Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006
Wu XC , Eide MJ , King J , Saraiya M , Huang Y , Wiggins C , Barnholtz-Sloan JS , Martin N , Cokkinides V , Miller J , Patel P , Ekwueme DU , Kim J . J Am Acad Dermatol 2011 65 S26-37 BACKGROUND: Most melanoma studies use data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program or individual cancer registries. Small numbers of melanoma cases have limited in-depth analyses for all racial and ethnic groups. OBJECTIVE: We sought to describe racial and ethnic variations in melanoma incidence and survival. METHODS: Incidence for invasive melanoma and 5-year melanoma-specific survival were calculated for whites, blacks, American Indians/Alaskan Natives, Asians/Pacific Islanders (API), and Hispanics using data from 38 population-based cancer registries. RESULTS: Incidence rates of melanoma were significantly higher for females than males among whites and Hispanics under 50 years of age and APIs under 40 years of age. White and black patients were older (median age: 59-63 years) compared with Hispanics, American Indians/Alaskan Natives, and API (median age: 52-56 years). The most common histologic type was acral lentiginous melanoma among blacks and superficial spreading melanoma among all other racial and ethnic groups. Hispanics had the highest incidence rate of acral lentiginous melanoma, significantly higher than whites and API. Nonwhites were more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites. LIMITATIONS: Over 50% of melanoma cases did not have specified histology. The numbers of nonwhite patients were still relatively small despite broad population coverage (67% of United States). CONCLUSIONS: Racial and ethnic differences in age at melanoma diagnosis, anatomic sites, and histologic types suggest variations in etiologic pathways. The high percentages of advanced and thicker melanomas among nonwhites highlight the need to improve melanoma awareness for all race and ethnicity in the United States. |
Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006
Jemal A , Saraiya M , Patel P , Cherala SS , Barnholtz-Sloan J , Kim J , Wiggins CL , Wingo PA . J Am Acad Dermatol 2011 65 S17-S25 e3 BACKGROUND: Increasing cutaneous melanoma incidence rates in the United States have been attributed to heightened detection of thin (≤1-mm) lesions. OBJECTIVE: We sought to describe melanoma incidence and mortality trends in the 12 cancer registries covered by the Surveillance, Epidemiology, and End Results program and to estimate the contribution of thin lesions to melanoma mortality. METHODS: We used joinpoint analysis of Surveillance, Epidemiology, and End Results incidence and mortality data from 1992 to 2006. RESULTS: During 1992 through 2006, melanoma incidence rates among non-Hispanic whites increased for all ages and tumor thicknesses. Death rates increased for older (>65 years) but not younger persons. Between 1998 to 1999 and 2004 to 2005, melanoma death rates associated with thin lesions increased and accounted for about 30% of the total melanoma deaths. LIMITATIONS: Availability of long-term incidence data for 14% of the US population was a limitation. CONCLUSIONS: The continued increases in melanoma death rates for older persons and for thin lesions suggest that the increases may partly reflect increased ultraviolet radiation exposure. The substantial contribution of thin lesions to melanoma mortality underscores the importance of standard wide excision techniques and the need for molecular characterization of the lesions for aggressive forms. |
Subsequent primary cancers among men and women with in situ and invasive melanoma of the skin
Balamurugan A , Rees JR , Kosary C , Rim SH , Li J , Stewart SL . J Am Acad Dermatol 2011 65 S69-77 BACKGROUND: An estimated 750,000 melanoma survivors in the United States are at increased risk of subsequent primary cancers. OBJECTIVE: We sought to assess the risk of developing subsequent primary cancers among people with cutaneous melanoma. METHODS: Using 1992 to 2006 data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program, 40,881 people with in situ melanoma and 76,041 people with invasive melanoma were followed up (mean of 5.6 years) for the development of subsequent primary cancers. The observed number of subsequent cancers was compared with those expected based on age-/race-/year-/site-specific rates in the Surveillance, Epidemiology, and End Results population. Standardized incidence ratios (SIRs) (SIR = observed number/expected number) were considered statistically significant if they differed from 1, with an alpha level of 0.05. RESULTS: After a first primary in situ melanoma, risk was significantly elevated for subsequent invasive melanoma and chronic lymphocytic leukemia among men (SIRs = 8.43 and 1.44, respectively) and women (SIRs = 12.33 and 1.79, respectively). After a first primary invasive melanoma, risk was significantly elevated for subsequent invasive melanoma, thyroid cancer, non-Hodgkin lymphoma, and chronic lymphocytic leukemia among both men (SIRs = 12.50, 2.67, 1.56, and 1.57, respectively) and women (SIRs = 15.67, 1.77, 1.42, and 1.63, respectively). LIMITATIONS: Case ascertainment issues particularly affecting in situ melanoma cases could affect results. The role of detection bias in the diagnoses of some subsequent cancers cannot be completely eliminated. CONCLUSIONS: The findings of the study should guide the development of strategies such as posttreatment surveillance, screening, and ultraviolet exposure education among melanoma survivors to improve cancer survivorship. |
Effect of the staging schema on melanoma cancer reporting, 1999 to 2006
Lai SM , King JB , Garimella S , Keighley J , Lewis M . J Am Acad Dermatol 2011 65 S95-S103 BACKGROUND: Staging schemas have changed multiple times over the past 10 years. OBJECTIVE: We sought to examine the impact of staging schemas on the distribution of stages at diagnosis over time. METHODS: We examined the stage at diagnosis for melanoma cancer cases diagnosed between 1999 and 2006 using data provided by the Surveillance, Epidemiology, and End Results (SEER) and National Program of Cancer Registries (NPCR) programs. The staging schemas were summary staging 1977 (SS1977), summary staging 2000 (SS2000), derived SS2000, and SEER historic staging systems. RESULTS: Melanoma was predominantly staged as a localized disease in all schemas. Using SEER data, the proportion of localized melanomas diagnosed in 2001 to 2003 using SS2000 was about 2.5% lower than the proportion diagnosed in 1999 to 2000 using SS1977, whereas the proportion of cases staged as regional was 2.7% higher using the SS2000 than SS1977. The distribution of stages for cases diagnosed in 2001 to 2003 using SS2000 was similar to that for cases diagnosed in 2004 to 2006 using a derived SS2000. Shift in stage distribution among SS1977, SS2000, and SEER historic staging was found to be about 6% (localized to regional) and about 17.5% (unknown to regional stage). The distribution of changes in stage observed for the SEER cases was not evident for cases from NPCR. LIMITATIONS: SEER historic staging was not available for NPCR cases. CONCLUSION: Changes in staging rules resulted in cases being moved from the localized to the regional stage and from unknown to the regional stage. Without staging rules that have been consistently applied to melanomas over many years, surveillance of prevention, treatment, and control of this condition is difficult. |
Heart rate recovery after treadmill exercise testing is an independent predictor of stroke incidence in men with metabolic syndrome
Kim J , Byun W , Sui X , Lee DC , Cheng YJ , Blair SN . Obes Res Clin Pract 2011 5 (4) e295-e303 BACKGROUND AND AIMS: Heart rate recovery (HRR), a measure of the heart rate which decreases after a graded exercise test, has been associated with mortality and cardiovascular diseases. However, the association between HRR and risk of stroke has not been fully determined in men with metabolic syndrome (MetS). METHODS: Participants were 3886 men with MetS, aged 40-79 years, who completed a maximal exercise test during 1979-2004. We calculated 5-min HRR as the primary predictor and identified HRR tertiles; tertile 1 (<59 bpm), tertile 2 (59-71 bpm), and tertile 3 (>71 bpm). Stroke incidence was ascertained from responses to mail-back surveys during 1982-2004. Differences in baseline characteristics across HRR tertiles were examined using general linear model. Hazard ratios (HRs) and 95% confidence intervals (95% CIs), were estimated using Cox regression model after adjusted for potential confounders. RESULTS: We identified 90 incident stroke cases during an average follow-up of 15.2 years. After adjusting for age-, examination year-, and survey response indicator, a significant inverse association between HRR and incident stroke was observed in men with MetS (p < 0.001). Compared with the lowest tertile of HRR, adjusted HRs in the second and third tertiles were 0.96 (0.53-1.74) and 0.41 (0.20-0.87), respectively. We also found a significant linear trend (p < 0.03) across increments of HRR. CONCLUSION: Delayed HRR was independently associated the higher risk of incident stroke in men with MetS. This suggests that HRR have prognostic value of stroke risk for men with MetS. (2010 Asian Oceanian Association for the Study of Obesity). |
Rocky Mountain spotted fever in Panama: a cluster description
Tribaldos M , Zaldivar Y , Bermudez S , Samudio F , Mendoza Y , Martinez AA , Villalobos R , Eremeeva ME , Paddock CD , Page K , Smith RE , Pascale JM . J Infect Dev Ctries 2011 5 (10) 737-41 Rocky Mountain spotted fever (RMSF) is a tick-borne infection caused by Rickettsia rickettsii. We report a cluster of fatal cases of RMSF in 2007 in Panama, involving a pregnant woman and two children from the same family. The woman presented with a fever followed by respiratory distress, maculopapular rash, and an eschar at the site from which a tick had been removed. She died four days after disease onset. This is the second published report of an eschar in a patient confirmed by PCR to be infected with R. rickettsii. One month later, the children presented within days of one another with fever and rash and died three and four days after disease onset. The diagnosis was confirmed by immunohistochemistry, PCR and sequencing of the genes of R. rickettsii in tissues obtained at autopsy. |
Mortality trends in the US Perinatal AIDS Collaborative Transmission Study (1986-2004)
Kapogiannis BG , Soe MM , Nesheim SR , Abrams EJ , Carter RJ , Farley J , Palumbo P , Koenig LJ , Bulterys M . Clin Infect Dis 2011 53 (10) 1024-34 BACKGROUND: Highly active antiretroviral therapy (HAART) has improved human immunodeficiency virus (HIV)-associated morbidity and mortality. The bimodal mortality distribution in HIV-infected children makes it important to evaluate temporal effects of HAART among a birth cohort with long-term, prospective follow-up. METHODS: Perinatal AIDS Collaborative Transmission Study (PACTS)/PACTS-HIV Follow-up of Perinatally Exposed Children (HOPE) study was a Centers for Disease Control and Prevention-sponsored multicenter, prospective birth cohort study of HIV-exposed uninfected and infected infants from 1985 until 2004. Mortality was evaluated for the no/monotherapy, mono-/dual-therapy, and HAART eras, that is, 1 January 1986 through 31 December 1990, from 1 January 1991 through 31 December 1996, and 1 January 1997 through 31 December 2004. RESULTS: Among 364 HIV-infected children, 56% were female and 69% black non-Hispanic. Of 98 deaths, 79 (81%) and 61 (62%) occurred in children ≤3 and ≤2 years old, respectively. The median age at death increased significantly across the eras (P < .0001). The average annual mortality rates were 18 (95% confidence interval [CI], 11.6-26.8), 6.9 (95% CI, 5.4-8.8), and 0.8 (95% CI, 0.4-1.5) events per 100 person-years for the no/monotherapy, mono-/dual-therapy and HAART eras, respectively. The corresponding 6-year survival rates for children born in these eras were 57%, 76%, and 91%, respectively (P < .0001). Among children who received HAART in the first 6 months of age, the probability of 6-year survival was 94%. Ten-year survival rates for HAART and non-HAART recipients were 94% and 45% (P < .05). HAART-associated reductions in mortality remained significant after adjustment for confounders (hazard ratio, 0.3; 95% CI, .08-.76). Opportunistic infections (OIs) caused 31.8%, 16.9%, and 9.1% of deaths across the respective eras (P = .051). CONCLUSIONS: A significant decrease in annual mortality and a prolongation in survival were seen in this US perinatal cohort of HIV-infected children. Temporal decreases in OI-associated mortality resulted in relative proportional increases of non-OI-associated deaths. (See the Editorial Commentary by Nachman, on pages 1035-6.) |
Predictors of time to enter medical care after a new HIV diagnosis: a statewide population-based study
Tripathi A , Gardner LI , Ogbuanu I , Youmans E , Stephens T , Gibson JJ , Duffus WA . AIDS Care 2011 23 (11) 1366-73 Public health benefits of expanded HIV screening will be adequately realized only if an early diagnosis is followed by prompt linkage to care. We characterized rates and factors associated with failure to enter into medical care within three months of HIV diagnosis and assessed the predictors of time to enter care over a follow-up period of up to 60 months. The study cohort included 3697 South Carolina (SC) residents'≥13 years who were newly HIV-diagnosed in 2004-2008. Date of first laboratory report of CD4(+) T-cell count or viral load (VL) test after 30 days of confirmatory HIV diagnosis was used to define time to linkage to care. Results showed that of the total 3697 persons, 1768 (48%) entered care within three months, 1115 (30%) in four-12 months after diagnosis, and 814 (22%) failed to initiate care within 12 months of HIV diagnosis. At the end of study follow-up period of up to 60 months from the date of HIV diagnosis, 472/3697 (13%) individuals remained out of care. Multivariable Cox proportional hazards analysis showed that compared with hospitals, time to enter care was shorter in those diagnosed at state mental health/correctional facilities (adjusted hazards ratio [aHR] 1.16; 95% confidence interval [CI] 1.02-1.34) and longer in those diagnosed at county health departments (aHR 0.87; 95% CI 0.80-0.96) and at "Other/unknown" facilities (aHR 0.79; 95% CI 0.70-0.89). Time to entry into care was longer for men (aHR 0.82; 95% CI 0.75-0.89) compared with women, blacks (aHR 0.91; 95% CI 0.83-0.98) compared with whites, and males who have sex with males (MSM) (aHR 0.89; 95% CI 0.80-0.98) compared with heterosexual exposure. Delayed entry into HIV care remains a challenge in controlling HIV transmission in SC. Better integration of testing and care facilities could improve the proportion of newly HIV-diagnosed persons who enter care in a timely manner. |
Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa
Van Kerkhove MD , Mounts AW , Mall S , Vandemaele KA , Chamberland M , Dos Santos T , Fitzner J , Widdowson MA , Michalove J , Bresee J , Olsen SJ , Quick L , Baumeister E , Carlino LO , Savy V , Uez O , Owen R , Ghani F , Paterson B , Forde A , Fasce R , Torres G , Andrade W , Bustos P , Mora J , Gonzalez C , Olea A , Sotomayor V , Najera De Ferrari M , Burgos A , Hunt D , Huang QS , Jennings LC , Macfarlane M , Lopez LD , McArthur C , Cohen C , Archer B , Blumberg L , Cengimbo A , Makunga C , McAnerney J , Msimang V , Naidoo D , Puren A , Schoub B , Thomas J , Venter M . Influenza Other Respir Viruses 2011 5 (6) e487-e498 INTRODUCTION AND SETTING: Our analysis compares the most comprehensive epidemiologic and virologic surveillance data compiled to date for laboratory-confirmed H1N1pdm patients between 1 April 2009 - 31 January 2010 from five temperate countries in the Southern Hemisphere-Argentina, Australia, Chile, New Zealand, and South Africa. OBJECTIVE: We evaluate transmission dynamics, indicators of severity, and describe the co-circulation of H1N1pdm with seasonal influenza viruses. RESULTS: In the five countries, H1N1pdm became the predominant influenza strain within weeks of initial detection. South Africa was unique, first experiencing a seasonal H3N2 wave, followed by a distinct H1N1pdm wave. Compared with the 2007 and 2008 influenza seasons, the peak of influenza-like illness (ILI) activity in four of the five countries was 3-6 times higher with peak ILI consultation rates ranging from 35/1,000 consultations/week in Australia to 275/100,000 population/week in New Zealand. Transmission was similar in all countries with the reproductive rate ranging from 1.2-1.6. The median age of patients in all countries increased with increasing severity of disease, 4-14% of all hospitalized cases required critical care, and 26-68% of fatal patients were reported to have ≥1 chronic medical condition. Compared with seasonal influenza, there was a notable downward shift in age among severe cases with the highest population-based hospitalization rates among children <5 years old. National population-based mortality rates ranged from 0.8-1.5/100,000. CONCLUSIONS: The difficulty experienced in tracking the progress of the pandemic globally, estimating its severity early on, and comparing information across countries argues for improved routine surveillance and standardization of investigative approaches and data reporting methods. |
Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, black men who have sex with men
Wu E , El-Bassel N , Donald McVinney L , Hess L , Remien RH , Charania M , Mansergh G . AIDS Behav 2011 15 (8) 1745-54 Accumulating evidence supports couple-based approaches for HIV/STI preventive interventions. Yet, to date, no studies have examined couple-based sexual risk reductions intervention specifically for men who have sex with men (MSM) from populations with elevated rates of HIV/STI transmission, such as black MSM and methamphetamine-involved MSM. We pilot tested-using a pre-/post-test design-a seven-session couple-based intervention for black, methamphetamine-using, black MSM couples engaging in sexual risk. Feasibility was assessed via recruitment and retention rates; potential efficacy relied on self-reported sexual risk and drug use prior to and two months following intervention delivery. We enrolled 34 couples (N = 68 men). Over 80% attended all seven intervention sessions, and retention exceeded 95% at two-month follow-up. At follow-up, participants reported significantly fewer sexual partners, fewer episodes of unprotected anal sex, and greater condom use with their main partner; participants also reported significantly less methamphetamine use, any illicit drug use, and number of illicit drugs used. These findings indicate that couple-based HIV/STI intervention is feasible and promising for at-risk black MSM couples. |
Influence of birth rates and transmission rates on the global seasonality of rotavirus incidence
Pitzer VE , Viboud C , Lopman BA , Patel MM , Parashar UD , Grenfell BT . J R Soc Interface 2011 8 (64) 1584-93 Rotavirus is a major cause of mortality in developing countries, and yet the dynamics of rotavirus in such settings are poorly understood. Rotavirus is typically less seasonal in the tropics, although recent observational studies have challenged the universality of this pattern. While numerous studies have examined the association between environmental factors and rotavirus incidence, here we explore the role of intrinsic factors. By fitting a mathematical model of rotavirus transmission dynamics to published age distributions of cases from 15 countries, we obtain estimates of local transmission rates. Model-predicted patterns of seasonal incidence based solely on differences in birth rates and transmission rates are significantly correlated with those observed (Spearman's rho = 0.65, p < 0.05). We then examine seasonal patterns of rotavirus predicted across a range of different birth rates and transmission rates and explore how vaccination may impact these patterns. Our results suggest that the relative lack of rotavirus seasonality observed in many tropical countries may be due to the high birth rates and transmission rates typical of developing countries rather than being driven primarily by environmental conditions. While vaccination is expected to decrease the overall burden of disease, it may increase the degree of seasonal variation in the incidence of rotavirus in some settings. |
Critically ill children during the 2009-2010 influenza pandemic in the United States
Randolph AG , Vaughn F , Sullivan R , Rubinson L , Thompson BT , Yoon G , Smoot E , Rice TW , Loftis LL , Helfaer M , Doctor A , Paden M , Flori H , Babbitt C , Graciano AL , Gedeit R , Sanders RC , Giuliano JS , Zimmerman J , Uyeki TM . Pediatrics 2011 128 (6) e1450-8 BACKGROUND: The 2009 pandemic influenza A (H1N1) (pH1N1) virus continues to circulate worldwide. Determining the roles of chronic conditions and bacterial coinfection in mortality is difficult because of the limited data for children with pH1N1-related critical illness. METHODS: We identified children (<21 years old) with confirmed or probable pH1N1 admitted to 35 US PICUs from April 15, 2009, through April 15, 2010. We collected data on demographics, baseline health, laboratory results, treatments, and outcomes. RESULTS: Of 838 children with pH1N1 admitted to a PICU, the median age was 6 years, 58% were male, 70% had ≥1 chronic health condition, and 88.2% received oseltamivir (5.8% started before PICU admission). Most patients had respiratory failure with 564 (67.3%) receiving mechanical ventilation; 162 (19.3%) received vasopressors, and 75 (8.9%) died. Overall, 71 (8.5%) of the patients had a presumed diagnosis of early (within 72 hours after PICU admission) Staphylococcus aureus coinfection of the lung with 48% methicillin-resistant S aureus (MRSA). In multivariable analyses, preexisting neurologic conditions or immunosuppression, encephalitis (1.7% of cases), myocarditis (1.4% of cases), early presumed MRSA lung coinfection, and female gender were mortality risk factors. Among 251 previously healthy children, only early presumed MRSA coinfection of the lung (relative risk: 8 [95% confidence interval: 3.1-20.6]; P < .0001) remained a mortality risk factor. CONCLUSIONS: Children with preexisting neurologic conditions and immune compromise were at increased risk of pH1N1-associated death after PICU admission. Secondary complications of pH1N1, including myocarditis, encephalitis, and clinical diagnosis of early presumed MRSA coinfection of the lung, were mortality risk factors. |
Current epidemiology and trends in invasive Haemophilus influenzae disease - United States, 1989-2008
MacNeil JR , Cohn AC , Farley M , Mair R , Baumbach J , Bennett N , Gershman K , Harrison LH , Lynfield R , Petit S , Reingold A , Schaffner W , Thomas A , Coronado F , Zell ER , Mayer LW , Clark TA , Messonnier NE . Clin Infect Dis 2011 53 (12) 1230-1236 BACKGROUND: With the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines, there has been a dramatic reduction of Hib disease in young children and the epidemiological trends of invasive H. influenzae have shifted. METHODS: Data were collected from active surveillance for invasive H. influenzae disease conducted through Active Bacterial Core surveillance sites during 1989-2008. RESULTS: During 1999-2008, the estimated mean annual incidence of H. influenzae infection was 1.62 cases per 100,000 population; 15.3% of cases were fatal. Incidence was higher among adults aged ≥65 years, compared with other age groups. The largest burden of disease among children aged <5 years was in infants aged <1 year; many of these cases occurred during the first month of life in preterm or low-birth weight infants. An estimated 10% of the total burden of disease among children aged <5 years occurred in American Indian and Alaska Native children. During 1989-2008, 7559 cases of H. influenzae disease were reported from Active Bacterial Core surveillance sites. Small increases in the incidence of serotypes a, e, and f were observed during 1989-2008. The largest of these increases was in serotype f and was primarily among adults aged ≥18 years. CONCLUSIONS: Since the introduction of Hib conjugate vaccines, the incidence of invasive disease caused by H. influenzae in the United States has decreased dramatically; however, a considerable burden of non-Hib disease is still present in the oldest and youngest age groups. There is no evidence of substantial replacement disease with non-b serotypes in young children in the United States. |
Detection of human parechovirus (HPeV)-3 in spinal fluid specimens from pediatric patients in the Chicago area
Walters B , Penaranda S , Nix WA , Oberste MS , Todd KM , Katz BZ , Zheng X . J Clin Virol 2011 52 (3) 187-91 BACKGROUND: The human parechoviruses (HPeV) have recently been recognized as important viral pathogens causing various illnesses including sepsis and meningitis in children. However, data from the United States is limited. OBJECTIVES: To better understand the epidemiology of HPeV in the United States and its role in pediatric disease through detection and typing of the virus in cerebrospinal fluid specimens. STUDY DESIGN: Four hundred and twenty-one spinal fluid samples collected from 373 patients ranging in age from 1 day to 18 years were tested using a real-time reverse transcription-PCR assay. The specimens were originally collected for routine viral and bacterial testing to assist in the diagnosis of meningitis or sepsis. Amplification products of the VP1 region in the virus genome were sequenced to identify the parechovirus type. RESULTS: Ten positive specimens were identified from 10 different patients. All ten samples were typed as HPeV3 and were negative for bacteria by culture, and for enterovirus and herpes simplex virus by PCR. All of the HPeV3-infected patients were young infants ranging in age from 6 to 59 days. Infants in whom HPeV3 was detected had significantly decreased peripheral white blood cell counts. Positive specimens were all from the summer and early fall. CONCLUSIONS: HPeV3 infection of the central nervous system is found in very young infants in certain years during the summer and early fall, and is associated with leukopenia. Real-time RT-PCR is an effective tool for rapid detection of these infections, and could help prevent unnecessary hospitalization and antibiotic use in HPeV infected infants. More widespread use of this tool in diagnosing HPeV infection would aid in further clarifying the prevalence of this disease in the United States. |
Global population structure of Aspergillus terreus inferred by ISSR typing reveals geographical subclustering.
Neal CO , Richardson AO , Hurst SF , Tortorano AM , Viviani MA , Stevens DA , Balajee SA . BMC Microbiol 2011 11 203 BACKGROUND: Aspergillus terreus causes invasive aspergillosis (IA) in immunocompromised individuals and can be the leading cause of IA in certain medical centers. We examined a large isolate collection (n = 117) for the presence of cryptic A. terreus species and employed a genome scanning method, Inter-Simple Sequence Repeat (ISSR) PCR to determine A. terreus population structure. RESULTS: Comparative sequence analyses of the calmodulin locus revealed the presence of the recently recognized species A. alabamensis (n = 4) in this collection. Maximum parsimony, Neighbor joining, and Bayesian clustering of the ISSR data from the 113 sequence-confirmed A. terreus isolates demonstrated that one clade was composed exclusively of isolates from Europe and another clade was enriched for isolates from the US. CONCLUSIONS: This study provides evidence of a population structure linked to geographical origin in A. terreus. |
Experimental infection by capillary tube feeding of Rhipicephalus sanguineus with Bartonella vinsonii subspecies berkhoffii
Billeter SA , Kasten RW , Killmaster LF , Breitschwerdt EB , Levin ML , Levy MG , Kosoy MY , Chomel BB . Comp Immunol Microbiol Infect Dis 2011 35 (1) 9-15 It has been speculated that ticks may serve as vectors of Bartonella species. Circumstantial, clinical, epidemiological and serological evidence suggest that B. vinsonii subspecies berkhoffii (B. v. berkhoffii) might be transmitted by Rhipicephalus sanguineus. The purpose of the present study was to determine whether adult R. sanguineus ticks can be infected with a B. v. berkhoffii genotype II isolate via capillary tube feeding and whether the infection can then be transmitted from adult females to their eggs via trans-ovarial transmission. Furthermore, tick fecal material was also collected and screened as a possible source of infectious inoculum for canine infections. B. v. berkhoffii DNA was detected in 50% (7 of 14) of females that did not oviposit and in 14.3% (2 of 14) of female ticks that laid eggs, but not detected in egg clutches (100 eggs/female). DNA was also detected in tick feces collected on days 2 through 6 post-capillary tube feeding, however, dogs (n=3) did not become bacteremic or seroconvert when inoculated with tick fecal material. Therefore, trans-ovarial transmission of B. v. berkhoffii by R. sanguineus is unlikely, but further studies are needed to determine if tick fecal material can serve as a source of infection to canines. |
The last mile: taking the final steps in preventing pediatric pharmaceutical poisonings
Budnitz DS , Lovegrove MC . J Pediatr 2011 160 (2) 190-2 The dramatic reduction in pediatric deaths from unintentional poisonings in the last half of the 20th century is a model of the successful application of injury prevention theory and practice. The increases in hospitalizations and emergency department (ED) visits and persistence of deaths caused by unintentional pediatric pharmaceutical poisonings in the first decade of this century described by Bond et al in this issue of The Journal remind us that this effort is not yet complete.1 Hopefully the findings in this study can help catalyze targeted efforts to reverse the rise in injuries from pediatric pharmaceutical poisonings and push the number of pediatric deaths closer to zero. | Educational initiatives, engineering modifications, and enforcement actions (the three E’s of injury prevention) all contributed to a decrease in pediatric poisonings in the 20th century. Educational initiatives for parents, caregivers, and children became a cornerstone of poisoning prevention activities when the third week of March was designated as National Poison Prevention Week in 1961.2 An engineering approach to pharmaceutical poisoning prevention was introduced in the 1950s when Dr. Jay Arena convinced manufacturers to place “safety closures” on bottles of flavored children’s aspirin to prevent self-ingestion by young children.3 Unfortunately, the number of pediatric salicylate poisoning deaths continued to increase. The most popular early cap design depended on friction to keep the cap in place, and although many young children could not open these caps with their hands, they could open them using their teeth. With adoption of other types of closures, such as those which required pressure and rotation, deaths began to decline.4 After studies in the late 1960s demonstrated that child resistant closures (CRCs) on bottles of adult prescription medicines reduced unintentional poisonings among children, the Poison Prevention and Packaging Act (PPPA) was passed in 1970.5 The U.S. Consumer Product Safety Commission now enforces the use of CRCs on potentially toxic products, including many over-the-counter (OTC) and nearly all prescription medications.6,7 |
Oral contraceptive formulation and risk of breast cancer
Marchbanks PA , Curtis KM , Mandel MG , Wilson HG , Jeng G , Folger SG , McDonald JA , Daling JR , Bernstein L , Malone KE , Wingo PA , Simon MS , Norman SA , Strom BL , Ursin G , Weiss LK , Burkman RT , Spirtas R . Contraception 2011 85 (4) 342-50 BACKGROUND: While evidence on the association between oral contraceptive (OC) use and breast cancer generally suggests little or no increased risk, the question of whether breast cancer risk varies by OC formulation remains controversial. Few studies have examined this issue because large samples and extensive OC histories are required. STUDY DESIGN: We used data from a multicenter, population-based, case-control investigation. Women aged 35-64 years were interviewed. To explore the association between OC formulation and breast cancer risk, we used conditional logistic regression to derive adjusted odds ratios, and we used likelihood ratio tests for heterogeneity to assess whether breast cancer risk varied by OC formulation. Key OC exposure variables were ever use, current or former use, duration of use and time since last use. To strengthen inferences about specific formulations, we restricted most analyses to the 2282 women with breast cancer and the 2424 women without breast cancer who reported no OC use or exclusive use of one OC. RESULTS: Thirty-eight formulations were reported by the 2674 women who used one OC; most OC formulations were used by only a few women. We conducted multivariable analyses on the 10 formulations that were each used by at least 50 women and conducted supplemental analyses on selected formulations of interest based on recent research. Breast cancer risk did not vary significantly by OC formulation, and no formulation was associated with a significantly increased breast cancer risk. CONCLUSIONS: These results add to the small body of literature on the relationship between OC formulation and breast cancer. Our data are reassuring in that, among women 35-64 years of age, we found no evidence that specific OC formulations increase breast cancer risk. |
Case files of the Emory University Medical Toxicology Fellowship: inhalational mercury toxicity from a traditional Vietnamese product
Pandalai SL , Morgan BW . J Med Toxicol 2011 7 (4) 295-305 A 41-year-old woman attempted to treat her sinus congestion with a complementary and alternative medicine (CAM) product consisting of dime-size white pellets originally purchased in Vietnam by a family member who brought it with her to the USA. The remedy was obtained from one of her relatives who stated that treatment with these pellets had alleviated similar symptoms of other persons from her hometown in Vietnam. The patient was advised to heat the pellets on an electric stove for 2–3 days at various times, and inhale the fumes that were produced. After using the product for 2 days, she developed generalized malaise, dry skin, and poor appetite. She was later informed by a family member in Vietnam that the remedy may contain mercury and lead. She presented to her primary care clinic for metal testing, where initial total blood mercury (organic plus inorganic) and total blood lead concentrations were found to be 409 μg/L (normal, ≤10 μg/L) and 1 μg/L (normal, <10 μg/L), respectively. Her physician advised her to discontinue this treatment and was subsequently referred to the authors’ toxicology clinic. | The patient’s initial evaluation in our toxicology clinic was approximately 4 weeks after her initial exposure to the CAM product, and she continued to describe overall malaise and dry skin. She also complained of depressed mood and poor appetite. On physical examination, the patient was in no distress and her vital signs included a temperature of 36.9°C, heart rate of 109 beats per minute, blood pressure of 125/81 mmHg, and respiratory rate of 18 breaths per minute. Her oral exam showed mild erythema of the tongue, but no evidence of gingivostomatitis (which may occur with mercury toxicity). Her mini-mental status examination including orientation to person, place, time, attention, immediate and delayed recall, naming, repetition, reading, writing and copying was normal. She was able to follow a three-stage command with no difficulty. No other abnormalities were noted on the remainder of her neurological examination, which included gross cranial nerve testing, deep tendon reflexes, muscle strength, gait, cerebellar function, and sensation to pin-prick testing. Her skin exam was notable for generalized dryness of the extremities. |
Cell phone- and internet-based monitoring and evaluation of the national antiretroviral treatment program during rapid scale-up in Rwanda: TRACnet, 2004--2010
Nsanzimana S , Ruton H , Lowrance DW , Cishahayo S , Nyemazi JP , Muhayimpundu R , Karema C , Raghunathan PL , Binagwaho A , Riedel DJ . J Acquir Immune Defic Syndr 2011 59 (2) e17-23 BACKGROUND: Monitoring and evaluation of antiretroviral treatment (ART) scale-up has been challenging in resource-limited settings. We describe an innovative cell-phone and internet-based reporting system (TRACnet) utilized in Rwanda. METHODS: From January 2004 to June 30, 2010, all health facilities with ART services submitted standardized monthly aggregate reports of key indicators. National cohort data were analyzed to examine trends in characteristics of patients initiating ART and cumulative cohort outcomes. Estimates of HIV-infected patients eligible for ART were obtained from UNAIDS (EPP-Spectrum, 2010). RESULTS: By June 30, 2010, 295 (65%) of 451 health centers, District and referral hospitals provided ART services; of these, 255 (86%) were located outside Kigali, the capital. Cell-phone- and internet-based reporting was used by 253 (86%) and 42 (14%), respectively. As of June 30, 2010, 83,041 patients were alive on ART, 6,171 (6%) had died, and 9,621 (10%) were lost-to-follow-up. Of those alive on ART, 7,111 (8.6%) were children, 50,971 (61.4%) were female, and 1,823 (2.2%) were on a second-line regimen. The proportion of all patients initiating ART at WHO clinical stages 3 and 4 declined from 65% in 2005 to 27% in 2010. National ART coverage of eligible patients increased from 13% in 2005 to 79% in 2010. CONCLUSIONS: Rwanda has successfully expanded ART access and achieved high national ART coverage among eligible patients. TRACnet captured essential data about the ART program during rapid scale-up. Cell-phone and internet-based reporting may be useful for monitoring and evaluation of similar public health initiatives in other resource-limited settings. |
Completion of the 2-dose influenza vaccine series among children aged 6 to 59 months: Immunization Information System sentinel sites, 2007-2008 influenza season
Pabst LJ , Fiore AE , Cullen KA . Clin Pediatr (Phila) 2011 50 (11) 1068-70 Recommendations for routine vaccination of all children aged 6 to 23 months and 24 to 59 months with seasonal influenza vaccine were first published by the Advisory Committee for Immunization Practices (ACIP) in 2004 and 2006, respectively.1 Vaccine effectiveness and immunogenicity studies have shown that administration of only 1 influenza vaccine dose in the first year of vaccination conveys suboptimal protection.2-4 Prior to the 2007-2008 influenza season, children aged less than 9 years were recommended to receive 2 doses in their first year of vaccination.1 Two-dose vaccination recommendations were expanded for the 2007-2008 season to include children who received only 1 dose for the first time in the previous season.1 | Monitoring 2-dose compliance for influenza vaccination is important for evaluating vaccination efforts and developing innovative strategies to improve coverage. A limited number of studies have assessed 2-dose compliance in children. The Vaccine Safety Datalink Project, which includes data from 8 health maintenance organizations, reported that 2-dose compliance among children aged 6 to 23 months ranged from 29% to 54% during the 2001-2002, 2002-2003, and 2004-2005 seasons.5 Rates were lower among children aged 2 to 8 years (12%-24%). Data from the National Immunization Survey showed that only 11% of vaccine naïve children aged 6 to 23 months received both doses during the 2005-2006 influenza season.6 And, a recent study using private pediatric practice data from the 2007-2008 and 2008-2009 seasons found 2-dose compliance rates of 49.9% to 58.7% among 6- to 23-month-olds and 37.6% to 45.2% among 24- to 59-month-olds.7 | Because 2-dose compliance for immunization vaccination has not been assessed using population-based data since 2-dose vaccination recommendations changed for the 2007-2008 season, data from the Immunization Information System Sentinel Site Project were used to assess compliance among children aged 6 to 59 months during the 2007-2008 season and to determine if influenza vaccination history was associated with completion of 2 doses. |
A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant Latino men
Rhodes SD , McCoy TP , Vissman AT , Diclemente RJ , Duck S , Hergenrather KC , Foley KL , Alonzo J , Bloom FR , Eng E . AIDS Behav 2011 15 (8) 1764-75 This randomized controlled trial tested the efficacy of an HIV prevention intervention to increase condom use and HIV testing among Spanish-speaking, heterosexually active immigrant Latino men. A community-based participatory research partnership developed the intervention and selected the study design. Following baseline data collection, 142 immigrant Latino men were randomized to the HIV prevention intervention or the cancer education intervention. Three-month follow-up data were collected from 139 participants, for a 98% retention rate. Mean age of participants was 31.6 years and 60% reported being from Mexico. Adjusting for baseline behaviors, relative to their peers in the cancer education comparison, participants in the HIV prevention intervention were more likely to report consistent condom use and receiving an HIV test. Community-based interventions for immigrant Latino men that are built on state of the art prevention science and developed in partnership with community members can greatly enhance preventive behaviors and may reduce HIV infection. |
Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: review from national surveys and case studies of 3 states
Buller DB , Cokkinides V , Hall HI , Hartman AM , Saraiya M , Miller E , Paddock L , Glanz K . J Am Acad Dermatol 2011 65 S114-23 BACKGROUND: Exposure to ultraviolet radiation (from solar and nonsolar sources) is a risk factor for skin cancer. OBJECTIVE: We sought to summarize recent estimates on sunburns, sun-protection behaviors, and indoor tanning available from national and selected statewide behavioral surveys. METHODS: Estimates of the prevalence of sunburn, sun-protection behaviors, and indoor tanning by US adults, adolescents, and children collected in national surveys in 1992, 2004 to 2005, and 2007 to 2009 were identified and extracted from searches of computerized databases (ie, MEDLINE and PsychINFO), reference lists, and survey World Wide Web sites. Sunburn estimates from 3 state Behavioral Risk Factors Surveillance Systems were also analyzed. RESULTS: Latest published estimates (2005) showed that 34.4% of US adults were sunburned in the past year. Incidence of sunburns was highest among men, non-Hispanic whites, young adults, and high-income groups in national surveys. About 3 in 10 adults routinely practiced sun-protection behaviors, and women and older adults took the most precautions. Among adolescents, 69% were sunburned in the previous summer and less than 40% practiced sun protection. Approximately 60% of parents applied sunscreen and a quarter used shade to protect children. Indoor tanning was prevalent among younger adults and females. LIMITATIONS: Limitations include potential recall errors and social desirability in self-report measures, and lack of current data on children. CONCLUSION: Many Americans experienced sunburns and a minority engaged in protective behaviors. Females and older adults were most vigilant about sun protection. Substantial proportions of young women and adolescents recently used indoor tanning. Future efforts should promote protective hats, clothing, and shade; motivate males and younger populations to take precautions; and convince women and adolescents to reduce indoor tanning. |
Girlfriends: evaluation of an HIV-risk reduction intervention for adult transgender women
Taylor RD , Bimbi DS , Joseph HA , Margolis AD , Parsons JT . AIDS Educ Prev 2011 23 (5) 469-78 This study evaluated Girlfriends, a behavioral HIV intervention, developed for male-to-female transgender persons, for whom there are few scientifically evaluated prevention programs. The Girlfriends intervention included four group-level sessions. We used a single group, pre-post test design to assess changes in sexual risk behaviors at 3-month follow-up. We enrolled 63 transgender women into the study. Forty-six percent were Hispanic and 35% were African American. Three months after the intervention, participants had fewer sexual partners (p = .043) and were less likely to have any unprotected anal intercourse (UAI) with male exchange partners (p = .013) and unprotected sex at last vaginal or anal sex episode with female and male partners (p = .039). The findings of this study are promising. We observed behavioral effects among a largely ethnic minority sample of transgender women. Replication with a larger sample and a control group is needed. |
Differences in the social networks of African American men who have sex with men only and those who have sex with men and women
Latkin C , Yang C , Tobin K , Penniman T , Patterson J , Spikes P . Am J Public Health 2011 101 (10) e18-23 OBJECTIVES: We compared social network characteristics of African American men who have sex with men only (MSMO) with social network characteristics of African American men who have sex with men and women (MSMW). METHODS: Study participants were 234 African American men who have sex with men who completed a baseline social network assessment for a pilot behavioral HIV prevention intervention in Baltimore, Maryland, from 2006 through 2009. We surveyed the men to elicit the characteristics of their social networks, and we used logistic regression models to assess differences in network characteristics. RESULTS: MSMO were significantly more likely than were MSMW to be HIV-positive (52% vs 31%). We found no differences between MSMO and MSMW in the size of kin networks or emotional and material support networks. MSMW had denser sexual networks, reported more concurrent and exchange partners, used condoms with more sexual partners, and reported interaction with a larger number of sexual partners at least once a week. CONCLUSIONS: Although there were many similarities in the social and sexual network characteristics of MSMO and MSMW, differences did exist. HIV prevention interventions should address the unique needs of African American MSMW. |
Efficacy of a health educator-delivered HIV prevention intervention for Latina women: a randomized controlled trial
Wingood GM , Diclemente RJ , Villamizar K , Er D , Devarona M , Taveras J , Painter TM , Lang DL , Hardin JW , Ullah E , Stallworth J , Purcell DW , Jean R . Am J Public Health 2011 101 (12) 2245-52 OBJECTIVES: We developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women. METHODS: We recruited 252 Latina women aged 18 to 35 years in Miami, Florida, in 2008 to 2009 and randomized them to the 4-session AMIGAS intervention or a 1-session health intervention. Participants completed audio computer-assisted self-interviews at baseline and follow-up. RESULTS: Over the 6-month follow-up, AMIGAS participants reported more consistent condom use during the past 90 (adjusted odds ratio [AOR]=4.81; P<.001) and 30 (AOR=3.14; P<.001) days and at last sexual encounter (AOR=2.76; P<.001), and a higher mean percentage condom use during the past 90 (relative change=55.7%; P<.001) and 30 (relative change=43.8%; P<.001) days than did comparison participants. AMIGAS participants reported fewer traditional views of gender roles(P=008), greater self-efficacy for negotiating safer sex (P<.001), greater feelings of power in relationships (P=.02), greater self-efficacy for using condoms (P<.001), and greater HIV knowledge (P=.009) and perceived fewer barriers to using condoms (P<.001). CONCLUSIONS: Our results support the efficacy of this linguistically and culturally adapted HIV intervention among ethnically diverse, predominantly foreign-born Latina women. (Am J Public Health. Published online ahead of print October 20, 2011:e1-e8. doi:10.2105/AJPH.2011.300340). |
Progress in newborn hepatitis B vaccination by birth year cohorts-1998-2007, USA
Zhao Z , Murphy TV , Jacques-Carroll L . Vaccine 2011 30 (1) 14-20 BACKGROUND: In 1999, the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (USPHS), issued a joint statement on thimerosal in vaccines, which advised clinicians to temporarily postpone the first dose of hepatitis B vaccine for infants born to hepatitis B surface antigen (HBsAg)-negative women. In 2005, the Advisory Committee on Immunization Practices (ACIP) updated the strategy to improve prevention of perinatal and early childhood hepatitis B virus (HBV) transmission. OBJECTIVES: To evaluate the progress in hepatitis B birth dose vaccination coverage in birth year cohort from 1998 to 2007 and assess the impact of changes in ACIP recommendations on the birth dose coverage. METHODS: Birth year cohort study of hepatitis B birth dose vaccination status of 200,865 children aged 19-35 months in the United States and by selected socio-demographic factors; percentage increases of hepatitis B birth dose vaccination coverage between two consecutive birth year cohorts from 1998 to 2007. RESULTS: From 1998 to 1999, hepatitis B birth dose vaccination coverage declined overall in the United States and among selected socio-demographic groups (P<0.001). Conversely, from 1999 to 2007 hepatitis B birth dose vaccination coverage increased significantly by birth year cohort (P<0.001), from approximately 30% in the 1999 birth year cohort to approximately 60% in the 2007 birth year cohort. The first significant increase in hepatitis B birth dose vaccination coverage occurred from 2000 to 2001 birth year cohort. Coverage increases ranged from 8.4% to 11.9% (P<0.001) in the U.S. and across all socio-demographic strata. The second largest increase in hepatitis B birth dose vaccination coverage occurred from 2005 to 2006 birth year cohort in the U.S. and among almost all socio-demographic strata, ranging from 5.6% to 8.7% (P<0.001). Forty-one of the 50 states and the District of Columbia (80%) in the U.S. had increases in hepatitis B birth dose vaccination coverage from 2005 to 2006 birth year cohort. CONCLUSIONS: The United States has made substantial progress in increasing hepatitis B birth dose vaccination and recovered from coverage declines associated with temporary postponement of the birth dose in 1999. The hepatitis B birth dose coverage in the U.S. remains substantially below the Healthy People 2020 target of 85%. |
Immunogenicity of supplemental doses of poliovirus vaccine for children aged 6-9 months in Moradabad, India: a community-based, randomised controlled trial
Estivariz CF , Jafari H , Sutter RW , John TJ , Jain V , Agarwal A , Verma H , Pallansch MA , Singh AP , Guirguis S , Awale J , Burton A , Bahl S , Chatterjee A , Aylward RB . Lancet Infect Dis 2011 12 (2) 128-35 BACKGROUND: The continued presence of polio in northern India poses challenges to the interruption of wild poliovirus transmission and the management of poliovirus risks in the post-eradication era. We aimed to assess the current immunity profile after routine doses of trivalent oral poliovirus vaccine (OPV) and numerous supplemental doses of type-1 monovalent OPV (mOPV1), and compared the effect of five vaccine formulations and dosages on residual immunity gaps. METHODS: We did a community-based, randomised controlled trial of healthy infants aged 6-9 months at ten sites in Moradabad, India. Serum neutralising antibody was measured before infants were randomly assigned to a study group and given standard-potency or higher-potency mOPV1, intradermal fractional-dose inactivated poliovirus vaccine (IPV, GlaxoSmithKline), or intramuscular full-dose IPV from two different manufacturers (GlaxoSmithKline or Panacea). Follow-up sera were taken at days 7 and 28. Our primary endpoint was an increase of more than four times in antibody titres. We did analyses by per-protocol in children with a blood sample available before, and 28 days after, receiving study vaccine (or who completed study procedures). This trial is registered with Current Controlled Trials, number ISRCTN90744784. FINDINGS: Of 1002 children enrolled, 869 (87%) completed study procedures (ie, blood sample available at day 0 and day 28). At baseline, 862 (99%), 625 (72%), and 418 (48%) had detectable antibodies to poliovirus types 1, 2, and 3, respectively. In children who were type-1 seropositive, an increase of more than four times in antibody titre was detected 28 days after they were given standard-potency mOPV1 (5/13 [38%]), higher-potency mOPV1 (6/21 [29%]), intradermal IPV (9/16 [56%]), GlaxoSmithKline intramuscular IPV (19/22 [86%]), and Panacea intramuscular IPV (11/13 [85%]). In those who were type-2 seronegative, 42 (100%) of 42 seroconverted after GlaxoSmithKline intramuscular IPV, and 24 (59%) of 41 after intradermal IPV (p<0.0001). 87 (90%) of 97 infants who were type-3 seronegative seroconverted after intramuscular IPV, and 21 (36%) of 49 after intradermal IPV (p<0.0001). INTERPRETATION: Supplemental mOPV1 resulted in almost total seroprevalence against poliovirus type 1, which is consistent with recent absence of poliomyelitis cases; whereas seroprevalence against types 2 and 3 was expected for routine vaccination histories. The immunogenicity of IPV produced in India (Panacea) was similar to that of an internationally manufactured IPV (GSK). Intradermal IPV was less immunogenic. FUNDING: Global Alliance for Vaccines and Immunization (GAVI), WHO. |
Commentary on Foubert, Godin, & Tatum (2010): the evolution of sexual violence prevention and the urgency for effectiveness
Tharp AT , Degue S , Lang K , Valle LA , Massetti G , Holt M , Matjasko J . J Interpers Violence 2011 26 (16) 3383-92 Foubert, Godin, and Tatum describe qualitative effects among college men of The Men's Program, a one-session sexual violence prevention program. This article and the program it describes are representative of many sexual violence prevention programs that are in practice and provide an opportunity for a brief discussion of the development and evaluation of sexual violence prevention approaches. In this commentary, we will focus on two considerations for an evolving field: the adherence to the principles of prevention and the use of rigorous evaluation methods to demonstrate effectiveness. We argue that the problem of sexual violence has created urgency for effective prevention programs and that scientific and prevention standards provide the best foundation to meet this need. |
Streptococcus pneumoniae serotype 9A isolates contain diverse mutations to wcjE that result in variable expression of serotype 9V-specific epitope.
Calix JJ , Oliver MB , Sherwood LK , Beall BW , Hollingshead SK , Nahm MH . J Infect Dis 2011 204 (10) 1585-95 BACKGROUND: Streptococcus pneumoniae is a significant pathogen capable of expressing protective and antigenically diverse capsules. To better understand the molecular basis of capsular antigenic diversity, we investigated the hypothetical serological role of wcjE, which encodes a capsule O-acetyltransferase, in the vaccine-targeted serotype 9V and related serotype 9A. METHODS: We inactivated wcjE by recombination in a serotype 9V strain and determined wcjE sequences of 11 serotype 9A clinical isolates. We determined the antigenic phenotypes of these pneumococcal strains with serogroup 9-specific antibodies and flow cytometry. RESULTS: Inactivation of wcjE in a serotype 9V strain resulted in expression of the 9A phenotype. Each serotype 9A clinical isolate contained a distinct mutation to wcjE. Flow cytometry showed that some 9A isolates (herein named 9Aalpha) expressed trace amounts of 9V-specific epitopes whereas others (named 9Abeta) did not express any. Recombination with 9Aalpha wcjE alleles into a 9Abeta strain conferred partial expression of 9V-specific epitopes. CONCLUSIONS: Each serotype 9A strain independently arose from a serotype 9V strain. Furthermore, clinical isolates identified as 9A can contain mutations to wcjE that are either partially functional or completely nonfunctional, demonstrating a previously unidentified antigenic heterogeneity of serotype 9A isolates. |
Serology as an adjunct to polymerase chain reaction assays for surveillance of acute respiratory virus infections.
Sawatwong P , Chittaganpitch M , Hall H , Peruski LF , Xu X , Baggett HC , Fry AM , Erdman DD , Olsen SJ . Clin Infect Dis 2011 54 (3) 445-6 Diagnostic testing for viral infections has evolved during the past decade. Documenting a seroconversion, or significant increase in antibody titer between paired acute-phase and convalescent-phase serum specimens, is a well-proven method for detecting acute viral infection but can be challenging, because blood sample collection is invasive, a second blood sample is required, and late collection of the acute-phase serum sample complicates interpretation. In contrast, polymerase chain reaction (PCR) assays are rapid and sensitive when performed on respiratory specimens collected early in the illness but can lack specificity because of amplicon contamination or presence of virus not etiologically linked to the illness. PCR assays have largely replaced serologic examination and culture for detecting viral pathogens in respiratory disease surveillance [1]. The added value of serologic examination in disease surveillance has not been fully assessed. | We compared serologic examination and PCR results among patients enrolled in a pneumonia etiology study in rural Thailand from September 2003 through August 2005 [2]. Patients who were hospitalized and met a broad case definition for respiratory disease were enrolled. We compared patients who had specimens (nasopharyngeal swab and serum) tested for adenovirus, human metapneumovirus (HMPV), influenza viruses A and B, parainfluenza viruses (PIVs) 1–3, and respiratory syncytial virus (RSV), as described elsewhere [2]. Conventional (first 18 months) and real-time (last 6 months) reverse-transcription PCR assays were used [3]. Influenza human serologic examination was conducted using hemagglutination inhibition test [4]. Adenovirus; PIVs 1, 2, and 3; HMPV; and RSV immunoglobulin G antibodies were tested using enzyme immunoassay [5–8]. A positive result was defined as a positive PCR test result and/or a ≥4-fold increase in antibody titer of the convalescent serum sample. We analyzed PIV 1 and 3 together, because the presence of cross-reactive epitopes on these related viruses complicates serologic discrimination. We compared proportions using McNemar’s χ2 statistic. |
In vitro evolution of H5N1 avian influenza virus toward human-type receptor specificity.
Chen LM , Blixt O , Stevens J , Lipatov AS , Davis CT , Collins BE , Cox NJ , Paulson JC , Donis RO . Virology 2011 422 (1) 105-13 Acquisition of alpha2-6 sialoside receptor specificity by alpha2-3 specific highly-pathogenic avian influenza viruses (H5N1) is thought to be a prerequisite for efficient transmission in humans. By in vitro selection for binding alpha2-6 sialosides, we identified four variant viruses with amino acid substitutions in the hemagglutinin (S227N, D187G, E190G, and Q196R) that revealed modestly increased alpha2-6 and minimally decreased alpha2-3 binding by glycan array analysis. However, a mutant virus combining Q196R with mutations from previous pandemic viruses (Q226L and G228S) revealed predominantly alpha2-6 binding. Unlike the wild type H5N1, this mutant virus was transmitted by direct contact in the ferret model although not by airborne respiratory droplets. However, a reassortant virus with the mutant hemagglutinin, a human N2 neuraminidase and internal genes from an H5N1 virus was partially transmitted via respiratory droplets. The complex changes required for airborne transmissibility in ferrets suggest that extensive evolution is needed for H5N1 transmissibility in humans. |
Mathematical models of skin permeability: an overview
Mitragotri S , Anissimov YG , Bunge AL , Frasch HF , Guy RH , Hadgraft J , Kasting GB , Lane ME , Roberts MS . Int J Pharm 2011 418 (1) 115-29 Mathematical models of skin permeability play an important role in various fields including prediction of transdermal drug delivery and assessment of dermal exposure to industrial chemicals. Extensive research has been performed over the last several decades to yield predictions of skin permeability to various molecules. These efforts include the development of empirical approaches such as quantitative structure-permeability relationships and porous pathway theories as well as the establishment of rigorous structure-based models. In addition to establishing the necessary mathematical framework to describe these models, efforts have also been dedicated to determining the key parameters that are required to use these models. This article provides an overview of various modeling approaches with respect to their advantages, limitations and future prospects. |
Human pulmonary microvascular endothelial cells support productive replication of highly pathogenic avian influenza viruses: possible involvement in the pathogenesis of human H5N1 virus infection
Zeng H , Pappas C , Belser JA , Houser KV , Zhong W , Wadford DA , Stevens T , Balczon R , Katz JM , Tumpey TM . J Virol 2011 86 (2) 667-78 Highly pathogenic avian influenza (HPAI) H5N1 viruses continue to cause sporadic human infections with a high fatality rate. Respiratory failure due to acute respiratory distress syndrome (ARDS) is a complication among hospitalized patients. Since progressive pulmonary endothelial damage is the hallmark of ARDS, we investigated host responses following HPAI virus infection of human pulmonary microvascular endothelial cells. Evaluation of these cells for the presence of receptors preferred by influenza virus demonstrated that avian-like (alpha2-3 linked) receptors were more abundant than human-like (alpha2-6 linked) receptors. To test the permissiveness of pulmonary endothelial cells to virus infection, we compared the replication of selected seasonal, pandemic (2009 H1N1 and 1918), and potentially pandemic (H5N1) influenza strains. We observed that these cells only support productive replication of HPAI H5N1 viruses which preferentially enter through and are released from the apical surface of polarized human endothelial monolayers. Furthermore, A/Thailand/16/2004 and A/Vietnam/1203/2004 (VN/1203) H5N1 viruses, which exhibit heightened virulence in mammalian models, replicated to higher titers than less virulent H5N1 strains. VN/1203 infection caused a significant decrease in endothelial cell proliferation compared to other subtype viruses. VN/1203 virus was also found to be a potent inducer of cytokines and adhesion molecules known to regulate inflammation during acute lung injury. Deletion of the H5 hemagglutinin (HA) multi-basic cleavage site did not impact virus infectivity but resulted in decreased virus replication in endothelial cells. Our results highlight remarkable tropism and infectivity of the H5N1 viruses for human pulmonary endothelial cells resulting in the potent induction of host inflammatory responses. |
Digitoxin and a synthetic monosaccharide analog inhibit cell viability in lung cancer cells
Elbaz HA , Stueckle TA , Wang HY , O'Doherty G , Lowry DT , Sargent LM , Wang L , Dinu CZ , Rojanasakul Y . Toxicol Appl Pharmacol 2011 258 (1) 51-60 Mechanisms of digitoxin-inhibited cell growth and induced apoptosis in human non-small cell lung cancer (NCI-H460) cells remain unclear. Understanding how digitoxin or derivate analogs induce their cytotoxic effect below therapeutically relevant concentrations will help in designing and developing novel, safer and more effective anti-cancer drugs. In this study, NCI-H460 cells were treated with digitoxin and a synthetic analog D6-MA to determine their anti-cancer activity. Different concentrations of digitoxin and D6-MA were used and the subsequent changes in cell morphology, viability, cell cycle, and protein expressions were determined. Digitoxin and D6-MA induced dose-dependent apoptotic morphologic changes in NCI-H460 cells via caspase-9 cleavage, with D6-MA possessing 5-fold greater potency than digitoxin. In comparison, non-tumorigenic immortalized bronchial and small airway epithelial cells displayed significantly less apoptotic sensitivity compared to NCI-H460 cells suggesting that both digitoxin and D6-MA were selective for NSCLC. Furthermore, NCI-H460 cells arrested in G(2)/M phase following digitoxin and D6-MA treatment. Post-treatment evaluation of key G2/M checkpoint regulatory proteins identified down-regulation of cyclin B1/cdc2 complex and survivin. Additionally, Chk1/2 and p53 related proteins experienced down-regulation suggesting a p53-independent cell cycle arrest mechanism. In summary, digitoxin and D6-MA exert anti-cancer effects on NCI-H460 cells through apoptosis or cell cycle arrest, with D6-MA showing at least 5-fold greater potency relative to digitoxin. |
Racial and ethnic variations in temporal changes in fetal deaths and first day infant deaths
Wingate MS , Barfield WD . Matern Child Health J 2011 15 (8) 1135-42 The purpose was to examine changes in overall and gestational age-specific proportions and rates of fetal death, first day death (<24 h), and combined fetal-first day death from 1990-1991 to 2001-2002. Changes were considered by race/ethnicity. Deliveries to U.S. white, black, and Hispanic mothers were selected from the NCHS linked live birth-infant death cohort and fetal deaths files (1990-1991 and 2001-2002). There was an overall improvement in mortality, but improvements were not uniform across all racial/ethnic groups or by gestational age. The fetal mortality rate among whites and Hispanics declined 4.32 and 12.82 percent, respectively. For blacks, the fetal mortality rate increased 4.06 percent between 1990-1991 and 2001-2002. Despite overall reductions in perinatal and <24 h mortality, black rates in all outcomes maintained a twofold disparity. The overall black: white fetal mortality rate ratio increased from 2.17 to 2.36 over time. The gestational age-specific black: white combined fetal-first day mortality rate ratios were greater than 1 at later gestational ages. In some cases, the ratio increased over time, indicating that despite reductions, fetal mortality did not decline uniformly among whites and blacks at term and post-term. Despite overall improvements in fetal, first day, and combined fetal-first day mortality, racial disparities persisted and in some cases widened. This study identifies lack of improvements in fetal death in the black population compared to the white or Hispanic population at later gestational ages. |
Sirenomelia: an epidemiologic study in a large dataset from the International Clearinghouse of Birth Defects Surveillance and Research, and literature review
Orioli IM , Amar E , Arteaga-Vazquez J , Bakker MK , Bianca S , Botto LD , Clementi M , Correa A , Csaky-Szunyogh M , Leoncini E , Li Z , Lopez-Camelo JS , Lowry RB , Marengo L , Martinez-Frias ML , Mastroiacovo P , Morgan M , Pierini A , Ritvanen A , Scarano G , Szabova E , Castilla EE . Am J Med Genet C Semin Med Genet 2011 157 (4) 358-73 Sirenomelia is a very rare limb anomaly in which the normally paired lower limbs are replaced by a single midline limb. This study describes the prevalence, associated malformations, and maternal characteristics among cases with sirenomelia. Data originated from 19 birth defect surveillance system members of the International Clearinghouse for Birth Defects Surveillance and Research, and were reported according to a single pre-established protocol. Cases were clinically evaluated locally and reviewed centrally. A total of 249 cases with sirenomelia were identified among 25,290,172 births, for a prevalence of 0.98 per 100,000, with higher prevalence in the Mexican registry. An increase of sirenomelia prevalence with maternal age less than 20 years was statistically significant. The proportion of twinning was 9%, higher than the 1% expected. Sex was ambiguous in 47% of cases, and no different from expectation in the rest. The proportion of cases born alive, premature, and weighting less than 2,500 g were 47%, 71.2%, and 88.2%, respectively. Half of the cases with sirenomelia also presented with genital, large bowel, and urinary defects. About 10-15% of the cases had lower spinal column defects, single or anomalous umbilical artery, upper limb, cardiac, and central nervous system defects. There was a greater than expected association of sirenomelia with other very rare defects such as bladder exstrophy, cyclopia/holoprosencephaly, and acardia-acephalus. The application of the new biological network analysis approach, including molecular results, to these associated very rare diseases is suggested for future studies. (c) 2011 Wiley Periodicals, Inc. |
Use of family history information for neural tube defect prevention: integration into state-based recurrence prevention programs
Green RF , Ehrhardt J , Ruttenber MF , Olney RS . Am J Health Educ 2011 42 (5) 296-308 A family history of neural tube defects (NTDs) can increase the risk of a pregnancy affected by an NTD. Periconceptional folic acid use decreases this risk. Purpose: Our objective was to determine whether seconddegree relatives of NTD-affected children showed differences in folic acid use compared with the general population and to provide them with folic acid education. Methods: Michigan and Colorado health workers contacted families with a previous pregnancy or child affected by an NTD, identified through NTD recurrence prevention programs. Families were interviewed to identify the number of second-degree relatives of child-bearing age. Families mailed surveys to these relatives, who returned them to the state health departments. The survey assessed folic acid use, views on having an affected child, and reproductive planning. Folic acid education materials were sent to relatives who provided contact information. Results: Folic acid supplement use among relatives was similar to that of the general population, despite elevated risk perceptions. Discussion: Both state health departments plan to increase efforts to contact affected families and their relatives through partnerships with family support groups. Translation to Health Education Practice: Including outreach to second-degree relatives in NTD recurrence prevention programs could increase the impact of these programs. |
Low-income parents' warmth and parent-child activities for children with disabilities, suspected delays and biological risks
Eshbaugh EM , Peterson CA , Wall S , Carta JJ , Luze G , Swanson M , Jeon H . Infant Child Dev 2011 20 (5) 509-524 Warm and responsive parenting is optimal for child development, but this style of parenting may be difficult for some parents to achieve. This study examines how parents' observed warmth and their reported frequency of parent-child activities were related to children's classifications as having biological risks or a range of disability indicators. Children were low-income prekindergarteners who participated in the Early Head Start Research and Evaluation Project Longitudinal Follow-up. Data from parent, early care and education staff reports, and direct child assessments were used to classify children into the following groups: disabilities, suspected delays, biological risks, disabilities and biological risk, suspected delays and biological risk, and no disability indicator. Socioeconomic status (ethnicity, maternal education and poverty level) and maternal depression were controlled in the analyses. The parents of children with disabilities and suspected delays evidenced significantly lower levels of warmth and less frequent parent-child activities compared with other parents. The parents of children with biological risk factors who did not also have disabilities or suspected delays did not exhibit decreased warmth and less frequent parent-child activities. (Copyright © 2010 John Wiley & Sons, Ltd.) |
NTP-CERHR expert panel report on the developmental toxicity of soy infant formula
McCarver G , Bhatia J , Chambers C , Clarke R , Etzel R , Foster W , Hoyer P , Leeder JS , Peters JM , Rissman E , Rybak M , Sherman C , Toppari J , Turner K . Birth Defects Res B Dev Reprod Toxicol 2011 92 (5) 421-68 Soy infant formula contains soy protein isolates and is fed to infants as a supplement to or replacement for human milk or cow milk. Soy protein isolates contains estrogenic isoflavones (phytoestrogens) that occur naturally in some legumes, especially soybeans. Phytoestrogens are nonsteroidal, estrogenic compounds. In plants, nearly all phytoestrogens are bound to sugar molecules and these phytoestrogen-sugar complexes are not generally considered hormonally active. Phytoestrogens are found in many food products in addition to soy infant formula, especially soy-based foods such as tofu, soy milk, and in some over-the-counter dietary supplements. Soy infant formula was selected for National Toxicology Program (NTP) evaluation because of (1) the availability of large number of developmental toxicity studies in laboratory animals exposed to the isoflavones found in soy infant formula (namely, genistein) or other soy products, as well as few studies on human infants fed soy infant formula, (2) the availability of information on exposures in infants fed soy infant formula, and (3) public concern for effects on infant or child development. On October 2, 2008 (73 FR 57360), the NTP Center for the Evaluation of Risks to Human Reproduction (CERHR) announced its intention to conduct an updated review of soy infant formula to complete a previous evaluation that was initiated in 2005. Both the current and previous evaluations relied on expert panels to assist the NTP in developing its conclusions on the potential developmental effects associated with the use of soy infant formula, presented in the NTP Brief on Soy Infant Formula. The initial expert panel met on March 15 to 17, 2006, to reach conclusions on the potential developmental and reproductive toxicities of soy infant formula and its predominant isoflavone constituent genistein. The expert panel reports were released for public comment on May 5, 2006 (71 FR 28368). On November 8, 2006 (71 FR 65537), CERHR staff released draft NTP Briefs on Genistein and Soy Formula that provided the NTP's interpretation of the potential for genistein and soy infant formula to cause adverse reproductive and/or developmental effects in exposed humans. However, CERHR did not complete these evaluations, finalize the briefs, or issue NTP Monographs on these substances based on this initial evaluation. Between 2006 and 2009, a substantial number of new publications related to human exposure or reproductive and/or developmental toxicity were published for these substances. Thus, CERHR determined that updated evaluations of genistein and soy infant formula were needed. However, the current evaluation focuses only on soy infant formula and the potential developmental toxicity of its major isoflavone components, e.g. genistein, daidzein (and estrogenic metabolite, equol), and glycitein. This updated evaluation does not include an assessment on the potential reproductive toxicity of genistein following exposures during adulthood as was carried out in the 2006 evaluation. CERHR narrowed the scope of the evaluation because the assessment of reproductive effects of genistein following exposure to adults was not considered relevant to the consideration of soy infant formula use in infants during the 2006 evaluation. To obtain updated information about soy infant formula for the CERHR evaluation, the PubMed (Medline) database was searched from February 2006 to August 2009 with genistein/genistin, daidzein/daidzin, glycitein/glycitin, equol, soy, and other relevant keywords. References were also identified from the bibliographies of published literature. The updated expert panel report represents the efforts of a 14-member panel of government and nongovernment scientists, and was prepared with assistance from NTP staff. The finalized report, released on January 15, 2010 (75 FR 2545), reflects consideration of public comments received on a draft report that was released on October 19, 2009, for public comment and discussions that occurred at a public meeting of the expert panel held December 16 to 18, 2009 (74 FR 53509). The finalized report presents conclusions on (1) the strength of scientific evidence that soy infant formula or its isoflavone constituents are developmental toxicants based on data from in vitro, animal, or human studies; (2) the extent of exposures in infants fed soy infant formula; (3) the assessment of the scientific evidence that adverse developmental health effects may be associated with such exposures; and (4) knowledge gaps that will help establish research and testing priorities to reduce uncertainties and increase confidence in future evaluations. The Expert Panel expressed minimal concern for adverse developmental effects in infants fed soy infant formula. This level of concern represents a "2" on the five-level scale of concern used by the NTP that ranges from negligible concern ("1") to serious concern ("5"). The Expert Panel Report on Soy Infant Formula was considered extensively by NTP staff in preparing the 2010 NTP Brief on Soy Infant Formula, which represents the NTP's opinion on the potential for exposure to soy infant formula to cause adverse developmental effects in humans. The NTP concurred with the expert panel that there is minimal concern for adverse effects on development in infants who consume soy infant formula. This conclusion was based on information about soy infant formula provided in the expert panel report, public comments received during the course of the expert panel evaluation, additional scientific information made available since the expert panel meeting, and peer reviewer critiques of the draft NTP Brief by the NTP Board of Scientific Counselors (BSC) on May 10, 2010 (Meeting materials are available at http://ntp.niehs.nih.gov/go/9741.). The BSC voted in favor of the minimal concern conclusion with 7 yes votes, 3 no votes, and 0 abstentions. One member thought that the conclusion should be negligible concern and two members thought that the level of concern should be higher than minimal concern. The NTP's response to the May 10, 2010 review ("peer-review report") is available on the NTP website at http://ntp.niehs.nih.gov/go/9741. The monograph includes the NTP Brief on Soy Infant Formula as well as the entire final Expert Panel Report on Soy Infant Formula. Public comments received as part of the NTP's evaluation of soy infant formula and other background materials are available at http://cerhr.niehs.nih.gov/evals/index.html. Reports can be obtained from the web site (http://cerhr.niehs.nih.gov/) or from: Kristina A. Thayer, PhD, NIEHS/NTP K2-04, PO Box 12233, Research Triangle Park, NC 27709. E-mail: thayer@niehs.nih.gov. Birth Defects Res (Part B) 92:421-468, 2011. (c) 2011 Wiley Periodicals, Inc. |
Phocomelia: a worldwide descriptive epidemiologic study in a large series of cases from the International Clearinghouse for Birth Defects Surveillance and Research, and overview of the literature
Bermejo-Sanchez E , Cuevas L , Amar E , Bianca S , Bianchi F , Botto LD , Canfield MA , Castilla EE , Clementi M , Cocchi G , Landau D , Leoncini E , Li Z , Lowry RB , Mastroiacovo P , Mutchinick OM , Rissmann A , Ritvanen A , Scarano G , Siffel C , Szabova E , Martinez-Frias ML . Am J Med Genet C Semin Med Genet 2011 157 (4) 305-20 Epidemiologic data on phocomelia are scarce. This study presents an epidemiologic analysis of the largest series of phocomelia cases known to date. Data were provided by 19 birth defect surveillance programs, all members of the International Clearinghouse for Birth Defects Surveillance and Research. Depending on the program, data corresponded to a period from 1968 through 2006. A total of 22,740,933 live births, stillbirths and, for some programs, elective terminations of pregnancy for fetal anomaly (ETOPFA) were monitored. After a detailed review of clinical data, only true phocomelia cases were included. Descriptive data are presented and additional analyses compared isolated cases with those with multiple congenital anomalies (MCA), excluding syndromes. We also briefly compared congenital anomalies associated with nonsyndromic phocomelia with those presented with amelia, another rare severe congenital limb defect. A total of 141 phocomelia cases registered gave an overall total prevalence of 0.62 per 100,000 births (95% confidence interval: 0.52-0.73). Three programs (Australia Victoria, South America ECLAMC, Italy North East) had significantly different prevalence estimates. Most cases (53.2%) had isolated phocomelia, while 9.9% had syndromes. Most nonsyndromic cases were monomelic (55.9%), with an excess of left (64.9%) and upper limb (64.9%) involvement. Most nonsyndromic cases (66.9%) were live births; most isolated cases (57.9%) weighed more than 2,499 g; most MCA (60.7%) weighed less than 2,500 g, and were more likely stillbirths (30.8%) or ETOPFA (15.4%) than isolated cases. The most common associated defects were musculoskeletal, cardiac, and intestinal. Epidemiological differences between phocomelia and amelia highlighted possible differences in their causes. (c) 2011 Wiley Periodicals, Inc. |
Previous breastfeeding practices and duration of exclusive breastfeeding in the United States
Phillips G , Brett K , Mendola P . Matern Child Health J 2011 15 (8) 1210-6 We examined the influence of duration of exclusive breastfeeding (DEBF) for a mother's earlier children on the DEBF for her later children among multiparous women from the 2002 National Survey of Family Growth. DEBF was categorized as: never breastfed (NBF) (referent); not exclusively breastfed or exclusively breastfed for <4 months (EBF < 4); and exclusively breastfed for ≥4 months (EBF ≥ 4). We examined DEBF using weighted percentages and odds ratios (OR) with 95% confidence intervals (CI) from multinomial logistic regression models, adjusting for maternal factors. About 70% of multiparous women (n = 2,149) repeated the duration of exclusive breastfeeding of their first child for their second child; 14% of women repeated EBF ≥ 4. Among multiparous women, the adjusted odds ratio for EBF ≥ 4 for second children was 7.2 (95% CI = 4.0-12.9) when first children were EBF < 4 and 90.7 (95% CI = 45.4-181.4) when first children were EBF ≥ 4, relative to NBF first children. In analyses where DEBF of third children was the outcome, odds of EBF ≥ 4 were more strongly influenced by DEBF of second children while the impact of DEBF of first children was not as strong. Older maternal age and being married were related to an increased DEBF. Being married at second birth predicted a change from NBF for first children to EBF ≥ 4 for second children (OR = 6.2, 95% CI = 2.7-14.2). In conclusion, mothers generally repeated the DEBF of their previous child. For third children, DEBF of the second child was more likely to be repeated than that of the first child. |
Amelia: a multi-center descriptive epidemiologic study in a large dataset from the International Clearinghouse for Birth Defects Surveillance and Research, and overview of the literature
Bermejo-Sanchez E , Cuevas L , Amar E , Bakker MK , Bianca S , Bianchi F , Canfield MA , Castilla EE , Clementi M , Cocchi G , Feldkamp ML , Landau D , Leoncini E , Li Z , Lowry RB , Mastroiacovo P , Mutchinick OM , Rissmann A , Ritvanen A , Scarano G , Siffel C , Szabova E , Martinez-Frias ML . Am J Med Genet C Semin Med Genet 2011 157 (4) 288-304 This study describes the epidemiology of congenital amelia (absence of limb/s), using the largest series of cases known to date. Data were gathered by 20 surveillance programs on congenital anomalies, all International Clearinghouse for Birth Defects Surveillance and Research members, from all continents but Africa, from 1968 to 2006, depending on the program. Reported clinical information on cases was thoroughly reviewed to identify those strictly meeting the definition of amelia. Those with amniotic bands or limb-body wall complex were excluded. The primary epidemiological analyses focused on isolated cases and those with multiple congenital anomalies (MCA). A total of 326 amelia cases were ascertained among 23,110,591 live births, stillbirths and (for some programs) elective terminations of pregnancy for fetal anomalies. The overall total prevalence was 1.41 per 100,000 (95% confidence interval: 1.26-1.57). Only China Beijing and Mexico RYVEMCE had total prevalences, which were significantly higher than this overall total prevalence. Some under-registration could influence the total prevalence in some programs. Liveborn cases represented 54.6% of total. Among monomelic cases (representing 65.2% of nonsyndromic amelia cases), both sides were equally involved, and the upper limbs (53.9%) were slightly more frequently affected. One of the most interesting findings was a higher prevalence of amelia among offspring of mothers younger than 20 years. Sixty-nine percent of the cases had MCA or syndromes. The most frequent defects associated with amelia were other types of musculoskeletal defects, intestinal, some renal and genital defects, oral clefts, defects of cardiac septa, and anencephaly. (c) 2011 Wiley Periodicals, Inc. |
Cloacal exstrophy: an epidemiologic study from the International Clearinghouse for Birth Defects Surveillance and Research
Feldkamp ML , Botto LD , Amar E , Bakker MK , Bermejo-Sanchez E , Bianca S , Canfield MA , Castilla EE , Clementi M , Csaky-Szunyogh M , Leoncini E , Li Z , Lowry RB , Mastroiacovo P , Merlob P , Morgan M , Mutchinick OM , Rissmann A , Ritvanen A , Siffel C , Carey JC . Am J Med Genet C Semin Med Genet 2011 157 (4) 333-43 Cloacal exstrophy presents as a complex abdominal wall defect thought to result from a mesodermal abnormality. Anatomically, its main components are Omphalocele, bladder Exstrophy and Imperforate anus. Other associated malformations include renal malformations and Spine defects (OEIS complex). Historically, the prevalence ranges from 1 in 200,000 to 400,000 births, with higher rates in females. Cloacal exstrophy is likely etiologically heterogeneous as suggested by its recurrence in families and occurrence in monozygotic twins. The defect has been described in infants with limb-body wall, with trisomy 18, and in one pregnancy exposed to Dilantin and diazepam. Due to its rarity, the use of a nonspecific diagnostic code for case identification, and lack of validation of the clinical findings, cloacal exstrophy remains an epidemiologic challenge. The purpose of this study was to describe the prevalence, associated anomalies and maternal characteristics among infants born with cloacal exstrophy. We used data from the International Clearinghouse for Birth Defects Surveillance and Research submitted from 18 birth defect surveillance programs representing 24 countries. Cases were clinically evaluated locally and reviewed centrally by two authors. Cases of persistent cloaca were excluded. A total of 186 cases of cloacal exstrophy were identified. Overall prevalence was 1 in 131,579 births: ranging from 1 in 44,444 births in Wales to 1 in 269,464 births in South America. Live birth prevalence was 1 in 184,195 births. Prevalence ratios did not vary by maternal age. Forty-two (22.6%) cases met the criteria for the OEIS complex, whereas 60 (32.3%) were classified as OEI and 18 (9.7%) as EIS (one with suspected VATER (0.5%)). Other findings included two cases with trisomy 13 (one without a karyotype confirmation), one with mosaic trisomy 12 (0.5%), one with mosaic 45,X (0.5%) and one classified as having amnion band sequence (0.5%). Twenty-seven (14.5%) infants had other anomalies unrelated to cloacal exstrophy. Cloacal exstrophy is a rare anomaly with variability in prevalence by geographic location. The proportion of cases classified as OEIS complex was lower in this study than previously reported. Among all cases, 54.8% were reported to have an omphalocele. (c) 2011 Wiley Periodicals, Inc. |
Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research
Mutchinick OM , Luna-Munoz L , Amar E , Bakker MK , Clementi M , Cocchi G , da Graca Dutra M , Feldkamp ML , Landau D , Leoncini E , Li Z , Lowry B , Marengo LK , Martinez-Frias ML , Mastroiacovo P , Metneki J , Morgan M , Pierini A , Rissman A , Ritvanen A , Scarano G , Siffel C , Szabova E , Arteaga-Vazquez J . Am J Med Genet C Semin Med Genet 2011 157 (4) 274-87 Conjoined twins (CT) are a very rare developmental accident of uncertain etiology. Prevalence has been previously estimated to be 1 in 50,000 to 1 in 100,000 births. The process by which monozygotic twins do not fully separate but form CT is not well understood. The purpose of the present study was to analyze diverse epidemiological aspects of CT, including the different variables listed in the Introduction Section of this issue of the Journal. The study was made possible using the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) structure. This multicenter worldwide research includes the largest sample of CT ever studied. A total of 383 carefully reviewed sets of CT obtained from 26,138,837 births reported by 21 Clearinghouse Surveillance Programs (SP) were included in the analysis. Total prevalence was 1.47 per 100,000 births (95% CI: 1.32-1.62). Salient findings including an evident variation in prevalence among SPs: a marked variation in the type of pregnancy outcome, a similarity in the proportion of CT types among programs: a significant female predominance in CT: particularly of the thoracopagus type and a significant male predominance in parapagus and parasitic types: significant differences in prevalence by ethnicity and an apparent increasing prevalence trend in South American countries. No genetic, environmental or demographic significant associated factors were identified. Further work in epidemiology and molecular research is necessary to understand the etiology and pathogenesis involved in the development of this fascinating phenomenon of nature. (c) 2011 Wiley Periodicals, Inc. |
Cyclopia: an epidemiologic study in a large dataset from the International Clearinghouse of Birth Defects Surveillance and Research
Orioli IM , Amar E , Bakker MK , Bermejo-Sanchez E , Bianchi F , Canfield MA , Clementi M , Correa A , Csaky-Szunyogh M , Feldkamp ML , Landau D , Leoncini E , Li Z , Lowry RB , Mastroiacovo P , Morgan M , Mutchinick OM , Rissmann A , Ritvanen A , Scarano G , Szabova E , Castilla EE . Am J Med Genet C Semin Med Genet 2011 157 (4) 344-57 Cyclopia is characterized by the presence of a single eye, with varying degrees of doubling of the intrinsic ocular structures, located in the middle of the face. It is the severest facial expression of the holoprosencephaly (HPE) spectrum. This study describes the prevalence, associated malformations, and maternal characteristics among cases with cyclopia. Data originated in 20 Clearinghouse (ICBDSR) affiliated birth defect surveillance systems, reported according to a single pre-established protocol. A total of 257 infants with cyclopia were identified. Overall prevalence was 1 in 100,000 births (95%CI: 0.89-1.14), with only one program being out of range. Across sites, there was no correlation between cyclopia prevalence and number of births (r = 0.08; P = 0.75) or proportion of elective termination of pregnancy (r = -0.01; P = 0.97). The higher prevalence of cyclopia among older mothers (older than 34) was not statistically significant. The majority of cases were liveborn (122/200; 61%) and females predominated (male/total: 42%). A substantial proportion of cyclopias (31%) were caused by chromosomal anomalies, mainly trisomy 13. Another 31% of the cases of cyclopias were associated with defects not typically related to HPE, with more hydrocephalus, heterotaxia defects, neural tube defects, and preaxial reduction defects than the chromosomal group, suggesting the presence of ciliopathies or other unrecognized syndromes. Cyclopia is a very rare defect without much variability in prevalence by geographic location. The heterogeneous etiology with a high prevalence of chromosomal abnormalities, and female predominance in HPE, were confirmed, but no effect of increased maternal age or association with twinning was observed. (c) 2011 Wiley Periodicals, Inc. |
Acceptance of a semi-custom hearing protector by manufacturing workers
Davis RR , Murphy WJ , Byrne DC , Shaw PB . J Occup Environ Hyg 2011 8 (12) D125-30 Workers complain about wearing hearing protection for two primary reasons: comfort and communication.(1) Employers are concerned about hearing protection costs. Recent advances in hearing protector technology seemed to address those issues through a semi-custom earplug. This new device was designed to prevent overprotection by incorporating only enough attenuation to bring the worker down into the safe exposure zone. Although initially more expensive than disposable hearing protection devices (HPDs), the semi-custom hearing protector would be expected to last several years. | The Hearing Loss Prevention Team of the National Institute for Occupational Safety and Health (NIOSH) was invited by a major auto manufacturing company and the union (UAW) to supervise a longitudinal trial of a semi-custom hearing protector (SonoCustom by Sonomax Technologies, Inc.,Montreal, Canada). This protectorwas advertised as (1) being more comfortable since each plug was custom molded for each worker, and (2) more effective because each plug’s noise reduction rating was tuned to that worker’s particular job. The company’s hearing conservation contractor partnered with NIOSH by recruiting volunteers for the study and providing follow-up usage reports. The study was conducted over the course of 1 year with NIOSH site visits at the start, at 1 month, at 4 months, and at 1-year time intervals. The goal of this trial was to determine worker acceptance of the semi-custom earplug. | Compared with the non-custom earplugs used in this study, the SonoCustom ear plugs were relatively new to the market and have not been extensively investigated in the literature. Initial studies have focused on a new way to measure and model the acoustical performance.(2–4) Wagoner et al.(5) studied speech intelligibility and attenuation while subjects wore the SonoCustom earplugs or two other non-custom, commercially available hearing protectors in laboratory tests and in the field. In the laboratory they were not able to find any statistically significant difference, between the three earplugs, for speech intelligibility or attenuation. Regarding comfort issues, they briefly mentioned that the two non-custom HPDs were judged by the workers to be more comfortable and easier to use than the SonoCustom earplug. |
Assessment of occupational cosmic radiation exposure of flight attendants using questionnaire data
Anderson JL , Waters MA , Hein MJ , Schubauer-Berigan MK , Pinkerton LE . Aviat Space Environ Med 2011 82 (11) 1049-1054 INTRODUCTION: Female flight attendants may have a higher risk of breast and other cancers than the general population because of routine exposure to cosmic radiation. As part of a forthcoming study of breast and other cancer incidence, occupational cosmic radiation exposure of a cohort of female flight attendants was estimated. METHODS: Questionnaire data were collected from living female cohort members who were formerly employed as flight attendants with Pan American World Airways. These data included airline at which the flight attendant was employed, assigned domicile, start and end dates for employment at domicile, and number of block hours and commuter segments flown per month. Questionnaire respondents were assigned daily absorbed and effective doses using a time-weighted dose rate specific to the domicile and/or work history era combined with self-reported work history information. RESULTS: Completed work history questionnaires were received from 5898 living cohort members. Mean employment time as a flight attendant was 7.4 yr at Pan Am and 12 yr in total. Estimated mean annual effective dose from all sources of occupational cosmic radiation exposure was 2.5 +/- 1.0 mSv, with a mean career dose of 30 mSv. DISCUSSION: Annual effective doses were similar to doses assessed for other flight attendant cohorts; however, questionnaire-based cumulative doses assessed in this study were on average higher than those assessed for other flight attendant cohorts using company-based records. The difference is attributed to the inclusion of dose from work at other airlines and commuter flights, which was made possible by using questionnaire data. |
How does network structure affect partnerships for promoting physical activity? Evidence from Brazil and Colombia
Parra DC , Dauti M , Harris JK , Reyes L , Malta DC , Brownson RC , Quintero MA , Pratt M . Soc Sci Med 2011 73 (9) 1365-70 The objective of this study was to describe the network structure and factors associated with collaboration in two networks that promote physical activity (PA) in Brazil and Colombia. Organizations that focus on studying and promoting PA in Brazil (35) and Colombia (53) were identified using a modified one-step reputational snowball sampling process. Participants completed an on-line survey between December 2008 and March 2009 for the Brazil network, and between April and June 2009 for the Colombia network. Network stochastic modeling was used to investigate the likelihood of reported inter-organizational collaboration. While structural features of networks were significant predictors of collaboration within each network, the coefficients and other network characteristics differed. Brazil's PA network was decentralized with a larger number of shared partnerships. Colombia's PA network was centralized and collaboration was influenced by perceived importance of peer organizations. On average, organizations in the PA network of Colombia reported facing more barriers (1.5 vs. 2.5 barriers) for collaboration. Future studies should focus on how these different network structures affect the implementation and uptake of evidence-based PA interventions. |
Informational privacy, public health, and state laws
O'Connor J , Matthews G . Am J Public Health 2011 101 (10) 1845-50 Developments in information technology that make it possible to rapidly transmit health information also raise questions about the possible inappropriate use and protection of identifiable (or potentially identifiable) personal health information. Despite efforts to improve state laws, adoption of provisions has lagged. We found that half of states have no statutes addressing nondisclosure of personally identifiable health information generally held by public health agencies. Exceptional treatment of HIV, sexually transmitted infections, or tuberculosis-related information was common. Where other provisions were found, there was little consistency in the laws across states. The variation in state laws supports the need to build consensus on the appropriate use and disclosure of public health information among public health practitioners. |
Laboratory equipment maintenance: a critical bottleneck for strengthening health systems in sub-Saharan Africa?
Fonjungo PN , Kebede Y , Messele T , Ayana G , Tibesso G , Abebe A , Nkengasong JN , Kenyon T . J Public Health Policy 2011 33 (1) 34-45 Properly functioning laboratory equipment is a critical component for strengthening health systems in developing countries. The laboratory can be an entry point to improve population health and care of individuals for targeted diseases - prevention, care, and treatment of TB, HIV/AIDS, and malaria, plus maternal and neonatal health - as well as those lacking specific attention and funding. We review the benefits and persistent challenges associated with sustaining laboratory equipment maintenance. We propose equipment management policies as well as a comprehensive equipment maintenance strategy that would involve equipment manufacturers and strengthen local capacity through pre-service training of biomedical engineers. Strong country leadership and commitment are needed to assure development and sustained implementation of policies and strategies for standardization of equipment, and regulation of its procurement, donation, disposal, and replacement. (Journal of Public Health Policy advance online publication, 10 November 2011; doi:10.1057/jphp.2011.57). |
Community health workers can be a public health force for change in the United States: three actions for a new paradigm
Balcazar H , Rosenthal EL , Brownstein JN , Rush CH , Matos S , Hernandez L . Am J Public Health 2011 101 (12) 2199-203 Community health workers (CHWs) have gained increased visibility in the United States. We discuss how to strengthen the roles of CHWs to enable them to become collaborative leaders in dramatically changing health care from "sickness care" systems to systems that provide comprehensive care for individuals and families and support community and tribal wellness. We recommend drawing on the full spectrum of CHWs' roles so that they can make optimal contributions to health systems and the building of community capacity for health and wellness. We also urge that CHWs be integrated into "community health teams" as part of "medical homes" and that evaluation frameworks be improved to better measure community wellness and systems change. (Am J Public Health. Published online ahead of print October 20, 2011: e1-e5. doi:10.2105/AJPH.2011.300386). |
Performances on the CogState and standard neuropsychological batteries among HIV patients without dementia
Overton ET , Kauwe JS , Paul R , Tashima K , Tate DF , Patel P , Carpenter CC , Patty D , Brooks JT , Clifford DB . AIDS Behav 2011 15 (8) 1902-9 HIV-associated neurocognitive disorders remain prevalent but challenging to diagnose particularly among non-demented individuals. To determine whether a brief computerized battery correlates with formal neurocognitive testing, we identified 46 HIV-infected persons who had undergone both formal neurocognitive testing and a brief computerized battery. Simple detection tests correlated best with formal neuropsychological testing. By multivariable regression model, 53% of the variance in the composite Global Deficit Score was accounted for by elements from the brief computerized tool (P < 0.01). These data confirm previous correlation data with the computerized battery. Using the five significant parameters from the regression model in a Receiver Operating Characteristic curve, 90% of persons were accurately classified as being cognitively impaired or not. The test battery requires additional evaluation, specifically for identifying persons with mild impairment, a state upon which interventions may be effective. |
How effective are severe disciplinary policies? School policies and offending from adolescence into young adulthood
Matjasko JL . J Sch Psychol 2011 49 (5) 555-72 Based on the stage environment and the person environment fit perspectives, the current study examined the relation between school disciplinary policies and offending from adolescence into young adulthood. Using Waves I and III of the National Longitudinal Study of Adolescent Health (a.k.a., Add Health), hierarchical multinomial logistic regression models were utilized to test whether school disciplinary policies were related to offending patterns during adolescence and young adulthood. Descriptive results suggest that, overall, severe school policies were not associated with the course of offending. However, relations between individual characteristics (i.e., inattention and impulsivity) and offending patterns did appear to differ depending on the severity of disciplinary policies. Within schools with more severe policies, adolescents scoring higher on inattention were more likely to be in the adolescent-limited offender group over the persistent offender group. On the other hand, adolescents with high levels of impulsivity were more likely to be in the persistent group over the non-offender group within schools with more severe policies. The results suggest that severe policies may not be effective for all students and the policies, alone, may not be promising avenues for the prevention of offending during adolescence and young adulthood. |
Past and current alcohol consumption patterns and elevations in serum hepatic enzymes among US adults
Tsai J , Ford ES , Li C , Zhao G . Addict Behav 2012 37 (1) 78-84 OBJECTIVE: The aim of this study was to examine the association between patterns of past and current alcohol consumption and elevations in serum hepatic enzymes among a nationally representative sample of adults in the United States. METHODS: We estimated the age-adjusted prevalence of elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among 8993 adults aged 20years or older who participated in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). We produced prevalence ratios by using patterns of alcohol consumption as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. RESULTS: The age-adjusted prevalence of elevated serum ALT, AST, and GGT in adults was 9.7%, 16.0%, and 8.6%, respectively. Male excessive current drinkers had 50%-71% and 75%-314% increased likelihoods of having elevated serum AST and GGT, respectively; female excessive drinkers with a history of consuming 5 or more drinks almost daily had a 226% increased likelihood of having elevated serum GGT, when compared to their respective counterparts who were lifetime abstainers. CONCLUSIONS: The results of this study indicate that elevations in serum hepatic enzymes, especially AST and GGT, are common in adults who are excessive current drinkers. There is evidence to suggest that excessive current drinkers with a history of protracted drinking are especially vulnerable to potential liver injury. These findings lend further support to the early identification of excessive drinkers who may have an increased risk for alcohol-related morbidity and mortality in health care settings. |
Patterns and predictors of current cigarette smoking in women and men of reproductive age - Ecuador, El Salvador, Guatemala, and Honduras
Tong VT , Turcios-Ruiz RM , Dietz PM , England LJ . Rev Panam Salud Publica 2011 30 (3) 240-7 OBJECTIVE: To estimate smoking prevalence by gender, describe patterns of cigarette use, and identify predictors of current smoking in reproductive-age adults in four Latin American countries. METHODS: Self-reported smoking was examined using data from Reproductive Health Surveys of women aged 15-49 years in Ecuador (2004), El Salvador (2002-2003), Guatemala (2002), and Honduras (2001), and of men aged 15-59 years in El Salvador, Guatemala, and Honduras for the same years. Current smoking was assessed by demographic characteristics, and independent associations were examined using logistic regression. Data were weighted to be nationally representative of households with reproductive-age women and men. RESULTS: Current smoking prevalence ranged from 2.6% (Guatemala) to 13.1% (Ecuador) for women and from 23.1% (Guatemala) to 34.9% (El Salvador) for men. In Ecuador, 67.6% of female smokers were non-daily users; in other countries, daily use was more prevalent than non-daily use for both men and women. In daily users, the median number of cigarettes smoked per day ranged from 1.9 (Ecuador, Honduras) to 2.3 (Guatemala) for women and from 2.1 (Guatemala) to 3.6 (Honduras) for men. In bivariate analysis, smoking prevalence in all countries was highest in women who lived in urban areas, were previously married, and/or had high socioeconomic status. Risk factors for smoking varied by country and gender. CONCLUSIONS: National tobacco control programs in these countries should aggressively target high-risk populations (reproductive-age men) and maintain low prevalence in low-risk populations (reproductive-age women). More research is needed to understand addiction patterns in non-daily smokers. |
Quit attempt correlates among smokers by race/ethnicity
Kahende JW , Malarcher AM , Teplinskaya A , Asman KJ . Int J Environ Res Public Health 2011 8 (10) 3871-88 INTRODUCTION: Cigarette smoking is the leading preventable cause of premature deaths in the U.S., accounting for approximately 443,000 deaths annually. Although smoking prevalence in recent decades has declined substantially among all racial/ethnic groups, disparities in smoking-related behaviors among racial/ethnic groups continue to exist. Two of the goals of Healthy People 2020 are to reduce smoking prevalence among adults to 12% or less and to increase smoking cessation attempts by adult smokers from 41% to 80%. Our study assesses whether correlates of quit attempts vary by race/ethnicity among adult (≥18 years) smokers in the U.S. Understanding racial/ethnic differences in how both internal and external factors affect quit attempts is important for targeting smoking-cessation interventions to decrease tobacco-use disparities. METHODS: We used 2003 Tobacco Use Supplement to the Current Population Survey (CPS) data from 16,213 adults to examine whether the relationship between demographic characteristics, smoking behaviors, smoking policies and having made a quit attempt in the past year varied by race/ethnicity. RESULTS: Hispanics and persons of multiple races were more likely to have made a quit attempt than whites. Overall, younger individuals and those with >high school education, who smoked fewer cigarettes per day and had smoked for fewer years were more likely to have made a quit attempt. Having a smoke-free home, receiving a doctor's advice to quit, smoking menthol cigarettes and having a greater time to when you smoked your first cigarette of the day were also associated with having made a quit attempt. The relationship between these four variables and quit attempts varied by race/ethnicity; most notably receiving a doctor's advice was not related to quit attempts among Asian American/Pacific Islanders and menthol use among whites was associated with a lower prevalence of quit attempts while black menthol users were more likely to have made a quit attempt than white non-menthol users. CONCLUSIONS: Most correlates of quit attempts were similar across all racial/ethnic groups. Therefore population-based comprehensive tobacco control programs that increase quit attempts and successful cessation among all racial/ethnic groups should be continued and expanded. Additional strategies may be needed to encourage quit attempts among less educated, older, and more addicted smokers. |
United States life tables, 2007
Arias E . Natl Vital Stat Rep 2011 59 (9) 1-60 OBJECTIVES: This report presents complete period life tables by race, Hispanic origin, and sex for the United States based on age-specific death rates in 2007. METHODS: Data used to prepare the 2007 life tables are 2007 final mortality statistics, July 1, 2007, population estimates based on the 2000 decennial census, and 2007 Medicare data for ages 66-100. The methods used to estimate the life tables for the total, white, and black populations were first used in annual life tables in 2005 and have been in use since that time (1). The methods used to estimate the life tables for the Hispanic, non-Hispanic white, and non-Hispanic black populations were first used to estimate U.S. life tables by Hispanic origin for data year 2006 (2). RESULTS: In 2007, the overall expectation of life at birth was 77.9 years, representing an increase of 0.2 years from life expectancy in 2006. From 2006 to 2007, life expectancy at birth increased for all groups considered. It increased for males (from 75.1 to 75.4) and females (from 80.2 to 80.4), the white (from 78.2 to 78.4) and black (from 73.2 to 73.6) populations, the Hispanic population (from 80.6 to 80.9), the non-Hispanic white population (from 78.1 to 78.2), and the non-Hispanic black population (from 72.9 to 73.2). |
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