Reducing obesity among people with disabilities
Fox MH , Witten MH , Lullo Carolyn . J Disabil Policy Stud 2014 25 (3) 175-185 Achieving healthy weight for people with disabilities in the United States is a challenge. Obesity rates for adults and children with disabilities are significantly higher than for those without disabilities, with differences remaining even when controlling for other factors. Reasons for this disparity include lack of healthy food options for many people with disabilities living in restrictive environments, difficulty with chewing or swallowing food, medication use contributing to changes in appetite, physical limitations that can reduce a person’s ability to exercise, constant pain, energy imbalance, lack of accessible environments in which to exercise or fully participate in other activities, and resource scarcity among many segments of the disability population. In order for there to be a coordinated national effort to address this issue, a framework needs to be developed from which research, policy, and practice can emerge. This paper reviews existing literature and presents a conceptual model that can be used to inform such a framework, provides examples of promising practices, and discusses challenges and opportunities moving forward. |
Trends in blood pressure among adults with hypertension: United States, 2003 to 2012
Yoon SS , Gu Q , Nwankwo T , Wright JD , Hong Y , Burt V . Hypertension 2014 65 (1) 54-61 The aim of this study is to describe trends in the awareness, treatment, and control of hypertension; mean blood pressure; and the classification of blood pressure among US adults 2003 to 2012. Using data from the National Health and Nutrition Examination Survey 2003 to 2012, a total of 9255 adult participants aged ≥18 years were identified as having hypertension, defined as measured blood pressure ≥140/90 mm Hg or taking prescription medication for hypertension. Awareness and treatment among hypertensive adults were ascertained via an interviewer administered questionnaire. Controlled hypertension among hypertensive adults was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Blood pressure was categorized as optimal blood pressure, prehypertension, and stage I and stage II hypertension. Between 2003 and 2012, the percentage of adults with controlled hypertension increased (P-trend <0.01). Hypertensive adults with optimal blood pressure and with prehypertension increased from 13% to 19% and 27% to 33%, respectively (P-trend <0.01 for both groups). Among hypertensive adults who were taking antihypertensive medication, uncontrolled hypertension decreased from 38% to 30% (P-trend <0.01). Similarly, a decrease in mean systolic blood pressure was observed (P-trend <0.01); however, mean diastolic blood pressure remained unchanged. The trend in the control of blood pressure has improved among hypertensive adults resulting in a higher percentage with blood pressure at the optimal or prehypertension level and a lower percentage in stage I and stage II hypertension. Overall, mean systolic blood pressure decreased as did the prevalence of uncontrolled hypertension among the treated hypertensive population. |
Trends in mortality rates by subtypes of heart disease in the United States, 2000-2010
Ritchey MD , Loustalot F , Bowman BA , Hong Y . JAMA 2014 312 (19) 2037-9 Despite considerable information on overall heart disease (HD) and coronary HD (CHD) mortality trends,1 less is known about trends for other HD subtypes. This study examines the contributions of HD subtypes to overall HD mortality trends during 2000–2010. |
Patients with undiagnosed hypertension: hiding in plain sight
Wall HK , Hannan JA , Wright JS . JAMA 2014 312 (19) 1973-4 According to the 2011–2012 National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey of the noninstitutionalized US population that combines interviews and physical examinations, 1 of 3 US adults (estimated at approximately 71 million people) has high blood pressure and almost half of these individuals (48.2%) do not have their blood pressure under control.1 Closer examination of the population with uncontrolled blood pressure reveals that 36.2% (estimated at approximately 13 million people) are neither aware of their hypertension nor taking antihypertensive medications.1 | A common assumption might be that these individuals are among the uninsured population without regular access to the health care system and who, consequently, have not had an opportunity for detection and diagnosis of hypertension. However, data from analysis of 2009–2012 NHANES show that among the unaware, untreated, and uncontrolled hypertensive population, 81.8% have health insurance, 82.5% have a usual source of care, and 61.7% have received care 2 or more times in the past year (written communication from Cathleen Gillespie, MS, Centers for Disease Control and Prevention, October 30, 2014). These data suggest that potentially millions of people with uncontrolled high blood pressure are being seen by health care professionals each year but remain undiagnosed and “hiding in plain sight” within clinical settings. |
Response to importation of a case of Ebola virus disease - Ohio, October 2014
McCarty CL , Basler C , Karwowski M , Erme M , Nixon G , Kippes C , Allan T , Parrilla T , DiOrio M , Fijter Sd , Stone ND , Yost DA , Lippold SA , Regan JJ , Honein MA , Knust B , Braden C . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1089-91 On September 30, 2014, the Texas Department of State Health Services reported a case of Ebola virus disease (Ebola) diagnosed in Dallas, Texas, and confirmed by CDC, the first case of Ebola diagnosed in the United States. The patient (patient 1) had traveled from Liberia, a country which, along with Sierra Leone and Guinea, is currently experiencing the largest recorded Ebola outbreak. A nurse (patient 2) who provided hospital bedside care to patient 1 in Texas visited an emergency department (ED) with fever and was diagnosed with laboratory-confirmed Ebola on October 11, and a second nurse (patient 3) who also provided hospital bedside care visited an ED with fever and rash on October 14 and was diagnosed with laboratory-confirmed Ebola on October 15. Patient 3 visited Ohio during October 10-13, traveling by commercial airline between Dallas, Texas, and Cleveland, Ohio. Based on the medical history and clinical and laboratory findings on October 14, the date of illness onset was uncertain; therefore, CDC, in collaboration with state and local partners, included the period October 10-13 as being part of the potentially infectious period, out of an abundance of caution to ensure all potential contacts were monitored. On October 15, the Ohio Department of Health requested CDC assistance to identify and monitor contacts of patient 3, assess the risk for disease transmission, provide infection control recommendations, and assess and guide regional health care system preparedness. The description of this contact investigation and hospital assessment is provided to help other states in planning for similar events. |
Successful delivery of RRT in Ebola virus disease
Connor MJ Jr , Kraft C , Mehta AK , Varkey JB , Lyon GM , Crozier I , Stroher U , Ribner BS , Franch HA . J Am Soc Nephrol 2014 26 (1) 31-7 AKI has been observed in cases of Ebola virus disease. We describe the protocol for the first known successful delivery of RRT with subsequent renal recovery in a patient with Ebola virus disease treated at Emory University Hospital, in Atlanta, Georgia. Providing RRT in Ebola virus disease is complex and requires meticulous attention to safety for the patient, healthcare workers, and the community. We specifically describe measures to decrease the risk of transmission of Ebola virus disease and report pilot data demonstrating no detectable Ebola virus genetic material in the spent RRT effluent waste. This article also proposes clinical practice guidelines for acute RRT in Ebola virus disease. |
Update: Ebola virus disease epidemic - West Africa, November 2014
CDC Incident Management System Ebola Epidemiology Team , Guinea Interministerial Committee for Response Against the Ebola Virus and the World Health Organization , CDC Guinea Response Team , Liberia Ministry of Health and Social Welfare , CDC Liberia Response Team , Sierra Leone Ministry of Health and Sanitation , CDC Sierra Leone Response Team , CDC Viral Special Pathogens Branch . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1064-6 CDC is assisting ministries of health and working with other organizations to end the ongoing epidemic of Ebola virus disease (Ebola) in West Africa. The updated data in this report were compiled from situation reports from the Guinea Interministerial Committee for Response Against the Ebola Virus and the World Health Organization, the Liberia Ministry of Health and Social Welfare, and the Sierra Leone Ministry of Health and Sanitation. Total case counts include all suspected, probable, and confirmed cases, which are defined similarly by each country. These data reflect reported cases, which make up an unknown proportion of all cases, and reporting delays that vary from country to country. |
Migration patterns and characteristics of sexual partners associated with unprotected sexual intercourse among Hispanic immigrant and migrant women in the United States
Valverde EE , Painter T , Heffelfinger JD , Schulden JD , Chavez P , DiNenno EA . J Immigr Minor Health 2014 17 (6) 1826-33 In 2011, Hispanic immigrant women comprised 44 % of HIV diagnoses among Hispanic women in the United States but little is known about factors that may place these women at risk for infection with HIV or sexually transmitted diseases. From March 2005 to February 2007, women were recruited at community-based organizations offering services to immigrant and migrant communities in five U.S. states. We report factors independently associated with unprotected anal and vaginal sex in the past 12 months among Hispanic immigrant and migrant women. Greater work-related mobility was associated with unprotected anal sex, while recency of immigration and prior refusal of HIV testing were associated with women's reports of unprotected vaginal sex. Prior sex with an injection drug user was associated with reports of both unprotected anal and vaginal sex. Findings highlight the need for HIV/STD risk reduction interventions designed specifically for Hispanic immigrant and migrant women. |
Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)
Reniers G , Slaymaker E , Nakiyingi-Miiro J , Nyamukapa C , Crampin AC , Herbst K , Urassa M , Otieno F , Gregson S , Sewe M , Michael D , Lutalo T , Hosegood V , Kasamba I , Price A , Nabukalu D , McLean E , Zaba B . AIDS 2014 28 Suppl 4 (4) S533-s542 BACKGROUND: The rollout of antiretroviral therapy (ART) is one of the largest public health interventions in Eastern and Southern Africa of recent years. Its impact is well described in clinical cohort studies, but population-based evidence is rare. METHODS: We use data from seven demographic surveillance sites that also conduct community-based HIV testing and collect information on the uptake of HIV services. We present crude death rates of adults (aged 15-64) for the period 2000-2011 by sex, HIV status, and treatment status. Parametric survival models are used to estimate age-adjusted trends in the mortality rates of people living with HIV (PLHIV) before and after the introduction of ART. RESULTS: The pooled ALPHA Network dataset contains 2.4 million person-years of follow-up time, and 39114 deaths (6893 to PLHIV). The mortality rates of PLHIV have been relatively static before the availability of ART. Mortality declined rapidly thereafter, with typical declines between 10 and 20% per annum. Compared with the pre-ART era, the total decline in mortality rates of PLHIV exceeds 58% in all study sites with available data, and amounts to 84% for women in Masaka (Uganda). Mortality declines have been larger for women than for men; a result that is statistically significant in five sites. Apart from the early phase of treatment scale up, when the mortality of PLHIV on ART was often very high, mortality declines have been observed in PLHIV both on and off ART. CONCLUSION: The expansion of treatment has had a large and pervasive effect on adult mortality. Mortality declines have been more pronounced for women, a factor that is often attributed to women's greater engagement with HIV services. Improvements in the timing of ART initiation have contributed to mortality reductions in PLHIV on ART, but also among those who have not (yet) started treatment because they are increasingly selected for early stage disease. |
Mycobacterium ulcerans infection imported from Australia to Missouri, USA, 2012
Thomas BS , Bailey TC , Bhatnagar J , Ritter JM , Emery BD , Jassim OW , Hornstra IK , George SL . Emerg Infect Dis 2014 20 (11) 1876-9 Buruli ulcer, the third most common mycobacterial disease worldwide, rarely affects travelers and is uncommon in the United States. We report a travel-associated case imported from Australia and review 3 previous cases diagnosed and treated in the United States. The differential diagnoses for unusual chronic cutaneous ulcers and those nonresponsive to conventional therapy should include Mycobacterium ulcerans infection. |
Progress toward poliomyelitis eradication - Nigeria, January 2013-September 2014
Etsano A , Gunnala R , Shuaib F , Damisa E , Mkanda P , Banda R , Korir C , Enemaku O , Corkum M , Usman S , Davis LB , Nganda GW , Burns CC , Mahoney F , Vertefeuille JF . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1059-63 In 1988, the World Health Assembly resolved to interrupt wild poliovirus (WPV) transmission worldwide. By 2013, only three countries remained that had never interrupted WPV transmission: Afghanistan, Nigeria, and Pakistan. Since 2003, northern Nigeria has been a reservoir for WPV reintroduction into 26 previously polio-free countries. In May 2014, the World Health Organization declared the international spread of polio a Public Health Emergency of International Concern. Nigeria's main strategic goal is to interrupt WPV type 1 (WPV1) transmission by the end of 2014, which is also a main objective of the Global Polio Eradication Initiative's Polio Eradication and Endgame Strategic Plan for 2013-2018. This report updates previous reports (4-6) and describes polio eradication activities and progress in Nigeria during January 2013-September 30, 2014. Only six WPV cases had been reported in 2014 through September 30 compared with 49 reported cases during the same period in 2013. The quality of supplemental immunization activities (SIAs) improved during this period; the proportion of local government areas (LGAs) within 11 high-risk states with estimated oral poliovirus vaccine (OPV) campaign coverage at or above the 90% threshold increased from 36% to 67%. However, the number of reported circulating vaccine-derived poliovirus type 2 (cVDPV2) cases increased from four in 2013 to 21 to date in 2014, and surveillance gaps are suggested by genomic sequence analysis and continued detection of WPV1 by environmental surveillance. Interrupting all poliovirus circulation in Nigeria is achievable with continued attention to stopping cVDPV2 transmission, improving the quality of acute flaccid paralysis (AFP) surveillance, increasing vaccination coverage by strengthened routine immunization services, continuing support from all levels of government, and undertaking special initiatives to provide vaccination to children in conflict-affected areas in northeastern Nigeria. |
Ebola epidemic - Liberia, March-October 2014
Nyenswah T , Fahnbulleh M , Massaquoi M , Nagbe T , Bawo L , Falla JD , Kohar H , Gasasira A , Nabeth P , Yett S , Gergonne B , Casey S , Espinosa B , McCoy A , Feldman H , Hensley L , Baily M , Fields B , Lo T , Lindblade K , Mott J , Boulanger L , Christie A , Wang S , Montgomery J , Mahoney F . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1082-6 On March 21, 2014, the Guinea Ministry of Health reported the outbreak of an illness characterized by fever, severe diarrhea, vomiting and a high fatality rate (59%), leading to the first known epidemic of Ebola virus disease (Ebola) in West Africa and the largest and longest Ebola epidemic in history. As of November 2, Liberia had reported the largest number of cases (6,525) and deaths (2,697) among the three affected countries of West Africa with ongoing transmission (Guinea, Liberia, and Sierra Leone). The response strategy in Liberia has included management of the epidemic through an incident management system (IMS) in which the activities of all partners are coordinated. Within the IMS, key strategies for epidemic control include surveillance, case investigation, laboratory confirmation, contact tracing, safe transportation of persons with suspected Ebola, isolation, infection control within the health care system, community engagement, and safe burial. This report provides a brief overview of the progression of the epidemic in Liberia and summarizes the interventions implemented. |
Ebola virus disease cases among health care workers not working in Ebola treatment units - Liberia, June-August, 2014
Matanock A , Arwady MA , Ayscue P , Forrester JD , Gaddis B , Hunter JC , Monroe B , Pillai SK , Reed C , Schafer IJ , Massaquoi M , Dahn B , De Cock KM . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1077-81 West Africa is experiencing the largest Ebola virus disease (Ebola) epidemic in recorded history. Health care workers (HCWs) are at increased risk for Ebola. In Liberia, as of August 14, 2014, a total of 810 cases of Ebola had been reported, including 10 clusters of Ebola cases among HCWs working in facilities that were not Ebola treatment units (non-ETUs). The Liberian Ministry of Health and Social Welfare and CDC investigated these clusters by reviewing surveillance data, interviewing county health officials, HCWs, and contact tracers, and visiting health care facilities. Ninety-seven cases of Ebola (12% of the estimated total) were identified among HCWs; 62 HCW cases (64%) were part of 10 distinct clusters in non-ETU health care facilities, primarily hospitals. Early recognition and diagnosis of Ebola in patients who were the likely source of introduction to the HCWs (i.e., source patients) was missed in four clusters. Inconsistent recognition and triage of cases of Ebola, overcrowding, limitations in layout of physical spaces, lack of training in the use of and adequate supply of personal protective equipment (PPE), and limited supervision to ensure consistent adherence to infection control practices all were observed. Improving infection control infrastructure in non-ETUs is essential for protecting HCWs. Since August, the Liberian Ministry of Health and Social Welfare with a consortium of partners have undertaken collaborative efforts to strengthen infection control infrastructure in non-ETU health facilities. |
Ebola virus disease cluster in the United States - Dallas County, Texas, 2014
Chevalier MS , Chung W , Smith J , Weil LM , Hughes SM , Joyner SN , Hall E , Srinath D , Ritch J , Thathiah P , Threadgill H , Cervantes D , Lakey DL . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1087-8 Since March 10, 2014, Guinea, Liberia, and Sierra Leone have experienced the largest known Ebola virus disease (Ebola) epidemic with approximately 13,000 persons infected as of October 28, 2014. Before September 25, 2014, only four patients with Ebola had been treated in the United States; all of these patients had been diagnosed in West Africa and medically evacuated to the United States for care. |
Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial
DiClemente RJ , Davis TL , Swartzendruber A , Fasula AM , Boyce L , Gelaude D , Gray SC , Hardin J , Rose E , Carry M , Sales JM , Brown JL , Staples-Horne M . Women Health 2014 54 (8) 726-49 Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains. |
Evidence for a decrease in transmission of Ebola virus - Lofa County, Liberia, June 8-November 1, 2014
Sharma A , Heijenberg N , Peter C , Bolongei J , Reeder B , Alpha T , Sterk E , Robert H , Kurth A , Cannas A , Bocquin A , Strecker T , Logue C , Caro AD , Pottage T , Yue C , Stoecker K , Wolfel R , Gabriel M , Gunther S , Damon I . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1067-71 Lofa County has one of the highest cumulative incidences of Ebola virus disease (Ebola) in Liberia. Recent situation reports from the Liberian Ministry of Health and Social Welfare (MoHSW) have indicated a decrease in new cases of Ebola in Lofa County. In October 2014, the Liberian MoHSW requested the assistance of CDC to further characterize recent trends in Ebola in Lofa County. Data collected during June 8-November 1, 2014 from three sources were analyzed: 1) aggregate data for newly reported cases, 2) case-based data for persons admitted to the dedicated Ebola treatment unit (ETU) for the county, and 3) test results for community decedents evaluated for Ebola. Trends from all three sources suggest that transmission of Ebola virus decreased as early as August 17, 2014, following rapid scale-up of response activities in Lofa County after a resurgence of Ebola in early June 2014. The comprehensive response strategy developed with participation from the local population in Lofa County might serve as a model to implement in other affected areas to accelerate control of Ebola. |
Evidence for declining numbers of Ebola cases - Montserrado County, Liberia, June-October 2014
Nyenswah TG , Westercamp M , Kamali AA , Qin J , Zielinski-Gutierrez E , Amegashie F , Fallah M , Gergonne B , Nugba-Ballah R , Singh G , Aberle-Grasse JM , Havers F , Montgomery JM , Bawo L , Wang SA , Rosenberg R . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1072-6 The epidemic of Ebola virus disease (Ebola) in West Africa that began in March 2014 has caused approximately 13,200 suspected, probable, and confirmed cases, including approximately 6,500 in Liberia. About 50% of Liberia's reported cases have been in Montserrado County (population 1.5 million), the most populous county, which contains the capital city, Monrovia. To examine the course of the Ebola epidemic in Montserrado County, data on Ebola treatment unit (ETU) admissions, laboratory testing of patient blood samples, and collection of dead bodies were analyzed. Each of the three data sources indicated consistent declines of 53%-73% following a peak incidence in mid-September. The declines in ETU admissions, percentage of patients with reverse transcription-polymerase chain reaction (RT-PCR) test results positive for Ebola, and dead bodies are the first evidence of reduction in disease after implementation of multiple prevention and response measures. The possible contributions of these interventions to the decline is not yet fully understood or corroborated. A reduction in cases suggests some progress; however, eliminating Ebola transmission is the critical goal and will require greatly intensified efforts for complete, high-quality surveillance to direct and drive the rapid intervention, tracking, and response efforts that remain essential. |
HIV prevalence and risk behaviors among people who inject drugs in two serial cross-sectional respondent-driven sampling surveys, Zanzibar 2007 and 2012
Matiko E , Khatib A , Khalid F , Welty S , Said C , Ali A , Othman A , Haji S , Kibona M , Kim E , Broz D , Dahoma M . AIDS Behav 2014 19 Suppl 1 S36-45 People who inject drugs (PWID) are at higher risk of acquiring HIV due to risky injection and sexual practices. We measured HIV prevalence and behaviors related to acquisition and transmission risk at two time points (2007 and 2012) in Zanzibar, Tanzania. We conducted two rounds of behavioral and biological surveillance among PWID using respondent-driven sampling, recruiting 499 and 408 PWID, respectively. Through faceto- face interviews, we collected information on demographics as well as sexual and injection practices. We obtained blood samples for biological testing. We analyzed data using RDSAT and exported weights into STATA for multivariate analysis. HIV prevalence among sampled PWID in Zanzibar was 16.0 % in 2007 and 11.3 % in 2012; 73.2 % had injected drugs for 7 years or more in 2007, while in the 2012 sample this proportion was 36.9 %. In 2007, 53.6 % reported having shared a needle in the past month, while in the 2012 sample, 29.1 % reported having done so. While 13.3 % of PWID in 2007 reported having been tested for HIV infection and received results in the past year, this proportion was 38.0 % in 2012. Duration of injection drug use for 5 years or more was associated with higher odds of HIV infection in both samples. HIV prevalence and indicators of risk and preventive behaviors among PWID in Zanzibar were generally more favorable in 2012 compared to 2007-a period marked by the scale-up of prevention programs focusing on PWID. While encouraging, causal interpretation needs to be cautious and consider possible sample differences in these two cross-sectional surveys. HIV prevalence and related risk behaviors persist at levels warranting sustained and enhanced efforts of primary prevention and harm reduction. |
Biomarkers for understanding Ebola virus disease
McElroy AK , Spiropoulou CF . Biomark Med 2014 8 (9) 1053-6 The Filoviridae family of negative-strand RNA viruses is feared for these viruses’ ability to cause hemorrhage and death in infected individuals. Depending on the infecting species of virus, the case fatality rate can be anywhere from 30 to 90% [1]. Ebola virus (EBOV), Sudan virus (SUDV) and Bundibugyo virus (BDBV) are the three clinically significant species that cause Ebola virus disease (EVD). These viruses are typically found in sub-Saharan Africa, and cause sporadic outbreaks that can be brought under control with appropriate rapid public health responses. However, the recent emergence of EBOV in west Africa in early 2014 [2] has been challenging to contain, and has spread to three countries in the region so far. This outbreak, now the largest EBOV outbreak on record, is still ongoing at the time of writing this editorial. | Efforts by many investigators have led to the development of potential vaccines and therapeutics [3,4]. However, none of these have yet resulted in commercially available products, and are unlikely to do so in the near future due to the cost of developing novel products for human use and the challenges of conducting a clinical trial during an outbreak in a developing nation that lacks the necessary healthcare infrastructure. The most cost-effective and timely option would be to identify an already approved drug that might be effective at combating disease caused by EBOV and SUDV for off-label use by treating physicians. In order to identify currently licensed drugs that might be beneficial, we need to know more about the pathophysiology of the disease. Biomarker analyses could prove to be useful for this purpose. |
Clinician perspectives on delaying initiation of antiretroviral therapy for clinically eligible HIV-infected patients
Beer L , Valverde EE , Raiford JL , Weiser J , White BL , Skarbinski J . J Int Assoc Provid AIDS Care 2014 14 (3) 245-54 OBJECTIVES: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. METHODS: In 2009, we surveyed a probability sample of HIV care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. RESULTS: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. CONCLUSION: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients. |
Context of risk for HIV and sexually transmitted infections among incarcerated women in the South: individual, interpersonal, and societal factors
Fogel CI , Gelaude DJ , Carry M , Herbst JH , Parker S , Scheyette A , Neevel A . Women Health 2014 54 (8) 694-711 Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women. |
Declining HIV incidence among women in the United States
Lansky A , Hall I , Mermin J . Womens Health Issues 2014 24 (6) 581-583 HIV infection is a major health issue for women in the United States. There are an estimated 275,700 women living with HIV (Centers for Disease Control and Prevention [CDC], 2013b) and stark racial and ethnic differences exist. In 2011, the rate of HIV diagnoses among Black/African-American women was 20 times the rate among White women and the rate of HIV diagnoses among Hispanic/Latina women was 4 times the rate among White women (CDC, 2013a). Recent data show promising trends. Comparing 2008 with 2010, the estimated number of new HIV infections among women in the United States decreased by 21%, from 12,000 in 2008 to 9,500 in 2010 (CDC, 2012; Figure 1). During the same time period, there were also decreases among women in the number of HIV diagnoses (17% decrease) and AIDS diagnoses (14% decrease; CDC, 2013a). However, significant decreases in HIV incidence were found only for Black women, with a decrease of 21% from 7,700 new infections in 2008 to 6,100 in 2010 (CDC, 2012), and for women with infection attributed to heterosexual contact, with a decrease of 18% from 9,800 new infections in 2008 to 8,000 in 2010 (CDC, 2012; Figure 1). |
Physical durability of two types of long-lasting insecticidal nets (LLINs) three years after a mass LLIN distribution campaign in Mozambique, 2008-2011
Morgan J , Abilio AP , do Rosario Pondja M , Marrenjo D , Luciano J , Fernandes G , Sabindy S , Wolkon A , Ponce de Leon G , Chan A , Eng JV . Am J Trop Med Hyg 2014 92 (2) 286-93 We conducted a prospective evaluation to measure the physical durability of two brands of long-lasting insecticidal nets (LLINs) distributed during a campaign in 2008 in Nampula Province, Mozambique. Households with LLINs tagged during the campaign (6,000) were geo-located (34%) and a random sample was selected for each of 3 years of follow-up. The LLINs were evaluated in the field and a laboratory for presence of holes and a proportional hole index (pHI) was calculated following the World Health Organization guidelines. We performed 567 interviews (79.0%) and found 75.3% (72.1-78.4%) of households retained at least one LLIN after 3 years; the most common cause of attrition was damage beyond repair (51.0%). Hole damage was evident after 1 year, and increased by year. Olyset had a significantly greater mean number of holes and pHI compared with PermaNet 2.0 brand (all P values ≤ 0.001). Additional information about LLIN durability is recommended to improve malaria control efforts. |
Incrimination of Aedes (Stegomyia) hensilli Farner as an epidemic vector of chikungunya virus on Yap Island, Federated States of Micronesia, 2013
Savage HM , Ledermann JP , Yug L , Burkhalter KL , Marfel M , Hancock WT . Am J Trop Med Hyg 2014 92 (2) 429-436 Two species of Aedes (Stegomyia) were collected in response to the first chikungunya virus (CHIKV) outbreak on Yap Island: the native species Ae. hensilli Farner and the introduced species Ae. aegypti (L.). Fourteen CHIKV-positive mosquito pools were detected. Six pools were composed of female Ae. hensilli, six pools were composed of female Ae. aegypti, one pool was composed of male Ae. hensilli, and one pool contained female specimens identified as Ae. (Stg.) spp. Infection rates were not significantly different between female Ae. hensilli and Ae. aegypti. The occurrence of human cases in all areas of Yap Island and the greater number of sites that yielded virus from Ae. hensilli combined with the ubiquitous distribution of this species incriminate Ae. hensilli as the most important vector of CHIKV during the outbreak. Phylogenic analysis shows that virus strains on Yap are members of the Asia lineage and closely related to strains currently circulating in the Caribbean. |
The behaviour of mosquitoes in relation to humans under holed bednets: the evidence from experimental huts
Irish SR . Mem Inst Oswaldo Cruz 2014 109 (7) 905-911 The physical integrity of bednets is a concern of national malaria control programs, as it is a key factor in determining the rate of replacement of bednets. It is largely assumed that increased numbers of holes will result in a loss of protection of sleepers from potentially infective bites. Experimental hut studies are valuable in understanding mosquito behaviour indoors, particularly as it relates to blood feeding and mortality. This review summarises findings from experimental hut studies, focusing on two issues: (i) the effect of different numbers or sizes of holes in bednets and (ii) feeding behaviour and mortality with holed nets as compared with unholed nets. As might be expected, increasing numbers and area of holes resulted in increased blood feeding by mosquitoes on sleepers. However, the presence of holes did not generally have a large effect on the mortality of mosquitoes. Successfully entering a holed mosquito net does not necessarily mean that mosquitoes spend less time in contact with the net, which could explain the lack in differences in mortality. Further behavioural studies are necessary to understand mosquito behaviour around nets and the importance of holed nets on malaria transmission. |
Brainstem auditory evoked potentials in children with lead exposure
Alvarenga KF , Morata TC , Lopes AC , Feniman MR , Corteletti LC . Braz J Otorhinolaryngol 2014 81 (1) 37-43 INTRODUCTION: Earlier studies have demonstrated an auditory effect of lead exposure in children, but information on the effects of low chronic exposures needs to be further elucidated. OBJECTIVE: To investigate the effect of low chronic exposures of the auditory system in children with a history of low blood lead levels, using an auditory electrophysiological test. METHODS: Contemporary cross-sectional cohort. Study participants underwent tympanometry, pure tone and speech audiometry, transient evoked otoacoustic emissions, and brainstem auditory evoked potentials, with blood lead monitoring over a period of 35.5 months. The study included 130 children, with ages ranging from 18 months to 14 years, 5 months (mean age 6 years, 8 months ± 3 years, 2 months). RESULTS: The mean time-integrated cumulative blood lead index was 12 ug/dL (SD ± 5.712 microg/dL (SD ± 5.7 range: 2.433). All participants had hearing thresholds equal to or below 20 dBHL and normal amplitudes of transient evoked otoacoustic emissions. No association was found between the absolute latencies of waves I, III, and V, the interpeak latencies I---III, III---V, and I---V, and the cumulative lead values. CONCLUSION: No evidence of toxic effects from chronic low lead exposures was observed on the auditory function of children living in a lead contaminated area. |
Implementation science and the Pregnancy Risk Assessment Monitoring System
Grigorescu VI , D'Angelo DV , Harrison LL , Taraporewalla AJ , Shulman H , Smith RA . J Womens Health (Larchmt) 2014 23 (12) 989-94 This paper describes the restructuring of the Pregnancy Risk Assessment Monitoring System (PRAMS), a surveillance system of the Centers for Disease Control and Prevention (CDC)'s Division of Reproductive Health conducted for 25 years in collaboration with state and city health departments. With the ultimate goal to better inform health care providers, public health programs, and policy, changes were made to various aspects of PRAMS to enhance its capacity on assessing and monitoring public health interventions and clinical practices in addition to risk behaviors, disease prevalence, comorbidities, and service utilization. Specifically, the three key PRAMS changes identified as necessary and described in this paper are questionnaire revision, launching the web-based centralized PRAMS Integrated Data Collection System, and enhancing the access to PRAMS data through the web query system known as Centers for Disease Control and Prevention's PRAMS Online Data for Epidemiologic Research/PRAMStat. The seven action steps of Knowledge To Action cycle, an illustration of the implementation science process, that reflect the milestones necessary in bridging the knowledge-to-action gap were used as framework for each of these key changes. |
Assessment and indirect adjustment for confounding by smoking in cohort studies using relative hazards models
Richardson DB , Laurier D , Schubauer-Berigan MK , Tchetgen ET , Cole SR . Am J Epidemiol 2014 180 (9) 933-40 Workers' smoking histories are not measured in many occupational cohort studies. Here we discuss the use of negative control outcomes to detect and adjust for confounding in analyses that lack information on smoking. We clarify the assumptions necessary to detect confounding by smoking and the additional assumptions necessary to indirectly adjust for such bias. We illustrate these methods using data from 2 studies of radiation and lung cancer: the Colorado Plateau cohort study (1950-2005) of underground uranium miners (in which smoking was measured) and a French cohort study (1950-2004) of nuclear industry workers (in which smoking was unmeasured). A cause-specific relative hazards model is proposed for estimation of indirectly adjusted associations. Among the miners, the proposed method suggests no confounding by smoking of the association between radon and lung cancer-a conclusion supported by adjustment for measured smoking. Among the nuclear workers, the proposed method suggests substantial confounding by smoking of the association between radiation and lung cancer. Indirect adjustment for confounding by smoking resulted in an 18% decrease in the adjusted estimated hazard ratio, yet this cannot be verified because smoking was unmeasured. Assumptions underlying this method are described, and a cause-specific proportional hazards model that allows easy implementation using standard software is presented. |
Outbreaks associated with cantaloupe, watermelon, and honeydew in the United States, 1973-2011
Walsh KA , Bennett SD , Mahovic M , Gould LH . Foodborne Pathog Dis 2014 11 (12) 945-52 Fresh fruits and vegetables are an important part of a healthy diet. Melons have been associated with enteric infections. We reviewed outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1973-2011 in which the implicated food was a single melon type. We also reviewed published literature and records obtained from investigating agencies. During 1973-2011, 34 outbreaks caused by a single melon type were reported, resulting in 3602 illnesses, 322 hospitalizations, 46 deaths, and 3 fetal losses. Cantaloupes accounted for 19 outbreaks (56%), followed by watermelons (13, 38%) and honeydew (2, 6%). Melon-associated outbreaks increased from 0.5 outbreaks per year during 1973-1991 to 1.3 during 1992-2011. Salmonella was the most common etiology reported (19, 56%), followed by norovirus (5, 15%). Among 13 outbreaks with information available, melons imported from Mexico and Central America were implicated in 9 outbreaks (69%) and domestically grown melons were implicated in 4 outbreaks (31%). The point of contamination was known for 20 outbreaks; contamination occurred most commonly during growth, harvesting, processing, or packaging (13, 65%). Preventive measures focused on reducing bacterial contamination of melons both domestically and internationally could decrease the number and severity of melon-associated outbreaks. |
NLRC5 interacts with RIG-I to induce a robust antiviral response against influenza virus infection.
Ranjan P , Singh N , Kumar A , Neerincx A , Kremmer E , Cao W , Davis WG , Katz JM , Gangappa S , Lin R , Kufer TA , Sambhara S . Eur J Immunol 2014 45 (3) 758-72 The NLR protein, NLRC5, is an important regulator of MHC I gene expression, however, the role of NLRC5 in other innate immune responses is less well defined. In the present study, we report that NLRC5 binds RIG-I and that this interaction is critical for robust antiviral responses against influenza virus. Overexpression of NLRC5 in the human lung epithelial cell line, A549, and normal human bronchial epithelial (NHBE) cells resulted in impaired replication of influenza virus A/Puerto Rico/8/34 virus (PR8) and enhanced IFN-beta expression. Influenza virus leads to induction of IFN-beta that drives RIG-I and NLRC5 expression in host cells. Our results suggest that NLRC5 extends and stabilizes influenza virus-induced RIG-I expression and delays expression of the viral inhibitor protein NS1. We show that NS1 binds to NLRC5 to suppress its function. Interaction domain mapping revealed that NLRC5 interacts with RIG-I via its N-terminal death domain and that NLRC5 enhanced antiviral activity in a LRR-domain-independent manner. Taken together, our findings identify a novel role for NLRC5 in RIG-I-mediated antiviral host responses against influenza virus infection, distinguished from the role of NLRC5 in MHC class I gene regulation. |
A systematic and functional classification of Streptococcus pyogenes that serves as a new tool for molecular typing and vaccine development.
Sanderson-Smith M , De Oliveira DM , Guglielmini J , McMillan DJ , Vu T , Holien JK , Henningham A , Steer AC , Bessen DE , Dale JB , Curtis N , Beall BW , Walker MJ , Parker MW , Carapetis JR , Van Melderen L , Sriprakash KS , Smeesters PR . J Infect Dis 2014 210 (8) 1325-38 Streptococcus pyogenes ranks among the main causes of mortality from bacterial infections worldwide. Currently there is no vaccine to prevent diseases such as rheumatic heart disease and invasive streptococcal infection. The streptococcal M protein that is used as the substrate for epidemiological typing is both a virulence factor and a vaccine antigen. Over 220 variants of this protein have been described, making comparisons between proteins difficult, and hindering M protein-based vaccine development. A functional classification based on 48 emm-clusters containing closely related M proteins that share binding and structural properties is proposed. The need for a paradigm shift from type-specific immunity against S. pyogenes to emm-cluster based immunity for this bacterium should be further investigated. Implementation of this emm-cluster-based system as a standard typing scheme for S. pyogenes will facilitate the design of future studies of M protein function, streptococcal virulence, epidemiological surveillance, and vaccine development. |
Global routine vaccination coverage, 2013
Harris JB , Gacic-Dobo M , Eggers R , Brown DW , Sodha SV . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1055-8 In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to ensure that all children have access to routinely recommended vaccines. Since then, global coverage with the four core vaccines (Bacille Calmette-Guerin vaccine [for protection against tuberculosis], diphtheria-tetanus-pertussis vaccine [DTP], polio vaccine, and measles vaccine) has increased from <5% to ≥84%, and additional vaccines have been added to the recommended schedule. Coverage with the third dose of DTP vaccine (DTP3) by age 12 months is a key indicator of immunization program performance. Estimated global DTP3 coverage has remained at 83%-84% since 2009, with estimated 2013 coverage at 84%. Global coverage estimates for the second routine dose of measles-containing vaccine (MCV2) are reported for the first time in 2013; global coverage was 35% by the end of the second year of life and 53% when including older age groups. Improvements in equity of access and use of immunization services will help ensure that all children are protected from vaccine-preventable diseases. |
Influenza vaccine effectiveness in the United States during 2012-13: variable protection by age and virus type
McLean HQ , Thompson MG , Sundaram ME , Kieke BA , Gaglani M , Murthy K , Piedra PA , Zimmerman RK , Nowalk MP , Raviotta JM , Jackson ML , Jackson L , Ohmit SE , Petrie JG , Monto AS , Meece JK , Thaker SN , Clippard JR , Spencer SM , Fry AM , Belongia EA . J Infect Dis 2014 211 (10) 1529-40 BACKGROUND: During the 2012-13 influenza season, there was co-circulation of A/H3N2 and two B lineage viruses in the United States. METHODS: Patients with acute cough illness ≤7 days duration were prospectively enrolled and swabbed at outpatient clinics in five states. Influenza vaccination dates were confirmed by medical records. Vaccine effectiveness (VE) was estimated as [100% x (1-adjusted odds ratio)] for vaccination in cases vs. test-negative controls. RESULTS: Influenza was detected in 2,307 (36%) of 6,452 patients; 1,292 (56%) had A/H3N2, 582 (25%) had B/Yamagata, and 303 (13%) had B/Victoria. VE was 49% (95% CI: 43, 55) overall; 39% (95% CI: 29, 47) against A/H3N2, 66% (95% CI: 58, 73) against B/Yamagata (vaccine lineage), and 51% (95% CI: 36, 63) against B/Victoria. VE against A/H3N2 was highest among persons aged 50-64 years (52%; 95% CI: 33, 65) and 6 months-8 years (51%; 95% CI: 32, 64) and lowest among those ≥65 years (11%; 95% CI: -41, 43). In younger age groups, there was evidence of residual protection from receipt of the 2011-12 vaccine one year earlier. CONCLUSIONS: The 2012-13 vaccines were moderately effective in most age groups. Cross-lineage protection and residual effects from prior vaccination were observed and warrant further investigation. |
Interim estimates of the effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2014
Turner N , Pierse N , Huang Q , Radke S , Bissielo A , Thompson M , Kelly H . Euro Surveill 2014 19 (42) We present preliminary results of influenza vaccine effectiveness (VE) in New Zealand using a case test-negative design for 28 April to 31 August 2014. VE adjusted for age and time of admission among all ages against severe acute respiratory illness hospital presentation due to laboratory-confirmed influenza was 54% (95% CI: 19 to 74) and specifically against A(H1N1)pdm09 was 65% (95% CI:33 to 81). For influenza-confirmed primary care visits, VE was 67% (95% CI: 48 to 79) overall and 73% (95% CI: 50 to 85) against A(H1N1)pdm09. |
Exploring alcohol policy approaches to prevent sexual violence perpetration
Lippy C , DeGue S . Trauma Violence Abuse 2014 17 (1) 26-42 Sexual violence continues to be a significant public health problem worldwide with serious consequences for individuals and communities. The implementation of prevention strategies that address risk and protective factors for sexual violence at the community level are important components of a comprehensive approach, but few such strategies have been identified or evaluated. The current review explores one potential opportunity for preventing sexual violence perpetration at the community level: alcohol policy. Alcohol policy has the potential to impact sexual violence perpetration through the direct effects of excessive alcohol consumption on behavior or through the impact of alcohol and alcohol outlets on social organization within communities. Policies affecting alcohol pricing, sale time, outlet density, drinking environment, marketing, and college environment are reviewed to identify existing evidence of impact on rates of sexual violence or related outcomes, including risk factors and related health behaviors. Several policy areas with initial evidence of an association with sexual violence outcomes were identified, including policies affecting alcohol pricing, alcohol outlet density, barroom management, sexist content in alcohol marketing, and policies banning alcohol on campus and in substance-free dorms. We identify other policy areas with evidence of an impact on related outcomes and risk factors that may also hold potential as a preventative approach for sexual violence perpetration. Evidence from the current review suggests that alcohol policy may represent one promising avenue for the prevention of sexual violence perpetration at the community level, but additional research is needed to directly examine effects on sexual violence outcomes. |
Abuse impedes prevention: the intersection of intimate partner violence and HIV/STI risk among young African American women
Seth P , Wingood GM , Robinson LS , Raiford JL , DiClemente RJ . AIDS Behav 2014 19 (8) 1438-45 Intimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. 848 African American women, 18-29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. In an HIV intervention that did not specifically address IPV, women in the control condition were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs. |
Molecular differentiation of Treponema pallidum subspecies in skin ulceration clinically suspected as yaws in Vanuatu using real-time multiplex PCR and serological methods.
Chi KH , Danavall D , Taleo F , Pillay A , Ye T , Nachamkin E , Kool JL , Fegan D , Asiedu K , Vestergaard LS , Ballard RC , Chen CY . Am J Trop Med Hyg 2014 92 (1) 134-8 We developed a TaqMan-based real-time quadriplex polymerase chain reaction (PCR) to simultaneously detect Treponema pallidum subspecies pallidum, T. pallidum subsp. pertenue, and T. pallidum subsp. endemicum, the causative agents of venereal syphilis, yaws, and bejel, respectively. The PCR assay was applied to samples from skin ulcerations of clinically presumptive yaws cases among children on Tanna Island, Vanuatu. Another real-time triplex PCR was used to screen for the point mutations in the 23S rRNA genes that have previously been associated with azithromycin resistance in T. pallidum subsp. pallidum strains. Seropositivity by the classical syphilis serological tests was 35.5% among children with skin ulcerations clinically suspected with yaws, whereas the presence of T. pallidum subsp. pertenue DNA was only found in lesions from 15.5% of children. No evidence of T. pallidum subsp. pertenue infection, by either PCR or serology was found in approximately 59% of cases indicating alternative causes of yaws-like lesions in this endemic area. |
The draft genome sequence of the ferret (Mustela putorius furo) facilitates study of human respiratory disease.
Peng X , Alfoldi J , Gori K , Eisfeld AJ , Tyler SR , Tisoncik-Go J , Brawand D , Law GL , Skunca N , Hatta M , Gasper DJ , Kelly SM , Chang J , Thomas MJ , Johnson J , Berlin AM , Lara M , Russell P , Swofford R , Turner-Maier J , Young S , Hourlier T , Aken B , Searle S , Sun X , Yi Y , Suresh M , Tumpey TM , Siepel A , Wisely SM , Dessimoz C , Kawaoka Y , Birren BW , Lindblad-Toh K , Di Palma F , Engelhardt JF , Palermo RE , Katze MG . Nat Biotechnol 2014 32 (12) 1250-5 The domestic ferret (Mustela putorius furo) is an important animal model for multiple human respiratory diseases. It is considered the 'gold standard' for modeling human influenza virus infection and transmission. Here we describe the 2.41 Gb draft genome assembly of the domestic ferret, constituting 2.28 Gb of sequence plus gaps. We annotated 19,910 protein-coding genes on this assembly using RNA-seq data from 21 ferret tissues. We characterized the ferret host response to two influenza virus infections by RNA-seq analysis of 42 ferret samples from influenza time-course data and showed distinct signatures in ferret trachea and lung tissues specific to 1918 or 2009 human pandemic influenza virus infections. Using microarray data from 16 ferret samples reflecting cystic fibrosis disease progression, we showed that transcriptional changes in the CFTR-knockout ferret lung reflect pathways of early disease that cannot be readily studied in human infants with cystic fibrosis disease. |
Size distribution and estimated respiratory deposition of total chromium, hexavalent chromium, manganese, and nickel in gas metal arc welding fume aerosols
Cena LG , Chisholm WP , Keane MJ , Cumpston A , Chen BT . Aerosol Sci Technol 2014 48 (12) 1254-1263 A laboratory study was conducted to determine the mass of total Cr, Cr(VI), Mn, and Ni in 15 size fractions for mild and stainless steel gas-metal arc welding (GMAW) fumes. Samples were collected using a nano multi orifice uniform deposition impactor (MOUDI) with polyvinyl chloride filters on each stage. The filters were analyzed by inductively coupled plasma mass spectrometry (ICP-MS) and ion chromatography. Limits of detection (LODs) and quantitation (LOQs) were experimentally calculated and percent recoveries were measured from spiked metals in solution and dry, certified welding-fume reference material. The fraction of Cr(VI) in total Cr was estimated by calculating the ratio of Cr(VI) to total Cr mass for each particle size range. Expected, regional deposition of each metal was estimated according to respiratory-deposition models. The weight percent (standard deviation) of Mn in mild steel fumes was 9.2% (6.8%). For stainless steel fumes, the weight percentages were 8.4% (5.4%) for total Cr, 12.2% (6.5%) for Mn, 2.1% (1.5%) for Ni and 0.5% (0.4%) for Cr(VI). All metals presented a fraction between 0.04 and 0.6 ?m. Total Cr and Ni presented an additional fraction <0.03 ?m. On average 6% of the Cr was found in the Cr(VI) valence state. There was no statistical difference between the smallest and largest mean Cr(VI) to total Cr mass ratio (p-value = 0.19), hence our analysis does not show that particle size affects the contribution of Cr(VI) to total Cr. The predicted total respiratory deposition for the metal particles was ?25%. The sites of principal deposition were the head airways (7?10%) and the alveolar region (11?14%). Estimated Cr(VI) deposition was highest in the alveolar region (14%). |
Small airway epithelial cells exposure to printer-emitted engineered nanoparticles induces cellular effects on human microvascular endothelial cells in an alveolar-capillary co-culture model
Sisler JD , Pirela SV , Friend S , Farcas M , Schwegler-Berry D , Shvedova A , Castranova V , Demokritou P , Qian Y . Nanotoxicology 2014 9 (6) 1-11 The printer is one of the most common pieces of office equipment. Recently, it was reported that toner formulations for printing equipment constitute nano-enabled products (NEPs) and contain engineered nanomaterials (ENMs) that become airborne during printing. To date, insufficient research has been performed to understand the potential toxicological properties of printer-emitted particles (PEPs) with several studies using bulk toner particles as test particles. These studies demonstrated the ability of toner particles to cause chronic inflammation and fibrosis in animal models. However, the toxicological implications of inhalation exposures to ENMs emitted from laser printing equipment remain largely unknown. The present study investigates the toxicological effects of PEPs using an in vitro alveolar-capillary co-culture model with Human Small Airway Epithelial Cells (SAEC) and Human Microvascular Endothelial Cells (HMVEC). Our data demonstrate that direct exposure of SAEC to low concentrations of PEPs (0.5 and 1.0 microg/mL) caused morphological changes of actin remodeling and gap formations within the endothelial monolayer. Furthermore, increased production of reactive oxygen species (ROS) and angiogenesis were observed in the HMVEC. Analysis of cytokine and chemokine levels demonstrates that interleukin (IL)-6 and MCP-1 may play a major role in the cellular communication observed between SAEC and HMVEC and the resultant responses in HMVEC. These data indicate that PEPs at low, non-cytotoxic exposure levels are bioactive and affect cellular responses in an alveolar-capillary co-culture model, which raises concerns for potential adverse health effects. |
A two-stage multiplex method for quantitative analysis of botulinum neurotoxins type A, B, E, and F by MALDI-TOF mass spectrometry
Wang D , Baudys J , Krilich J , Smith TJ , Barr JR , Kalb SR . Anal Chem 2014 86 (21) 10847-54 In this publication, we report on the development of a quantitative enzymatic method for the detection of four botulinum neurotoxin (BoNT) serotypes responsible for human botulism by MALDI-TOF mass spectrometry. Factors that might affect the linearity and dynamic range for detection of BoNT cleavage products were initially examined, including the amount of peptide substrate and internal standard, the timing of cleavage reaction, and the components in the reaction solution. It was found that a long incubation time produced sensitive results, but was not capable of determining higher toxin concentrations, whereas a short incubation time was less sensitive so that lower toxin concentrations were not detected. In order to overcome these limitations, a two-stage analysis strategy was applied. The first stage analysis involved a short incubation period (e.g., 30 min). If no toxin was detected at this stage, the cleavage reaction was allowed to continue and the samples were analyzed at a second time point (4 h), so that toxin levels lower than 1 mouse LD50 or 55 attomoles per milliliter (55 amol/mL) could be quantified. By combining the results from two-stage quantification, 4 or 5 orders of magnitude in dynamic range were achieved for the detection of the serotypes of BoNT/A, BoNT/B, BoNT/E, or BoNT/F. The effect of multiplexing the assay by mixing substrates for different BoNT serotypes into a single reaction was also investigated in order to reduce the numbers of the cleavage reactions and save valuable clinical samples. |
Mouth-level intake of benzo[a]pyrene from reduced nicotine cigarettes
Ding YS , Ward J , Hammond D , Watson CH . Int J Environ Res Public Health 2014 11 (11) 11898-11914 Cigarette smoke is a known source of exposure to carcinogenic polycyclic aromatic hydrocarbons (PAHs), especially benzo[a]pyrene (BaP). Exposure to BaP in cigarette smoke is influenced by how a person smokes and factors, such as tobacco blend. To determine whether sustained use of reduced-nicotine cigarettes is associated with changes in exposure to nicotine and BaP, levels of BaP in spent cigarette filter butts were correlated with levels of BaP in cigarette smoke to estimate mouth-level intake (MLI) of BaP for 72 daily smokers given three progressively reduced nicotine content cigarettes. Urinary cotinine, a marker of nicotine exposure, and urinary 1-hydroxypyrene (1-HOP), a marker of PAH exposure, were measured throughout the study. Median daily BaP MLI and urine cotinine decreased in a similar manner as smokers switched to progressively lower nicotine cigarettes, despite relatively constant daily cigarette consumption. 1-HOP levels were less responsive to the use of reduced nicotine content cigarettes. We demonstrate that spent cigarette filter butt analysis is a promising tool to estimate MLI of harmful chemicals on a per cigarette or per-day basis, which partially addresses the concerns of the temporal influence of smoking behavior or differences in cigarette design on exposure. |
Noise exposure immediately activates cochlear mitogen-activated protein kinase signaling
Alagramam KN , Stepanyan R , Jamesdaniel S , Chen DH , Davis RR . Noise Health 2014 16 (73) 400-9 Noise-induced hearing loss (NIHL) is a major public health issue worldwide. Uncovering the early molecular events associated with NIHL would reveal mechanisms leading to the hearing loss. Our aim is to investigate the immediate molecular responses after different levels of noise exposure and identify the common and distinct pathways that mediate NIHL. Previous work showed mice exposed to 116 decibels sound pressure level (dB SPL) broadband noise for 1 h had greater threshold shifts than the mice exposed to 110 dB SPL broadband noise, hence we used these two noise levels in this study. Groups of 4-8-week-old CBA/CaJ mice were exposed to no noise (control) or to broadband noise for 1 h, followed by transcriptome analysis of total cochlear RNA isolated immediately after noise exposure. Previously identified and novel genes were found in all data sets. Following exposure to noise at 116 dB SPL, the earliest responses included up-regulation of 243 genes and down-regulation of 61 genes, while a similar exposure at 110 dB SPL up-regulated 155 genes and down-regulated 221 genes. Bioinformatics analysis indicated that mitogen-activated protein kinase (MAPK) signaling was the major pathway in both levels of noise exposure. Nevertheless, both qualitative and quantitative differences were noticed in some MAPK signaling genes, after exposure to different noise levels. Cacna1b , Cacna1g , and Pla2g6 , related to calcium signaling were down-regulated after 110 dB SPL exposure, while the fold increase in the expression of Fos was relatively lower than what was observed after 116 dB SPL exposure. These subtle variations provide insight on the factors that may contribute to the differences in NIHL despite the activation of a common pathway. |
A polyvalent clade B virus-like particle HIV vaccine combined with partially protective oral preexposure prophylaxis prevents simian-human immunodeficiency virus infection in macaques and primes for virus-amplified immunity
Ross TM , Pereira LE , Luckay A , McNicholl JM , Garcia-Lerma JG , Heneine W , Eugene HS , Pierce-Paul BR , Zhang J , Hendry RM , Smith JM . AIDS Res Hum Retroviruses 2014 30 (11) 1072-81 Vaccination and preexposure prophylaxis (PrEP) with antiretrovirals have shown only partial protection from HIV-1 infection in human trials. Oral Truvada (emtricitabine/tenofovir disoproxil fumarate) is FDA approved as PrEP but partial adherence reduces efficacy. If combined as biomedical preventions (CBP), an HIV vaccine could protect when PrEP adherence is low and PrEP could prevent vaccine breakthroughs. The efficacy of combining oral PrEP with an HIV vaccine has not been evaluated in humans. We determined the efficacy of combining a DNA/virus-like particle (VLP) vaccine with partially effective intermittent PrEP in Indian rhesus macaques (RM). Eight RM received intramuscular inoculations of five DNA plasmids encoding four HIV-1 Clade B primary isolate Envs and SIVmac239 Gag (at weeks 0 and 4), followed by intramuscular and intranasal inoculations of homologous Gag VLPs and four Env VLPs (at weeks 12, 16, and 53). At week 61, we initiated weekly rectal exposures with heterologous SHIV162p3 (10 TCID50) along with oral Truvada (TDF, 22 mg/kg; FTC 20 mg/kg) dosing 2 h before and 22 h after each exposure. This PrEP regimen previously demonstrated 50% efficacy. Five controls (no vaccine, no PrEP) received weekly SHIV162p3. All controls were infected after a median of four exposures; the mean peak plasma viral load (VL) was 3.9x10(7) vRNA copies/ml. CBP protected seven of eight (87.5%) RM. The one infected CBP RM had a reduced peak VL of 8.8x10(5) copies/ml. SHIV exposures during PrEP amplified Gag and Env antibody titers in protected RM. These results suggest that combining oral PrEP with HIV vaccines could enhance protection against HIV-1 infection. |
Field evaluation of a real-time fluorescence loop-mediated isothermal amplification assay, RealAmp, for the diagnosis of malaria in Thailand and India
Patel JC , Lucchi NW , Srivastava P , Lin JT , Sug-Aram R , Aruncharus S , Bharti PK , Shukla MM , Congpuong K , Satimai W , Singh N , Udhayakumar V , Meshnick SR . J Infect Dis 2014 210 (8) 1180-7 BACKGROUND: To eliminate malaria, surveillance for submicroscopic infections is needed. Molecular methods can detect submicroscopic infections but have not hitherto been amenable to implementation in surveillance programs. A portable loop-mediated isothermal amplification assay called RealAmp was assessed in 2 areas of low malaria transmission. METHODS: RealAmp was evaluated in 141 patients from health clinics in India (passive surveillance) and in 127 asymptomatic persons in Thailand (active surveillance). The diagnostic validity, precision, and predictive value of RealAmp were determined using polymerase chain reaction (PCR) as the reference method. A pilot study of RealAmp was also performed on samples from patients presenting at a Thai health center. RESULTS: A total of 96 and 7 positive cases were detected in India and Thailand, respectively, via PCR. In comparison with nested PCR, the sensitivity and specificity of RealAmp in India were 94.8% (95% confidence interval [CI], 88.3%-98.3%) and 100% (95% CI, 92.1%-100%), respectively, with correct identification of all 5 Plasmodium vivax cases. In Thailand, compared with pooled real-time PCR, RealAmp demonstrated 100% sensitivity (95% CI, 59.0%-100%) and 96.7% specificity (95% CI, 91.7%-99.1%). Testing at the health center demonstrated RealAmp's potential to serve as a point-of-care test with results available in 30-75 minutes. CONCLUSION: RealAmp was comparable to PCR in detecting malaria parasites and shows promise as a tool to detect submicroscopic infections in malaria control and elimination programs worldwide. |
Application of pharmacokinetic modelling for 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure assessment
Ruiz P , Aylward LL , Mumtaz M . SAR QSAR Environ Res 2014 25 (11) 873-90 Polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and mono- and non-ortho polychlorinated biphenyls (dioxin-like PCBs) are identified as a family or group of organic compounds known as 'dioxins' or dioxin-like chemicals (DLCs). The most toxic member of this group is 2,3,7,8-tetrachlorodibenzo-(p)-dioxin (TCDD). Historically, DLCs have caused a variety of negative human health effects, but a disfiguring skin condition known as chloracne is the only health effect reported consistently. As part of translational research to make computerized models accessible to health risk assessors, the Concentration- and Age-Dependent Model (CADM) for TCDD was recoded in the Berkeley Madonna simulation language. The US Agency for Toxic Substances and Disease Registry's computational toxicology laboratory used the recoded model to predict TCDD tissue concentrations at different exposure levels. The model simulations successfully reproduced the National Health and Nutrition Examination Survey (NHANES) 2001-2002 TCDD data in age groups from 6 to 60 years and older, as well as in other human datasets. The model also enabled the estimation of lipid-normalized serum TCDD concentrations in breastfed infants. The model performed best for low background exposures over time compared with a high acute poisoning case that could due to the large dose and associated liver toxicity. Hence, this model may be useful for interpreting human biomonitoring data as a part of an overall DLC risk assessment. |
Universal state newborn screening programs can reduce health disparities.
Brosco JP , Grosse SD , Ross LF . JAMA Pediatr 2014 169 (1) 7-8 Fifty years after the advent of state newborn screening (NBS) programs for a metabolic condition, there is evidence that the decision to mandate universal screening can reduce health disparities. When in-hospital screening for phenylketonuria began in the early 1960s, most hospitals simply added the procedure to the list of routine clinical practices for newborns, such as giving vitamin K. For a variety of reasons, including fear of missed cases, advocates managed to get state governments involved. By the late 1960s, most states required screening of all or almost all newborns.1 Although these advocates and state legislators did not describe their actions as addressing population-level health disparities, they believed that it was unfair for some infants to bear the consequences of late diagnosis of phenylketonuria simply because they were born in a hospital that did not provide the test. By making NBS for phenylketonuria universally available, they reduced the impact of unequal access to a new and effective therapeutic intervention– one cause of health disparities based on income, location, education, and race/ethnicity.2 | Recent reports from states that perform NBS for severe combined immune deficiency (SCID) confirm this hypothesis. This is a rare condition that is typically diagnosed when an infant or young child has 1 or more unusual infections. Bone marrow transplantation is highly effective to treat this condition, and outcomes are better when performed in the newborn period. In 2010 SCID was added to the Recommended Uniform Screening Panel (RUSP), the list of conditions recommended for NBS by the US Secretary of Health and Human Services. Early reports of NBS for SCID have revealed that SCID is much more common in black and Hispanic individuals than previously suggested by clinical referrals to transplant centers. Data from the first 2 years of screening for SCID in California, for example, reveal rates of SCID among black, Hispanic, and Asian children that are much higher than would be predicted by birth rates.3 More importantly, only 2 of the 15 infants who have undergone lifesaving bone marrow transplantation because of the state NBS program begun in 2010 were non-Hispanic white. This contrasts with earlier clinical series in which more than 80% of bone marrow transplantations for SCID were performed in non-Hispanic white children. The difference in the frequency of SCID among various racial/ethnic groups had been thought to be genetic. However, data from the California NBS program suggest that differential access to specialty care is a more likely explanation and that universal screening for SCID reduces health disparities from that condition. |
Race, otitis media, and antibiotic selection
Fleming-Dutra KE , Shapiro DJ , Hicks LA , Gerber JS , Hersh AL . Pediatrics 2014 134 (6) 1059-66 BACKGROUND AND OBJECTIVE: Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally. METHODS: We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM. RESULTS: The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86). CONCLUSIONS: Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM. |
Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes
Maeda A , Bateman BT , Clancy CR , Creanga AA , Leffert LR . Anesthesiology 2014 121 (6) 1158-1165 BACKGROUND: The authors investigated nationwide trends in opioid abuse or dependence during pregnancy and assessed the impact on maternal and obstetrical outcomes in the United States. METHODS: Hospitalizations for delivery were extracted from the Nationwide Inpatient Sample from 1998 to 2011. Temporal trends were assessed and logistic regression was used to examine the associations between maternal opioid abuse or dependence and obstetrical outcomes adjusting for relevant confounders. RESULTS: The prevalence of opioid abuse or dependence during pregnancy increased from 0.17% (1998) to 0.39% (2011) for an increase of 127%. Deliveries associated with maternal opioid abuse or dependence compared with those without opioid abuse or dependence were associated with an increased odds of maternal death during hospitalization (adjusted odds ratio [aOR], 4.6; 95% CI, 1.8 to 12.1, crude incidence 0.03 vs. 0.006%), cardiac arrest (aOR, 3.6; 95% CI, 1.4 to 9.1; 0.04 vs. 0.01%), intrauterine growth restriction (aOR, 2.7; 95% CI, 2.4 to 2.9; 6.8 vs. 2.1%), placental abruption (aOR, 2.4; 95% CI, 2.1 to 2.6; 3.8 vs. 1.1%), length of stay more than 7 days (aOR, 2.2; 95% CI, 2.0 to 2.5; 3.0 vs. 1.2%), preterm labor (aOR, 2.1; 95% CI, 2.0 to 2.3; 17.3 vs. 7.4%), oligohydramnios (aOR, 1.7; 95% CI, 1.6 to 1.9; 4.5 vs. 2.8%), transfusion (aOR, 1.7; 95% CI, 1.5 to 1.9; 2.0 vs. 1.0%), stillbirth (aOR, 1.5; 95% CI, 1.3 to 1.8; 1.2 vs. 0.6%), premature rupture of membranes (aOR, 1.4; 95% CI, 1.3 to 1.6; 5.7 vs. 3.8%), and cesarean delivery (aOR, 1.2; 95% CI, 1.1 to 1.3; 36.3 vs. 33.1%). CONCLUSIONS: Opioid abuse or dependence during pregnancy is associated with considerable obstetrical morbidity and mortality, and its prevalence is dramatically increasing in the United States. Identifying preventive strategies and therapeutic interventions in pregnant women who abuse drugs are important priorities for clinicians and scientists. |
Birth defects data from population-based birth defects surveillance programs in the United States, 2007 to 2011: highlighting orofacial clefts
Mai CT , Cassell CH , Meyer RE , Isenburg J , Canfield MA , Rickard R , Olney RS , Stallings EB , Beck M , Hashmi SS , Cho SJ , Kirby RS . Birth Defects Res A Clin Mol Teratol 2014 100 (11) 895-904 The National Birth Defects Prevention Network (NBDPN) published the first Congenital Malformations Surveillance Report in 1997 and has annually released a report since 2000 that contains state-specific population-based data on major birth defects and a directory describing data collection information for population-based birth defects surveillance programs in the United States. The birth defects in these reports have included conditions affecting major organs of the central nervous, eye, ear, cardiovascular, orofacial, gastrointestinal, genitourinary, and musculoskeletal systems, as well as other disorders, including trisomies and amniotic band sequence. | In 2014, the NBDPN released an updated list of major birth defects as part of its national standards development for birth defects surveillance. The criteria used to guide deliberations for inclusion on the reportable list were: (1) public health importance; (2) accuracy of diagnosis; (3) amenable to prevention/intervention; (4) state of knowledge; (5) structural malformations, diagnosed within the first year of life; and (6) ability to separate into syndromic/nonsyndromic. For example, the NBDPN list now includes all 12 critical congenital heart defects (CCHDs) that are primary and secondary targets of pulse oximetry screening as a result of the addition of CCHD to the U.S. Recommended Universal Screening Panel for newborns (Mahle et al., 2012). Other noncardiac conditions that were added include clubfoot, cloacal exstrophy, craniosynostosis, deletion 22q11.2, holoprosencephaly, small intestinal atresia/stenosis, and Turner syndrome. These additions were balanced with the removal of several conditions, including: amniotic bands, aniridia, congenital hip dislocation, epispadias, fetus or newborn affected by maternal alcohol use, Hirschsprung disease (congenital megacolon), hydrocephalus, microcephalus, patent ductus arterious, and pyloric stenosis. Additional modifications to the list resulted in the regrouping of some conditions. Upper and lower limb deficiencies were collapsed into all limb deficiencies, while cleft lip with or without cleft palate was separated into cleft lip alone and cleft lip with cleft palate. Finally, obstructive genitourinary defect was limited to just the reporting of congenital posterior urethral valves. Table 1 presents the new reported list of birth defects and their diagnostic codes (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM]; and Centers for Disease Control and Prevention/British Pediatric Association Classification of Diseases [CDC/BPA]). |
Can the Perinatal Information System in Peru be used to measure the proportion of adverse birth outcomes attributable to maternal syphilis infection?
Bradley H , Tapia V , Kamb ML , Newman LM , Garcia PJ , Serruya SJ , Fort AL , Broutet N , Nelson R , Kirkcaldy RD , Gonzales GF . Rev Panam Salud Publica 2014 36 (2) 73-9 OBJECTIVE: To describe the capacity of Peru's Perinatal Information System (Sistema Informatico Perinatal, SIP) to provide estimates for monitoring the proportion of stillbirths and other adverse birth outcomes attributable to maternal syphilis. METHODS: A descriptive study was conducted to assess the quality and completeness of SIP data from six Peruvian public hospitals that used the SIP continuously from 2000 - 2010 and had maternal syphilis prevalence of at least 0.5% during that period. In-depth interviews were conducted with Peruvian stakeholders about their experiences using the SIP. RESULTS: Information was found on 123 575 births from 2000 - 2010 and syphilis test results were available for 99 840 births. Among those 99 840 births, there were 1 075 maternal syphilis infections (1.1%) and 619 stillbirths (0.62%). Among women with syphilis infection in pregnancy, 1.7% had a stillbirth, compared to 0.6% of women without syphilis infection. Much of the information needed to estimate the proportion of stillbirths attributable to maternal syphilis was available in the SIP, with the exception of syphilis treatment information, which was not collected. However, SIP data collection is complex and time-consuming for clinicians. Data were unlinked across hospitals and not routinely used or quality-checked. Despite these limitations, the SIP data examined were complete and valid; in 98% of records, information on whether or not the infant was stillborn was the same in both the SIP and clinical charts. Nearly 89% of women had the same syphilis test result in clinical charts and the SIP. CONCLUSIONS: The large number of syphilis infections reported in Peru's SIP and the ability to link maternal characteristics to newborn outcomes make the system potentially useful for monitoring the proportion of stillbirths attributable to congenital syphilis in Peru. To ensure good data quality and sustainability of Peru's SIP, data collection should be simplified and information should be continually quality-checked and used for the benefit of participating facilities. |
Associations between posterior functional contacts and nutrient intakes and serum nutrient values among adults in NHANES 2003-2004
Ervin RB , Dye BA . Oral Health Prev Dent 2014 12 (3) 265-76 PURPOSE: To examine the associations between the numbers of posterior functional contacts (FCs) and selected nutrient intakes and serum/plasma nutrient values in 3,554 adults 25 years of age and older from the 2003-2004 National Health and Nutrition Examination Survey (NHANES). MATERIALS AND METHODS: FCs consist of the number of zones of contact between the maxillary and opposing mandibular posterior teeth when the maxillary and mandibular posterior teeth are together. There were 16 possible zones of contact. Nutrient intakes were calculated from one 24-h dietary recall and selected nutritional biochemistries were measured. Multivariate linear regression was used to examine the association between the numbers of FCs and nutrient intakes or serum/plasma nutrient values, controlling for potential confounding variables. RESULTS: Males with 6 or more FCs had higher vitamin A (P < 0.05), C (P < 0.05), E (P < 0.01) and B-6 intakes (P < 0.05) than those with 5 or fewer FCs. Females with 6 or more FCs had higher dietary ber (P < 0.05), vitamin E (P < 0.05) and folate intakes (P < 0.05) than those with 5 or fewer FCs. Males and females with 6 or more FCs had higher serum beta-carotene than those with 5 or fewer FCs (P < 0.05 and P < 0.001, respectively). Males with 6 or more FCs had higher serum folate levels than those with 5 or fewer FCs (P < 0.01), and females with 6 or more FCs had higher serum vitamin C levels than those with 5 or fewer FCs (P < 0.05). CONCLUSIONS: Dietary intakes and serum levels of certain nutrients differ by the number of FCs present. |
Tool-specific performance of vibration-reducing gloves for attenuating palm-transmitted vibrations in three orthogonal directions
Dong RG , Welcome DE , Peterson DR , Xu XS , McDowell TW , Warren C , Asaki T , Kudernatsch S , Brammer A . Int J Ind Ergon 2014 44 (6) 827-839 Vibration-reducing (VR) gloves have been increasingly used to help reduce vibration exposure, but it remains unclear how effective these gloves are. The purpose of this study was to estimate tool-specific performances of VR gloves for reducing the vibrations transmitted to the palm of the hand in three orthogonal directions (3-D) in an attempt to assess glove effectiveness and aid in the appropriate selection of these gloves. Four typical VR gloves were considered in this study, two of which can be classified as anti-vibration (AV) gloves according to the current AV glove test standard. The average transmissibility spectrum of each glove in each direction was synthesized based on spectra measured in this study and other spectra collected from reported studies. More than seventy vibration spectra of various tools or machines were considered in the estimations, which were also measured in this study or collected from reported studies. The glove performance assessments were based on the percent reduction of frequency-weighted acceleration as is required in the current standard for assessing the risk of vibration exposures. The estimated tool-specific vibration reductions of the gloves indicate that the VR gloves could slightly reduce (<5%) or marginally amplify (<10%) the vibrations generated from low-frequency (<25 Hz) tools or those vibrating primarily along the axis of the tool handle. With other tools, the VR gloves could reduce palm-transmitted vibrations in the range of 5%–58%, primarily depending on the specific tool and its vibration spectra in the three directions. The two AV gloves were not more effective than the other gloves with some of the tools considered in this study. The implications of the results are discussed. Relevance to industry Hand-transmitted vibration exposure may cause hand-arm vibration syndrome. Vibration-reducing gloves are considered as an alternative approach to reduce the vibration exposure. This study provides useful information on the effectiveness of the gloves when used with many tools for reducing the vibration transmitted to the palm in three directions. The results can aid in the appropriate selection and use of these gloves. |
Maternal periconceptional occupational pesticide exposure and neural tube defects
Makelarski JA , Romitti PA , Rocheleau CM , Burns TL , Stewart PA , Waters MA , Lawson CC , Bell EM , Lin S , Shaw GM , Olney RS . Birth Defects Res A Clin Mol Teratol 2014 100 (11) 877-86 BACKGROUND: Adverse associations between maternal pesticide exposure and neural tube defects (NTDs) have been suggested but not consistently observed. This study used data from the multisite National Birth Defects Prevention Study to examine associations between maternal periconceptional (1 month preconception through 2 months postconception) occupational pesticide exposure and NTDs. METHODS: Mothers of 502 NTD cases and 2950 unaffected live-born control infants with estimated delivery dates from 1997 through 2002 were included. Duration, categorical intensity scores, and categorical frequency scores for pesticide classes (e.g., insecticides) were assigned using a modified, literature-based job-exposure matrix and maternal-reported occupational histories. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated based on fitted multivariable logistic regression models that described associations between maternal periconceptional occupational pesticide exposure and NTDs. The aORs were estimated for pesticide exposure (any [yes/no] and cumulative exposure [intensity x frequency x duration] to any pesticide class, each pesticide class, or combination of pesticide classes) and all NTD cases combined and NTD subtypes. RESULTS: Positive, but marginally significant or nonsignificant, aORs were observed for exposure to insecticides + herbicides for all NTD cases combined and for spina bifida alone. Similarly, positive aORs were observed for any exposure and cumulative exposure to insecticides + herbicides + fungicides and anencephaly alone and encephalocele alone. All other aORs were near unity. CONCLUSION: Pesticide exposure associations varied by NTD subtype and pesticide class. Several aORs were increased, but not significantly. Future work should continue to examine associations between pesticide classes and NTD subtypes using a detailed occupational pesticide exposure assessment and examine pesticide exposures outside the workplace. |
Generation of reactive oxygen species from silicon nanowires
Leonard SS , Cohen GM , Kenyon AJ , Schwegler-Berry D , Fix NR , Bangsaruntip S , Roberts JR . Environ Health Insights 2014 8 21-29 Processing and synthesis of purified nanomaterials of diverse composition, size, and properties is an evolving process. Studies have demonstrated that some nanomaterials have potential toxic effects and have led to toxicity research focusing on nanotoxicology. About two million workers will be employed in the field of nanotechnology over the next 10 years. The unknown effects of nanomaterials create a need for research and development of techniques to identify possible toxicity. Through a cooperative effort between National Institute for Occupational Safety and Health and IBM to address possible occupational exposures, silicon-based nanowires (SiNWs) were obtained for our study. These SiNWs are anisotropic filamentary crystals of silicon, synthesized by the vapor–liquid–solid method and used in bio-sensors, gas sensors, and field effect transistors. Reactive oxygen species (ROS) can be generated when organisms are exposed to a material causing cellular responses, such as lipid peroxidation, H2O2 production, and DNA damage. SiNWs were assessed using three different in vitro environments (H2O2, RAW 264.7 cells, and rat alveolar macrophages) for ROS generation and possible toxicity identification. We used electron spin resonance, analysis of lipid peroxidation, measurement of H2O2 production, and the comet assay to assess generation of ROS from SiNW and define possible mechanisms. Our results demonstrate that SiNWs do not appear to be significant generators of free radicals. |
Progress toward global eradication of dracunculiasis - January 2013-June 2014
Hopkins DR , Ruiz-Tiben E , Eberhard ML , Roy SL . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1050-4 Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after a person acquires infection from contaminated drinking water, the worm will emerge through the skin, usually on the lower limb. Pain and secondary bacterial infection can cause temporary or permanent disability that disrupts work and schooling. In 1986, the World Health Assembly called for dracunculiasis elimination. The global Guinea Worm Eradication Program, supported by The Carter Center, World Health Organization (WHO), UNICEF, CDC, and other partners, began assisting ministries of health of countries in which dracunculiasis is endemic in meeting this goal. At that time, an estimated 3.5 million cases occurred each year in 20 countries in Africa and Asia. This report updates published (3-5) and unpublished surveillance data reported by ministries of health and describes progress toward dracunculiasis eradication. A total of 148 cases were reported in 2013 from five countries (in order of prevalence: South Sudan, Chad, Mali, Ethiopia, and Sudan) compared with 542 cases in 2012 from four countries (South Sudan, Chad, Mali, and Ethiopia). The disease remains endemic in four countries in 2014 (South Sudan, Chad, Mali, and Ethiopia), but the overall incidence is falling faster in 2013 compared with 2012 (by 73%) and continues to fall faster in the first 6 months of 2014 (by 71%) compared with the same period in 2013. Failures in surveillance and containment, lack of clean drinking water, insecurity in Mali and parts of South Sudan, and an unusual epidemiologic pattern in Chad are the main remaining challenges to dracunculiasis eradication. |
Public health workforce taxonomy
Boulton ML , Beck AJ , Coronado F , Merrill JA , Friedman CP , Stamas GD , Tyus N , Sellers K , Moore J , Tilson HH , Leep CJ . Am J Prev Med 2014 47 S314-S323 Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012-2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection. |
Enumeration of the governmental public health workforce, 2014
Beck AJ , Boulton ML , Coronado F . Am J Prev Med 2014 47 S306-S313 BACKGROUND: Regular assessment of the size and composition of the U.S. public health workforce has been a challenge for decades. Previous enumeration efforts estimated 450,000 public health workers in governmental and voluntary agencies in 2000, and 326,602 governmental public health workers in 2012, although differences in enumeration methodology and the definitions of public health worker between the two make comparisons problematic. PURPOSE: To estimate the size of the governmental public health workforce in 14 occupational classifications recommended for categorizing public health workers. METHODS: Six data sources were used to develop enumeration estimates: five for state and local public health workers and one for the federal public health workforce. Statistical adjustments were made to address missing data, overcounting, and duplicate counting of workers across surveys. Data were collected for 2010-2013; analyses were conducted in 2014. RESULTS: The multiple data sources yielded an estimate of 290,988 (range=231,464-341,053) public health workers in governmental agencies, 50%, 30%, and 20% of whom provide services in local, state, and federal public health settings, respectively. Administrative or clerical personnel (19%) represent the largest group of workers, followed by public health nurses (16%); environmental health workers (8%); public health managers (6%); and laboratory workers (5%). CONCLUSIONS: Using multiple data sources for public health workforce enumeration potentially improves accuracy of estimates but also adds methodologic complexity. Improvement of data sources and development of a standardized study methodology is needed for continuous monitoring of public health workforce size and composition. |
Beyond content leadership development through a journal club
Kattan JA , Apostolou A , Al-Samarrai T , El Bcheraoui C , Kay MK , Khaokham CB , Pillai P , Sapkota S , Jani AA , Koo D , Taylor WC . Am J Prev Med 2014 47 S301-S305 CDC designed its Health Systems Integration Program to prepare leaders to function-at the interface of public health and health care. Specific Health Systems Integration Program competencies in the areas of communication, analysis and assessment, and health systems were developed to nurture evidence-based decision-making and leadership skills crucial for future public health leaders. The program therefore designed an innovative journal club as part of its competency-based curriculum not only to meet the standard goals for a journal club critical reading, interpretation, and acquiring content knowledge but also to foster leadership development. This report describes the Health Systems Integration Program journal club format, its implementation, challenges, and key elements of success. Other programs using a journal club model as a learning format might consider using the Health Systems Integration Program's innovative approach that focuses on leadership development. |
A systematic review of sexual health interventions for adults: narrative evidence
Hogben M , Ford J , Becasen JS , Brown KF . J Sex Res 2014 52 (4) 1-26 Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health. |
Assisted reproductive technology surveillance - United States, 2011
Sunderam S , Kissin DM , Crawford SB , Folger SG , Jamieson DJ , Barfield WD . MMWR Surveill Summ 2014 63 Suppl 10 (10) 1-28 PROBLEM/CONDITION: Since the first U.S. infant conceived with Assisted Reproductive Technology (ART) was born in 1981, both the use of advanced technologies to overcome infertility and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which both eggs and embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Women who undergo ART procedures are more likely to deliver multiple-birth infants than those who conceive naturally because more than one embryo might be transferred during a procedure. Multiple births pose substantial risks to both mothers and infants, including pregnancy complications, preterm delivery, and low birthweight infants. This report provides state-specific information on U.S. ART procedures performed in 2011 and compares infant outcomes that occurred in 2011 (resulting from procedures performed in 2010 and 2011) with outcomes for all infants born in the United States in 2011. REPORTING PERIOD COVERED: 2011. DESCRIPTION OF SYSTEM: In 1996, CDC began collecting data on all ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493). Data are collected through the National ART Surveillance System (NASS), a web-based data collecting system developed by CDC. RESULTS: In 2011, a total of 151,923 ART procedures performed in 451 U.S. fertility clinics were reported to CDC. These procedures resulted in 47,818 live-birth deliveries and 61,610 infants. The largest numbers of ART procedures were performed among residents of six states: California (18,808), New York (excluding New York City) (14,576), Massachusetts (10,106), Illinois (9,886), Texas (9,576), and New Jersey (8,698). These six states also had the highest number of live-birth deliveries as a result of ART procedures and together accounted for 47.2% of all ART procedures performed, 45.3% of all infants born from ART, and 45.1% of all multiple live-birth deliveries, but only 34% of all infants born in the United States. Nationally, the average number of ART procedures performed per 1 million women of reproductive age (15-44 years), which is a proxy indicator of ART use, was 2,401. In 11 states (Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Virginia), the District of Columbia, and New York City, this proxy measure was higher than the national rate, and of these, in three states (Massachusetts, New Jersey, and New York) and the District of Columbia, it exceeded twice the national rate. Nationally, among ART cycles with patients using fresh embryos from their own eggs in which at least one embryo was transferred, the average number of embryos transferred increased with increasing age (2.0 among women aged <35 years, 2.3 among women aged 35-40 years, and 2.9 among women aged >40 years). Elective single-embryo transfer (eSET) rates decreased with increasing age (12.2% among women aged <35 years, 4.7% among women aged 35-40 years, and 0.7% among women aged >40 years). Rates of eSET also varied substantially between states (range: 0.7% in Idaho to 53% in Delaware among women aged <35 years). The number of ART births as a percentage of total infants born in the state is considered as another measure of ART use. Overall, ART contributed to 1.5% of U.S. births (range: 0.2% in Puerto Rico to 4.5% in Massachusetts) with the highest rates (≥3.5% of all infants born) observed in four states (Connecticut, Massachusetts, New Jersey, and New York state), and the District of Columbia. Infants conceived with ART comprised 20% of all multiple-birth infants (range: 4.7% in Puerto Rico to 41.3% in New York state), 19% of all twin infants (range: 4.1% in Mississippi to 39.7% in Massachusetts), and 32% of triplet or higher order infants (range: 0 in several states to 71.4% in Hawaii). Among infants conceived with ART, 45.6% were born in multiple-birth deliveries (range: 23.1% in Delaware to 61.3% in Wyoming), compared with only 3.4% of infants among all births in the general population (range: 1.9% in Puerto Rico to 4.8% in New Jersey). Approximately 43% of ART-conceived infants were twins, and 3% were triplets and higher order infants. Nationally, infants conceived with ART comprised 5.7% of all low birthweight (<2,500 grams) infants (range: 0.6% in Puerto Rico to 15% in Massachusetts) and 5.9% of all very low birthweight (<1,500 grams) infants (range: 0.8% in Mississippi to 17.3% in Massachusetts). Overall, among ART-conceived infants, 31% were low birthweight (range: 18% in District of Columbia to 44.6% in Puerto Rico), compared with 8.1% among all infants (range: 6% in Alaska to 12.5% in Puerto Rico); 5.7% of ART infants were very low birthweight (range: 0 in North Dakota to 8.5% in Hawaii), compared with 1.4% among all infants (range: 0.9% in Alaska to 2.2% in Mississippi). Finally, ART-conceived infants comprised 4.6% of all infants born preterm (<37 weeks; range: 0.5% in Puerto Rico to 13% in Massachusetts) and 5.2% of all infants born very preterm (<32 weeks; range: 0 in Wyoming to 17.1% in Massachusetts). Overall, among infants conceived with ART, 36.2% were born preterm (range: 12.5% in Vermont to 56.9% in Puerto Rico), compared with 11.8% among all infants born in the general population (range: 8.8% in Vermont to 17.6% in Puerto Rico); 6.7% of ART infants were born very preterm (range: 0 in Wyoming to 12.5% in Alaska), compared with 1.9% among all infants born in the general population (range: 1.3% in Wyoming to 3.0% in Puerto Rico). The percentage of infants conceived with ART who were low birthweight varied from 8.8% (range: 3.9% in the District of Columbia to 17.9% in Puerto Rico) among singletons, to 56.4% (range: 34.6% in Vermont to 70.4% in Mississippi) among twins, and 95.7% (range: 79.5% in North Carolina to 100% in several states) among triplets or higher-order multiples; comparable percentages for all infants were 6.4% (range: 4.5% in Idaho and Oregon to 11.3% in Puerto Rico), 56.3% (range: 47.7% in Vermont to 72.1% in Puerto Rico), and 93.9% (range: 50% in Wyoming to 100% in several states), respectively. The percentage of ART infants who were preterm varied from 13.2% (range: 7.3% in the District of Columbia to 28.6% in Puerto Rico) among singletons, to 61.8% (range: 46% in the District of Columbia to 82.7% in Oklahoma) among twins, and 97.1% (range: 76.9% in Iowa to 100% in several states) among triplets or higher-order multiples; comparable percentages for all infants were 10.1% (range:7.5% in Oregon to 16.6% in Puerto Rico), 57.3% (range: 46.8% in New Hampshire to 68.8% in Louisiana), and 93.4% (range: 73.3% in Rhode Island to 100% in several states), respectively. Only nonsuppressed values from reporting areas are provided to protect confidentiality. INTERPRETATION: The percentage of infants conceived with ART varied considerably by state (range: 0.2% to 4.5%). In most states, multiples from ART comprised a substantial proportion of all twin, triplet, and higher-order infants born in the state, and the rates of low birthweight and preterm infants were disproportionately higher among ART infants than in the birth population overall. Even among women aged <35 years, for whom elective single embryo transfers should be considered (particularly in patients with a favorable prognosis), on average, two embryos were transferred per cycle in ART procedures, influencing the overall multiple infant rates in the United States. Compared with ART singletons, ART twins were approximately 5 times more likely to be born preterm, and approximately six times more likely to be low birthweight. Singleton infants conceived with ART had slightly higher rates of preterm delivery and low birthweight than among all singleton infants born in the United States. However, all multiple-birth infants, regardless of whether they were ART-conceived or not, were more likely to be preterm and low birthweight compared with singletons. Further, ART use per population unit was distributed disproportionately in the United States, with 11 states showing ART use above the national rate. Of the four states (Illinois, Massachusetts, New Jersey, and Rhode Island) with comprehensive statewide-mandated health insurance coverage for ART procedures (e.g., coverage for at least four cycles of in vitro fertilization, three states (Illinois, Massachusetts, and New Jersey) also had rates of ART use >1.5 times the national level. This type of mandated insurance has been associated with greater use of ART and might account for the differences in per capita ART use observed among states. PUBLIC HEALTH ACTIONS: Reducing the number of embryos transferred per ART procedure and promoting eSET procedures, when clinically appropriate, are needed to reduce multiple births and related adverse consequences of ART. Improved patient education and counseling on the health risks of having twins might be useful in reducing twin births given that twins account for the majority of ART-conceived multiple births. Although ART contributes to increasing rates of multiple births, it does not explain all of the increases, and therefore other explanations for multiple births not investigated in this report, such as the possible role of non-ART fertility treatments, warrants further study. |
Prevalence of alcohol dependence among US adult drinkers, 2009-2011
Esser MB , Hedden SL , Kanny D , Brewer RD , Gfroerer JC , Naimi TS . Prev Chronic Dis 2014 11 E206 INTRODUCTION: Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States $223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers. METHODS: Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of $75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than $25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency. CONCLUSION: Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services. |
Helping smokers quit - opportunities created by the Affordable Care Act
McAfee T , Babb S , McNabb S , Fiore MC . N Engl J Med 2014 372 (1) 5-7 In its review of tobacco-dependence treatments, the 2008 clinical practice guideline of the U.S. Public Health Service concluded, "Indeed, it is difficult to identify any other condition that presents such a mix of lethality, prevalence, and neglect, despite effective and readily available interventions." The low utilization of clinical cessation interventions by smokers and physicians alike is partly attributable to inadequate insurance coverage: many health insurers still fail to cover the evidence-based counseling and medication treatments recommended in the 2008 guideline. Even when these treatments are covered, barriers to utilization such as copayments and prior-authorization requirements make obtaining them costly and inconvenient. |
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