibility of a National Spina Bifida Patient Registry
Thibadeau JK , Ward EA , Soe MM , Liu T , Swanson M , Sawin KJ , Freeman KA , Castillo H , Rauen K , Schechter MS . Birth Defects Res A Clin Mol Teratol 2012 97 (1) 36-41 BACKGROUND: The purpose of this study was to describe the development and early implementation of a national spina bifida (SB) patient registry, the goal of which is to monitor the health status, clinical care, and outcomes of people with SB by collecting and analyzing patient data from comprehensive SB clinics. METHODS: Using a web-based, SB-specific electronic medical record, 10 SB clinics collected health-related information for patients diagnosed with myelomeningocele, lipomyelomeningocele, fatty filum, or meningocele. This information was compiled and de-identified for transmission to the Centers for Disease Control and Prevention (CDC) for quality control and analysis. RESULTS: A total of 2070 patients were enrolled from 2009 through 2011: 84.9% were younger than 18 years of age; 1095 were women; 64.2% were non-Hispanic white; 6.5% were non-Hispanic black or African American; and 24.2% were Hispanic or Latino. Myelomeningocele was the most common diagnosis (81.5%). CONCLUSIONS: The creation of a National Spina Bifida Patient Registry partnership between the CDC and SB clinics has been feasible. Through planned longitudinal data collection and the inclusion of additional clinics, the data generated by the registry will become more robust and representative of the population of patients attending SB clinics in the United States and will allow for the investigation of patient outcomes. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Epidemiology of influenza A (H1N1)pdm09-associated deaths in the United States, September-October 2009
Regan J , Fowlkes A , Biggerstaff M , Jhung MA , Gindler J , Kennedy E , Fields V , Finelli L . Influenza Other Respir Viruses 2012 6 (6) e169-e177 BACKGROUND: From April to July 2009, the United States experienced a wave of influenza A (H1N1)pdm09 virus (H1N1pdm09) infection. The majority of the deaths during that period occurred in persons <65 years of age with underlying medical conditions. OBJECTIVE: To describe the epidemiology of H1N1pdm09-associated deaths in the US during the fall of 2009. METHODS: We collected demographic, medical history, and cause of death information on a nationally representative, stratified random sample of 323 H1N1pdm09-associated deaths that occurred during September 1-October 31, 2009. RESULTS: Data were available for 302/323 (93%) deaths. Most cases (74%) were 18-64 years of age and had ≥1 underlying medical condition (72%). Among cases aged <18 years, 16/43 (37%) had a chronic lung disease, and 15/43 (35%) a neurological disorder; among cases aged ≥18 years, 94/254 (37%) had a chronic lung disease and 84/254 (33%) had a metabolic disorder. The median number of days between symptom onset and death was six among children (range, 1-48) and 12 among adults (range, 0-109). Influenza antiviral agents were prescribed for 187/268 (70%) of cases, but only 48/153 (31%) received treatment within 2 days of illness onset. CONCLUSIONS: The characteristics of H1N1pdm09 deaths identified during the fall of 2009 were similar to those occurring April-July 2009. While most cases had conditions that were known to increase the risk for severe outcomes and were recommended to receive antiviral therapy, a minority of cases received antivirals early in the course of illness. |
Extension of the representativeness of the Traumatic Brain Injury Model Systems National Database: 2001 to 2010
Cuthbert JP , Corrigan JD , Whiteneck GG , Harrison-Felix C , Graham JE , Bell JM , Coronado VG . J Head Trauma Rehabil 2012 27 (6) E15-27 OBJECTIVE: To extend the representativeness of the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) for individuals 16 years and older, admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI) analyses completed by Corrigan and colleagues by comparing this data set to national data for patients admitted to inpatient rehabilitation with identical inclusion criteria that included 3 additional years of data and 2 new demographic variables. DESIGN: Secondary analysis of existing data sets and extension of previously published analyses. SETTING: Acute inpatient rehabilitation facilities. PARTICIPANTS: Patients 16 years and older with a primary rehabilitation diagnosis of TBI; the US TBI Rehabilitation population, n=156,447; and the TBIMS-NDB population, n=7373. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Demographics, functional status, and length of stay in hospital. RESULTS: The TBIMS-NDB was largely representative of patients 16 years and older, admitted for rehabilitation in the United States with a primary diagnosis of TBI on or after October 1, 2001, and discharged as of December 31, 2010. The results of the extended analyses were similar to those reported by Corrigan and colleagues. Age accounted for the largest difference between the samples, with the TBIMS-NDB including a smaller proportion of patients 65 years and older than all those admitted for rehabilitation with a primary diagnosis of TBI in the United States. After partitioning each data set at age 65, most distributional differences found between samples were markedly reduced; however, differences in the preinjury vocational status of the employed and rehabilitation lengths of stay between 1 and 9 days remained robust. The subsamples of patients 64 years and younger were found to differ only slightly on all remaining variables, whereas those 65 years and older were found to have meaningful differences in insurance type and age distribution. CONCLUSIONS: These results reconfirm that the TBIMS-NDB is largely representative of patients with TBI receiving inpatient rehabilitation in the United States. Differences between the 2 data sets were found to be stable across the 3 additional years of data, and new differences were limited to those involving newly introduced variables. To use these data for population-based research, it is strongly recommended that statistical adjustment be conducted to account for the lower percentage of patients older than 65 years, inpatient rehabilitation stays less than 10 days, and preinjury vocational status in the TBIMS-NDB. |
The relationship between gender role conflict and condom use among black MSM
Malebranche DJ , Gvetadze R , Millett GA , Sutton MY . AIDS Behav 2012 16 (7) 2051-61 Gender role conflict may influence condom use among black MSM. We examined relationships between the Gender Role Conflict Scale (GRCS), social/demographic variables and condom use among 456 black MSM. Higher total GRCS scores did not predict unprotected insertive anal intercourse (UIAI) or unprotected receptive anal intercourse (URAI) with men, but were associated with unprotected vaginal or anal intercourse (UVI/UAI) with women among bisexually active participants (n = 69). Higher perceived HIV risk reduced the likelihood of both UIAI and URAI with men. Internet recruitment venues, sexual discrimination experiences, higher numbers of sex partners and UVI/UAI with women all increased the likelihood of UIAI with men, while education (college/technical school or college degree) was associated with URAI with men. Future sexual health interventions for black MSM should emphasize broader social/demographic and alternative gender role variables with male sexual partners, while traditional GRCS variables may prove useful among those with female sexual partners. |
Role flexing: how community, religion, and family shape the experiences of young black men who have sex with men
Balaji AB , Oster AM , Viall AH , Heffelfinger JD , Mena LA , Toledo CA . AIDS Patient Care STDS 2012 26 (12) 730-7 While the disproportionate impact of HIV on young black men who have sex with men (MSM) is well documented, the reasons for this disparity remain less clear. Through in-depth interviews, we explored the role of familial, religious, and community influence on the experiences of young black MSM and identified strategies that these young men use to negotiate and manage their sexual minority status. Between February and April 2008, 16 interviews were conducted among HIV-infected and HIV-uninfected young (19- to 24-year-old) black MSM in the Jackson, Mississippi, area. Results suggest that overall, homosexuality remains highly stigmatized by the men's families, religious community, and the African American community. To manage this stigma, many of the participants engaged in a process of "role flexing," in which individuals modified their behavior in order to adapt to a particular situation. The data also provided evidence of internalized homophobia among a number of the participants. The impact of stigma on risk behavior should be more fully explored, and future intervention efforts need to explicitly address and challenge stigma, both among young men themselves and the communities in which they reside. Attention should also be paid to the role masculinity may play as a driver of the HIV epidemic among young black MSM and how this knowledge can be used to inform prevention efforts. |
Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men
Reback CJ , Grant DL , Fletcher JB , Branson CM , Shoptaw S , Bowers JR , Charania M , Mansergh G . AIDS Behav 2012 16 (7) 1993-2002 Text-messaging interventions present a novel approach for targeting high-risk men who have sex with men (MSM) who may not respond to or may be difficult to reach for face-to-face or site-based interventions. Project Tech Support (N = 52) was an open label pilot study testing the feasibility and utility of a text-messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM. Participants in the two-week intervention received social support and health education text messages transmitted in real-time. At follow-up, there were significant decreases in frequency of methamphetamine use and unprotected sex while on methamphetamine (both p < 0.01), and a significant increase in self-reported abstinence from methamphetamine use (13.3 % vs. 48.9 %; p < 0.001). Additionally, participants reported reductions of unprotected anal intercourse with HIV-positive partners (p < 0.01); with HIV-negative partners, participants reported fewer insertive and receptive episodes (both p < 0.05). Findings demonstrate that text messaging is a promising intervention for reaching and potentially changing HIV high-risk behaviors among out-of-treatment, methamphetamine-using MSM. |
Effect of nonpayment for preventable infections in U.S. hospitals
Lee GM , Kleinman K , Soumerai SB , Tse A , Cole D , Fridkin SK , Horan T , Platt R , Gay C , Kassler W , Goldmann DA , Jernigan J , Jha AK . N Engl J Med 2012 367 (15) 1428-37 BACKGROUND: In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. The effect of this policy on rates of health care-associated infections is unknown. METHODS: Using a quasi-experimental design with interrupted time series with comparison series, we examined changes in trends of two health care-associated infections that were targeted by the CMS policy (central catheter-associated bloodstream infections and catheter-associated urinary tract infections) as compared with an outcome that was not targeted by the policy (ventilator-associated pneumonia). Hospitals participating in the National Healthcare Safety Network and reporting data on at least one health care-associated infection before the onset of the policy were eligible to participate. Data from January 2006 through March 2011 were included. We used regression models to measure the effect of the policy on changes in infection rates, adjusting for baseline trends. RESULTS: A total of 398 hospitals or health systems contributed 14,817 to 28,339 hospital unit-months, depending on the type of infection. We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented. There were no significant changes in quarterly rates of central catheter-associated bloodstream infections (incidence-rate ratio in the postimplementation vs. preimplementation period, 1.00; P=0.97), catheter-associated urinary tract infections (incidence-rate ratio, 1.03; P=0.08), or ventilator-associated pneumonia (incidence-rate ratio, 0.99; P=0.52) after the policy implementation. Our findings did not differ for hospitals in states without mandatory reporting, nor did it differ according to the quartile of percentage of Medicare admissions or hospital size, type of ownership, or teaching status. CONCLUSIONS: We found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals. (Funded by the Agency for Healthcare Research and Quality.). |
Fungal infections associated with contaminated methylprednisolone in Tennessee
Kainer MA , Reagan DR , Nguyen DB , Wiese AD , Wise ME , Ward J , Park BJ , Kanago ML , Baumblatt J , Schaefer MK , Berger BE , Marder EP , Min JY , Dunn JR , Smith RM , Dreyzehner J , Jones TF . N Engl J Med 2012 367 (23) 2194-203 BACKGROUND: We investigated an outbreak of fungal infections of the central nervous system that occurred among patients who received epidural or paraspinal glucocorticoid injections of preservative-free methylprednisolone acetate prepared by a single compounding pharmacy. METHODS: Case patients were defined as patients with fungal meningitis, posterior circulation stroke, spinal osteomyelitis, or epidural abscess that developed after epidural or paraspinal glucocorticoid injections. Clinical and procedure data were abstracted. A cohort analysis was performed. RESULTS: The median age of the 66 case patients was 69 years (range, 23 to 91). The median time from the last epidural glucocorticoid injection to symptom onset was 18 days (range, 0 to 56). Patients presented with meningitis alone (73%), the cauda equina syndrome or focal infection (15%), or posterior circulation stroke with or without meningitis (12%). Symptoms and signs included headache (in 73% of the patients), new or worsening back pain (in 50%), neurologic symptoms (in 48%), nausea (in 39%), and stiff neck (in 29%). The median cerebrospinal fluid white-cell count on the first lumbar puncture among patients who presented with meningitis, with or without stroke or focal infection, was 648 per cubic millimeter (range, 6 to 10,140), with 78% granulocytes (range, 0 to 97); the protein level was 114 mg per deciliter (range, 29 to 440); and the glucose concentration was 44 mg per deciliter (range, 12 to 121) (2.5 mmol per liter [range, 0.7 to 6.7]). A total of 22 patients had laboratory confirmation of Exserohilum rostratum infection (21 patients) or Aspergillus fumigatus infection (1 patient). The risk of infection increased with exposure to lot 06292012@26, older vials, higher doses, multiple procedures, and translaminar approach to epidural glucocorticoid injection. Voriconazole was used to treat 61 patients (92%); 35 patients (53%) were also treated with liposomal amphotericin B. Eight patients (12%) died, seven of whom had stroke. CONCLUSIONS: We describe an outbreak of fungal meningitis after epidural or paraspinal glucocorticoid injection with methylprednisolone from a single compounding pharmacy. Rapid recognition of illness and prompt initiation of therapy are important to prevent complications. (Funded by the Tennessee Department of Health and the Centers for Disease Control and Prevention.). |
Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review
Rostad CA , McElroy AK , Hilinski JA , Thompson MP , Drew CP , Denison AM , Zaki SR , Mahle WT , Rogers J , Abramowsky CR , Shehata B . Transpl Infect Dis 2012 14 (5) E71-81 Bartonella henselae, the etiologic agent of cat-scratch disease, causes a well-defined, self-limited syndrome of fever and regional lymphadenopathy in immunocompetent hosts. In immunocompromised hosts, however, B. henselae can cause severe disseminated disease and pathologic vasoproliferation known as bacillary angiomatosis (BA) or bacillary peliosis. BA was first recognized in patients infected with human immunodeficiency virus. It has become more frequently recognized in solid organ transplant (SOT) recipients, but reports of pediatric cases remain rare. Our review of the literature revealed only one previously reported case of BA in a pediatric SOT recipient. We herein present 2 pediatric cases, one of which is the first reported case of BA in a pediatric cardiac transplant recipient, to our knowledge. In addition, we review and summarize the literature pertaining to all cases of B. henselae-mediated disease in SOT recipients. |
Impact of a third dose of measles-mumps-rubella vaccine on a mumps outbreak
Ogbuanu IU , Kutty PK , Hudson JM , Blog D , Abedi GR , Goodell S , Lawler J , McLean HQ , Pollock L , Rausch-Phung E , Schulte C , Valure B , Armstrong GL , Gallagher K . Pediatrics 2012 130 (6) e1567-74 BACKGROUND AND OBJECTIVE: During 2009-2010, a northeastern US religious community experienced a large mumps outbreak despite high 2-dose measles-mumps-rubella (MMR) vaccine coverage. A third dose of MMR vaccine was offered to students in an affected community in an effort to control the outbreak. METHODS: Eligible sixth- to 12th-grade students in 3 schools were offered a third dose of MMR vaccine. Baseline and follow-up surveys and physician case reports were used to monitor mumps attack rates (ARs). We calculated ARs for defined 3-week periods before and after the intervention. RESULTS: Of 2265 eligible students, 2178 (96.2%) provided documentation of having received 2 previous doses of MMR vaccine, and a high proportion (1755 or 80.6%) chose to receive an additional vaccine dose. The overall AR for all sixth- to 12th-grade students declined from 4.93% in the prevaccination period to 0.13% after vaccination (P < .001). Villagewide, overall AR declined by 75.6% after the intervention. A decline occurred in all age groups but was significantly greater (96.0%) among 11- to 17-year-olds, the age group targeted for vaccination, than among all other age groups. The proportions of adverse events reported were lower than or within the range of those in previous reports of first- and second-dose MMR vaccine studies. CONCLUSIONS: This is the first study to assess the impact of a third MMR vaccine dose for mumps outbreak control. The decline in incidence shortly after the intervention suggests that a third dose of MMR vaccine may help control mumps outbreaks among populations with preexisting high 2-dose vaccine coverage. |
Physicians who use social media and other internet-based communication technologies
Cooper CP , Gelb CA , Rim SH , Hawkins NA , Rodriguez JL , Polonec L . J Am Med Inform Assoc 2012 19 (6) 960-4 The demographic and practice-related characteristics of physicians who use social networking websites, portable devices to access the internet, email to communicate with patients, podcasts, widgets, RSS feeds, and blogging were investigated. Logistic regression was used to analyze a survey of US primary care physicians, pediatricians, obstetrician/gynecologists, and dermatologists (N=1750). Reported technology use during the last 6 months ranged from 80.6% using a portable device to access the internet to 12.9% writing a blog. The most consistent predictors of use were being male, being younger, and having teaching hospital privileges. Physician specialty, practice setting, years in practice, average number of patients treated per week, and number of physicians in practice were found to be inconsistently associated or unassociated with use of the technologies examined. Demographic characteristics, rather than practice-related characteristics, were more consistent predictors of physician use of seven internet-based communication technologies with varying levels of uptake. |
Clinical application of a multiplex real-time PCR assay for simultaneous detection of Legionella species, Legionella pneumophila, and Legionella pneumophila serogroup 1.
Benitez AJ , Winchell JM . J Clin Microbiol 2012 51 (1) 348-51 We developed a single-tube multiplex real-time PCR assay capable of simultaneously detecting and discriminating Legionella spp., Legionella pneumophila, and Legionella pneumophila serogroup 1 in primary specimens. Evaluation of 21 clinical specimens and 115 clinical isolates demonstrated this assay to be a rapid, high-throughput diagnostic test with 100% specificity that may aid during legionellosis outbreaks and epidemiologic investigations. |
Host mTORC1 signaling regulates andes virus replication.
McNulty S , Flint M , Nichol ST , Spiropoulou CF . J Virol 2012 87 (2) 912-22 Hantavirus pulmonary syndrome (HPS) is a severe respiratory disease characterized by pulmonary edema with a fatality of 35-45%. Disease occurs following infection by pathogenic New World hantaviruses, such as Andes virus (ANDV), which targets lung microvascular endothelial cells. During replication the virus scavenges 5' m(7)G-caps from cellular mRNA to ensure efficient translation of viral proteins by the host-cell cap-dependent translation machinery. In cells, mammalian target of rapamycin (mTOR) regulates the activity of host cap-dependent translation by integrating amino acid, energy, and oxygen availability signals. Since there is no approved pharmacological treatment for HPS, we investigated whether inhibitors of the mTOR pathway could reduce hantavirus infection. Here, we demonstrate that treatment with an FDA-approved rapamycin analogue (temsirolimus, CCI-779) blocks ANDV protein expression and virion release, but not entry into primary human microvascular endothelial cells. This effect was specific to viral proteins, as temsirolimus treatment did not block host protein synthesis. We confirmed that temsirolimus targeted host mTOR complex 1 (mTORC1) and not a viral protein as knockdown of mTORC1 and mTORC1 activators, but not mTOR complex 2 components reduced ANDV replication. Additionally, primary fibroblasts from a patient with tuberous sclerosis exhibited increased mTORC1 activity and increased ANDV protein expression, which was blocked following temsirolimus treatment. Finally, we show that ANDV glycoprotein Gn co-localizes with mTOR and lysosomes in infected cells. Together, these data demonstrate that mTORC1 signaling regulates ANDV replication and suggest that the hantavirus Gn protein may modulate mTOR and lysosomal signaling during infection, thus bypassing the cellular regulation of translation. |
Assessment of real-time PCR assay for detection of Rickettsia spp. and Rickettsia rickettsii in banked clinical samples.
Kato CY , Chung IH , Robinson LK , Austin AL , Dasch GA , Massung RF . J Clin Microbiol 2012 51 (1) 314-7 Two novel real-time PCR assays were developed for the detection of Rickettsia spp. One assay detects all tested Rickettsia spp.; the other is specific for Rickettsia rickettsii. Evaluation using DNA from human blood and tissue samples showed both assays to be more sensitive than nested PCR assays currently in use at the CDC. |
Standardized methods and quality control limits for agar and broth microdilution susceptibility testing of Mycoplasma pneumoniae, Mycoplasma hominis, and Ureaplasma urealyticum
Waites KB , Duffy LB , Bebear CM , Matlow A , Talkington DF , Kenny GE , Totten PA , Bade DJ , Zheng X , Davidson MK , Shortridge VD , Watts JL , Brown SD . J Clin Microbiol 2012 50 (11) 3542-7 An international multilaboratory collaborative study was conducted to develop standard media and consensus methods for the performance and quality control of antimicrobial susceptibility testing of Mycoplasma pneumoniae, Mycoplasma hominis, and Ureaplasma urealyticum using broth microdilution and agar dilution techniques. A reference strain from the American Type Culture Collection was designated for each species, which was to be used for quality control purposes. Repeat testing of replicate samples of each reference strain by participating laboratories utilizing both methods and different lots of media enabled a 3- to 4-dilution MIC range to be established for drugs in several different classes, including tetracyclines, macrolides, ketolides, lincosamides, and fluoroquinolones. This represents the first multilaboratory collaboration to standardize susceptibility testing methods and to designate quality control parameters to ensure accurate and reliable assay results for mycoplasmas and ureaplasmas that infect humans. |
Optimal methods for collecting and storing vaginal specimens for prostate-specific antigen testing in research studies
Gallo MF , Snead MC , Black CM , Brown TM , Kourtis AP , Jamieson DJ , Carter M , Penman-Aguilar A , Macaluso M . Contraception 2012 87 (6) 830-5 BACKGROUND: Prostate-specific antigen (PSA) detected in vaginal fluid can be used in studies of HIV/sexually transmitted infection (STI) and pregnancy prevention as an alternative to relying on participant reports of exposure to semen. Optimal methods for collecting and storing specimens for this testing have not been determined. STUDY DESIGN: We conducted a controlled, in vitro experiment of 550 specimens spiked with semen to determine the effects of swab type (five types), storage conditions of the swabs (room temperature with or without desiccant or at -80 degrees C without desiccant) and time from collection to testing (seven intervals over the course of 12 months) on the identification of PSA. We performed factorial analysis of variance to identify factors influencing PSA detection. RESULTS: Concentrations of PSA detected in the swabs declined with time of storage over the 1-year experiment (p<.01). The 1-mL, rayon-tipped swab stored immediately at -80 degrees C following collection performed best. CONCLUSIONS: If immediate testing or freezer storage is not feasible, investigators should use a swab with 1-mL capacity with processing and testing as soon as possible after specimen collection. |
Performance of a fourth-generation HIV screening assay and an alternative HIV diagnostic testing algorithm
Nasrullah M , Wesolowski LG , Meyer WA 3rd , Owen SM , Masciotra S , Vorwald C , Becker WJ , Branson BM . AIDS 2012 27 (5) 731-7 OBJECTIVE: We evaluated the performance of the GS fourth-generation antigen/antibody assay and compared CDC's proposed alternative algorithm (repeatedly reactive [RR] fourth-generation immunoassay [IA] followed by an HIV-1/HIV-2 differentiation IA and, if needed, nucleic acid testing [NAT]) with the current algorithm (RR third-generation IA followed by HIV-1 Western blot [WB]). DESIGN: A convenience sample of the following four specimen sets was acquired: 10 014 from insurance applicants, 493 known WB-positive, 20 known WB-indeterminate specimens, and 230 specimens from 26 HIV-1 seroconverters. METHODS: Specimens were tested with the GS third- and fourth-generation IAs, the Multispot HIV-1/HIV-2 differentiation IA, NAT, and WB. We applied the two algorithms using these results. RESULTS: Among insurance specimens, 13 (0.13%) specimens were IA RR: 2 were HIV-positive (RR by third- and fourth-generation IAs, and WB and Multispot positive); 2 third-generation RR and 9 fourth-generation RR specimens were false-positive. Third- and fourth-generation specificities were 99.98% (95%CI: 99.93%-100%) and 99.91% (95%CI: 99.84%-99.96%) respectively.All HIV-1 WB-positive specimens were RR by third- and fourth-generation IAs. By Multispot, 491 (99.6%) were HIV-1 positive and 2 (0.4%) were HIV-2 positive. Only eight (40%) WB-indeterminate specimens were fourth-generation RR: 6 were Multispot and NAT negative and 2 were Multispot HIV-1 positive but NAT negative.The alternative algorithm correctly classified as positive 102 seroconverter specimens with the third-generation IA and 130 with the fourth-generation IA compared with 56 using the WB with either IA. CONCLUSIONS: The alternative testing algorithm improved early infection sensitivity and identified HIV-2 infections. Two potential false-positive algorithm results occurred with WB-indeterminate specimens. |
High-throughput immunomagnetic scavenging technique for quantitative analysis of live VX nerve agent in water, hamburger, and soil matrixes
Knaack JS , Zhou Y , Abney CW , Prezioso SM , Magnuson M , Evans R , Jakubowski EM , Hardy K , Johnson RC . Anal Chem 2012 84 (22) 10052-7 We have developed a novel immunomagnetic scavenging technique for extracting cholinesterase inhibitors from aqueous matrixes using biological targeting and antibody-based extraction. The technique was characterized using the organophosphorus nerve agent VX. The limit of detection for VX in high-performance liquid chromatography (HPLC)-grade water, defined as the lowest calibrator concentration, was 25 pg/mL in a small, 500 mcL sample. The method was characterized over the course of 22 sample sets containing calibrators, blanks, and quality control samples. Method precision, expressed as the mean relative standard deviation, was less than 9.2% for all calibrators. Quality control sample accuracy was 102% and 100% of the mean for VX spiked into HPLC-grade water at concentrations of 2.0 and 0.25 ng/mL, respectively. This method successfully was applied to aqueous extracts from soil, hamburger, and finished tap water spiked with VX. Recovery was 65%, 81%, and 100% from these matrixes, respectively. Biologically based extractions of organophosphorus compounds represent a new technique for sample extraction that provides an increase in extraction specificity and sensitivity. |
Humoral immunity to smallpox vaccines and monkeypox virus challenge; proteomic assessment and clinical correlations
Townsend MB , Keckler MS , Patel N , Davies DH , Felgner P , Damon IK , Karem KL . J Virol 2012 87 (2) 900-11 Despite the eradication of smallpox, Orthopoxviruses (OPV) remain public health concerns. Efforts to develop new therapeutics and vaccines for smallpox continue through their evaluation in animal models despite limited understanding of the specific correlates of protective immunity. Recent monkeypox virus challenge studies have established the Black-Tailed Prairie Dog (Cynomys ludovicianus) as a model of human systemic OPV infections. In this study, we assess the induction of humoral immunity in humans and prairie dogs receiving Dryvax(R), ACAM2000(R), or IMVAMUNE(R) vaccines and characterize the proteomic profile of immune recognition using ELISA, neutralization assays and protein microarrays. We confirm anticipated similarities of antigenic protein targets of smallpox vaccine-induced responses in humans and prairie dogs and identify several differences. Subsequent monkeypox intranasal infection of vaccinated prairie dogs results in a significant boost in humoral immunity characterized by a shift in reactivity of increased intensity to a broader range of OPV proteins. This work provides evidence of similarities between the vaccine response in prairie dogs and humans, which enhance the value of the prairie dog model system as an OPV vaccination model and offers novel findings that form a framework for examining humoral immune response induced by systemic infection of orthopoxviruses. |
CT694 and pgp3 as serological tools for monitoring trachoma programs
Goodhew EB , Priest JW , Moss DM , Zhong G , Munoz B , Mkocha H , Martin DL , West SK , Gaydos C , Lammie PJ . PLoS Negl Trop Dis 2012 6 (11) e1873 BACKGROUND: Defining endpoints for trachoma programs can be a challenge as clinical signs of infection may persist in the absence of detectable bacteria. Antibody-based tests may provide an alternative testing strategy for surveillance during terminal phases of the program. Antibody-based assays, in particular ELISAs, have been shown to be useful to document C. trachomatis genital infections, but have not been explored extensively for ocular C. trachomatis infections. METHODOLOGY/PRINCIPAL FINDINGS: An antibody-based multiplex assay was used to test two C. trachomatis antigens, pgp3 and CT694, for detection of trachoma antibodies in bloodspots from Tanzanian children (n=160) collected after multiple rounds of mass azithromycin treatment. Using samples from C. trachomatis-positive (by PCR) children from Tanzania (n=11) and control sera from a non-endemic group of U.S. children (n=122), IgG responses to both pgp3 and CT694 were determined to be 91% sensitive and 98% specific. Antibody responses of Tanzanian children were analyzed with regard to clinical trachoma, PCR positivity, and age. In general, children with more intense ocular pathology (TF/TI=2 or most severe) had a higher median antibody response to pgp3 (p=0.0041) and CT694 (p=0.0282) than those with normal exams (TF/TI=0). However, 44% of children with no ocular pathology tested positive for antibody, suggesting prior infection. The median titer of antibody responses for children less than three years of age was significantly lower than those of older children. (p<0.0001 for both antigens). CONCLUSIONS/SIGNIFICANCE: The antibody-based multiplex assay is a sensitive and specific additional tool for evaluating trachoma transmission. The assay can also be expanded to include antigens representing different diseases, allowing for a robust assay for monitoring across NTD programs. |
Maternal tea consumption during early pregnancy and the risk of spina bifida
Yazdy MM , Tinker SC , Mitchell AA , Demmer LA , Werler MM . Birth Defects Res A Clin Mol Teratol 2012 94 (10) 756-61 Studies have demonstrated that catechin, an antioxidant found in tea, can reduce the bioavailability of folate. Because periconceptional folic acid intake has been demonstrated to reduce the risk of spina bifida, tea consumption may put pregnant women at risk because of its possible antifolate properties. Using data collected in the Slone Epidemiology Center Birth Defects Study, we examined whether tea consumption during early pregnancy was associated with an increased risk of spina bifida. Mothers of 518 spina bifida cases and 6424 controls were interviewed within 6 months after delivery about pregnancy events and exposures. Data on tea intake were collected during three periods (1976-1988, 1998-2005 and 2009-2010). Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for study center. Intake of both periconceptional food folate and diet and supplemental folic acid were examined as a potential effect modifier. For 1976 to 1988, ORs were not elevated for daily tea intake. For 1998 and onward, ORs were also close to 1.0, but there was a modest increase for those who drank more than 3 cups/day (OR, 1.92; 95% CI, 0.84-4.38). Among women with total folic acid intake greater than 400 mcg, consumption of 3 cups or more of tea per day was associated with an increased risk of spina bifida in 1976 to 1988 (OR, 2.04; 95% CI, 0.69-7.66) and in the later periods (OR, 3.13; 95% CI, 0.87-11.33). Our data do not support an overall association between tea consumption and spina bifida, but there is a suggestion of a possible interaction between higher levels of folic acid intake and tea consumption. (Birth Defects Research (Part A) 2012. (c) 2012 Wiley Periodicals, Inc.) |
Prepregnancy obesity trends among low-income women, United States, 1999-2008
Hinkle SN , Sharma AJ , Kim SY , Park S , Dalenius K , Brindley PL , Grummer-Strawn LM . Matern Child Health J 2012 16 (7) 1339-48 There is limited data on prepregnancy obesity trends specifically among low-income women, a population at high risk for obstetric complications. Using the Pregnancy Nutrition Surveillance System, we assessed prepregnancy obesity [body mass index (BMI) ≥ 30 kg/m(2)] trends among women who participated in the Supplemental Nutrition Program for Women, Infants, and Children in 1999, 2004, and 2008. Prepregnancy BMI was calculated using measured height and self-reported prepregnancy weight. We report unadjusted contributor (state, territory or Indian tribal organization) specific trends, and both unadjusted and adjusted overall trends, to account for changes in maternal age and race-ethnic distributions, using 1999 as the referent. Of the 27 contributors in 1999, 2 had a prepregnancy obesity prevalence <20%, and 1 had a prevalence ≥30%. Of the 35 contributors in 2008, none had a prepregnancy obesity prevalence <20%, and 14 had a prevalence ≥30%. From 1999 to 2008, the overall prevalence of prepregnancy obesity increased among all racial-ethnic groups, except among American Indian/Alaskan Natives, where it remained high, but stable. Overall prepregnancy obesity increased most rapidly among Hispanics, and remained stable from 2004 to 2008 among non-Hispanic blacks. In 2008, prevalence was highest among American Indian/Alaskan Natives (36.1%) and lowest among Asians/Pacific Islanders (10.8%). The adjusted prepregnancy obesity prevalence increased from 24.8% in 1999 to 28.3% in 2008, a relative increase of 14.1%. Prepregnancy obesity among low-income women increased from 1999 to 2008 and varied by race-ethnicity. These data can be used by obesity prevention programs to better target high-risk women. |
Antimicrobial and analgesic prescribing patterns for acute otitis externa, 2004-2010
Collier SA , Hlavsa MC , Piercefield EW , Beach MJ . Otolaryngol Head Neck Surg 2012 148 (1) 128-34 OBJECTIVE: Acute otitis externa (AOE) is a common but preventable ear condition. Clinical guidelines issued in 2006 recommended topical treatments for uncomplicated AOE, but systemic antimicrobials appear to be commonly prescribed. The objective of this analysis was to describe pre- and postguideline prescribing patterns by clinician specialty and antimicrobial type and assess trends over time. STUDY DESIGN: Retrospective longitudinal analysis of a large insurance database. SETTING: Outpatient departments in the United States. METHODS: Initial outpatient visits in 2004 to 2010 for AOE (excluding visits with complicating conditions) were extracted from an insurance database. Prescription drug claims were linked and categorized by clinician specialty and antimicrobial type. RESULTS: The analysis included 907,261 initial outpatient visits. Use of systemic antimicrobials declined by 4.9% (95% confidence interval [CI], 4.1%, 5.7%) from 36.5% of initial visits in 2004 to 32.1% in 2010. Use of systemic antimicrobials varied by specialty. Systemic antimicrobials were prescribed in 47.1% of 2010 emergency department (ED) visits (-6.9% from 2004, 95% CI -12.3, -1.5), 25.9% of otolaryngologist visits (-1.6%, 95% CI -5.6, 2.4), and 20.4% of pediatrician visits (-6.6%, 95% CI -8.8, -4.4). Penicillins were prescribed most frequently (42.3% of systemic prescriptions in 2010), followed by cephalosporins (19.8%), erythromycin/macrolides (17.4%), and quinolones (11.1%). Opioids were prescribed in 26.4% of ED visits and 9% of outpatient visits. CONCLUSIONS: Use of systemic antimicrobials declined over time, but one-third of 2010 visits resulted in systemic antimicrobials, despite exclusion of visits with complicating factors. Use of systemic antimicrobials varied by specialty. Further educational efforts and outreach to other specialties might be warranted. |
Occupational exposure assessment in carbon nanotube and nanofiber primary and secondary manufacturers: mobile direct-reading sampling
Dahm MM , Evans DE , Schubauer-Berigan MK , Birch ME , Deddens JA . Ann Occup Hyg 2012 57 (3) 328-44 RESEARCH SIGNIFICANCE: Toxicological evidence suggests the potential for a wide range of health effects from exposure to carbon nanotubes (CNTs) and carbon nanofibers (CNFs). To date, there has been much focus on the use of direct-reading instruments (DRIs) to assess multiple airborne exposure metrics for potential exposures to CNTs and CNFs due to their ease of use and ability to provide instantaneous results. Still, uncertainty exists in the usefulness and interpretation of the data. To address this gap, air-monitoring was conducted at six sites identified as CNT and CNF manufacturers or users and results were compared with filter-based metrics. METHODS: Particle number, respirable mass, and active surface area concentrations were monitored with a condensation particle counter, a photometer, and a diffusion charger, respectively. The instruments were placed on a mobile cart and used as area monitors in parallel with filter-based elemental carbon (EC) and electron microscopy samples. Repeat samples were collected on consecutive days, when possible, during the same processes. All instruments in this study are portable and routinely used for industrial hygiene sampling. RESULTS: Differences were not observed among the various sampled processes compared with concurrent indoor or outdoor background samples while examining the different DRI exposure metrics. Such data were also inconsistent with results for filter-based samples collected concurrently at the same sites [Dahm MM, Evans DE, Schubauer-Berigan MK et al. (2012) Occupational exposure assessment in CNT and nanofiber primary and secondary manufacturers. Ann Occup Hyg; 56: 542-56]. Significant variability was seen between these processes as well as the indoor and outdoor backgrounds. However, no clear pattern emerged linking the DRI results to the EC or the microscopy data (CNT and CNF structure counts). CONCLUSIONS: Overall, no consistent trends were seen among similar processes at the various sites. The DRI instruments employed were limited in their usefulness in assessing and quantifying potential exposures at the sampled sites but were helpful for hypothesis generation, control technology evaluations, and other air quality issues. The DRIs employed are nonspecific, aerosol monitors, and, therefore, subject to interferences. As such, it is necessary to collect samples for analysis by more selective, time-integrated, laboratory-based methods to confirm and quantify exposures. |
Evaluation of a nationally funded state-based programme to reduce fatal occupational injuries
Menendez C , Castillo D , Rosenman K , Harrison R , Hendricks S . Occup Environ Med 2012 69 (11) 810-4 BACKGROUND: The Fatality Assessment and Control Evaluation (FACE) programme was established by the National Institute for Occupational Safety and Health to help prevent occupational traumatic fatalities by funding states to conduct targeted fatality investigations within cause-specific focus areas and associated prevention efforts. PURPOSE: To investigate the impact of the state-based FACE programme on two previous focus areas. METHODS: A longitudinal time-series analysis spanning 22 years compared state fatality rates for occupational falls and electrocutions before and after FACE programme funding with states not receiving FACE programme funding. Lag periods were utilised to allow time for the programme to have an effect, and rates were adjusted for a variety of covariates. Separate analyses were conducted for each injury outcome. RESULTS: A reduction in fall fatality rates that was of borderline significance (1-year lag adjRR=0.92 (0.84 to 1.00)) and a non-significant reduction in electrocution fatality rates (3-year lag adjRR=0.92 (0.82 to 1.03)) were observed in states with FACE programme funding, Best-fit models presented two separate lag periods. CONCLUSIONS: While it is challenging to quantitatively evaluate effectiveness of programmes such as FACE, the data suggest the FACE programme may be effective in preventing occupational injury deaths within its outcome focus areas throughout the state. It is important to look for ways to measure intermediate effects more precisely, as well as ways to maintain effects over time. |
The cost of physical inactivity: moving into the 21st century
Pratt M , Norris J , Lobelo F , Roux L , Wang G . Br J Sports Med 2012 48 (3) 171-3 Physical inactivity is increasingly being recognised as a major problem in global health. The WHO estimates that 3.3 million people die around the world each year due to physical inactivity, making it the fourth leading underlying cause of mortality.1 Physical activity has beneficial effects on 23 diseases or health conditions.2 However, in most countries fewer than half of adults are active enough to reap most of these benefits.3 ,4 Given that inactivity increases the risk for many of the most costly medical conditions such as type 2 diabetes, stroke, ischaemic heart disease, falls and hip fractures, and depression, it is not surprising that physical inactivity has a substantial cost burden in addition to a large health burden. |
Assessing the acceptability and feasibility of a school-located influenza vaccination program with third-party billing in elementary schools
Christensen JJ , Humiston SG , Long CE , Kennedy AM , Dimattia K , Kolasa MS . J Sch Nurs 2012 28 (5) 344-51 This study qualitatively assesses the acceptability and feasibility of a school-located vaccination for influenza (SLIV) project that was conducted in New York State in 2009-2011, from the perspectives of project participants with different roles. Fourteen in-depth semistructured interviews with participating schools' personnel and the mass vaccinator were tape-recorded and transcribed. Interviewees were randomly selected from stratified lists and included five principals, five school nurses, two school administrators, and two lead personnel from the mass vaccinator. A content analysis of transcripts from the interviews was completed and several themes emerged. All participants generally found the SLIV project acceptable. School personnel and the vaccinator viewed the SLIV project process as feasible and beneficial. However, the vaccinator identified difficulties with third-party billing as a potential threat to sustainability. |
Physical examination prior to initiating hormonal contraception: a systematic review
Tepper NK , Curtis KM , Steenland MW , Marchbanks PA . Contraception 2012 87 (5) 650-4 BACKGROUND: Provision of contraception is often linked with physical examination, including clinical breast examination (CBE) and pelvic examination. This review was conducted to evaluate the evidence regarding outcomes among women with and without physical examination prior to initiating hormonal contraceptives. STUDY DESIGN: The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning CBE and pelvic examination prior to initiating hormonal contraceptives. The quality of each study was assessed using the United States Preventive Services Task Force grading system. RESULTS: The search did not identify any evidence regarding outcomes among women screened versus not screened with CBE prior to initiation of hormonal contraceptives. The search identified two case-control studies of fair quality which compared women who did or did not undergo pelvic examination prior to initiating oral contraceptives (OCs) or depot medroxyprogesterone acetate (DMPA). No differences in risk factors for cervical neoplasia, incidence of sexually transmitted infections, incidence of abnormal Pap smears or incidence of abnormal wet mount findings were observed. CONCLUSIONS: Although women with breast cancer should not use hormonal contraceptives, there is little utility in screening prior to initiation, due to the low incidence of breast cancer and uncertain value of CBE among women of reproductive age. Two fair quality studies demonstrated no differences between women who did or did not undergo pelvic examination prior to initiating OCs or DMPA with respect to risk factors or clinical outcomes. In addition, pelvic examination is not likely to detect any conditions for which hormonal contraceptives would be unsafe. |
Identifying implausible gestational ages in preterm babies with Bayesian mixture models.
Zhang G , Schenker N , Parker JD , Liao D . Stat Med 2012 32 (12) 2097-113 Infant birth weight and gestational age are two important variables in obstetric research. The primary measure of gestational age used in US birth data is based on a mother's recall of her last menstrual period, which has been shown to introduce random or systematic errors. To mitigate some of those errors, Oja et al., Platt et al., and Tentoni et al. estimated the probabilities of gestational ages being misreported under the assumption that the distribution of infant birth weights for a true gestational age is approximately Gaussian. From this assumption, Oja et al. fitted a three-component mixture model, and Tentoni et al. and Platt et al. fitted two-component mixture models. We build on their methods and develop a Bayesian mixture model. We then extend our methods using reversible jump Markov chain Monte Carlo to incorporate the uncertainty in the number of components in the model. We conduct simulation studies and apply our methods to singleton births with reported gestational ages of 23-32 weeks using 2001-2008 US birth data. Results show that a three-component mixture model fits the birth data better for gestational ages reported as 25 weeks or less; and a two-component mixture model fits better for the higher gestational ages. Under the assumption that our Bayesian mixture models are appropriate for US birth data, our research provides useful statistical tools to identify records with implausible gestational ages, and the techniques can be used in part of a multiple-imputation procedure for missing and implausible gestational ages. (Published 2012. This article is a US Government work and is in the public domain in the USA.) |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
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- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Health Behavior and Risk
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