Women's intentions to receive cervical cancer screening with primary human papillomavirus testing
Ogilvie GS , Smith LW , van Niekerk DJ , Khurshed F , Krajden M , Saraiya M , Goel V , Rimer BK , Greene SB , Hobbs S , Coldman AJ , Franco EL . Int J Cancer 2013 133 (12) 2934-43 We explored the potential impact of human papillomavirus (HPV) testing on women's intentions to be screened for cervical cancer in a cohort of Canadian women. Participants aged 25-65 years from an ongoing trial were sent a questionnaire to assess women's intentions to be screened for cervical cancer with HPV testing instead of Pap smears and to be screened every 4 years or after 25 years of age. We created scales for attitudes about HPV testing, perceived behavioral control, and direct and indirect subjective norms. Demographic data and scales that were significantly different (p < 0.1) between women who intended to be screened with HPV and those who did not intend were included in a stepwise logistic regression model. Of the 2,016 invitations emailed, 1,538 were received, and 981 completed surveys for a response rate of 63% (981/1,538). Eighty-four percent of women (826/981) responded that they intended to attend for HPV-based cervical cancer screening, which decreased to 54.2% when the screening interval was extended, and decreased further to 51.4% when screening start was delayed to age of 25. Predictors of intentions to undergo screening were attitudes (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.15, 1.30), indirect subjective norms (OR: 1.02; 95% CI: 1.01, 1.03) and perceived behavioral control (OR: 1.16; 95% CI: 1.10; 1.22). Intentions to be screened for cervical cancer with HPV testing decreased substantially when the screening interval was extended and screening started at age of 25. Use of primary HPV testing may optimize the screening paradigm, but programs should ensure robust planning and education to mitigate any negative impact on screening attendance rates. |
Physician visits and preventive care among Asian American and Pacific Islander long-term survivors of colorectal cancer, USA, 1996-2006
Steele CB , Townsend JS , Tai E , Thomas CC . J Cancer Surviv 2013 8 (1) 70-9 PURPOSE: Published literature on receipt of preventive healthcare services among Asian American and Pacific Islander (API) cancer survivors is scarce. We describe patterns in receipt of preventive services among API long-term colorectal cancer (CRC) survivors. METHODS: Surveillance, Epidemiology, and End Results registry-Medicare data were used to identify 9,737 API and white patients who were diagnosed with CRC during 1996-2000 and who survived 5 or more years beyond their diagnoses. We examined receipt of vaccines, mammography (females), bone densitometry (females), and cholesterol screening among the survivors and how the physician specialties they visited for follow-up care correlated to services received. RESULTS: APIs were less likely than whites to receive mammography (52.0 vs. 69.3 %, respectively; P < 0.0001) but more likely to receive influenza vaccine, cholesterol screening, and bone densitometry. These findings remained significant in our multivariable model, except for receipt of bone densitometry. APIs visited PCPs only and both PCPs and oncologists more frequently than whites (P < 0.0001). Women who visited both PCPs and oncologists compared with PCPs only were more likely to receive mammography (odds ratio = 1.40; 95 % confidence interval, 1.05-1.86). CONCLUSIONS: Visits to both PCPs and oncologists were associated with increased use of mammography. Although API survivors visited these specialties more frequently than white survivors, API women may need culturally appropriate outreach to increase their use of this test. IMPLICATIONS FOR CANCER SURVIVORS: Long-term cancer survivors need to be aware of recommended preventive healthcare services, as well as who will manage their primary care and cancer surveillance follow-up. |
Barriers and facilitators to implementing cancer survivorship care plans
Dulko D , Pace CM , Dittus KL , Sprague BL , Pollack LA , Hawkins NA , Geller BM . Oncol Nurs Forum 2013 40 (6) 575-80 PURPOSE/OBJECTIVES: To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs. DESIGN: Descriptive pilot study. SETTING: Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center.Sample: 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey. METHODS: Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit. MAIN RESEARCH VARIABLES: SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit. FINDINGS: Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis.Conclusions: Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation.Implications for Nursing: Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative. KNOWLEDGE TRANSLATION: Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care. |
Hepatitis A virus: host interactions, molecular epidemiology and evolution.
Vaughan G , Goncalves Rossi LM , Forbi JC , de Paula VS , Purdy MA , Xia G , Khudyakov YE . Infect Genet Evol 2013 21 227-43 Infection with hepatitis A virus (HAV) is the commonest viral cause of liver disease and presents an important public health problem worldwide. Several unique HAV properties and molecular mechanisms of its interaction with host were recently discovered and should aid in clarifying the pathogenesis of hepatitis A. Genetic characterization of HAV strains have resulted in the identification of different genotypes and subtypes, which exhibit a characteristic worldwide distribution. Shifts in HAV endemicity occurring in different parts of the world, introduction of genetically diverse strains from geographically distant regions, genotype displacement observed in some countries and population expansion detected in the last decades of the 20th century using phylogenetic analysis are important factors contributing to the complex dynamics of HAV infections worldwide. Strong selection pressures, some of which, like usage of deoptimized codons, are unique to HAV, limit genetic variability of the virus. Analysis of subgenomic regions has been proven useful for outbreak investigations. However, sharing short sequences among epidemiologically unrelated strains indicates that specific identification of HAV strains for molecular surveillance can be achieved only using whole-genome sequences. Here, we present up-to-date information on the HAV molecular epidemiology and evolution, and highlight the most relevant features of the HAV-host interactions. |
Simultaneous detection of major drug resistance mutations in the protease and reverse transcriptase genes for HIV-1 subtype C by use of a multiplex allele-specific assay.
Zhang G , Cai F , Zhou Z , Devos J , Wagar N , Diallo K , Zulu I , Wadonda-Kabondo N , Stringer JS , Weidle PJ , Ndongmo CB , Sikazwe I , Sarr A , Kagoli M , Nkengasong J , Gao F , Yang C . J Clin Microbiol 2013 51 (11) 3666-74 High-throughput, sensitive, and cost-effective HIV drug resistance (HIVDR) detection assays are needed for large-scale monitoring of the emergence and transmission of HIVDR in resource-limited settings. Using suspension array technology, we have developed a multiplex allele-specific (MAS) assay that can simultaneously detect major HIVDR mutations at 20 loci. Forty-five allele-specific primers tagged with unique 24-base oligonucleotides at the 5' end were designed to detect wild-type and mutant alleles at the 20 loci of HIV-1 subtype C. The MAS assay was first established and optimized with three plasmid templates (C-wt, C-mut1, and C-mut2) and then evaluated using 148 plasma specimens from HIV-1 subtype C-infected individuals. All the wild-type and mutant alleles were unequivocally distinguished with plasmid templates, and the limits of detection were 1.56% for K219Q and K219E, 3.13% for L76V, 6.25% for K65R, K70R, L74V, L100I, K103N, K103R, Q151M, Y181C, and I47V, and 12.5% for M41L, K101P, K101E, V106A, V106M, Y115F, M184V, Y188L, G190A, V32I, I47A, I84V, and L90M. Analyses of 148 plasma specimens revealed that the MAS assay gave 100% concordance with conventional sequencing at eight loci and >95% (range, 95.21% to 99.32%) concordance at the remaining 12 loci. The differences observed were caused mainly by 24 additional low-abundance alleles detected by the MAS assay. Ultradeep sequencing analysis confirmed 15 of the 16 low-abundance alleles. This multiplex, sensitive, and straightforward result-reporting assay represents a new efficient genotyping tool for HIVDR surveillance and monitoring. |
Prevalence of sequence types among clinical and environmental isolates of Legionella pneumophila serogroup 1 in the United States from 1982 to 2012.
Kozak-Muiznieks NA , Lucas CE , Brown E , Pondo T , Taylor TH Jr , Frace M , Miskowski D , Winchell JM . J Clin Microbiol 2013 52 (1) 201-11 Since the establishment of sequence-based typing as the gold standard for DNA-based typing of Legionella pneumophila, the Centers for Disease Control and Prevention's (CDC) Legionella laboratory has conducted routine SBT analysis of all incoming L. pneumophila serogroup 1 (Lp1) isolates to identify potential links between cases and to better understand genetic diversity and clonal expansion among L. pneumophila. Retrospective genotyping of Lp1 isolates from sporadic cases and Legionnaires' disease (LD) outbreaks deposited into the CDC reference collection since 1982 has been completed. For this study, we compared the distribution of sequence types (STs) among Lp1 isolates implicated in 26 US outbreaks, 571 clinical isolates from US sporadic cases of LD and 149 environmental isolates with no known association with LD. The Lp1 isolates under study had been deposited into our collection between 1982 and 2012. We identified 17 outbreak-associated, 153 sporadic, and 49 environmental STs. We observed that Lp1 STs from outbreaks and sporadic cases are more similar to each other than either group is to environmental STs. The most frequent ST for both sporadic and environmental isolates was ST1, accounting for 25% and 49% of the total number of isolates, respectively. The STs shared by both outbreak-associated and sporadic Lp1 included ST1, ST35, ST36, ST37, and ST222. The STs most commonly found in sporadic and outbreak-associated Lp1 populations may have an increased ability to cause disease and thus may require special attention when detected. |
Spread of Pacific Northwest Vibrio parahaemolyticus strain
Martinez-Urtaza J , Baker-Austin C , Jones JL , Newton AE , Gonzalez-Aviles GD , DePaola A . N Engl J Med 2013 369 (16) 1573-4 Globally, Vibrio parahaemolyticus is a leading cause of seafood-associated gastroenteritis. Historically, the V. parahaemolyticus serotypes O4:K12 and O4:KUT, which have been shown to be more virulent than other pathogenic V. parahaemolyticus strains, have been unique to the Pacific Northwest region.1 These strains, which were first identified in the Pacific Northwest in 1988, caused large U.S. outbreaks in 1997 and 2004.2 The outbreaks were linked to consumption of Pacific shellfish, but these strains have not been linked to illness or isolated outside the Pacific Northwest until recently. | During the summer of 2012, outbreaks of V. parahaemolyticus infection caused by these serotypes occurred on the Atlantic coasts of the United States and Spain. The U.S. Centers for Disease Control and Prevention received reports of 28 cases of infection from 9 states, and regional health authorities in Galicia in northwest Spain received reports of 51 cases, of which 9 were subsequently confirmed by laboratory tests. | The U.S. outbreak was linked to consumption of shellfish harvested from Oyster Bay Harbor, New York, between April and August 2012. The Spanish outbreak occurred in August 2012 on a cruise ship in Galicia and was epidemiologically linked to cooked seafood cooled with ice produced from untreated local seawater. |
Maternal and neonatal outcomes among pregnant women with 2009 pandemic influenza A(H1N1) illness in Florida, 2009-2010: a population-based cohort study
Doyle TJ , Goodin K , Hamilton JJ . PLoS One 2013 8 (10) e79040 INTRODUCTION: Pregnant women have been identified as a high risk group for severe illness with 2009 pandemic influenza A(H1N1) virus infection (pH1N1). Obesity has also been identified as a risk factor for severe illness, though this has not been thoroughly assessed among pregnant women. The objectives of this study were to provide risk estimates for adverse maternal and neonatal outcomes associated with pH1N1 illness during pregnancy and to assess the role of obesity in these outcomes. METHODS: We established a retrospective population-based cohort of all live births occurring in Florida during the first 15 months of the pandemic. Illness with pH1N1 during pregnancy was ascertained through record linkage with the Florida state notifiable disease surveillance database. Data from the birth record, including pre-pregnancy body mass index, were analyzed to assess risk of adverse outcomes associated with pH1N1 illness. RESULTS: A total of 194 women were identified through surveillance with pH1N1 illness during pregnancy. Children born to women with pH1N1 illness during pregnancy were at increased risk for low birth weight [OR (95%CI): 1.78 (1.11-2.860)], premature birth [2.21 (1.47-3.330)], and infant death [4.46 (1.80-11.00)], after adjusting for other factors. Women with pH1N1 illness during pregnancy were at increased risk for severe outcomes including admission to an intensive care unit. Obesity was an observed risk factor, both for the more severe pH1N1 illness detected through surveillance, and for severe maternal outcomes. CONCLUSIONS: Case-patients in this analysis likely represent the most severely ill subset of all women infected with pH1N1 during pregnancy, limiting the generalizability of these findings to more severely ill patients rather than influenza infection in general. Nevertheless, these results suggest that more severe pH1N1 illness during pregnancy is associated with adverse neonatal outcomes and that pregnant women should continue to be targeted for appropriate prophylaxis and early treatment. |
A national cholera epidemic with high case fatality rates--Kenya 2009
Loharikar A , Briere E , Ope M , Langat D , Njeru I , Gathigi L , Makayotto L , Ismail AM , Thuranira M , Abade A , Amwayi S , Omolo J , Oundo J , De Cock KM , Breiman RF , Ayers T , Mintz E , O'Reilly CE . J Infect Dis 2013 208 Suppl 1 S69-77 BACKGROUND: Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. METHODS: We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. RESULTS:. In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. CONCLUSIONS: High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies. |
Ongoing surveillance for lymphatic filariasis in Togo: assessment of alternatives and nationwide reassessment of transmission status
Budge PJ , Dorkenoo AM , Sodahlon YK , Fasuyi OB , Mathieu E . Am J Trop Med Hyg 2013 90 (1) 89-95 Tremendous progress has been made to the goal of global elimination of lymphatic filariasis (LF) transmission by 2020. The number of endemic countries reducing LF transmission through mass drug administration continues to increase, and therefore, the need for effective post-intervention surveillance also continues to increase. Togo is the first sub-Saharan African country to implement LF surveillance, and it has 6 years of experience with this passive surveillance system. We herein report the results of a recent evaluation of the Togolese LF surveillance system, including an evaluation of blood donors as a surveillance population, and provide updated results of ongoing surveillance, including expansion in remote areas. Since implementation of LF surveillance in 2006, only three cases of positive Wuchereria bancrofti filaremia have been detected, suggesting that interruption of transmission has been sustained. Given the impracticality of validating the surveillance system in the absence of ongoing transmission, we confirmed the lack of transmission through a nationwide reassessment survey. |
Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review
Abdul-Quader AS , Feelemyer J , Modi S , Stein ES , Briceno A , Semaan S , Horvath T , Kennedy GE , Des Jarlais DC . AIDS Behav 2013 17 (9) 2878-92 Needle-syringe programs (NSP) have been effective in reducing HIV and hepatitis C (HCV) infection among people who inject drugs (PWID). Achieving sustainable reductions in these blood-borne infections requires addressing structural factors so PWID can legally access NSP services. Systematic literature searches collected information on NSP coverage and changes in HIV or HCV infection prevalence or incidence at the population level. Included studies had to document biomarkers (HIV or HCV) coupled with structural-level NSP, defined by a minimum 50 % coverage of PWID and distribution of 10 or more needles/syringe per PWID per year. Fifteen studies reported structural-level NSP and changes in HIV or HCV infection prevalence/incidence. Nine reported decreases in HIV prevalence, six in HCV infection prevalence, and three reported decreases in HIV incidence. The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection. |
Evaluation of a rapid cholera response activity--Nyanza Province, Kenya, 2008
Date K , Person B , Nygren B , Were V , Kola S , Ayers T , Quick R . J Infect Dis 2013 208 Suppl 1 S62-8 BACKGROUND: In response to recurrent cholera outbreaks in Nyanza Province, Kenya, a local nongovernmental organization assisted the Ministry of Health by providing cholera education activities to some cholera-affected communities. We evaluated the impact on cholera prevention knowledge and practices. METODS: In November-December 2008, we conducted a cross-sectional household survey and tested stored water for chlorine in 6 cholera-affected enumeration areas (intervention-EAs) where response activities had occurred between March-September 2008, and 6 comparison-EAs with no known reports of cholera outbreaks or response activities. RESULTS: We enrolled 358 individuals from intervention-EAs and 365 from comparison-EAs. Overall, >80% knew cholera symptoms and over 60% knew that water treatment prevented diarrhea; <20% had chlorine residual in stored water. More intervention-EA respondents than comparison-EA respondents recalled a cholera outbreak in their community (52% vs 19%, P < .0001), and of those, 51% versus 39%, respectively, had attended a cholera response event. Detectable chlorine residuals in stored water were found in a higher percentage of intervention-EA and comparison-EA event attendees (21% and 25%, respectively) than nonattendees (17% and 8%, respectively). CONCLUSIONS: There was a gap between knowledge and practice of water treatment as a cholera preventive measure. Cholera event attendance may have modestly motivated increased household water treatment. |
Influenza surveillance in Russia based on epidemiological and laboratory data for the period from 2005 to 2012
Anna S , Burtseva E , Eropkin M , Karpova L , Zarubaev V , Smorodintseva E , Konovalova N , Danilenko D , Prokopetz A , Grudinin M , Pisareva M , Anfimov P , Stolyarov K , Kiselev O , Shevchenko E , Ivanova V , Trushakova S , Breslav N , Lvov D , Klimov A , Moen A , Cox N . Am J Infect Dis 2013 9 (3) 77-93 Exchange of information on and sharing of influenza viruses through the GISRS network has great significance for understanding influenza virus evolution, recognition of a new pandemic virus emergence and for preparing annual WHO recommendations on influenza vaccine strain composition. Influenza surveillance in Russia is based on collaboration of two NICs with 59 Regional Bases. Most epidemiological and laboratory data are entered through the internet into the electronic database at the Research Institute of Influenza (RII), where they are analyzed and then reported to the Ministry of Public Health of Russia. Simultaneously, data are introduced into WHO's Flu Net and Euro Flu, both electronic databases. Annual influenza epidemics of moderate intensity were registered during four pre-pandemic seasons. Children aged 0-2 and 3-6 years were the most affected groups of the population. Influenza registered clinically among hospitalized patients with respiratory infections for the whole epidemic period varied between 1.3 and 5.4% and up but to 18.5-23.0% during the peak of the two pandemic waves caused by influenza A(H1N1) pdm 09 virus and to lesser extent (2.9 to 8.5%) during usual seasonal epidemics. Most epidemics were associated with influenza A(H1N1), A(H3N2) and B co-circulation. During the two pandemic waves (in 2009-2010 and 2010-2011) influenza A(H1N1) pdm 09 predominated. It was accompanied by a rapid growth of influenza morbidity with a significant increase of both hospitalization and mortality. The new pandemic virus displaced the previous seasonal A(H1N1) virus completely. As a rule, most of the influenza viruses circulating in Russia were antigenic ally related to the strains recommended by WHO for vaccine composition for the Northern hemisphere with the exception of two seasons when an unexpected replacement of the influenza B Victoria lineage by Yamagata lineage (2007-2008) and the following return of Victoria lineage viruses (2008-2009) was registered. Influenza surveillance in Russia was improved as a result of enhancing capacity to international standards and the introduction of new methods in NICs such as rRT-PCR diagnosis, regular testing of influenza viruses for susceptibility to antivirals, phylogenetic analysis as well as organization of sentinel surveillance in a number of Regional Base Laboratories. Improvements promoted rapid recognition of the appearance a new pandemic virus in the country and enhancement of confirmation tests in investigation of influenza related death cases. |
The challenge of promoting interventions to prevent disease in impoverished populations in rural western Kenya
Schilling K , Person B , Faith SH , Otieno R , Quick R . Am J Public Health 2013 103 (12) 2131-5 Poverty is a critical social determinant of health. A particular approach toward mitigating inequitable access to health services in Kenya has been through a community-based distribution program implemented by the Safe Water and AIDS Project (SWAP) that has achieved modest uptake of public health interventions. To explore reasons for modest uptake, we asked program participants about child health problems, daily tasks, household expenditures, and services needed by their communities. Respondents identified child health problems consistent with health data and reported daily tasks, expenses, and needed services that were more related to basic needs of life other than health. These findings highlight the challenges of implementing potentially self-sustaining preventive interventions at scale in poor populations in the developing world. |
Cost-effectiveness of a 12-dose regimen for treating latent tuberculous infection in the United States
Shepardson D , Marks SM , Chesson H , Kerrigan A , Holland DP , Scott N , Tian X , Borisov AS , Shang N , Heilig CM , Sterling TR , Villarino ME , Mac Kenzie WR . Int J Tuberc Lung Dis 2013 17 (12) 1531-7 SETTING: A large randomized controlled trial recently showed that for treating latent tuberculous infection (LTBI) in persons at high risk of progression to tuberculosis (TB) disease, a 12-dose regimen of weekly rifapentine plus isoniazid (3HP) administered as directly observed treatment (DOT) can be as effective as 9 months of daily self-administered isoniazid (9H). OBJECTIVES: To assess the cost-effectiveness of 3HP compared to 9H. DESIGN: A computational model was designed to simulate individuals with LTBI treated with 9H or 3HP. Costs and health outcomes were estimated to determine the incremental costs per active TB case prevented and per quality-adjusted life year (QALY) gained by 3HP compared to 9H. RESULTS: Over a 20-year period, treatment of LTBI with 3HP rather than 9H resulted in 5.2 fewer cases of TB and 25 fewer lost QALYs per 1000 individuals treated. From the health system and societal perspectives, 3HP would cost respectively US21525 and 4294 more per TB case prevented, and respectively 4565 and 911 more per QALY gained. CONCLUSIONS: 3HP may be a cost-effective alternative to 9H, particularly if the cost of rifapentine decreases, the effectiveness of 3HP can be maintained without DOT, and 3HP treatment is limited to those with a high risk of progression to TB disease. |
Components associated with home visiting program outcomes: a meta-analysis
Filene JH , Kaminski JW , Valle LA , Cachat P . Pediatrics 2013 132 Suppl 2 S100-9 BACKGROUND: Although several systematic reviews have concluded that home visiting has strong evidence of effectiveness, individual evaluations have produced inconsistent results. We used a component-based, domain-specific approach to determine which characteristics most strongly predict outcomes. METHODS: Medline and PsycINFO searches were used to identify evaluations of universal and selective home visiting programs implemented in the United States. Coders trained to the study criterion coded characteristics of research design, program content, and service delivery. We conducted random-effects, inverse-variance-weighted linear regressions by using program characteristics to predict effect sizes on 6 outcome domains (birth outcomes, parenting behavior and skills, maternal life course, child cognitive outcomes, child physical health, and child maltreatment). RESULTS: Aggregated to a single effect size per study (k = 51), the mean effect size was 0.20 (95% confidence interval: 0.14 to 0.27), with a range of -0.68 to 3.95. Mean effect sizes were significant and positive for 3 of the 6 outcome domains (maternal life course outcomes, child cognitive outcomes, and parent behaviors and skills), with heterogeneity of effect sizes in all 6 outcome domains. Research design characteristics generally did not predict effect sizes. No consistent pattern of effective components emerged across all outcome domains. CONCLUSIONS: Home visiting programs demonstrated small but significant overall effects, with wide variability in the size of domain-specific effects and in the components that significantly predicted domain-specific effects. Communities may need complementary or alternative strategies to home visiting programs to ensure widespread impact on these 6 important public health outcomes. |
An examination of the handheld adapter approach for measuring hand-transmitted vibration exposure
Xu Xueyan S , Dong Ren G , Welcome Daniel E , Warren Christopher , McDowell Thomas W . Measurement ( Mahwah N J) 2014 47 (1) 64-77 The use of a handheld adapter equipped with a tri-axial accelerometer is the most convenient and efficient approach for measuring vibration exposure at the hand-tool interface, especially when the adapter is incorporated into a miniature handheld or wrist-strapped dosimeter. To help optimize the adapter approach, the specific aims of this study are to identify and understand the major sources and mechanisms of measurement errors and uncertainties associated with using these adapters, and to explore their improvements. Five representative adapter models were selected and used in the experiment. Five human subjects served as operators in the experiment on a hand-arm vibration test system. The results of this study confirm that many of the handheld adapters can produce substantial overestimations of vibration exposure, and measurement errors can significantly vary with tool, adapter model, mounting position, mounting orientation, and subject. Major problems with this approach include unavoidable influence of the hand dynamic motion on the adapter, unstable attachment, insufficient attachment contact force, and inappropriate adapter structure. However, the results of this study also suggest that measurement errors can be substantially reduced if the design and use of an adapter can be systematically optimized toward minimizing the combined effects of the identified factors. Some potential methods for improving the design and use of the adapters are also proposed and discussed. |
An enhanced throughput method for quantification of sulfur mustard adducts to human serum albumin via isotope dilution tandem mass spectrometry
Andacht TM , Pantazides BG , Crow BS , Fidder A , Noort D , Thomas JD , Blake TA , Johnson RC . J Anal Toxicol 2013 38 (1) 8-15 Here, we report an enhanced throughput method for the diagnosis of human exposure to sulfur mustard. A hydroxyethylthioethyl (HETE) ester-adducted tripeptide, produced by pronase digestion of human serum albumin, was selected as the quantitative exposure biomarker. Cibacron Blue enrichment was developed from an established cartridge method into a 96-well plate format, increasing throughput and ruggedness. This new method decreased sample volume 2.5-fold. Addition of a precipitation and solid-phase extraction concentration step increased the sensitivity of the method. With the conversion to a 96-well plate and optimization of chromatography, the method resulted in a 3-fold decrease in analysis time. Inclusion of a confirmation ion has increased specificity. The method was found to be linear between 0.050 and 50 microM sulfur mustard exposure with a precision for both quality control samples of ≤6.5% relative standard deviation and an accuracy of >96%. The limit of detection (3So) was calculated to be approximately 0.0048 microM, an exposure value similar to that of the HETE-albumin adduct method first described by Noort and co-workers (Noort et al., 1999; Noort el al., 2004) which used protein precipitation to isolate albumin. A convenience set of 124 plasma samples from healthy unexposed individuals was analyzed using this method to assess background levels of exposure to sulfur mustard; no positive results were detected. |
Standard enrichment methods for targeted next-generation sequencing in high-repeat genomic regions.
Mueller PW , Lyons J , Kerr G , Haase CP , Isett RB . Genet Med 2013 15 (11) 910-1 In addition to the increasing use of whole-exome and whole-genome sequencing for diagnosis of symptomatic recessive genetic diseases, researchers are developing targeted disease and gene panels using next-generation sequencing (NGS) for potential screening applications in adults and for newborn screening.1 Because significant actions could be taken based on the results of such screens, validation of the methods is necessary. To test the accuracy in a repeat genomic region of a published targeted NGS screening test for 448 childhood recessive diseases, we sequenced three samples reported to be positive by the authors for mutations in a newborn screening disease gene. This complex published method generated raw data from Agilent SureSelect hybrid capture enrichment of sheared DNA that was filtered using a variety of approaches. This method specified a minimum number of uniquely aligned reads of quality score >20; it specified that >14% of reads were needed to call a variant; and it restricted mutation calls to those associated with severe disease phenotypes in databases such as the Human Gene Mutation Database (HGMD). Using this highly curated approach, the authors reported mutations found in 104 Coriell samples, including two congenital adrenal hyperplasia (CAH) mutations in CYP21A2 in three samples clinically affected with diseases other than CAH. HGMD mutation CM071683, Ala392Thr (1174G>A), was reported in samples NA01881 and NA03365, and mutation CM920233, Pro454Ser (1360C>T), was reported in sample NA00059. The second mutation, CM920233, is a recognized cause of mild, nonclassical CAH,2 but the former, CM071683, was reported in 2006 as a novel mutation by Robins and coworkers, who were studying a Caucasian child presenting with premature adrenarche at 6 years of age and advanced bone age of 8.5 years.3 |
Philosophical Foundations of Health Education
Olson SJ . Health Promot Pract 2013 14 (6) 805-8 Philosophical Foundations of Health Education is a powerful, thorough, and unique resource for health educators and especially for health education and promotion faculty. It contains previously published articles by leaders in the profession since the 1950s. The articles are grouped by the topics into six distinct parts. The book argues that all health professionals, new or old, need to develop their own personal philosophy about health and the profession and to use it to inform how they view and use the philosophies in their roles as professional health educators. |
Healthcare-associated infections studies project: an American Journal of Infection Control and National Healthcare Safety Network data quality collaboration-ventilator-associated event 1, 2013
Allen-Bridson K , Gross C , Hebden JN , Morrell GC , Wright MO , Horan T . Am J Infect Control 2013 41 (11) 1085-6 This is the second case study published in a series in AJIC since the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) surveillance definition update of 2013. These cases reflect some of the complex patient scenarios Infection Preventionists (IP) have encountered in their daily surveillance of health care-associated infections (HAI) using NHSN definitions. This is the first case utilizing the new NHSN Ventilator-associated Events (VAE) module and criteria. |
Developing a new national approach to surveillance for ventilator-associated events: executive summary
Magill SS , Klompas M , Balk R , Burns SM , Deutschman CS , Diekema D , Fridkin S , Greene L , Guh A , Gutterman D , Hammer B , Henderson D , Hess DR , Hill NS , Horan T , Kollef M , Levy M , Septimus E , VanAntwerpen C , Wright D , Lipsett P . Am J Infect Control 2013 41 (11) 1096-9 In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1). The charges to the Working Group were to (1) critically review a draft, streamlined VAP surveillance definition developed for use in adult patients; (2) suggest modifications to enhance the reliability and credibility of the surveillance definition within the critical care and infection prevention communities; and (3) propose a final adult surveillance definition algorithm to be implemented in the CDC's National Healthcare Safety Network (NHSN), taking into consideration the potential future use of the definition algorithm in public reporting, interfacility comparisons, and pay-for-reporting and pay-for-performance programs. |
Developing a new, national approach to surveillance for ventilator-associated events
Magill SS , Klompas M , Balk R , Burns SM , Deutschman CS , Diekema D , Fridkin S , Greene L , Guh A , Gutterman D , Hammer B , Henderson D , Hess DR , Hill NS , Horan T , Kollef M , Levy M , Septimus E , Vanantwerpen C , Wright D , Lipsett P . Am J Crit Care 2013 22 (6) 469-73 This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled "Developing a New, National Approach to Surveillance for Ventilator-Associatied Events," published in Critical Care Medicine, by Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, et al. 2013;41(11):2467-2475. The full report provides a comprehensive description of the Working Group's process and outcome. |
Molecular resistance mechanisms of macrolide-resistant invasive Streptococcus pneumoniae isolates from Alaska, 1986 to 2010.
Rudolph K , Bulkow L , Bruce M , Zulz T , Reasonover A , Harker-Jones M , Hurlburt D , Hennessy T . Antimicrob Agents Chemother 2013 57 (11) 5415-22 The rapid emergence of antibiotic-resistant pneumococcal strains has reduced treatment options. The aim of this study was to determine antimicrobial susceptibilities, serotype distributions, and molecular resistance mechanisms among macrolide-resistant invasive pneumococcal isolates in Alaska from 1986 to 2010. We identified cases of invasive pneumococcal disease in Alaska from 1986 to 2010 through statewide population-based laboratory surveillance. All invasive pneumococcal isolates submitted to the Arctic Investigations Program laboratory were confirmed by standard microbiological methods and serotyped by slide agglutination and the Quellung reaction. MICs were determined by the broth microdilution method, and macrolide-resistant genotypes were determined by multiplex PCR. Among 2,923 invasive pneumococcal isolates recovered from 1986 to 2010, 270 (9.2%) were nonsusceptible to erythromycin; 177 (66%) erythromycin-nonsusceptible isolates demonstrated coresistance to penicillin, and 167 (62%) were multidrug resistant. The most frequent serotypes among the macrolide-resistant isolates were serotypes 6B (23.3%), 14 (20.7%), 19A (16.7%), 9V (8.9%), 19F (6.3%), 6A (5.6%), and 23F (4.8%). mef and erm(B) genes were detected in 207 (77%) and 32 (12%) of the isolates, respectively. Nineteen (7%) of the erythromycin-nonsusceptible isolates contained both mef and erm(B) genotypes; 15 were of serotype 19A. There was significant year-to-year variation in the proportion of isolates that were nonsusceptible to erythromycin (P < 0.001). Macrolide resistance among pneumococcal isolates from Alaska is mediated predominantly by mef genes, and this has not changed significantly over time. However, there was a statistically significant increase in the proportion of isolates that possess both erm(B) and mef, primarily due to serotype 19A isolates. |
Expanding resource theory and feminist-informed theory to explain intimate partner violence perpetration by court-ordered men
Basile KC , Hall JE , Walters ML . Violence Against Women 2013 19 (7) 848-80 This study tested resource and feminist-informed theories to explain physical, sexual, psychological, and stalking intimate partner violence (IPV) perpetrated by court-mandated men. Data were obtained from 340 men arrested for physical assault of a partner before their court-ordered treatment. Using path analysis, findings provided partial support for each model. Ineffective arguing and substance-use problems were moderators of resources and perpetration. Dominance mediated early exposures and perpetration in the feminist-informed model. In both models, predictors of stalking were different than those for other types of perpetration. Future studies should replicate this research and determine the utility of combining models. |
Safety of influenza A (H1N1) 2009 live attenuated monovalent vaccine in pregnant women
Moro PL , Museru OI , Broder K , Cragan J , Zheteyeva Y , Tepper N , Revzina N , Lewis P , Arana J , Barash F , Kissin D , Vellozzi C . Obstet Gynecol 2013 122 (6) 1271-8 OBJECTIVE: To characterize maternal and infant outcomes for pregnant women who received live H1N1 influenza vaccine and had no reported adverse events. METHODS: We identified Vaccine Adverse Event Reporting System reports, which described receipt of live H1N1 vaccine during pregnancy without an indication of an adverse event at the time of the report during October 2009 to June 2010. We reviewed the initial reports and obtained pregnancy outcome and infant data through 6 months of age from medical records. We reviewed the numbers and characteristics of pregnancy complications and infant outcomes including major birth defects and medically important infant conditions. Rates of spontaneous abortion, preterm birth, and major birth defects and their 95% confidence intervals were calculated. RESULTS: The Vaccine Adverse Event Reporting System received 113 reports stating receipt of live H1N1 vaccine during pregnancy with no adverse events reported. We obtained follow-up maternal records on 95 of the 113 (84%) live H1N1 reports (40.2% were vaccinated in the first trimester) and found: 87 live births (two twin pregnancies) and no maternal deaths occurred. Number and rates of pregnancy-specific adverse events included: 10 (10.5%, 5.8-18.3) spontaneous abortions; four (4.7%, 1.8-11.4) preterm deliveries at 35-36 weeks of gestation; three (3.4%, 1.2-9.7) infants had one or more major birth defects noted at birth: one cleft palate, one cleft lip, and one microtia (underdeveloped or absent external ear). Seven neonates and infants were hospitalized for medically important conditions. One infant death occurred in a 2.5-month-old boy as a result of pertussis. CONCLUSION: Rates of spontaneous abortion, preterm birth, and major birth defects in pregnant women who received live H1N1 vaccine were similar to or lower than published background rates. No concerning patterns of medical conditions in infants were identified. LEVEL OF EVIDENCE: III. |
Seroprevalence of measles and rubella antibodies in pregnant women Haiti, 2012
Fitter DL , Anselme R , Paluku G , Rey G , Flannery B , Tohme RA , Marston BJ , Griswold M , Boncy J , Vertefeuille JF . Vaccine 2013 32 (1) 69-73 BACKGROUND: Haiti had set a national goal to eliminate measles and rubella, as well as congenital rubella syndrome (CRS) by 2010. A 2007-2008 nationwide measles and rubella vaccination campaign targeting 1-19 years, however, reached only 79% of the target population. To assess whether population immunity was adequate to support elimination, we conducted a national serosurvey. METHODS: We systematically selected 740 serum specimens collected from pregnant women in a 2012 national antenatal HIV sentinel serosurvey across four age strata: 15-19, 20-24, 25-29 and 30-39 years. Sera were tested for measles and rubella specific immunoglobulin G antibodies (IgG) using commercial immunoassays. We classified sera as seropositive, seronegative or indeterminate per manufacturer's instructions, and analyzed seroprevalence according to age strata, and rural or urban residence. We assessed immunity by estimating antibody concentrations in international units per milliliter (IU/mL) for seropositive and indeterminate sera. Measles IgG concentrations >0.12IU/mL and rubella IgG concentrations >10IU/mL were considered clinically protective. RESULTS: Of 740 sera, 696 (94.1%) were seropositive and 20 (2.7%) were indeterminate for measles IgG; overall 716 (96.8%) sera had IgG concentrations >0.12IU/mL. For rubella IgG, 691 (93.4%) sera were seropositive and 1 (0.1%) was indeterminate; a total of 687 (92.8%) had IgG concentrations >10IU/mL. Measles seropositivity varied across age strata (p=0.003); seropositivity increased from 88.6% among 15-19 year olds to 98.4% among 30-39 year olds (Cochran-Armitage trend test≤0.0001). Rubella seropositivity did not differ across age strata. There were no statistically significant differences in measles or rubella seropositivity by urban versus rural residence. CONCLUSION: Despite previous low vaccination coverage for measles, results from this serosurvey indicate high levels of measles and rubella seropositivity in pregnant women, and contribute to the evidence for measles, rubella and CRS elimination from Haiti by the target date. |
Serum biomarkers of polyfluoroalkyl compound exposure in young girls in greater Cincinnati and the San Francisco Bay area, USA
Pinney SM , Biro FM , Windham GC , Herrick RL , Yaghjyan L , Calafat AM , Succop P , Sucharew H , Ball KM , Kato K , Kushi LH , Bornschein R . Environ Pollut 2013 184C 327-334 PFC serum concentrations were measured in 6-8 year-old girls in Greater Cincinnati (GC) (N = 353) and the San Francisco Bay Area (SFBA) (N = 351). PFOA median concentration was lower in the SFBA than GC (5.8 vs. 7.3 ng/mL). In GC, 48/51 girls living in one area had PFOA concentrations above the NHANES 95th percentile for children 12-19 years (8.4 ng/mL), median 22.0 ng/mL. The duration of being breast fed was associated with higher serum PFOA at both sites and with higher PFOS, PFHxS and Me-PFOSA-AcOH concentrations in GC. Correlations of the PFC analytes with each other suggest that a source upriver from GC may have contributed to exposures through drinking water, and water treatment with granular activated carbon filtration resulted in less exposure for SWO girls compared to those in NKY. PFOA has been characterized as a drinking water contaminant, and water treatment systems effective in removing PFCs will reduce body burdens. |
Urinary phthalate metabolite concentrations among pregnant women in northern Puerto Rico: distribution, temporal variability, and predictors
Cantonwine DE , Cordero JF , Rivera-Gonzalez LO , Anzalota Del Toro LV , Ferguson KK , Mukherjee B , Calafat AM , Crespo N , Jiménez-Vélez B , Padilla IY , Alshawabkeh AN , Meeker JD . Environ Int 2013 62C 1-11 BACKGROUND: Phthalate contamination exists in the North Coast karst aquifer system in Puerto Rico. In light of potential health impacts associated with phthalate exposure, targeted action for elimination of exposure sources may be warranted, especially for sensitive populations such as pregnant women. However, information on exposure to phthalates from a variety of sources in Puerto Rico is lacking. The objective of this study was to determine concentrations and predictors of urinary phthalate biomarkers measured at multiple times during pregnancy among women living in the Northern karst area of Puerto Rico. METHODS: We recruited 139 pregnant women in Northern Puerto Rico and collected urine samples and questionnaire data at three separate visits (18+/-2weeks, 22+/-2weeks, and 26+/-2weeks of gestation). Urine samples were analyzed for eleven phthalate metabolites: mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-hydroxyhexyl phthalate, mono-2-ethyl-5-oxohexyl phthalate, mono-2-ethyl-5-carboxypentyl phthalate, mono-ethyl phthalate (MEP), mono-n-butyl phthalate, mono-benzyl phthalate, mono-isobutyl phthalate, mono-3-carboxypropyl phthalate (MCPP), mono carboxyisononyl phthalate (MCNP), and mono carboxyisooctyl phthalate (MCOP). RESULTS: Detectable concentrations of phthalate metabolites among pregnant women living in Puerto Rico was prevalent, and metabolite concentrations tended to be higher than or similar to those measured in women of reproductive age from the general US population. Intraclass correlation coefficients ranged from very weak (MCNP; 0.05) to moderate (MEP; 0.44) reproducibility among all phthalate metabolites. We observed significant or suggestive positive associations between urinary phthalate metabolite concentrations and water usage/storage habits (MEP, MCNP, MCOP), use of personal care products (MEP), and consumption of certain food items (MCPP, MCNP, and MCOP). CONCLUSIONS: To our knowledge this is the first study to report concentrations, temporal variability, and predictors of phthalate biomarkers among pregnant women in Puerto Rico. Preliminary results suggest several potentially important exposure sources to phthalates in this population and future analysis from this ongoing prospective cohort will help to inform targeted approaches to reduce exposure. |
Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007
Mhyre JM , Shilkrut A , Kuklina EV , Callaghan WM , Creanga AA , Kaminsky S , Bateman BT . Obstet Gynecol 2013 122 (6) 1288-94 OBJECTIVE: To define the frequency, risk factors, and outcomes of massive transfusion in obstetrics. METHODS: The State Inpatient Dataset for New York (1998-2007) was used to identify all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year. Multivariable logistic regression analysis was performed to examine the relationship between maternal age, race, and relevant clinical variables and the risk of massive blood transfusion defined as 10 or more units of blood recorded. RESULTS: Massive blood transfusion complicated 6 of every 10,000 deliveries with cases observed even in the smallest facilities. Risk factors with the strongest independent associations with massive blood transfusion included abnormal placentation (1.6/10,000 deliveries, adjusted odds ratio [OR] 18.5, 95% confidence interval [CI] 14.7-23.3), placental abruption (1.0/10,000, adjusted OR 14.6, 95% CI 11.2-19.0), severe preeclampsia (0.8/10,000, adjusted OR 10.4, 95% CI 7.7-14.2), and intrauterine fetal demise (0.7/10,000, adjusted OR 5.5, 95% CI 3.9-7.8). The most common etiologies of massive blood transfusion were abnormal placentation (26.6% of cases), uterine atony (21.2%), placental abruption (16.7%), and postpartum hemorrhage associated with coagulopathy (15.0%). A disproportionate number of women who received a massive blood transfusion experienced severe morbidity including renal failure, acute respiratory distress syndrome, sepsis, and in-hospital death. CONCLUSION: Massive blood transfusion was infrequent, regardless of facility size. In the presence of known risk for receipt of massive blood transfusion, women should be informed of this possibility, should deliver in a well-resourced facility if possible, and should receive appropriate blood product preparation and venous access in advance of delivery. LEVEL OF EVIDENCE:: II. |
Blood mercury concentrations in pregnant and non-pregnant women in the United States; National Health and Nutrition Examination Survey 1999-2006
Razzaghi H , Tinker SC , Crider K . Am J Obstet Gynecol 2013 210 (4) 357 e1-357 e9 BACKGROUND: Prenatal exposure to methylmercury is associated with adverse neurological development in children. We examined total blood mercury (BHg) concentrations and predictors of higher BHg concentrations in pregnant and non-pregnant women. METHODS: We analyzed data from 1,183 pregnant and 5,587 non-pregnant women aged 16-49 years from the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We estimated geometric mean BHg concentrations and characteristics associated with higher mercury concentrations (≥3.5 mug/L) in crude and adjusted linear and logistic regression models. RESULTS: After adjusting for age and race/ethnicity, geometric mean BHg concentrations were clinically similar but significantly lower for pregnant (0.81 mug/L, 95% confidence interval [CI]: 0.71, 0.91) and non-pregnant women of childbearing age (0.93 mug/L, 95% CI: 0.87, 0.99); 94% of pregnant and 89% of non-pregnant women had BHg concentrations below 3.5 mug/L. The most significant predictor of higher BHg concentrations for both pregnant and non-pregnant women was any seafood consumption vs. no consumption in the last 30 days (Odds ratio [OR]: 18.7, 95% CI: 4.9, 71.1; OR: 15.5, 95% CI: 7.5, 32.1, respectively). Other characteristics associated with ≥3.5 mug/L BHg concentrations were older age (35+ years), higher education (greater than high school), and higher family income to poverty ratio (3.501+) for both pregnant and non-pregnant women. CONCLUSION: Pregnancy status was not strongly associated with BHg concentrations in women of childbearing age and BHg concentrations above the 3.5 mug/L cut were uncommon. |
Comparing methods for assessing beverage intake among high school students
O'Malley Olsen E , Eaton DK , Park S , Brener ND , Blanck HM . Am J Health Behav 2014 38 (1) 114-23 OBJECTIVES: To compare 7 beverage intake survey questions against criterion data from 24-hour dietary recall interviews (24HrDRIs) among adolescents. METHODS: Data were available from 610 US high school students completing a survey and ≥3 24HrDRIs. Analyses compared mean intake (times/day) calculated from the survey to intake (servings/day) from the 24HrDRIs. Proportions of students reporting intake of ≥1 times/day were compared to the 24HrDRI results. RESULTS: Survey data significantly correlated with 24HrDRI data (all corrected r: 0.26-0.49). Survey results differed from 24HrDRI results on reported intake of 5 beverages. CONCLUSION: Intake from these beverage questions should be reported in times/day, which is related to, but not a proxy for, servings/day. These questions are useful for population-level surveillance of beverage intake and monitoring trends over time. |
Use of and occupational exposure to indium in the United States
Hines CJ , Roberts JL , Andrews RN , Jackson MV , Deddens JA . J Occup Environ Hyg 2013 10 (12) 723-33 Indium use has increased greatly in the past decade in parallel with the growth of flat-panel displays, touchscreens, optoelectronic devices, and photovoltaic cells. Much of this growth has been in the use of indium tin oxide (ITO). This increased use has resulted in more frequent and intense exposure of workers to indium. Starting with case reports and followed by epidemiological studies, exposure to ITO has been linked to serious and sometimes fatal lung disease in workers. Much of this research was conducted in facilities that process sintered ITO, including manufacture, grinding, and indium reclamation from waste material. Little has been known about indium exposure to workers in downstream applications. In 2009-2011, the National Institute for Occupational Safety and Health (NIOSH) contacted 89 potential indium-using companies; 65 (73%) responded, and 43 of the 65 responders used an indium material. Our objective was to identify current workplace applications of indium materials, tasks with potential indium exposure, and exposure controls being used. Air sampling for indium was either conducted by NIOSH or companies provided their data for a total of 63 air samples (41 personal, 22 area) across 10 companies. Indium exposure exceeded the NIOSH recommended exposure limit (REL) of 0.1 mg/m(3) for certain methods of resurfacing ITO sputter targets, cleaning sputter chamber interiors, and in manufacturing some inorganic indium compounds. Indium air concentrations were low in sputter target bonding with indium solder, backside thinning and polishing of fabricated indium phosphide-based semiconductor devices, metal alloy production, and in making indium-based solder pastes. Exposure controls such as containment, local exhaust ventilation (LEV), and tool-mounted LEV can be effective at reducing exposure. In conclusion, occupational hygienists should be aware that the manufacture and use of indium materials can result in indium air concentrations that exceed the NIOSH REL. Given recent findings of adverse health effects in workers, research is needed to determine if the current REL sufficiently protects workers against indium-related diseases. |
A multi-cyclone sampling array for the collection of size-segregated occupational aerosols
Mischler SE , Cauda EG , Di Giuseppe M , Ortiz LA . J Occup Environ Hyg 2013 10 (12) 685-93 In this study a serial multi-cyclone sampling array capable of simultaneously sampling particles of multiple size fractions, from an occupational environment, for use in in vivo and in vitro toxicity studies and physical/chemical characterization, was developed and tested. This method is an improvement over current methods used to size-segregate occupational aerosols for characterization, due to its simplicity and its ability to collect sufficient masses of nano- and ultrafine sized particles for analysis. This method was evaluated in a chamber providing a uniform atmosphere of dust concentrations using crystalline silica particles. The multi-cyclone sampling array was used to segregate crystalline silica particles into four size fractions, from a chamber concentration of 10 mg/m(3). The size distributions of the particles collected at each stage were confirmed, in the air, before and after each cyclone stage. Once collected, the particle size distribution of each size fraction was measured using light scattering techniques to further confirm the size distributions. As a final confirmation, scanning electron microscopy was used to collect images of each size fraction. The results presented here, using multiple measurement techniques, show that this multi-cyclone system was able to successfully collect distinct size-segregated particles at sufficient masses to perform toxicological evaluations and physical/chemical characterization. |
Evaluation of a wearable monitor for measuring real-time diesel particulate matter concentrations in several underground mines
Noll JD , Janisko S . J Occup Environ Hyg 2013 10 (12) 716-22 The standard method for determining diesel particulate matter (DPM) exposures in underground metal/nonmetal mines provides the average exposure concentration for an entire working shift, and it can take weeks to obtain results. This approach is problematic because, although it reports that an overexposure has occurred, it fails to provide critical information about cause or prevention. Conversely, real-time measurement would provide miners with timely information to identify the major factors contributing to overexposures and would allow engineering controls to be deployed immediately. Due to these potential benefits, the National Institute for Occupational Safety and Health (NIOSH) developed a wearable instrument that measures real-time elemental carbon (EC) concentrations (EC is a DPM surrogate) via laser extinction. This instrument was later constructed into a commercial version (Airtec). This article evaluates the Airtec's performance in several underground metal/nonmetal mines by comparing it to the standard method for determining DPM exposures (NIOSH method 5040). The instrument was found to meet the NIOSH accuracy criteria and to show no statistical difference from NIOSH method 5040 results. In addition, the instrument's measurements were found to be unaffected by dust and humidity. |
Comparison of accelerometer cut points to estimate physical activity in US adults
Watson KB , Carlson SA , Carroll DD , Fulton JE . J Sports Sci 2013 32 (7) 660-9 The purpose of this study was (1) to describe physical activity prevalence, categorised according to the 2008 Physical Activity Guidelines for Americans (2008 Guidelines), using different accelerometer cut points and (2) to examine physical activity prevalence patterns by reported cut points across selected characteristics. Cut points from 9 studies were used to estimate physical activity prevalence in a national adult sample (n = 6547). Estimates were stratified by validation study activity protocols used to derive cut points - ambulatory (walking/running) and lifestyle activities (e.g. gardening, housework, walking). Results showed that the prevalence of meeting the 2008 Guidelines ranged from 6.3% to 98.3% overall and was lower for cut points derived from ambulatory (median = 11.5%, range = 6.3-27.4%) compared to lifestyle (median = 77.2%, range = 60.6-98.3%) protocols. Prevalence patterns across protocols differed for age, but were similar for other characteristics. In conclusion, prevalence of meeting the 2008 Guidelines varied widely, indicating that choice of cut point had an impact on prevalence. To generate future accelerometer cut points one may consider developing cut points for demographic subgroups using a variety of lifestyle physical activities. |
NHAMCS: does it hold up to scrutiny?
McCaig LF , Burt CW , Schappert SM , Albert M , Uddin S , Brown C , Madans J . Ann Emerg Med 2013 62 (5) 549-51 The Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS) is committed to collecting and disseminating high-quality data that meet the information needs of a wide range of users. We take issue with the unfavorable assessment of National Hospital Ambulatory Medical Care Survey (NHAMCS) data in a recent editorial by Cooper1 and appreciate the opportunity to respond to her comments. | We agree with Cooper1 that research findings need to be critically assessed, and we appreciate the guidelines she provides for potential authors using NHAMCS data, which are consistent with our recent article.2 We are troubled, however, by her sweeping indictment of the NHAMCS data-gathering process and her concern that medical practice or policy may have changed based on “the false assumption that the data were valid.”1 In fact, the authors cited by Cooper1 appropriately assessed the limitations of using NHAMCS data3, 4, 5, 6 and reported that their findings3, 4, 5 were consistent with previous research. In cases in which findings from studies diverge, it is important to consider the methodology of each study. A particular strength of NHAMCS is that it includes hospitals other than academic medical centers, which commonly serve as the settings for research studies, thereby giving a more complete picture of health care use patterns. When comparing data from NHAMCS with other studies, one should always be careful to keep such methodological differences in mind before making conclusions about validity. |
Strategies to reduce alcohol-exposed pregnancies
Floyd RL , Ebrahim S , Tsai J , O'Connor M , Sokol R . Matern Child Health J 2013 17 (9) 1735 This is how the correct footnote should read: Frequent refers to ≥7 drinks/week or binge. Binge drinking refers to ≥5 drinks on one occasion. |
Trends in cigarette smoking rates and quit attempts among adults with and without diagnosed diabetes, United States, 2001-2010
Fan AZ , Rock V , Zhang X , Li Y , Elam-Evans L , Balluz L . Prev Chronic Dis 2013 10 E160 INTRODUCTION: Quitting smoking is a critical step toward diabetes control. It is not known whether smoking rates in adults with diabetes are similar to rates among adults who do not have the disease or whether people with diabetes have increased motivation to quit. We examined prevalence trends of current smoking and quit attempts among US adults with and without diagnosed diabetes from 2001 through 2010. METHODS: We used data from the 2001 through 2010 Behavioral Risk Factor Surveillance System, a state-based telephone survey of noninstitutionalized US adults, and conducted linear trend analysis and log linear regression. RESULTS: The adjusted prevalence of cigarette smoking among adults with diagnosed diabetes was 9% less than adults without diagnosed diabetes (adjusted prevalence ratio [APR], 0.91; 99% confidence interval [CI], 0.89-0.93). Declines in smoking prevalence were greater among adults without diabetes than adults with diagnosed diabetes (P < .001). Among smokers, the adjusted prevalence of quit attempts among adults with diagnosed diabetes was 13% higher than among adults without diagnosed diabetes (APR, 1.13; 99% CI, 1.11-1.15). Among adult smokers with diagnosed diabetes, quit attempts were stable over time for those aged 18 to 44 years and those with a high school education or less. Quit attempts were also stable for older smokers, non-Hispanic African Americans, and Hispanic smokers, regardless of diagnosed diabetes status. CONCLUSION: A large proportion of smokers with diagnosed diabetes seemed to have quit smoking, but more research is needed to confirm success and how difficult it was to achieve. |
Effects of homologous and heterologous immunization on the reservoir competence of domestic dogs for Rickettsia conorii (israelensis)
Levin ML , Zemtsova GE , Montgomery M , Killmaster LF . Ticks Tick Borne Dis 2013 5 (1) 33-40 A number of spotted fever group (SFG) rickettsiae cause serious infections in humans. Several antigenically related rickettsial agents may coexist within the same geographical area, and humans or vertebrate hosts may be sequentially exposed to multiple SFG agents. We assessed whether exposure of a vertebrate reservoir to one SFG Rickettsia will affect the host's immune response to a related pathogen and the efficiency of transmission to uninfected ticks. Two pairs of dogs were each infected with either Rickettsia massiliae or Rickettsia conorii israelensis, and their immune response was monitored twice weekly by IFA. The four immunized dogs and a pair of naive dogs were each challenged with R. conorii israelensis-infected Rhipicephalus sanguineus nymphs. Uninfected Rh. sanguineus larvae were acquisition-fed on the dogs on days 1, 7, and 14 post-challenge. These ticks were tested for the presence of rickettsial DNA after molting to the nymphal stage. The naive dogs became infected with R. conorii israelensis and were infectious to ticks for at least 3 weeks, whereas reservoir competence of dogs previously infected with either R. massiliae or R. conorii was significantly diminished. This opens an opportunity for decreasing the efficiency of transmission and propagation of pathogenic Rickettsia in natural foci by immunizing the primary hosts with closely related nonpathogenic SFG bacteria. However, neither homologous immunization nor cross-immunization significantly affected the efficiency of R. conorii transmission between cofeeding infected nymphs and uninfected larvae. At high densities of ticks, the efficiency of cofeeding transmission may be sufficient for yearly amplification and persistent circulation of a rickettsial pathogen in the vector population. |
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