Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening
Halpern MT , Romaire MA , Haber SG , Tangka FK , Sabatino SA , Howard DH . Cancer 2014 120 (19) 3016-24 BACKGROUND: Although state Medicaid programs cover cancer screening, Medicaid beneficiaries are less likely to be screened for cancer and are more likely to present with tumors of an advanced stage than are those with other insurance. The current study was performed to determine whether state Medicaid eligibility and reimbursement policies affect the receipt of breast, cervical, and colon cancer screening among Medicaid beneficiaries. METHODS: Cross-sectional regression analyses of 2007 Medicaid data from 46 states and the District of Columbia were performed to examine associations between state-specific Medicaid reimbursement/eligibility policies and receipt of cancer screening. The study sample included individuals aged 21 years to 64 years who were enrolled in fee-for-service Medicaid for at least 4 months. Subsamples eligible for each screening test were: Papanicolaou test among 2,136,511 patients, mammography among 792,470 patients, colonoscopy among 769,729 patients, and fecal occult blood test among 753,868 patients. State-specific Medicaid variables included median screening test reimbursement, income/financial asset eligibility requirements, physician copayments, and frequency of eligibility renewal. RESULTS: Increases in screening test reimbursement demonstrated mixed associations (positive and negative) with the likelihood of receiving screening tests among Medicaid beneficiaries. In contrast, increased reimbursements for office visits were found to be positively associated with the odds of receiving all screening tests examined, including colonoscopy (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 1.06-1.08), fecal occult blood test (OR, 1.09; 95% CI, 1.08-1.10), Papanicolaou test (OR, 1.02; 95% CI, 1.02-1.03), and mammography (OR, 1.02; 95% CI, 1.02-1.03). Effects of other state-specific Medicaid policies varied across the screening tests examined. CONCLUSIONS: Increased reimbursement for office visits was consistently associated with an increased likelihood of being screened for cancer, and may be an important policy tool for increasing screening among this vulnerable population. |
Improving blood pressure control in a large multiethnic California population through changes in health care delivery, 2004-2012
Shaw KM , Handler J , Wall HK , Kanter MH . Prev Chronic Dis 2014 11 E191 The Kaiser Permanente Southern California (Kaiser) health care system succeeded in improving hypertension control in a multiethnic population by adopting a series of changes in health care delivery. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) was used to assess blood pressure control from 2004 through 2012. Hypertension control increased overall from 54% to 86% during that period, and 80% or more in every subgroup, regardless of race/ethnicity, preferred language, or type of health insurance plan. Health care delivery changes improved hypertension control across a large multiethnic population, which indicates that health care systems can achieve a clinical target goal of 70% for hypertension control in their populations. |
Characterization of the anti-factor VIII immunoglobulin profile in patients with hemophilia A using a fluorescence-based immunoassay
Boylan B , Rice AS , Dunn AL , Tarantino MD , Brettler DB , Barrett JC , Miller CH . J Thromb Haemost 2014 13 (1) 47-53 BACKGROUND: The development of neutralizing antibodies, referred to as inhibitors, against factor VIII (FVIII) is a major complication associated with FVIII infusion therapy for the treatment of hemophilia A (HA). Previous studies have shown that a subset of HA patients and a low percentage of healthy individuals harbor non-neutralizing anti-FVIII antibodies that do not elicit the clinical manifestations associated with inhibitor development. OBJECTIVE: Assess HA patients' anti-FVIII antibody profiles as potential predictors of clinical outcomes. METHODS: A fluorescence immunoassay (FLI) was used to detect anti-FVIII antibodies in 491 samples from 371 HA patients. RESULTS: Assessments of antibody profiles showed that the presence of anti-FVIII IgG1 , IgG2 , or IgG4 correlated qualitatively and quantitatively with the presence of a FVIII inhibitor as reported by the Nijmegen-Bethesda assay (NBA). Forty-eight patients with a negative inhibitor history contributed serial samples to the study, including seven patients who had negative NBA titers initially and later converted to NBA-positive. The FLI detected anti-FVIII IgG1 in five of those seven patients prior to their conversion to NBA-positive. Five of 15 serial-sample patients who had a negative inhibitor history and a positive anti-FVIII IgG1 later developed an inhibitor, compared to 2 of 33 patients with a negative inhibitor history without anti-FVIII IgG1 . CONCLUSIONS: These data provide a rationale for future studies designed both to monitor the dynamics of anti-FVIII antibody profiles in HA patients as a potential predictor of future inhibitor development and to assess the value of the anti-FVIII FLI as a supplement to traditional inhibitor testing. |
Investigations of Mycoplasma pneumoniae infections in the United States: trends in molecular typing and macrolide resistance from 2006 to 2013.
Diaz MH , Benitez AJ , Winchell JM . J Clin Microbiol 2014 53 (1) 124-30 Mycoplasma pneumoniae is a leading cause of respiratory infections, including community-acquired pneumonia (CAP). Currently pathogen-specific testing is not routinely performed in the primary care setting, and the United States lacks a systematic surveillance program for M. pneumoniae. Documentation of individual cases and clusters typically occurs only when severe illness and/or failure to improve on empiric antibiotic therapy is observed. Outbreaks, some lasting for extended periods and involving a large number of cases, occur regularly. However, many more likely go unrecognized due to the lack of diagnostic testing and structured reporting. We reviewed data from 17 investigations of cases, small clusters, and outbreaks of M. pneumoniae infections that were supported by the Centers for Disease Control and Prevention (CDC) between 2006 and 2013. We examined 199 M. pneumoniae-positive specimens collected during this time period in order to identify trends in antimicrobial resistance and circulating types. Overall, macrolide-resistance was identified in approximately 10% of M. pneumoniae infections occurring during this time period. Typing of strains revealed co-circulation of multiple MLVA and P1 types throughout this period, including diversity in types detected within individual outbreaks. Three MLVA types, 4572, 3562, and 3662 accounted for 97% of infections during the study period. A systematic surveillance program is necessary to understand the burden of M. pneumoniae disease in the U.S., facilitate case and outbreak identification, and inform appropriate therapeutic and infection control strategies. |
Harmonization of Bordetella pertussis real-time PCR diagnostics in the United States in 2012.
Williams MM , Taylor TH Jr , Warshauer DM , Martin MD , Valley AM , Tondella ML . J Clin Microbiol 2014 53 (1) 118-23 Real-time (rt-) PCR is an important diagnostic tool for identification of Bordetella pertussis, B. holmesii, and B. parapertussis. Most United States public health laboratories (USPHLs) target IS481, present in 218-238 copies in the B. pertussis genome, and 32-65 copies in B. holmesii. CDC developed a multi-target PCR assay to differentiate B. pertussis, B. holmesii, and B. parapertussis, and provided protocols and training to 19 USPHLs. The 2012 performance exercise (PE) assessed the capability of USPHLs to detect these three Bordetella species in clinical samples. Laboratories were recruited by the Wisconsin State Proficiency Testing program through the Association of Public Health Laboratories, in partnership with CDC. Spring and Fall PE panels contained 12 samples each of viable Bordetella and non-Bordetella species in saline. Fifty and 53 USPHLs participated in the spring and fall PEs, respectively, using a variety of nucleic acid extraction methods, PCR platforms, and assays. Ninety-six percent and 94% of laboratories targeted IS481 in spring and fall, respectively, either in singleplex or multiplex assays. Seventy two percent and 79% of USPHLs could differentiate B. pertussis and B. holmesii in spring and fall, respectively; 68% and 72% could identify B. parapertussis. IS481 cycle threshold (Ct) values for B. pertussis samples had coefficients of variation (CV) ranging from 10% to 28%. Of the USPHLs who differentiated B. pertussis and B. holmesii, sensitivity and specificity was 96% and 95%, respectively, for the combined panels. The 2012 PEs demonstrated increased harmonization of rt-PCR Bordetella diagnostic protocols in USPHLs compared to the previous survey. |
Update: Ebola virus disease outbreak - West Africa, October 2014
CDC Incident Management System Ebola Epidemiology Team , Guinea Interministerial Committee for Response Against the Ebola Virus , CDC Guinea Response Team , Liberia Ministry of Health and Social Welfare , CDC Liberia Response Team , Sierra Leone Ministry of Health and Sanitation , CDC Sierra Leone Response Team , CDC Viral Special Pathogens Branch . MMWR Morb Mortal Wkly Rep 2014 63 (43) 978-981 CDC is assisting ministries of health and working with other organizations to control and end the ongoing outbreak of Ebola virus disease (Ebola) in West Africa. The updated data in this report were compiled from situation reports from the Guinea Interministerial Committee for Response Against the Ebola Virus and the World Health Organization, the Liberia Ministry of Health and Social Welfare, and the Sierra Leone Ministry of Health and Sanitation. Total case counts include all suspected, probable, and confirmed cases as defined by each country. These data reflect reported cases, which make up an unknown proportion of all actual cases and reporting delays that vary from country to country. |
Utility of cryptococcal antigen screening and evolution of asymptomatic cryptococcal antigenemia among HIV-infected women starting antiretroviral therapy in Thailand
Kwan CK , Leelawiwat W , Intalapaporn P , Anekthananon T , Raengsakulrach B , Peters PJ , McNicholl JM , Park BJ , McConnell MS , Weidle PJ . J Int Assoc Provid AIDS Care 2014 13 (5) 434-7 Cryptococcal meningitis (CM) remains a significant HIV-associated opportunistic infection in Southeast Asia and Africa, with a high burden of disease and a high mortality rate despite the availability of antiretroviral therapy (ART). We retrospectively examined the utility of cryptococcal antigen screening to identify risk for CM among 211 Thai women initiating ART. Antigenemia prevalence was 11% (n = 9) among 84 women with a CD4 count <100 cells/mm(3). Screening identified all women who later developed CM. Cryptococcal antigen titers decreased over time with ART. Our study confirmed findings from previous studies in Thailand and South Africa and provided novel observational data regarding the course of cryptococcal antigenemia in patients initiating ART and the poor efficacy of low-dose fluconazole prophylaxis in preventing CM among patients with antigenemia. |
Latent tuberculosis infection among foreign-born persons: a prioritized approach
Baker BJ , Jeffries CD , Moonan PK . Ann Am Thorac Soc 2014 11 (8) 1335-6 We thank Dr. Griffith for his insightful commentary (1) on our recent analysis (2) and would like to address and expand on his remarks. More than two-thirds of all tuberculosis cases in the United States are among foreign-born persons, and it is estimated that most tuberculosis cases among these individuals are a result of the reactivation of latent tuberculosis infection. Testing and treatment of latent tuberculosis infection is a key strategy of tuberculosis prevention, and national guidelines are currently being jointly updated as part of a collaborative effort among the Centers for Disease Control and Prevention, the American Thoracic Society, and the Infectious Diseases Society of America. | The findings of our analysis and those of a recently published study (3) support Griffith's proposal to remove the variable “years since United States entry” as a criterion for testing and treatment of foreign-born persons. Griffith speculates that “reluctance to change this recommendation is due to concern about drug toxicity in older individuals” and suggests that limiting testing and treatment to those younger than 35 years might minimize concerns about drug toxicity. However, an examination of American Community Survey estimates from 2010 shows that among the 10.2 million Mexico-born persons living in the United States for more than 5 years, 6.3 million (65%) were aged 35 years or older (4). Therefore, if an age cutoff of younger than 35 years were adopted, it would greatly limit the potential effect of testing and treatment on tuberculosis morbidity among Mexico-born persons. |
Progress toward poliomyelitis eradication - Afghanistan and Pakistan, January 2013-August 2014
Farag NH , Alexander J , Hadler S , Quddus A , Durry E , Wadood MZ , Tangermann RH , Ehrhardt D . MMWR Morb Mortal Wkly Rep 2014 63 (43) 973-977 In 2012, the World Health Assembly declared the completion of polio eradication a programmatic emergency for global public health and called for a comprehensive polio endgame strategy. Afghanistan and Pakistan are two of the three remaining countries (the other is Nigeria) where circulation of indigenous wild poliovirus (WPV) has never been interrupted. This report updates previous reports and describes polio eradication activities and progress in Afghanistan and Pakistan during January 2013-August 2014. In Afghanistan, 14 WPV cases were reported in 2013, compared with 37 cases in 2012; nine cases were reported during January-August 2014, compared with six cases during the same period in 2013. In Pakistan, 93 WPV cases were reported in 2013, compared with 58 cases in 2012; 170 cases were reported during January-August 2014, compared with 33 cases during the same period in 2013. All WPV cases reported during January 2013-August 2014 were WPV type 1 (WPV1). Vaccination campaigns have been banned since June 2012 in specific areas in Pakistan, where an estimated 300,000 children aged <5 years reside and where 69% of WPV cases have occurred in 2014. To accomplish the objectives of the Polio Eradication and Endgame Strategic Plan for 2013-2018 both countries should continue to negotiate access of vaccinators to insecure and temporarily inaccessible areas, improve immunization program performance to reach more children in accessible areas, and ensure that political and health leaders at all levels are fully committed to the program, including being committed to providing financial resources needed to fully implement all the recommendations of external technical advisory groups. Both countries should also continue to strengthen cross-border collaboration to improve surveillance and case detection, coordinate outbreak response, and maximize vaccination coverage of children moving between the two countries. |
Incidence of Hansen's disease - United States, 1994-2011
Nolen L , Haberling D , Scollard D , Truman R , Rodriguez-Lainz A , Blum L , Blaney D . MMWR Morb Mortal Wkly Rep 2014 63 (43) 969-972 Hansen's disease (HD), or leprosy, is caused by the bacterium Mycobacterium leprae and is reportable in many states. It is a chronic disease affecting the skin and nerves, commonly presenting as pale or reddish skin patches with diminished sensation. Without treatment, it can progress to a severely debilitating disease with nerve damage, tissue destruction, and functional loss. An important factor in limiting HD morbidity is early diagnosis and prompt initiation of therapy. Because HD is rare, clinicians in the United States are often unfamiliar with it; however, HD continues to cause morbidity in the United States. To better characterize at-risk U.S. populations, HD trends during 1994-2011 were evaluated by reviewing records from the National Hansen's Disease Program (NHDP). When the periods 1994-1996 and 2009-2011 were compared, a decline in the rate for new diagnoses from 0.52 to 0.43 per million was observed. The rate among foreign-born persons decreased from 3.66 to 2.29, whereas the rate among U.S.-born persons was 0.16 in both 1994-1996 and 2009-2011. Delayed diagnosis was more common among foreign-born persons. Clinicians throughout the United States should familiarize themselves with the signs and symptoms of HD and understand that HD can occur in the United States. |
Environmental odors web site: providing communities and health officials with the tools to address odor issues
Jackson D , Rosales-Guevara L , Blake R . J Environ Health 2014 77 (4) 38-39 Environmental odor concerns are commonly reported to environmental health units at the local and state levels. Many U.S. Environmental Protection Agency program sites (Superfund and Resource Conservation and Recovery Act) and approximately 25% of Agency for Toxic Substances and Disease Registry (ATSDR) petition requests involve an odor concern component (e.g., industries, landfills, and confined animal feeding operations [CAFOs]). Increasing numbers of scientific studies are finding associations between environmental odors and health effects. Despite this need for information on environmental odors, no comprehensive electronic source or Web site existed that covered this topic and provided resources for the many parties that face environmental odor issues. Assessing the possible health impacts of odors is also complex. Even if the chemical or chemical mixture is identified, little to no regulations exist at the state and local levels. The lack of an effective odor response framework makes odor problems difficult to resolve. | In an effort to improve this situation, ATSDR collaborated with the National Center for Environmental Health at the Centers for Disease Control and Prevention to develop a comprehensive Web site that provides communities, health care providers, policy makers, health officials, municipalities, industries, and other stakeholders with actionable steps to deal with environmental odors in their communities. |
Applying a general best practices identification framework to environmental health
Kochtitzky CS . J Environ Health 2014 77 (4) 40-43 I was pleased to see Fried et al.1 make the case for a new era of graduate public health curriculum focused on integrated, problem-based learning and the companion article by Begg et al.2 describe the new MPH curriculum at Columbia University as a model for an integrated, problem-based curriculum. Graduate public health training needs to adapt to new models to adequately prepare the next generation of public health leaders to effectively manage the complex public health problems of the present. |
CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors-United States, 2005-2013
Johnson NB , Hayes LD , Brown K , Hoo EC , Ethier KA . MMWR Suppl 2014 63 (4) 3-27 PROBLEM: Although substantial progress has been made in improving the health of persons in the United States, serious problems remain to be solved. Life expectancy is increasing, and the rates of the leading causes of death are improving in many cases; however, numerous indicators (i.e., measures of observed or calculated data on the status of a condition) of the health and safety of the U.S. population remain poor. This report reviews population health in the United States and provides an assessment of recent progress in meeting high-priority health objectives. The health status indicators described in this report were selected because of their direct relation to the leading causes of death and other substantial sources of morbidity and mortality and should be the focus of prevention efforts. REPORTING PERIOD COVERED: Data are reported starting in 2005 (or the earliest available year since 2005) through the current data year. Because data sources and specific indicators vary regarding when data are available, the most recent year for which data are available might range from 2010 to 2013. DESCRIPTION OF THE SYSTEM: Data were obtained from 17 CDC surveys or surveillance systems and three non-CDC sources to provide a view of this particular point of time in the nation's health and trends in recent years. Data from the following CDC surveillance systems and surveys were used: Behavioral Risk Factor Surveillance System (BRFSS); Emerging Infections Program/Active Bacterial Core surveillance (EIP/ABCs); Foodborne Diseases Active Surveillance Network (FoodNet); Internet Panel Surveys: Influenza Vaccination Coverage Among Health-Care Personnel and Influenza Vaccination Coverage Among Pregnant Women; National Ambulatory Medical Care Survey (NAMCS); National Health and Nutrition Examination Survey (NHANES); National Health Interview Survey (NHIS); National Healthcare Safety Network (NHSN); National HIV Surveillance System; National Hospital Discharge Survey (NHDS); National Immunization Survey (NIS); National Immunization Survey-Teen (NIS-Teen); National Notifiable Disease Surveillance System (NNDSS); Nationally Notifiable STD Surveillance; National Vital Statistics System (NVSS); and Youth Risk Behavior Surveillance System (YRBSS). Three non-CDC sources were used: the Alcohol and Tobacco Tax and Trade Bureau Monthly Statistical Releases; the National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS); and the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (NSDUH). RESULTS: Since 2005, life expectancy at birth in the U.S. has increased by 1 year; however, the number of persons who died prematurely was relatively constant. The years of potential life lost declined for eight of the 10 leading causes of death. Age-adjusted rates declined among all leading causes except deaths attributable to Alzheimer's disease and suicide, although the numbers of deaths increased for most causes. Heart disease, stroke, and deaths attributed to motor-vehicle injuries demonstrated notable declines since 2005. Numbers and rates increased for both Alzheimer's disease and suicide. The number of deaths from drug poisoning increased by approximately 11,000, and the number of deaths among older adults caused by falls increased by approximately 7,000. Risk and protective factors for these leading causes of death also showed mixed progress. Current smoking among adults remained stable at approximately 25% while smoking among youths declined to a record low of 15.7%. Obesity rates remained level at approximately 35% for adults and approximately 17% for youths. Approximately 21% of adults met recommended levels of physical activity, consistent with results recorded in the 3 previous years. Control of blood pressure and cholesterol increased to 46.3% and 29.5%, respectively. During the 2012-13 influenza season, vaccination rates reached highs of 72.0% for health-care personnel, 56.6% for children aged <17 years, 50.5% for pregnant women, and 41.5% for persons aged >18 years. Other important measures of the health of the U.S. population also varied. Rates of foodborne illness varied from year to year, with average annual increases for Salmonella and Salmonella serotype Enteritidis. Listeria rates were stable in recent years at 0.26 cases per 100,000 population. Shiga toxin-producing E. coli (STEC) O157 increased during the past 3 years to a rate of 1.15 cases per 100,000 population, even though the annual change for the study period noted an average decline overall. Health-care-associated infections declined, on average, for central-line associated bloodstream infections (CLABSI), surgical site infections (SSI), and Methicillin-resistant Staphylococcus aureus (MRSA) infection. The percentage of persons living with HIV who know their serostatus increased to 84.2%, but trends fluctuated for the number of new HIV infections and the rate of HIV transmission among adolescents and adults. Chlamydia rates increased by an average of 3.3% per year for persons aged 15-19 years and by 4.9% per year for women aged 20-24 years. The number of new cases of hepatitis C and hepatitis C-associated deaths increased by an average of 6.4% and 6.0% per year. Indictors of maternal and child health all improved, including historically low rates of infant mortality (6.1 per 1,000 live births) and teen births (26.6 per 1,000 female population). The percentage of infants breastfed at 6 months increased to 49.4%. Among children aged 19-35 months, 70.4% received the set of universally recommended vaccines, an increase of 2.9% from the previous year. INTERPRETATION: The findings in this report indicate that progress has been steady but slow for many of the priority health issues in the United States. The age-adjusted rates for most of the leading causes of death are declining, but in some cases, the number of deaths is increasing, in part reflecting the growing U.S. population. Several protective factors that have registered substantial average increases (e.g., physical activity among adults, high blood pressure control, and human papillomavirus vaccination among adolescent females) have stalled in recent years. Many protective factors, even those with impressive relative gains, still represent only a minority of the U.S. population (e.g., control of high cholesterol at 29.5%). More data are needed to properly interpret fluctuating trends, such as those observed with the number of HIV infections and HIV transmission rates. Finally, some indicators of disease that appear to be increasing, such as chlamydia and hepatitis C, reflect increased efforts to engage in targeted screening but also suggest that the actual burden of infection is much greater than the reported data alone indicate. PUBLIC HEALTH ACTION: Although not all-inclusive, this compilation highlights important health concerns, points to areas in which important success has been achieved, and highlights areas in which more effort is needed. By tracking progress, public health officials, program managers, and decision makers can better identify areas for improvement and institute policies and programs to improve health and the quality of life. |
Serotypes and genotypes of invasive Streptococcus pneumoniae before and after PCV10 implementation in southern Brazil.
Caierao J , Hawkins P , Sant'anna FH , da Cunha GR , d'Azevedo PA , McGee L , Dias C . PLoS One 2014 9 (10) e111129 To reduce the burden of pneumococcal diseases, different formulations of pneumococcal conjugate vaccines (PCV) have been introduced in many countries. In Brazil, PCV10 has been available since 2010. We aimed to analyze the serotype and genetic composition of invasive pneumococci from Brazil in pre- and post- vaccination periods (2007-2012). Antibiotic susceptibility was determined and genotypes of macrolide and fluoroquinolone resistance were characterized. The genotypes of isolates of the most frequent serotypes were determined by multilocus sequence typing. The study included 325 isolates, which were primarily recovered from blood. The most common serotypes recovered were 14, 3, 4, 23F, 7F, 9V, 12F, 20, 19F, 8, 19A, and 5. Thirty-eight pneumococci (11.7%) were from children ≤5 years old. Considering the overall population, PCV10 and PCV13 serotype coverage was 50.1% and 64.9%, respectively. During the pre-vaccine period, isolates with serotypes belonging to the PVC10 represented 51.5% (100/194), whereas in the post vaccine they represented 48.0% (63/131). PCV13 serotypes represented 67.5% (131/194) and 59.2% (77/131) of total for pre- and post-vaccination periods, respectively. Seventy different sequence types [STs] were found, accounting for 9 clonal complexes [CCs] and 45 singletons. Eight STs (156, 180, 218, 8889, 53, 191, 770, and 4967) represented the majority (51.5%) of isolates. Fifty STs were associated with the pre-vaccination period (27 exclusive) and 43 (20 exclusive) with the post-vaccination period; 23 STs were identified in both periods. Some serotypes were particularly clonal (7F, 8, 12F, 20). Non-susceptibility to penicillin was associated with serotype 19A, CC320. Erythromycin resistance was heterogeneous when considering serotype and ST. A single serotype 23F (ST4967) isolate was resistant to levofloxacin. Continued surveillance is required to determine vaccine impact and to monitor changes in pneumococcal population biology post-PCV10 introduction in Brazil. |
Performance of Etest and disk diffusion for the detection of ciprofloxacin and levofloxacin resistance in Salmonella
Deak E , Hindler JA , Skov R , Sjolund-Karlsson M , Sokovic A , Humphries RM . J Clin Microbiol 2014 53 (1) 298-301 Etest and disk diffusion were compared to broth microdilution for the detection of fluoroquinolone resistance in 135 typhoidal and non-typhoidal serovars of Salmonella. Categorical agreement for ciprofloxacin and levofloxacin Etest was 89.6 and 83.7%, respectively. Disk diffusion categorical agreement was 88.2 and 93.3%, respectively. The only errors observed were minor errors. |
Pharmacokinetic evaluation of tenofovir disoproxil fumarate released from an intravaginal ring in pigtailed macaques after 6 months of continuous use
Srinivasan P , Dinh C , Zhang J , Pau CP , McNicholl JM , Lo YT , Herold BC , Teller R , Kiser P , Smith JM . J Med Primatol 2014 43 (5) 364-369 BACKGROUNDS AND METHODS: A reservoir intravaginal ring (IVR) eluting tenofovir disoproxil fumarate (TDF) was evaluated for 6 months of continuous use in normally cycling female pigtailed macaques with monthly IVR exchanges to define pharmacokinetics and safety. RESULTS AND CONCLUSIONS: Tenofovir levels in vaginal secretions and tissue remained consistent for 6 months with no adverse safety concerns. |
Preclinical evaluation of the immunomodulatory lymphocyte trafficking drug FTY720 for HIV prevention in the female genital mucosa of macaques
Morris M , Aubert RD , Butler K , Henning T , Mitchell J , Jenkins L , Garber D , McNicholl J , Kersh EN . J Med Primatol 2014 43 (5) 370-373 FTY720 has been shown to reduce inflammatory cytokines and immune cells in the genital mucosa of macaques. This pilot study examined the ability of FTY720 to inhibit HIV acquisition. Systemic treatment with FTY720 failed to prevent or delay vaginal SHIV transmission. |
Functional analysis of DENV-2 envelope protein domain 3 type-specific and DENV complex-reactive critical epitope residues
Pitcher TJ , Sarathy VV , Matsui K , Gromowski GD , Huang CY , Barrett AD . J Gen Virol 2014 96 288-293 The dengue virus (DENV) envelope protein domain 3 (ED3) is the target of potent virus neutralizing antibodies. The DENV-2 ED3 contains adjacent type-specific and DENV complex-reactive antigenic sites that are composed of a small number of residues that were previously demonstrated to be critical for antibody binding. Site-directed mutagenesis of a DENV-2 16681 infectious clone was used to mutate critical residues in the DENV-2 type-specific (K305A and P384A) and DENV complex-reactive (K310A) antigenic sites. The K305A mutant virus multiplied like the parent virus in mosquito and mammalian cells, as did the P384A mutant virus, which required a compensatory mutation (G330D) for viability. However, the K310A mutant virus could not be recovered. The DENV-2 type-specific critical residue mutations K305A and P384A+G330D reduced the ability of DENV-2 type-specific, but not DENV complex-reactive, monoclonal antibodies (mAbs) to neutralize virus infectivity and this was directly correlated with mAb binding affinity to the rED3 mutants. |
Development and optimization of a non-enzymatic method of leukocyte isolation from macaque tissues
Pereira LE , Makarova N , Dobard C , Aubert RD , Srinivasan P , McNicholl J , Smith JM . J Med Primatol 2014 43 (5) 360-363 BACKGROUND AND METHODS: Cell isolation from macaque tissues involves laborious enzymatic digestion. The Medimachine provides a simpler, quicker nonenzymatic method, yielding 1.5-5 million cells/g of vaginal or rectal tissue from pigtailed macaques. RESULTS AND CONCLUSIONS: Flow cytometry analysis of the two methods revealed similar levels of cell viability and most major cell lineage and activation markers. |
Disposable platform provides visual and color-based point-of-care anemia self-testing
Tyburski EA , Gillespie SE , Stoy WA , Mannino RG , Weiss AJ , Siu AF , Bulloch RH , Thota K , Cardenas A , Session W , Khoury HJ , O'Connor S , Bunting ST , Boudreaux J , Forest CR , Gaddh M , Leong T , Lyon LA , Lam WA . J Clin Invest 2014 124 (10) 4387-94 BACKGROUND: Anemia, or low blood hemoglobin (Hgb) levels, afflicts 2 billion people worldwide. Currently, Hgb levels are typically measured from blood samples using hematology analyzers, which are housed in hospitals, clinics, or commercial laboratories and require skilled technicians to operate. A reliable, inexpensive point-of-care (POC) Hgb test would enable cost-effective anemia screening and chronically anemic patients to self-monitor their disease. We present a rapid, stand-alone, and disposable POC anemia test that, via a single drop of blood, outputs color-based visual results that correlate with Hgb levels. METHODS: We tested blood from 238 pediatric and adult patients with anemia of varying degrees and etiologies and compared hematology analyzer Hgb levels with POC Hgb levels, which were estimated via visual interpretation using a color scale and an optional smartphone app for automated analysis. RESULTS: POC Hgb levels correlated with hematology analyzer Hgb levels (r = 0.864 and r = 0.856 for visual interpretation and smartphone app, respectively), and both POC test methods yielded comparable sensitivity and specificity for detecting any anemia (n = 178) (<11 g/dl) (sensitivity: 90.2% and 91.1%, specificity: 83.7% and 79.2%, respectively) and severe anemia (n = 10) (<7 g/dl) (sensitivity: 90.0% and 100%, specificity: 94.6% and 93.9%, respectively). CONCLUSIONS: These results demonstrate the feasibility of this POC color-based diagnostic test for self-screening/self-monitoring of anemia. TRIAL REGISTRATION: Not applicable. FUNDING: This work was funded by the FDA-funded Atlantic Pediatric Device Consortium, the Georgia Research Alliance, Children's Healthcare of Atlanta, the Georgia Center of Innovation for Manufacturing, and the InVenture Prize and Ideas to Serve competitions at the Georgia Institute of Technology. |
Using Bayesian models to assess the effects of under-reporting of cannabis use on the association with birth defects, National Birth Defects Prevention Study, 1997-2005
van Gelder MM , Donders AR , Devine O , Roeleveld N , Reefhuis J . Paediatr Perinat Epidemiol 2014 28 (5) 424-33 BACKGROUND: Studies on associations between periconceptional cannabis exposure and birth defects have mainly relied on self-reported exposure. Therefore, the results may be biased due to under-reporting of the exposure. The aim of this study was to quantify the potential effects of this form of exposure misclassification. METHODS: Using multivariable logistic regression, we re-analysed associations between periconceptional cannabis use and 20 specific birth defects using data from the National Birth Defects Prevention Study from 1997-2005 for 13 859 case infants and 6556 control infants. For seven birth defects, we implemented four Bayesian models based on various assumptions concerning the sensitivity of self-reported cannabis use to estimate odds ratios (ORs), adjusted for confounding and under-reporting of the exposure. We used information on sensitivity of self-reported cannabis use from the literature for prior assumptions. RESULTS: The results unadjusted for under-reporting of the exposure showed an association between cannabis use and anencephaly (posterior OR 1.9 [95% credible interval (CRI) 1.1, 3.2]) which persisted after adjustment for potential exposure misclassification. Initially, no statistically significant associations were observed between cannabis use and the other birth defect categories studied. Although adjustment for under-reporting did not notably change these effect estimates, cannabis use was associated with esophageal atresia (posterior OR 1.7 [95% CRI 1.0, 2.9]), diaphragmatic hernia (posterior OR 1.8 [95% CRI 1.1, 3.0]), and gastroschisis (posterior OR 1.7 [95% CRI 1.2, 2.3]) after correction for exposure misclassification. CONCLUSIONS: Under-reporting of the exposure may have obscured some cannabis-birth defect associations in previous studies. However, the resulting bias is likely to be limited. |
Using standardized diagnostic instruments to classify children with autism in the Study to Explore Early Development
Wiggins LD , Reynolds A , Rice CE , Moody EJ , Bernal P , Blaskey L , Rosenberg SA , Lee LC , Levy SE . J Autism Dev Disord 2014 45 (5) 1271-80 The Study to Explore Early Development (SEED) is a multi-site case-control study designed to explore the relationship between autism spectrum disorder (ASD) phenotypes and etiologies. The goals of this paper are to (1) describe the SEED algorithm that uses the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) to classify children with ASD, (2) examine psychometric properties of different ASD classification methods, including the SEED method that incorporates rules for resolving ADI-R and ADOS discordance, and (3) determine whether restricted interests and repetitive behaviors were noted for children who had instrument discordance resolved using ADI-R social and communication scores. Results support the utility of SEED criteria when well-defined groups of children are an important clinical or research outcome. |
Migration of beryllium via multiple exposure pathways among work processes in four different facilities
Armstrong JL , Day GA , Park JY , Stefaniak AB , Stanton ML , Deubner DC , Kent MS , Schuler CR , Virji MA . J Occup Environ Hyg 2014 11 (12) 781-792 Inhalation of beryllium is associated with the development of sensitization; however, dermal exposure may also be important. The primary aim of this study was to elucidate relationships among exposure pathways in four different manufacturing and finishing facilities. Secondary aims were to identify jobs with increased levels of beryllium in air, on skin, and on surfaces; identify potential discrepancies in exposure pathways, and determine if these are related to jobs with previously identified risk. Beryllium was measured in air, on cotton gloves, and on work surfaces. Summary statistics were calculated and correlations among all three measurement types were examined at the facility and job level. Exposure ranking strategies were used to identify jobs with higher exposures. The highest air, glove, and surface measurements were observed in beryllium metal production and beryllium oxide ceramics manufacturing jobs that involved hot processes and handling powders. Two finishing and distribution facilities that handle solid alloy products had lower exposures than the primary production facilities, and there were differences observed among jobs. For all facilities combined, strong correlations were found between air-surface (rp ≥ 0.77), glove-surface (rp ≥ 0.76), and air-glove measurements (rp ≥ 0.69). In jobs where higher risk of beryllium sensitization or disease has been reported, exposure levels for all three measurement types were higher than in jobs with lower risk, though they were not the highest. Some jobs with low air concentrations had higher levels of beryllium on glove and surface wipe samples, suggesting a need to further evaluate the causes of the discrepant levels. Although such correlations provide insight on where beryllium is located throughout the workplace, they cannot identify the direction of the pathways between air, surface, or skin. Ranking strategies helped to identify jobs with the highest combined air, glove, and/or surface exposures. All previously identified high-risk jobs had high air concentrations, dermal mass loading, or both, and none had low dermal and air. We have found that both pathways are relevant. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file describing the forms of beryllium materials encountered during production and characteristics of the aerosols by process areas.]. |
Primary prevention of fishing vessel disasters: evaluation of a United States Coast Guard policy intervention
Lucas DL , Kincl LD , Bovbjerg VE , Branscum AJ , Lincoln JM . Mar Policy 2014 50 67-73 Primary injury prevention strategies are needed to improve worker safety in the fishing industry by reducing the occurrence of vessel disasters. In 2006, the United States Coast Guard (USCG) implemented a novel safety policy intervention for two fleets of freezer-trawlers and freezer-longliners in Alaska. The Alternate Compliance and Safety Agreement (ACSA) set standards for vessel stability, watertight integrity, hull condition, and other critical vessel components. To determine if ACSA has been an effective primary prevention intervention for improving safety in the fishing industry, a longitudinal study was conducted using retrospective data on vessel casualties during 2003-2012. On both types of vessels, reported rates of serious vessel casualties decreased after the vessels reached compliance with ACSA requirements, suggesting that ACSA has had a positive effect on vessel safety in the freezer-trawl and freezer-longline fleets. These results support the premise that primary prevention policies can contribute to worker safety by reducing the occurrence of vessel disasters. Future USCG safety policies should be patterned after ACSA and improved by following the recommendations outlined in this study. |
Characterization of cleaning and disinfecting tasks and product use among hospital occupations
Saito R , Abbas Virji M , Henneberger PK , Humann MJ , LeBouf RF , Stanton ML , Liang X , Stefaniak AB . Am J Ind Med 2014 58 (1) 101-11 BACKGROUND: Healthcare workers have an elevated prevalence of asthma and related symptoms associated with the use of cleaning/disinfecting products. The objective of this study was to identify and characterize cleaning/disinfecting tasks and products used among hospital occupations. METHODS: Workers from 14 occupations at five hospitals were monitored for 216 shifts, and work tasks and products used were recorded at five-minute intervals. The major chemical constituents of each product were identified from safety data sheets. RESULTS: Cleaning and disinfecting tasks were performed with a high frequency at least once per shift in many occupations. Medical equipment preparers, housekeepers, floor strippers/waxers, and endoscopy technicians spent on average 108-177 min/shift performing cleaning/disinfecting tasks. Many occupations used products containing amines and quaternary ammonium compounds for >100 min/shift. CONCLUSIONS: This analysis demonstrates that many occupations besides housekeeping incur exposures to cleaning/disinfecting products, albeit for different durations and using products containing different chemicals. |
Severity of psychological distress among adults with and without disabilities
Okoro CA , Dhingra SS . Soc Work Public Health 2014 29 (7) 671-85 The aim of this study is to examine psychological distress and its individual symptoms between adults with and without disabilities, and among adults with disabilities, to examine whether an association exists between severity of distress and health-related factors. Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used for this study. Severity of psychological distress was assessed using the Kessler 6 scale of nonspecific psychological distress. Logistic regression analyses were performed to estimate predicted marginals and prevalence ratios. Nine percent of adults had mild to moderate psychological distress and 3.9% had serious psychological distress. The adjusted mean Kessler 6 total scores and individual item scores were higher for adults with disabilities, as was the average number of days that a mental health condition interfered with activities in the past 30 days. Among adults with disabilities, mild to moderate and serious psychological distress were particularly high among those who were unemployed or unable to work. Those who had either mild to moderate or serious psychological distress were significantly more likely than those with no psychological distress to be physically inactive, to smoke, and to report fair or poor health, life dissatisfaction, and inadequate social support. A dose-response relationship exists between categorical severity of psychological distress and examined health-related factors. These findings may inform the design of targeted public health strategies that aim to eliminate health disparities between people with and without disabilities. |
Factors associated with symptoms of depression among Bhutanese refugees in the United States
Vonnahme LA , Lankau EW , Ao T , Shetty S , Cardozo BL . J Immigr Minor Health 2014 17 (6) 1705-14 Refugees are at risk for psychiatric morbidity, yet little is known about their mental health conditions. We identified factors associated with depression symptoms among Bhutanese refugees in the US. We randomly selected adult Bhutanese refugees (N = 386) to complete a cross-sectional survey concerning demographics, mental health symptoms, and associated risk factors. The case definition for depression symptoms was ≥1.75 mean depression score on the Hopkins Symptom Checklist-25. More women (26 %) than men (16 %) reported depression symptoms (p = 0.0097). Higher odds of depression symptoms were associated with being a family provider, self-reported poor health, and inability to read and write Nepali (OR 4.6, 39.7 and 4.3, respectively) among men; and self-reported poor health and inability to read and write Nepali (OR 7.6, and 2.6 respectively) among women. US-settled Bhutanese refugees are at risk for depression. Providers should be aware of these concerns. Culturally appropriate mental health services should be made more accessible at a local level. |
Accuracy of self-reported smoking cessation during pregnancy
Tong VT , Althabe F , Aleman A , Johnson CC , Dietz PM , Berrueta M , Morello P , Colomar M , Buekens P , Sosnoff CS . Acta Obstet Gynecol Scand 2014 94 (1) 106-11 Evidence of bias of self-reported smoking cessation during pregnancy is reported in high-income countries but not elsewhere. We sought to evaluate self-reported smoking cessation during pregnancy using biochemical verification and to compare characteristics of women with and without biochemically-confirmed cessation in Argentina and Uruguay. In a cross-sectional study from October 2011-May 2012, women who attended one of 21 prenatal clinics and delivered at selected hospitals in Buenos Aires, Argentina and Montevideo, Uruguay were surveyed about their smoking cessation during pregnancy. We tested saliva collected from women <12 hours after delivery for cotinine to evaluate self-reported smoking cessation during pregnancy. Overall, 10.0% (44/441) of women who self-reported smoking cessation during pregnancy had biochemical evidence of continued smoking. Women who reported quitting later in pregnancy had a higher percentage of nondisclosure (17.2%) than women who reported quitting when learning of their pregnancy (6.4%). |
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