The relationship between periodontitis and alcohol use is not clear
Dye BA . J Evid Based Dent Pract 2010 10 (4) 225-7 PURPOSE/QUESTION: Is alcohol use or dependence associated with periodontitis? SOURCE OF FUNDING: Government: authors received partial support from Coordination of Improvement of Higher Education Personnel (CAPES) Ministry of Education, Brazil TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable. |
Serum alpha-carotene concentrations and risk of death among US adults: the third National Health and Nutrition Examination Survey Follow-up Study
Li C , Ford ES , Zhao G , Balluz LS , Giles WH , Liu S . Arch Intern Med 2010 171 (6) 507-15 BACKGROUND: Much research has been conducted relating total carotenoids-and beta-carotene in particular-to risk of cancer and cardiovascular disease (CVD). Limited data are emerging to implicate the important role of alpha-carotene in the development of CVD or cancer. METHODS: We assessed the direct relationship between alpha-carotene concentrations and risk of death among 15,318 US adults 20 years and older who participated in the Third National Health and Nutrition Examination Survey Follow-up Study. We used Cox proportional hazard regression analyses to estimate the relative risk for death from all causes and selected causes associated with serum alpha-carotene concentrations. RESULTS: Compared with participants with serum alpha-carotene concentrations of 0 to 1 mug/dL (to convert to micromoles per liter, multiply by 0.01863), those with higher serum levels had a lower risk of death from all causes (P < .001 for linear trend): the relative risk for death was 0.77 (95% confidence interval, 0.68-0.87) among those with alpha-carotene concentrations of 2 to 3 mug/dL, 0.73 (0.65-0.83) among those with concentrations of 4 to 5 mug/dL, 0.66 (0.55-0.79) among those with concentrations of 6 to 8 mug/dL, and 0.61 (0.51-0.73) among those with concentrations of 9 mug/dL or higher after adjustment for potential confounding variables. We also found significant associations between serum alpha-carotene concentrations and risk of death from CVD (P = .007), cancer (P = .02), and all other causes (P < .001). The association between serum alpha-carotene concentrations and risk of death from all causes was significant in most subgroups stratified by demographic characteristics, lifestyle habits, and health risk factors. CONCLUSIONS: Serum alpha-carotene concentrations were inversely associated with risk of death from all causes, CVD, cancer, and all other causes. These findings support increasing fruit and vegetable consumption as a means of preventing premature death. |
Treatment of chronic hepatitis B virus infection in resource-constrained settings: expert panel consensus
Wiersma ST , McMahon B , Pawlotsky JM , Thio CL , Thursz M , Lim SG , Ocama P , Esmat G , Maimuna M , Bell D , Vitoria M , Eramova I , Lavanchy D , Dusheiko G . Liver Int 2010 31 (6) 755-61 Most of the estimated 350 million people with chronic hepatitis B virus (HBV) infection live in resource-constrained settings. Up to 25% of those persons will die prematurely of hepatocellular carcinoma (HCC) or cirrhosis. Universal hepatitis B immunization programmes that target infants will have an impact on HBV-related deaths several decades after their introduction. Antiviral agents active against HBV are available; treatment of HBV infection in those who need it has been shown to reduce the risk of HCC and death. It is estimated that 20-30% of persons with HBV infection could benefit from treatment. However, drugs active against HBV are not widely available or utilized in persons infected with HBV. Currently recommended antiviral agents used for treatment of human immunodeficiency virus (HIV) infection do not adequately suppress HBV, which is of great concern for the estimated 10% of the HIV-infected persons in Africa who are co-infected with HBV. Progressive liver disease has been shown to occur in co-infected persons whose HBV infection is not suppressed. In view of these concerns, an informal World Health Organization consultation of experts concluded that: chronic HBV is a major public health problem in emerging nations; all HIV-infected persons should be screened for HBV infection; HIV/HBV co-infected persons should be treated with therapies active against both viruses and that reduce the risk of resistance; standards for the management of chronic HBV infection should be adapted to resource-constrained settings. In addition, a research agendum was developed focusing on issues related to prevention and treatment of chronic HBV in resource-constrained settings. |
Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006
Gilboa SM , Salemi JL , Nembhard WN , Fixler DE , Correa A . Circulation 2010 122 (22) 2254-63 BACKGROUND: Previous reports suggest that mortality resulting from congenital heart disease (CHD) among infants and young children has been decreasing. There is little population-based information on CHD mortality trends and patterns among older children and adults. METHODS AND RESULTS: We used data from death certificates filed in the United States from 1999 to 2006 to calculate annual CHD mortality by age at death, race-ethnicity, and sex. To calculate mortality rates for individuals ≥1 year of age, population counts from the US Census were used in the denominator; for infant mortality, live birth counts were used. From 1999 to 2006, there were 41 494 CHD-related deaths and 27 960 deaths resulting from CHD (age-standardized mortality rates, 1.78 and 1.20 per 100 000, respectively). During this period, mortality resulting from CHD declined 24.1% overall. Mortality resulting from CHD significantly declined among all race-ethnicities studied. However, disparities persisted; overall and among infants, mortality resulting from CHD was consistently higher among non-Hispanic blacks compared with non-Hispanic whites. Infant mortality accounted for 48.1% of all mortality resulting from CHD; among those who survived the first year of life, 76.1% of deaths occurred during adulthood (≥18 years of age). CONCLUSIONS: CHD mortality continued to decline among both children and adults; however, differences between race-ethnicities persisted. A large proportion of CHD-related mortality occurred during infancy, although significant CHD mortality occurred during adulthood, indicating the need for adult CHD specialty management. |
Gynecological history in chronic fatigue syndrome: a population-based case-control study
Boneva RS , Maloney EM , Lin JM , Jones JF , Wieser F , Nater UM , Heim CM , Reeves WC . J Womens Health (Larchmt) 2010 20 (1) 21-8 BACKGROUND: Chronic fatigue syndrome (CFS) affects disproportionately more women than men, and the condition is more common at perimenopause. We examined gynecological history events as risk factors for CFS. METHODS: In a case-control study from a randomly selected population sample from Wichita, Kansas, 36 women with CFS and 48 nonfatigued controls, of similar age, race, and body mass index (BMI), answered a structured gynecological history questionnaire. RESULTS: CFS cases and controls had the same mean age (51 years) and age at menarche (12 years). Overall, a greater proportion of women with CFS than controls reported pelvic pain unrelated to menstruation (22.2% vs. 1.7%, p = 0.004), endometriosis (36.1% vs. 16.7, %, p = 0.046), and periods of amenorrhea (53.9 % vs. 46.2%, p = 0.06). Compared to controls, women in the CFS group had a higher mean number of pregnancies (2.8 vs 2.0, p = 0.05) and gynecological surgeries (1.8 vs. 1.1, p = 0.05). Similar proportions of the CFS (69.4%) and control (72.9%) groups were menopausal. Although menopausal women in the CFS and control groups had similar mean age (55.5 and 55.8, respectively), menopause occurred about 4.4 years earlier in the CFS group (41.7 years vs. 46.1 years, respectively, p = 0.11). Among menopausal women, 76% of the CFS group reported hysterectomy vs. 54.6% of controls (p = 0.09), and 56% of women with CFS reported oophorectomy vs. 34.3% of controls (p = 0.11). CONCLUSIONS: The higher prevalence of gynecological conditions and gynecological surgeries in women with CFS highlights the importance of evaluating gynecological health in these patients and the need for more research to clarify the chronologic and the pathophysiological relationships between these conditions and CFS. |
Associations between intracranial haemorrhage and prescribed prophylaxis in a large cohort of haemophilia patients in the United States
Witmer C , Presley R , Kulkarni R , Soucie JM , Manno CS , Raffini L . Br J Haematol 2010 152 (2) 211-6 Intracranial haemorrhage (ICH) is the most serious type of bleeding for patients with haemophilia. Prior published reports regarding ICH predate the widespread provision of prophylaxis. Our study objectives were to determine risk factors for ICH and whether prophylaxis reduces ICH occurrence. We performed a nested case-control study of persons with haemophilia, ≥2 years of age enrolled in the Centers for Disease Control and Prevention Universal Data Collection project. Of 10 262 patients 199 (1.9%) experienced an ICH for an incidence rate of 390/10(5) patient years. Head trauma was reported in 44% (88/199). ICH mortality was 19.6% (39/199). Significant risk factors for ICH included a high titre inhibitor [odds ratio (OR) = 4.01, 95% confidence interval (2.40-6.71)], prior ICH [OR = 3.62 (2.66-4.92)] and severe haemophilia [OR = 3.25 (2.01-5.25)]. Prophylaxis was associated with a significant risk reduction for ICH occurrence in patients with severe haemophilia who were negative for human immunodeficiency virus or an inhibitor, with an OR of 0.52 (0.34-0.81) and 0.50 (0.32-0.77) respectively. The most significant risk factors for ICH included the presence of an inhibitor, prior ICH, severity of haemophilia and reported head trauma. This is the first study to demonstrate that prescribed prophylaxis conferred a protective effect against ICH in patients with uncomplicated severe disease. |
Dietary sodium reduction in the United States: its importance for women
Lee JM , Gunn JP . J Womens Health (Larchmt) 2010 19 (12) 2149-52 This article highlights sodium intake and risk for cardiovascular disease among women in the U.S. population and reviews selected interventions to promote sodium reduction conducted by CDC's Division for Heart Disease and Stroke Prevention. |
Transmitted drug resistance and type of infection in newly diagnosed HIV-1 individuals in Honduras
Murillo W , Paz-Bailey G , Morales S , Monterroso E , Paredes M , Dobbs T , Parekh BS , Albert J , Rivera IL . J Clin Virol 2010 49 (4) 239-44 BACKGROUND: Transmitted drug resistance (TDR) reduces the efficacy of antiretroviral treatment and is a public health concern. OBJECTIVES: To gain insight in the epidemiology of TDR in Honduras by evaluating the amount of TDR in a representative sample of newly diagnosed individuals and by determining whether these are recent or established infections. STUDY DESIGN: Two hundred treatment-naive, newly diagnosed HIV-positive individuals representing different population groups (general population, Garifunas ethnic group, female sex workers and men who have sex with men) and different geographic regions were enrolled during April 2004-April 2007. The HIV-1 pol gene was sequenced to identify drug-resistant mutations and TDR was scored as recommended by the WHO. Specimens were classified as recent or established infections using the BED assay. RESULTS: Among 200 samples analyzed from Honduran patients the prevalence of TDR was 7% (95% CI: 3.9-11.5%), 5% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 3% for nucleoside reverse transcriptase inhibitors (NRTIs) and 0.5% for protease inhibitors (PIs). Testing of these samples with the BED assay revealed that 12% of the specimens were associated with recent infections. TDR was significantly more common in specimens with recent infection (21%) than established infection (5%) (p=0.016). CONCLUSIONS: The prevalence of TDR in Honduras was moderate (7%). The percentage of specimens who were recently infected was low (12%), suggesting that late HIV diagnosis is common. The TDR prevalence was higher in recent than in established infections, which may indicate that TDR is increasing over time. The higher prevalence of NNRTI and NRTI mutations as compared to PI mutations is probably due to a broader and longer use of these drugs in Honduras. |
Exposure science for viral diseases: 2009 H1N1 pandemic influenza virus
Cox N , Donis R , Barr JR . J Expo Sci Environ Epidemiol 2010 21 (1) 1-2 The 2009 H1N1 virus, which caused this century's first pandemic (an epidemic over a very large geographic area), is a genetically novel influenza A virus. Virologists call it a “reassortant” virus because gene segments of the virus originated from different influenza virus sources (from pigs in Europe and Asia and from North American influenza viruses infecting birds, pigs, and humans). Initially, the press called it “swine flu”; the scientifically proper name of H1N1 is derived from proteins on the outer surface of the virus. The first diagnosis of a novel 2009 H1N1 infection in the United States was made on 15 April 2009 in a 10-year-old child who was enrolled in a Centers for Disease Control and Prevention (CDC)-sponsored clinical study. Two days later, laboratory testing at the CDC confirmed a second infection with this novel virus in another patient, an 8-year-old child living in California about 130 miles away from the first patient. There was no known connection between the two patients and no exposure to pigs. Laboratory analysis at the CDC determined that the viruses obtained from these two patients were almost identical to each other and different from any influenza virus previously seen in either humans or animals. Testing showed that these two viruses were resistant to certain influenza antiviral drugs (called M2 ion channel inhibitors) but susceptible to a class of antiviral drugs called neuraminidase inhibitors. |
Human tuberculosis caused by Mycobacterium bovis in the United States, Latin America and the Caribbean
de Kantor IN , LoBue PA , Thoen CO . Int J Tuberc Lung Dis 2010 14 (11) 1369-73 Human tuberculosis (TB) caused by Mycobacterium bovis appears to be rare in most of the region of the Americas, although some localities have reported an unusually high prevalence of M. bovis among human TB cases (e.g., San Diego, CA, USA; parts of Mexico). As surveillance data are lacking in many countries, there is substantial uncertainty regarding actual incidence. M. bovis is most often not identified, as the diagnosis of TB is made by smear microscopy alone or using egg-containing culture media lacking pyruvate. Where human M. bovis cases have been studied in the region, they appear to be associated with ingestion of unpasteurized dairy products, or with airborne acquired infection in animal keepers and meat industry workers from countries where bovine TB remains a problem. Human-to-human transmission of M. bovis does occur, but appears to account for a very small proportion of cases. Efforts to eradicate M. bovis in humans in the Americas should therefore be directed at eradicating the disease in cattle, increasing pasteurization of dairy products and providing education about the dangers of consuming unpasteurized dairy products. |
Intravenous streptomycin for treatment of Mycobacterium tuberculosis meningitis in an infant
Courter JD , Girotto JE , Lobato MN , Orcutt D , Burke M , Feder Jr HM , Krause PJ , Cohen-Abbo A , Salazar JC . Pharmacotherapy 2010 30 (11) 481e-484e Although tuberculous meningitis is rarely encountered in the United States, clinicians need to have a high index of suspicion for this disease. Intramuscular streptomycin is usually administered as part of a four-drug antituberculous regimen. However, we describe an 8-month-old girl who was diagnosed with Mycobacterium tuberculosis meningitis and received streptomycin intravenously. This route was chosen to avoid daily intramuscular injections because the infant had poor lean muscle mass. The patient's regimen consisted of isoniazid 15 mg/kg/day, rifampin 20 mg/kg/day, and pyrazinamide 40 mg/kg/day by nasogastric tube, and intravenous streptomycin 15 mg/kg twice/day administered using a controlled-rate infusion pump. The M. tuberculosis strain was subsequently found to be susceptible to all four antituberculous drugs. Her condition improved, and no drug toxicities were observed during her treatment course; isoniazid and rifampin were continued after discharge. The patient was readmitted 1 month later for mental status changes and right-sided weakness. Magnetic resonance scan of the brain revealed numerous solid and ring-enhancing hypointense tuberculomas in the suprasellar cistern, left medial temporal lobe, and brainstem, with significant secondary vasogenic edema as the cause of her symptoms. Although treatment failure was not suspected, cerebrospinal fluid and gastric cultures were tested; all were negative for M. tuberculosis. Dexamethasone was started for treatment of the focalized cerebral edema, presumably occurring from the breakdown of existing tuberculomas, and the patient rapidly improved. She was discharged and continued to receive oral antituberculous therapy for a total of 12 months. At her 1-year follow-up visit, the patient had recovered fully and had no apparent neurologic, otologic, or developmental deficits. The safe and effective use of intravenous streptomycin in this infant suggests that this route of administration may be an alternative to intramuscular streptomycin. |
Variation in school health policies and programs by demographic characteristics of US schools, 2006
Balaji AB , Brener ND , McManus T . J Sch Health 2010 80 (12) 599-613 BACKGROUND: To identify whether school health policies and programs vary by demographic characteristics of schools, using data from the School Health Policies and Programs Study (SHPPS) 2006. This study updates a similar study conducted with SHPPS 2000 data and assesses several additional policies and programs measured for the first time in SHPPS 2006. METHODS: SHPPS 2006 assessed the status of 8 components of the coordinated school health model using a nationally representative sample of public, Catholic, and private schools at the elementary, middle, and high school levels. Data were collected from school faculty and staff using computer-assisted personal interviews and then linked with extant data on school characteristics. RESULTS: Results from a series of regression analyses indicated that a number of school policies and programs varied by school type (public, Catholic, or private), urbanicity, school size, discretionary dollars per pupil, percentage of white students, percentage of students qualifying for free lunch funds, and, among high schools, percentage of college-bound students. Catholic and private schools, smaller schools, and those with low discretionary dollars per pupil did not have as many key school health policies and programs as did schools that were public, larger, and had higher discretionary dollars per pupil. However, no single type of school had all key components of a coordinated school health program in place. CONCLUSIONS: Although some categories of schools had fewer policies and programs in place, all had both strengths and weaknesses. Regardless of school characteristics, all schools have the potential to implement a quality school health program. |
Reassortant group A rotavirus from straw-colored fruit bat (Eidolon helvum)
Esona MD , Mijatovic-Rustempasic S , Conrardy C , Tong S , Kuzmin IV , Agwanda B , Breiman RF , Banyai K , Niezgoda M , Rupprecht CE , Gentsch JR , Bowen MD . Emerg Infect Dis 2010 16 (12) 1844-1852 Bats are known reservoirs of viral zoonoses. We report genetic characterization of a bat rotavirus (Bat/KE4852/07) detected in the feces of a straw-colored fruit bat (Eidolon helvum). Six bat rotavirus genes (viral protein [VP] 2, VP6, VP7, nonstructural protein [NSP] 2, NSP3, and NSP5) shared ancestry with other mammalian rotaviruses but were distantly related. The VP4 gene was nearly identical to that of human P[6] rotavirus strains, and the NSP4 gene was closely related to those of previously described mammalian rotaviruses, including human strains. Analysis of partial sequence of the VP1 gene indicated that it was distinct from cognate genes of other rotaviruses. No sequences were obtained for the VP3 and NSP1 genes of the bat rotavirus. This rotavirus was designated G25-P[6]-I15-R8(provisional)-C8-Mx-Ax-N8-T11-E2-H10. Results suggest that several reassortment events have occurred between human, animal, and bat rotaviruses. Several additional rotavirus strains were detected in bats. |
Bartonella spp. in bats, Kenya
Kosoy M , Bai Y , Lynch T , Kuzmin IV , Niezgoda M , Franka R , Agwanda B , Breiman RF , Rupprecht CE . Emerg Infect Dis 2010 16 (12) 1875-1881 We report the presence and diversity of Bartonella spp. in bats of 13 insectivorous and frugivorous species collected from various locations across Kenya. Bartonella isolates were obtained from 23 Eidolon helvum, 22 Rousettus aegyptiacus, 4 Coleura afra, 7 Triaenops persicus, 1 Hipposideros commersoni, and 49 Miniopterus spp. bats. Sequence analysis of the citrate synthase gene from the obtained isolates showed a wide assortment of Bartonella strains. Phylogenetically, isolates clustered in specific host bat species. All isolates from R. aegyptiacus, C. afra, and T. persicus bats clustered in separate monophyletic groups. In contrast, E. helvum and Miniopterus spp. bats harbored strains that clustered in several groups. Further investigation is needed to determine whether these agents are responsible for human illnesses in the region. |
Use of clomiphene citrate and birth defects, National Birth Defects Prevention Study, 1997-2005
Reefhuis J , Honein MA , Schieve LA , Rasmussen SA . Hum Reprod 2010 26 (2) 451-7 BACKGROUND: Clomiphene citrate (CC) is the first line drug for subfertility treatment. Studies assessing the association between CC and birth defects have been inconclusive. METHODS: We used data from the National Birth Defects Prevention Study, a population-based, multi-site case-control study of major birth defects. Women from 10 US regions with deliveries affected by at least one of >30 birth defects (cases) and mothers of live born infants without a major birth defect (controls) who delivered October 1997-December 2005 were interviewed. The exposure of interest was reported CC use in the period from 2 months before conception through the first month of pregnancy. Women who conceived using assisted reproductive technology were excluded. Thirty-six birth defect categories with at least three exposed cases were studied. Multiple logistic regression was used to control for potential confounders. RESULTS: CC use was reported by 1.4% of control mothers (94/6500). Among 36 case-groups assessed, increased adjusted odds ratios (aOR) were found [all: aOR, 95% confidence interval (CI)] for anencephaly (2.3, 1.1-4.7), Dandy-Walker malformation (4.4, 1.7-11.6), septal heart defects (1.6, 1.1-2.2), muscular ventricular septal defect (4.9, 1.4-16.8), coarctation of aorta (1.8, 1.1-3.0), esophageal atresia (2.3, 1.3-4.0), cloacal exstrophy (5.4, 1.6-19.3), craniosynostosis (1.9, 1.2-3.0) and omphalocele (2.2, 1.1-4.5). CONCLUSIONS: Several associations between CC use and birth defects were observed. However, because of the small number of cases, inconsistency of some findings with previous reports, and the fact that we cannot assess the CC effect separately from that of the subfertility, these associations should be interpreted cautiously. |
National estimates of emergency department visits for hemorrhage-related adverse events from clopidogrel plus aspirin and from warfarin
Shehab N , Sperling LS , Kegler SR , Budnitz DS . Arch Intern Med 2010 170 (21) 1926-33 BACKGROUND: Dual antiplatelet therapy (DAT) with clopidogrel plus aspirin is a well-established antithrombotic strategy, with hemorrhage being the chief adverse event (AE) of concern. Outside of clinical trials, few published data describe the magnitude and nature of hemorrhage-related AEs from DAT. METHODS: To estimate the numbers and rates of emergency department (ED) visits for hemorrhage-related AEs (hemorrhage or evaluation for potential hemorrhage) from DAT in the United States and put them in the context of those from warfarin, we analyzed AEs from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, 2006-2008, and outpatient prescribing from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, 2006-2007. RESULTS: Based on 384 cases, there were an estimated 7654 (95% confidence interval [CI], 3325-11 983) ED visits annually for hemorrhage-related AEs from DAT compared with 2926 cases and an estimated 60,575 (36,117-85,033) ED visits from warfarin. Approximately 60% of ED visits for DAT consisted of epistaxis or other minor hemorrhages (eg, bleeding from small cuts). The risk of hospitalization for ED visits involving acute hemorrhages was not significantly different between DAT and warfarin (risk ratio, 0.73; 95% CI, 0.38-1.08). The estimated rate of ED visits involving acute hemorrhages from DAT was 1.2 per 1000 outpatient prescription visits vs 2.5 per 1000 outpatient prescription visits for warfarin (risk ratio, 0.49; 95% CI, 0.15-0.83). CONCLUSIONS: These findings indicate that the acute hemorrhagic risk with DAT is clinically significant and reinforce the importance of practitioners and patients recognizing and anticipating this risk. |
Transportation noise and exposed population of an urban area in the Republic of Korea
Ko JH , Chang SI , Kim M , Holt JB , Seong JC . Environ Int 2010 37 (2) 328-34 Using noise prediction models, we explored the transportation noise levels of Youngdeungpo-gu, an urbanized area of Seoul Metropolitan City in the Republic of Korea. In addition, we estimated the population exposed to transportation noise levels and determined how many people are vulnerable to noise levels that would cause serious annoyance and sleep disturbance. Compared with the World Health Organization [WHO] recommended levels, the daytime and nighttime transportation noise levels were still high enough to have the two psychosocial effects on people when considering the recommended levels of the World Health Organization (WHO; 55 decibels [dB[A]] and 40dB[A] for daytime and nighttime, respectively). Particularly, nighttime transportation noise was discovered to be harmful to a wider area and more people than daytime noise. Approximately 91% of the Youngdeungpo-gu area experienced nighttime transportation noise levels exceeding those recommended by WHO. It was estimated that as much as 80% of the people in the study area were exposed to transportation noise levels >40dB[A] during nighttime. Taking this into account, there is an urgent need to control and reduce transportation noise levels in Seoul, to protect residents against the potential ill health effects caused by urban transportation. |
Perchlorate, nitrate, and iodide intake through tap water
Blount BC , Alwis KU , Jain RB , Solomon BL , Morrow JC , Jackson WA . Environ Sci Technol 2010 44 (24) 9564-70 Perchlorate is ubiquitous in the environment, leading to human exposure and potential impact on thyroid function. Nitrate can also competitively inhibit iodide uptake at the sodium-iodide symporter and thus reduce thyroid hormone production. This study investigates the intake of perchlorate, nitrate, and iodide attributable to direct and indirect tap water consumption. The National Health and Nutrition Examination Survey collected tap water samples and consumption data from 3262 U.S. residents during the years 2005-2006. The median perchlorate, nitrate, and iodide levels measured in tap water were 1.16, 758, and 4.55 mug/L, respectively. Measured perchlorate levels were below the United States Environmental Protection Agency (U.S. EPA) drinking water equivalent level for perchlorate (24.5 mug/L). Significant correlations were found between iodide and nitrate levels (r = 0.17, p < 0.0001) and perchlorate and nitrate levels (r = 0.25, p < 0.0001). On the basis of 24 h recall, 47% of the study participants reported drinking tap water; 89% reported either direct or indirect consumption of tap water. For the adult population (age ≥ 20 yrs) the median tap water consumption rate was 11.6 mL/kg-day. Using individual tap water consumption data and body weight, we estimated the median perchlorate, nitrate, and iodide dose attributable to tap water as 9.11, 11300, and 43.3 ng/kg-day, respectively, for U.S. adults. This perchlorate exposure dose from tap water is relatively small compared to the total perchlorate exposure dose previously characterized for the U.S. adults (median 64 ng/kg-day) and the U.S. EPA reference dose (700 ng/kg-day). |
Physiologically based pharmacokinetic (PBPK) tool kit for environmental pollutants - metals
Ruiz P , Fowler BA , Osterloh JD , Fisher J , Mumtaz M . SAR QSAR Environ Res 2010 21 (7) 603-18 The Agency for Toxic Substances and Disease Registry (ATSDR) is mandated by the US Congress to identify significant human exposure levels, develop methods to determine such exposures, and design strategies to mitigate them. Physiologically based pharmacokinetic (PBPK) models are increasingly being used to evaluate toxicity of environmental pollutants through multiple exposure pathways. As part of its translational research project, ATSDR is developing a human 'PBPK model tool kit' that consists of a series of published models re-coded in a common simulation language. The tool kit currently consists of models, at various stages of development, for priority environmental contaminants including solvents and persistent organic pollutants. Presented here are results of translational activities of re-coding models for cadmium, mercury, and arsenic. As part of this work, following re-coding each new model was evaluated for fidelity followed by sensitivity analysis. Good agreement was generally obtained for all three models when predictions of original and re-coded model simulations were compared. Also presented is an application of the cadmium toxicokinetic model to interpret biomonitoring data from the National Health and Nutrition Examination Survey (NHANES). The PBPK tool kit will enable ATSDR scientists to perform simulations of exposures from contaminated environmental media at sites of concern and to better interpret site-specific biomonitoring data. |
Association between children's blood lead levels, lead service lines, and water disinfection, Washington, DC, 1998-2006
Brown MJ , Raymond J , Homa D , Kennedy C , Sinks T . Environ Res 2010 111 (1) 67-74 OBJECTIVE: Evaluate the effect of changes in the water disinfection process, and presence of lead service lines (LSLs), on children's blood lead levels (BLLs) in Washington, DC. METHODS: Three cross-sectional analyses examined the relationship of LSL and changes in water disinfectant with BLLs in children <6 years of age. The study population was derived from the DC Childhood Lead Poisoning Prevention Program blood lead surveillance system of children who were tested and whose blood lead test results were reported to the DC Health Department. The Washington, DC Water and Sewer Authority (WASA) provided information on LSLs. The final study population consisted of 63,854 children with validated addresses. RESULTS: Controlling for age of housing, LSL was an independent risk factor for BLLs ≥10mug/dL, and ≥5mug/dL even during time periods when water levels met the US Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb). When chloramine alone was used to disinfect water, the risk for BLL in the highest quartile among children in homes with LSL was greater than when either chlorine or chloramine with orthophosphate was used. For children tested after LSLs in their houses were replaced, those with partially replaced LSL were >3 times as likely to have BLLs ≥10mug/dL versus children who never had LSLs. CONCLUSIONS: LSLs were a risk factor for elevated BLLs even when WASA met the EPA water action level. Changes in water disinfection can enhance the effect of LSLs and increase lead exposure. Partially replacing LSLs may not decrease the risk of elevated BLLs associated with LSL exposure. |
Determinants of use of household-level water chlorination products in rural Kenya, 2003-2005
DuBois AE , Crump JA , Keswick BH , Slutsker L , Quick RE , Vulule JM , Luby SP . Int J Environ Res Public Health 2010 7 (10) 3842-3852 Household-level water treatment products provide safe drinking water to at-risk populations, but relatively few people use them regularly; little is known about factors that influence uptake of this proven health intervention. We assessed uptake of these water treatments in Nyanza Province, Kenya, November 2003-February 2005. We interviewed users and non-user controls of a new household water treatment product regarding drinking water and socioeconomic factors. We calculated regional use-prevalence of these products based on 10 randomly selected villages in the Asembo region of Nyanza Province, Kenya. Thirty-eight percent of respondents reported ever using household-level treatment products. Initial use of a household-level product was associated with having turbid water as a source (adjusted odds ratio [AOR]=16.6, p=0.007), but consistent usage was more common for a less costly and more accessible product that did not address turbidity. A combination of social marketing, retail marketing, and donor subsidies may be necessary to extend the health benefits of household-level water treatment to populations most at risk. |
Varicella seroprevalence in the U.S.: data from the National Health and Nutrition Examination Survey, 1999-2004
Reynolds MA , Kruszon-Moran D , Jumaan A , Schmid DS , McQuillan GM . Public Health Rep 2010 125 (6) 860-9 OBJECTIVE: We estimated the varicella seroprevalence among the U.S. population aged 6-49 years based on retested National Health and Nutrition Examination Survey (NHANES) specimens collected between 1999 and 2004--originally tested using a method unsuitable for detecting vaccine-induced immunity--and compared it with historical estimates. METHODS: We performed a confirmatory test suitable for detecting vaccine-induced immunity on all available specimens from 6- to 19-year-olds who originally tested negative (n = 633), and on 297 randomly selected specimens that had tested positive. Retest results superseded original results for determining seroprevalence. We assessed seroprevalence for the entire sample aged 6-49 years (n = 16,050) by participant demographic characteristics and compared it with historical estimates (NHANES 1988-1994). RESULTS: The percentage of false-negative results for the original test was higher for specimens from younger children (6-11 years of age: 27.5%; 12-19 years of age: 13.3%) and for specimens collected most recently (2001-2004: 26.0%; 1999-2000: 12.6%). The age-adjusted rate of varicella seroprevalence for 1999-2004 was 93.6% for 6- to 19-year-olds and 98.0% for adults aged 20-49 years compared with 90.0% and 98.1%, respectively, for 1988-1994. We found an increase in seropositivity between the survey periods, from 93.2% to 97.2% (p < 0.001) among 12- to 19-year-olds. For children, non-Hispanic black ethnicity and younger age were associated with lower seroprevalence in both survey periods. CONCLUSIONS: Varicella seroprevalence increased with age among children and was uniformly high in the U.S. adult population between 1999 and 2004. The original testing produced false-negative seroprevalence results among children's specimens collected between 1999 and 2004 from 6- to 19-year-olds. |
The methodology of visual field testing with frequency doubling technology in the National Health and Nutrition Examination Survey, 2005-2006
Terry AL , Paulose-Ram R , Tilert TJ , Johnson CA , Zhang X , Lee PP , Saaddine JB . Ophthalmic Epidemiol 2010 17 (6) 411-21 PURPOSE: To describe the frequency doubling technology (FDT) methodology to measure visual field loss in the National Health and Nutrition Examination Survey and to evaluate data reliability. METHODS: Participants aged 40 years and older were eligible (n = 2,529) for 2 visual field tests per eye performed with the Humphrey Matrix N-30-5 screening test. Visual field loss was determined using a 2-2-1 algorithm requiring 2 complete tests per eye, with at least 2 abnormal field results in each test, and 1 common abnormal field. RESULTS: Response rate was 86.2%. Time constraints were the main reason for no exam (55.6%). Median times were: single test, 37 seconds; entire exam, 9.1 minutes. When defining reliability based on ≤ 1/3 blind spots, ≤ 1/3 false positive tests, and technician noted proper fixation, 80.1% of examined adults had 2 reliable tests for both eyes; an additional 13.4% had 2 reliable tests for 1 eye. Increasing age, decreasing visual acuity, and the presence of self-reported glaucoma resulted in decreased examination rates, increased test times, and decreased data reliability. Sensitivity and specificity to detect persons with glaucoma was 54.8% and 91.9%, respectively. CONCLUSIONS: FDT is a feasible, fast, and reliable method for visual field loss screening in a population-based U.S. study, with an 86.2% response rate, median exam time ~9 minutes, and nearly 95% of examined participants having complete, reliable results in 1 or both eyes. |
Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosamines
Stanfill SB , Connolly GN , Zhang L , Jia LT , Henningfield JE , Richter P , Lawler TS , Ayo-Yusuf OA , Ashley DL , Watson CH . Tob Control 2010 20 (3) e2 OBJECTIVE: Oral tobacco products contain nicotine and carcinogenic tobacco-specific N-nitrosamines (TSNAs) that can be absorbed through the oral mucosa. The aim of this study was to determine typical pH ranges and concentrations of total nicotine, unionised nicotine (the most readily absorbed form) and five TSNAs in selected oral tobacco products distributed globally. METHODS: A total of 53 oral tobacco products from 5 World Health Organisation (WHO) regions were analysed for total nicotine and TSNAs, including 4-(methyl-nitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), using gas chromatography or liquid chromatography with mass spectrometric detection. Unionised nicotine concentrations were calculated using product pH and total nicotine concentrations. Fourier transform infrared spectroscopy was used to help categorise or characterise some products. RESULTS: Total nicotine content varied from 0.16 to 34.1 mg/g product, whereas, the calculated unionised nicotine ranged from 0.05 to 31.0 mg/g product; a 620-fold range of variation. Products ranged from pH 5.2 to 10.1, which translates to 0.2% to 99.1% of nicotine being in the unionised form. Some products have very high pH and correspondingly high unionised nicotine (eg, gul powder, chimo, toombak) and/or high TSNA (eg, toombak, zarda, khaini) concentrations. The concentrations of TSNAs spanned five orders of magnitude with concentrations of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) ranging from 4.5 to 516 000 ng/g product. CONCLUSIONS: These data have important implications for risk assessment because they show that very different exposure risks may be posed through the use of these chemically diverse oral tobacco products. Because of the wide chemical variation, oral tobacco products should not be categorised together when considering the public health implications of their use. |
Health risk profile for older adults with blindness: an application of the international classification of functioning, disability, and health framework
Jones GC , Crews JE , Danielson ML . Ophthalmic Epidemiol 2010 17 (6) 400-10 PURPOSE: To develop a health risk profile for adults age 65 years or older with blindness, using the International Classification of Functioning, Disability and Health (ICF) as our conceptual framework. METHODS: We combined and analyzed data from the 2000-2006 National Health Interview Survey after backcoding questions to the ICF. We compared older adults with blindness (n = 477) and older adults with vision loss but not blindness (n = 6,721) with older adults who reported no vision loss (n = 33,497) for the following outcome measures: demographics, functional limitations (self-care, social participation, and mobility limitations), level of psychological distress, physical health status, selected chronic conditions and health risk behaviors (smoking, alcohol use, obesity, and physical inactivity). RESULTS: Older adults with blindness were more likely to be poorer, older, and less educated than older adults without vision loss. They were also more likely to have fair to poor health; to have difficulty walking; to experience diabetes, heart problems, and breathing problems; and to be physically inactive, compared with older adults reporting vision loss but not blindness and older adults without vision loss. CONCLUSION: Older adults with blindness face significant health disparities that can diminish their quality of life without timely, disability-sensitive interventions to address serious psychological distress and physical inactivity. |
The distribution of chlamydia, gonorrhoea and syphilis cases across states and counties in the USA, 2007
Chesson HW , Sternberg M , Leichliter JS , Aral SO . Sex Transm Infect 2010 86 Suppl 3 iii52-57 OBJECTIVES: To examine the distribution of chlamydia, gonorrhoea and syphilis in the USA through the use of Lorenz curves and Gini coefficients. METHODS: The distribution of three sexually transmitted diseases (STD; chlamydia, gonorrhoea and primary and secondary syphilis) was examined across states and counties in the USA in 2007, based on reported case numbers. Gini coefficients, which can range from 0 (equality in STD rates across geographical units) to 1 (complete inequality such that all STD occur in one geographical unit) were calculated. RESULTS: Overall, chlamydia was the most evenly distributed and syphilis was the most concentrated of the three STD examined. The Gini coefficients for chlamydia, gonorrhoea and syphilis were 0.121, 0.255 and 0.334, respectively, when examined across states, and 0.319, 0.494 and 0.630, respectively, when examined across counties. Differences in Gini coefficients were observed when the STD distributions were examined by sex, race/ethnicity and age group. CONCLUSIONS: The use of Lorenz curves and Gini coefficients can help to assess inequalities in the distribution of STD, to gauge the suitability of geographically targeted interventions, and to help in determining the epidemic phase of STD. Having a better understanding of the disparities in the distribution of STD across states and counties by sex, race/ethnicity and age group might help in understanding why disparities in STD rates exist across different groups and in developing interventions to address these disparities. |
Trypanosoma cruzi I genotypes in different geographical regions and transmission cycles based on a microsatellite motif of the intergenic spacer of spliced-leader genes
Cura CI , Mejia-Jaramillo AM , Duffy T , Burgos JM , Rodriguero M , Cardinal MV , Kjos S , Gurgel-Goncalves R , Blanchet D , De Pablos LM , Tomasini N , da Silva A , Russomando G , Cuba CA , Aznar C , Abate T , Levin MJ , Osuna A , Gurtler RE , Diosque P , Solari A , Triana-Chavez O , Schijman AG . Int J Parasitol 2010 40 (14) 1599-607 The intergenic region of spliced-leader (SL-IR) genes from 105 Trypanosoma cruzi I (Tc I) infected biological samples, culture isolates and stocks from 11 endemic countries, from Argentina to the USA were characterised, allowing identification of 76 genotypes with 54 polymorphic sites from 123 aligned sequences. On the basis of the microsatellite motif proposed by Herrera et al. (2007) to define four haplotypes in Colombia, we could classify these genotypes into four distinct Tc I SL-IR groups, three corresponding to the former haplotypes Ia (11 genotypes), Ib (11 genotypes) and Id (35 genotypes); and one novel group, Ie (19 genotypes). Genotypes harbouring the Tc Ic motif were not detected in our study. Tc Ia was associated with domestic cycles in southern and northern South America and sylvatic cycles in Central and North America. Tc Ib was found in all transmission cycles from Colombia. Tc Id was identified in all transmission cycles from Argentina and Colombia, including Chagas cardiomyopathy patients, sylvatic Brazilian samples and human cases from French Guiana, Panama and Venezuela. Tc Ie gathered five samples from domestic Triatoma infestans from northern Argentina, nine samples from wild Mepraia spinolai and Mepraia gajardoi and two chagasic patients from Chile and one from a Bolivian patient with chagasic reactivation. Mixed infections by Tc Ia+Tc Id, Tc Ia+Tc Ie and Tc Id+Tc Ie were detected in vector faeces and isolates from human and vector samples. In addition, Tc Ia and Tc Id were identified in different tissues from a heart transplanted Chagas cardiomyopathy patient with reactivation, denoting histotropism. Trypanosoma cruzi I SL-IR genotypes from parasites infecting Triatoma gerstaeckeri and Didelphis virginiana from USA, T. infestans from Paraguay, Rhodnius nasutus and Rhodnius neglectus from Brazil and M. spinolai and M. gajardoi from Chile are to our knowledge described for the first time. |
HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand
Guadamuz TE , Wimonsate W , Varangrat A , Phanuphak P , Jommaroeng R , McNicholl JM , Mock PA , Tappero JW , van Griensven F . AIDS Behav 2010 15 (3) 650-8 While male-to-female transgender persons (TG) are believed to often engage in sex work and have high HIV infection risk, little is known about demographics, surgical and hormone use history, risk behaviors and HIV prevalence. Between March and October 2005, 474 TG from Bangkok, Chiangmai, and Phuket were surveyed using venue-day-time sampling. Of 474 participants, overall HIV prevalence was 13.5%. Most participants had completed at least secondary or vocational education (79.2%), gender self-identified as female (89.0%), had received money, gifts or valuables for sex (60.8%), and reported hormone use (88.6%). Surgical history was taken from 325 participants. Of these, 68.6% reported some form of surgery and 11.1% had undergone penile-vaginal reconstructive surgery. In multivariate analysis, being recruited from a park/street; older age, anal sex role identification as "versatile" and anal sex debut before age 13 were independently associated with HIV prevalence. The development, implementation and evaluation of culturally appropriate sexual health interventions for Thai TG is urgently needed. |
HIV risk among young African American men who have sex with men: a case-control study in Mississippi
Oster AM , Dorell CG , Mena LA , Thomas PE , Toledo CA , Heffelfinger JD . Am J Public Health 2010 101 (1) 137-43 OBJECTIVES: We conducted a case-control study in the Jackson, Mississippi, area to identify factors associated with HIV infection among young African American men who have sex with men (MSM). METHODS: During February to April 2008, we used surveillance records to identify young (16-25 years old) African American MSM diagnosed with HIV between 2006 and 2008 (case participants) and recruited young African American MSM who did not have HIV (controls). Logistic regression analysis was used to assess factors associated with HIV infection. RESULTS: In a multivariable analysis of 25 case participants and 85 controls, having older male partners (adjusted odds ratio [OR]=5.5; 95% confidence interval [CI]=1.8, 17.3), engaging in unprotected anal intercourse with casual male partners (adjusted OR=6.3; 95% CI=1.8, 22.3), and being likely to give in to a partner who wanted to have unprotected sex (adjusted OR=5.0; 95% CI=1.2, 20.6) were associated with HIV infection. CONCLUSIONS: Given the high prevalence of risk behaviors among the young African American MSM in our study, HIV prevention efforts must begin before or during early adolescence and need to focus on improving negotiation and communication regarding sex. (Am J Public Health. Published online ahead of print November 18, 2010: e1-e7. doi:10.2105/AJPH.2009.185850). |
The association between cervical abnormalities and attitudes toward cervical cancer prevention
Salz T , Gottlieb SL , Smith JS , Brewer NT . J Womens Health (Larchmt) 2010 19 (11) 2011-6 BACKGROUND: We investigated whether a history of cervical abnormalities predicts responses to cervical cancer prevention for women and their daughters. METHODS: In 2007, we interviewed 832 mothers of adolescent daughters from North Carolina counties with elevated rates of cervical cancer. We measured the association of experiences with cervical abnormalities and emotions, beliefs, attitudes, and behaviors related to cervical cancer and its prevention. RESULTS: Anxiety about cervical cancer was higher among women who had cervical cancer, hysterectomies, and abnormal Pap test results (including false positives) than in women who had experienced none of these (each p < 0.05). Pap tests were perceived as being more effective at reducing the chance of developing cervical cancer by women with a history of cancer and women who reported hysterectomies relative to women with normal Pap results (each p < 0.05). Intentions to vaccinate their daughters against human papillomavirus (HPV) were highest among women who had cervical cancer, women who had hysterectomies, and women who were treated for precancerous lesions (each p < 0.05). CONCLUSIONS: Women with histories of cervical health abnormalities reported more favorable views of Pap testing and HPV vaccination than women who had received only normal Pap testing results. They also reported higher levels of anxiety about cervical cancer. |
Google it: obtaining information about local STD/HIV testing services online
Habel MA , Hood J , Desai S , Kachur R , Buhi ER , Liddon N . Sex Transm Dis 2010 38 (4) 334-8 BACKGROUND: Although the Internet is one of the most commonly accessed resources for health information, finding information on local sexual health services, such as sexually transmitted disease (STD) testing, can be challenging. Recognizing that most quests for online health information begin with search engines, the purpose of this exploratory study was to examine the extent to which online information about local STD/HIV testing services can be found using Google. METHODS: Queries on STD and HIV testing services were executed in Google for 6 geographically unique locations across the United States. The first 3 websites that resulted from each query were coded for the following characteristics: (1) relevancy to the search topic, (2) domain and purpose, (3) rank in Google results, and (4) content. RESULTS: Websites hosted at .com (57.3%), .org (25.7%), and .gov (10.5%) domains were retrieved most frequently. Roughly half of all websites (n = 376) provided information relevant to the query, and about three-quarters (77.0%) of all queries yielded at least 1 relevant website within the first 3 results. Searches for larger cities were more likely to yield relevant results compared with smaller cities (odds ratio [OR] = 10.0, 95% confidence interval [CI] = 5.6, 17.9). On comparison with .com domains, .gov (OR = 2.9, 95% CI = 1.4, 5.6) and .org domains (OR = 2.9, 95% CI = 1.7, 4.8) were more likely to provide information of the location to get tested. DISCUSSION: Ease of online access to information about sexual health services varies by search topic and locale. Sexual health service providers must optimize their website placement so as to reach a greater proportion of the sexually active population who use web search engines. |
Impact of the integration of water treatment and handwashing incentives with antenatal services on hygiene practices of pregnant women in Malawi
Sheth AN , Russo ET , Menon M , Wannemuehler K , Weinger M , Kudzala AC , Tauzie B , Masuku HD , Msowoya TE , Quick R . Am J Trop Med Hyg 2010 83 (6) 1315-21 Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea. We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers, sodium hypochlorite water treatment solution, soap, and educational messages. Program participants were more likely to know correct water treatment procedures (62% versus 27%, P < 0.0001), chlorinate drinking water (61% versus 1%, P < 0.0001), demonstrate correct handwashing practices (68% versus 22%, P < 0.0001), and purchase water treatment solution after free distribution (32% versus 1%, P < 0.0001). Among participants, 72% had at least three antenatal visits, 76% delivered in a health facility, and 54% had a postnatal check. This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women. Participants had high use of antenatal, delivery, and postnatal services, which could improve maternal and child health. |
Lipopolysaccharide increases Na(+),K(+)-pump, but not ENaC, expression in guinea-pig airway epithelium
Dodrill MW , Beezhold DH , Meighan T , Kashon ML , Fedan JS . Eur J Pharmacol 2010 651 176-86 Earlier, we found in functional experiments that lipopolysaccharide (LPS; 4 mg/kg; i.p.) hyperpolarized the epithelium by stimulating the transepithelial transport of Na(+) in guinea-pig tracheal epithelium. Epithelial sodium channel (ENaC) activity and Na(+),K(+)-pump activity were increased. In this study, we hypothesized that LPS increases the expression of ENaC and the Na(+),K(+)-pump in the epithelium and investigated the levels of transcription and protein abundance. Using qPCR, the effects of LPS on the transcription of alphaENaC, alpha(1) Na(+),K(+)-pump, COX-2, eNOS, iNOS, IL-1beta, and TNF-alpha were measured at 3 and 18 h. In the epithelium, LPS increased the transcription of COX-2, IL-1beta, and, to a nonsignificant extent, TNF-alpha at 3h, but not at 18 h. In alveolar macrophages, TNF-alpha, and, to a nonsignificant extent, COX-2 and IL-1beta were up-regulated at 3 h, but not at 18 h. Even though LPS stimulated the transcription of some genes, alphaENaC and alpha(1) Na(+),K(+)-ATPase transcription were not affected. The expression of alpha-, beta-, and gamma-ENaC and alpha(1) Na(+),K(+)-pump from tracheal epithelium and kidney cortex/medulla were investigated by western blotting. All three ENaC subunits were detected as cleavage fragments, yet LPS had no effect on their expression. LPS increased the expression of the alpha(1) subunit and the alpha(1)-, alpha(2)-, and alpha(3)-subunits, collectively, of the Na(+),K(+)-pump. Taken together, these data indicate that LPS increases Na(+) transport downstream of the genetic level, in part, by stimulating the expression of the Na(+),K(+)-pump. |
Neuraminidase inhibitor susceptibility testing in human influenza viruses: a laboratory surveillance perspective
Okomo-Adhiambo M , Sleeman K , Ballenger K , Nguyen HT , Mishin VP , Sheu TG , Smagala J , Li Y , Klimov AI , Gubareva LV . Viruses 2010 2 (10) 2269-2289 Neuraminidase inhibitors (NAIs) are vital in managing seasonal and pandemic influenza infections. NAI susceptibilities of virus isolates (n=5540) collected during the 2008-2009 influenza season were assessed in the chemiluminescent neuraminidase inhibition (NI) assay. Box-and-whisker plot analyses of log-transformed IC50s were performed for each virus type/subtype and NAI to identify outliers which were characterized based on a statistical cutoff of IC50 >3 interquartile ranges (IQR) from the 75th percentile. Among 1533 seasonal H1N1 viruses tested, 1431 (93.3%) were outliers for oseltamivir; they all harbored the H275Y mutation in the neuraminidase (NA) and were reported as oseltamivir-resistant. Only 15 (0.7%) of pandemic 2009 H1N1 viruses tested (n=2259) were resistant to oseltamivir. All influenza A(H3N2) (n=834) and B (n=914) viruses were sensitive to oseltamivir, except for one A(H3N2) and one B virus, with D151V and D197E (D198E in N2 numbering) mutations in the NA, respectively. All viruses tested were sensitive to zanamivir, except for six seasonal A(H1N1) and several A(H3N2) outliers (n=22) which exhibited cell culture induced mutations at residue D151 of the NA. A subset of viruses (n=1058) tested for peramivir were sensitive to the drug, with exception of H275Y variants that exhibited reduced susceptibility to this NAI. This study summarizes baseline susceptibility patterns of seasonal and pandemic influenza viruses, and seeks to contribute towards criteria for defining NAI resistance. |
Pathogenesis and transmission of triple-reassortant swine H1N1 influenza viruses isolated before the 2009 H1N1 pandemic
Belser JA , Gustin KM , Maines TR , Blau DM , Zaki SR , Katz JM , Tumpey TM . J Virol 2010 85 (4) 1563-72 The 2009 H1N1 pandemic virus represents the greatest incidence of human infection with an influenza virus of swine origin to date. Moreover, triple-reassortant swine (TRS) H1N1 viruses, which share similar host and lineage origins with 2009 H1N1 viruses, have been responsible for sporadic human cases since 2005. Similar to 2009 H1N1 viruses, TRS viruses are capable of causing severe disease in previously healthy individuals and frequently manifest with gastrointestinal symptoms, however their ability to cause severe disease has not been extensively studied. Here, we evaluated the pathogenicity and transmissibility of two TRS viruses associated with disease in humans in the ferret model. TRS and 2009 H1N1 viruses exhibited comparable viral titers and histopathology following virus infection, and were similarly unable to transmit efficiently via respiratory droplets in the ferret model. Utilizing TRS and 2009 H1N1 viruses, we conducted extensive hematologic and blood serum analyses on infected ferrets to identify lympohematopoietic parameters associated with mild to severe influenza virus infection. Following H1N1 or H5N1 influenza virus infection, ferrets were found to recapitulate several laboratory abnormalities previously documented with human disease, furthering the utility of the ferret model for the assessment of influenza virus pathogenicity. |
Pregnancy does not affect HIV incidence test results obtained using the BED capture enzyme immunoassay or an antibody avidity assay
Laeyendecker O , Church JD , Oliver AE , Mwatha A , Owen SM , Donnell D , Brookmeyer R , Musoke P , Jackson JB , Guay L , Nakabiito C , Quinn TC , Eshleman SH . PLoS One 2010 5 (10) e13259 BACKGROUND: Accurate incidence estimates are needed for surveillance of the HIV epidemic. HIV surveillance occurs at maternal-child health clinics, but it is not known if pregnancy affects HIV incidence testing. METHODS: We used the BED capture immunoassay (BED) and an antibody avidity assay to test longitudinal samples from 51 HIV-infected Ugandan women infected with subtype A, C, D and intersubtype recombinant HIV who were enrolled in the HIVNET 012 trial (37 baseline samples collected near the time of delivery and 135 follow-up samples collected 3, 4 or 5 years later). Nineteen of 51 women were also pregnant at the time of one or more of the follow-up visits. The BED assay was performed according to the manufacturer's instructions. The avidity assay was performed using a Genetic Systems HIV-1/HIV-2 + O EIA using 0.1M diethylamine as the chaotropic agent. RESULTS: During the HIVNET 012 follow-up study, there was no difference in normalized optical density values (OD-n) obtained with the BED assay or in the avidity test results (%) when women were pregnant (n = 20 results) compared to those obtained when women were not pregnant (n = 115; for BED: p = 0.9, generalized estimating equations model; for avidity: p = 0.7, Wilcoxon rank sum). In addition, BED and avidity results were almost exactly the same in longitudinal samples from the 18 women who were pregnant at only one study visit during the follow-up study (p = 0.6, paired t-test). CONCLUSIONS: These results from 51 Ugandan women suggest that any changes in the antibody response to HIV infection that occur during pregnancy are not sufficient to alter results obtained with the BED and avidity assays. Confirmation with larger studies and with other HIV subtypes is needed. |
Effect of specimen storage conditions on newborn dried blood spots used to assess Toxoplasma gondii Immunoglobulin M (IgM)
Mei JV , Li L , Rasmussen SA , Collier S , Frias JL , Honein MA , Shaw GM , Lorey F , Meyer R , Chaing S , Canfield MA , Jones J , Hannon WH . Clin Chim Acta 2010 412 455-9 BACKGROUND: Newborn screening programs store-under varying conditions-residual dried blood spots (DBS). Residual DBS were used to investigate the contribution of congenital infection with Toxoplasma gondii to the etiology of hydrocephalus and as a key step, we assessed the effect of storage conditions on the stability of newborn screening biomarkers. METHODS: Infants with hydrocephalus (410 cases) were identified using population-based birth defects surveillance systems in California, North Carolina, and Texas. Infants without birth defects (448 controls) were randomly selected from the same geographic areas and time periods. California stores DBS with controlled temperature, while North Carolina and Texas store DBS under ambient conditions. After removal of personal identifiers, DBS were tested for Toxo-specific immunoglobulin-M (Toxo-IgM). Because of poor elution of DBS stored in ambient conditions, additional biomarkers were tested on a specimen subset. RESULTS: Among 858 DBS tested, Toxo-IgM was found in 3 cases and no controls from California (N=515) and in no specimens from North Carolina or Texas (N=343). Among the 98 specimens tested for selected biomarkers, statistically significant differences were found for California vs. combined North Carolina and Texas DBS (thyroid stimulating hormone, phenylalanine, methionine, leucine, citrulline p<0.0001; tyrosine, valine p<0.001). CONCLUSIONS: Storage conditions for residual DBS had an effect on the ability to extract, recover, and accurately measure Toxo-IgM and other biomarkers from the filter paper matrix. |
Fungal pigments inhibit the MALDI-TOF mass spectrometry analysis of darkly pigmented fungi
Buskirk AD , Hettick JM , Chipinda I , Law BF , Siegel PD , Slaven JE , Green BJ , Beezhold DH . Anal Biochem 2010 411 (1) 122-8 Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been used to discriminate monilaceous fungal species, however, darkly pigmented fungi yield poor fingerprint mass spectra that contain few peaks of low relative abundance. In this study, the effect of dark fungal pigments on the observed MALDI mass spectra was investigated. Peptide and protein samples containing varying concentrations of synthetic melanin or fungal pigments extracted from Aspergillus niger were analyzed by MALDI-TOF and MALDI-qTOF MS. Signal suppression was observed in samples containing greater than 25 ng/muL pigment. Microscopic examination of the MALDI sample deposit was usually heterogeneous, with regions of high pigment concentration appearing black. Acquisition of MALDI mass spectra from these darkly pigmented regions of the sample deposit yielded poor or no [M+H](+) ion signal. In contrast, non-pigmented regions within the sample deposit and hyphal negative control extracts of A. niger were not inhibited. This study demonstrated that dark fungal pigments inhibited the desorption/ionization process during MALDI-MS; however these fungi may be successfully analyzed by MALDI-TOF MS when culture methods that suppress pigment expression are used. Addition of tricyclazole to the fungal growth media blocks fungal melanin synthesis and results in less-melanized fungi that may be analyzed by MALDI-TOF MS. |
Determinants of glycan receptor specificity of H2N2 influenza A virus hemagglutinin
Viswanathan K , Koh X , Chandrasekaran A , Pappas C , Raman R , Srinivasan A , Shriver Z , Tumpey TM , Sasisekharan R . PLoS One 2010 5 (10) e13768 The H2N2 subtype of influenza A virus was responsible for the Asian pandemic of 1957-58. However, unlike other subtypes that have caused pandemics such as H1N1 and H3N2, which continue to circulate among humans, H2N2 stopped circulating in the human population in 1968. Strains of H2 subtype still continue to circulate in birds and occasionally pigs and could be reintroduced into the human population through antigenic drift or shift. Such an event is a potential global health concern because of the waning population immunity to H2 hemagglutinin (HA). The first step in such a cross-species transmission and human adaptation of influenza A virus is the ability for its surface glycoprotein HA to bind to glycan receptors expressed in the human upper respiratory epithelia. Recent structural and biochemical studies have focused on understanding the glycan receptor binding specificity of the 1957-58 pandemic H2N2 HA. However, there has been considerable HA sequence divergence in the recent avian-adapted H2 strains from the pandemic H2N2 strain. Using a combination of structural modeling, quantitative glycan binding and human respiratory tissue binding methods, we systematically identify mutations in the HA from a recent avian-adapted H2N2 strain (A/Chicken/PA/2004) that make its quantitative glycan receptor binding affinity (defined using an apparent binding constant) comparable to that of a prototypic pandemic H2N2 (A/Albany/6/58) HA. |
Perinatal periods of risk: a community approach for using data to improve women and infants' health
Peck MG , Sappenfield WM , Skala J . Matern Child Health J 2010 14 (6) 864-74 This paper provides an overview of the origins, purpose, and methods of the Perinatal Periods of Risk (PPOR) approach to community-based planning for action to improve maternal and infant health outcomes. PPOR includes a new analytic framework that enables urban communities to better understand and address fetal and infant mortality. This article serves as the core reference for accompanying specific PPOR methods and practice articles. PPOR is based on core principles of full community engagement and equity and follows a six stage community-based planning process. In Stage 1, communities are mobilized and engaged, related planning efforts aligned, and community and analytic readiness assessed. In Stage 2, feto-infant mortality is mapped, excess mortality is estimated, likely causes of feto-infant mortality are determined, and appropriate actions are suggested. Stage 3 produces action plans for targeted prevention strategies. Stages 4 and 5 include implementation, monitoring, and evaluation. Stage 6 fosters political will to sustain efforts. PPOR can be used in local maternal child health (MCH) practice for improving perinatal outcomes. MCH programs can use PPOR to integrate health assessments, initiate planning, identify significant gaps, target more in-depth inquiry, and suggest clear interventions for lowering feto-infant mortality. PPOR enables greater cooperation in improving MCH through more effective data use, strengthened data capacity, and greater shared understanding of complex infant mortality issues. PPOR offers local health departments and their community partners a comprehensive approach to address the health of women and infants in their jurisdictions. |
Pregnancy-related mortality in the United States, 1998 to 2005
Berg CJ , Callaghan WM , Syverson C , Henderson Z . Obstet Gynecol 2010 116 (6) 1302-9 OBJECTIVE: To estimate the risk of women dying from pregnancy complications in the United States and to examine the risk factors for and changes in the medical causes of these deaths. METHODS: De-identified copies of death certificates for women who died during or within 1 year of pregnancy and matching birth or fetal death certificates for 1998 through 2005 were received by the Pregnancy Mortality Surveillance System from the 50 states, New York City, and Washington, DC. Causes of death and factors associated with them were identified, and pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were calculated. RESULTS: The aggregate pregnancy-related mortality ratio for the 8-year period was 14.5 per 100,000 live births, which is higher than any period in the previous 20 years of the Pregnancy Mortality Surveillance System. African-American women continued to have a three- to four-fold higher risk of pregnancy-related death. The proportion of deaths attributable to hemorrhage and hypertensive disorders declined from previous years, whereas the proportion from medical conditions, particularly cardiovascular, increased. Seven causes of death-hemorrhage, thrombotic pulmonary embolism, infection, hypertensive disorders of pregnancy, cardiomyopathy, cardiovascular conditions, and noncardiovascular medical conditions-each contributed 10% to 13% of deaths. CONCLUSION: The reasons for the reported increase in pregnancy-related mortality are unclear; possible factors include an increase in the risk of women dying, changed coding with the International Classification of Diseases, 10th revision, and the addition by states of pregnancy checkboxes to the death certificate. State-based maternal death reviews and maternal quality collaboratives have the potential to identify deaths, review the factors associated with them, and take action on the findings. LEVEL OF EVIDENCE: III. |
Establishing the baseline height and weight status of New Hampshire Head Start children, 2007-2008
Blaney DD , Flynn RT , Martin NR , Anderson L . NHSA Dialog 2010 13 (4) 217-224 We report on a standardized survey of height and weight status of children attending the New Hampshire Head Start Program during the 2007-2008 school year. Baseline prevalence estimates of overweight and obesity are needed for obesity prevention activities and intervention. | We selected a random one-stage cluster sample and screened 629 children ages 3-5 years attending 27 of 45 Head Start sites. Survey participants underwent standardized height and weight measurements. We recorded sex and date of birth and calculated body mass index (BMI). For each participating site, we determined rural or urban status. We assessed prevalence of overweight and obesity for the survey sample and the statistical significance of differences between subgroups. Prevalence of overweight (BMI ≥ 85th and < 95th percentile) was 18.4% (95% confidence interval [CI]: 16.5%-20.4%), and prevalence of obesity (BMI ≥ 95th percentile) was 18.1% (95% CI: 16.1%-20.2%). No statistically significant differences were noted by age or sex. Children attending urban sites were found to be significantly more likely obese when compared with children attending rural sites. Children enrolled in New Hampshire Head Start demonstrate an increased prevalence of overweight and obesity compared with the general population. There are marked differences in the prevalence of obesity by urban/rural sites. Specific interventions for Head Start children are warranted. |
NHANES monitoring of serum 25-hydroxyvitamin D: a roundtable summary
Yetley EA , Pfeiffer CM , Schleicher RL , Phinney KW , Lacher DA , Christakos S , Eckfeldt JH , Fleet JC , Howard G , Hoofnagle AN , Hui SL , Lensmeyer GL , Massaro J , Peacock M , Rosner B , Wiebe D , Bailey RL , Coates PM , Looker AC , Sempos C , Johnson CL , Picciano MF . J Nutr 2010 140 (11) 2030S-45S A roundtable to discuss monitoring of serum 25-hydroxyvitamin D [25(OH)D] in the NHANES was held in late July 2009. Topics included the following: 1) options for dealing with assay fluctuations in serum 25(OH)D in the NHANES conducted between 1988 and 2006; 2) approaches for transitioning between the RIA used in the NHANES between 1988 and 2006 to the liquid chromatography tandem MS (LC-MS/MS) measurement procedure to be used in NHANES 2007 and later; 3) approaches for integrating the recently available standard reference material for vitamin D in human serum (SRM 972) from the National Institute of Standards and Technology (NIST) into the NHANES; 4) questions regarding whether the C-3 epimer of 25-hydroxyvitamin D3 [3-epi-25(OH)D3] should be measured in NHANES 2007 and later; and 5) identification of research and educational needs. The roundtable experts agreed that the NHANES data needed to be adjusted to control for assay fluctuations and offered several options for addressing this issue. The experts suggested that the LC-MS/MS measurement procedure developed by NIST could serve as a higher order reference measurement procedure. They noted the need for a commutability study for the recently released NIST SRM 972 across a range of measurement procedures. They suggested that federal agencies and professional organizations work with manufacturers to improve the quality and comparability of measurement procedures across all laboratories. The experts noted the preliminary nature of the evidence of the 3-epi-25(OH)D3 but felt that it should be measured in 2007 NHANES and later. |
The Feeding Infants and Toddlers Study 2008: opportunities to assess parental, cultural, and environmental influences on dietary behaviors and obesity prevention among young children
May AL , Dietz WH . J Am Diet Assoc 2010 110 S11-5 In 2007-2008, the prevalence of obesity was 10% among 2- to 5-year-old US children (1). Even in early childhood, significant racial/ethnic differences were apparent. Approximately 9% of non-Hispanic white, 11% non-Hispanic black, and 14% of Hispanic 2- to 5-year-old children were obese. Sex differences within racial/ethnic groups were also present. Obesity was least prevalent among non-Hispanic white (7%) and most prevalent among 2- to 5-year-old Hispanic boys (18%), whereas only modest differences were observed among non-Hispanic white, non-Hispanic black, and Hispanic 2- to 5-year-old girls (1). An elevated body mass index early in life is positively associated with adult adiposity (2). Although the causes of obesity are complex and multifaceted, at the most basic level, obesity is the result of an imbalance in energy intake and energy expenditure. Energy intake, specifically food consumption, is perhaps the most widely studied contributor to obesity. | This supplement to the Journal of the American Dietetic Association contains two articles (3, 4) that use data from the Feeding Infants and Toddlers Study (FITS) 2008 to describe food consumption of infants and toddlers and provide insights into the potential foods that may contribute to excess energy intake. FITS 2008 is a cross-sectional, national follow-up survey to FITS 2002. The survey methodology is described in this issue (5), but in short was composed of recruitment interviews and a 24-hour telephone dietary recall completed by parents or primary caregivers of infants and toddlers aged 0 to 48 months. Respondents completed questionnaires regarding family demographic characteristics, child development, and knowledge and attitudes about infant feeding. A random subsample of respondents provided an additional 24-hour dietary recall to estimate usual food intake. The FITS data presented in this issue of the Journal include the dietary intake data of 3,273 children: 382 infants aged 0 to 5.9 months, 505 infants aged 6 to 11.9 months, 925 toddlers aged 12 to 23.9 months, and 1,461 children aged 2 to 3 years (3, 4). This commentary highlights those studies and demonstrates their importance within the broader context of obesity prevention among young children. Children's eating patterns and food preferences are well established early in life (6). Therefore, the dietary behaviors that young children adopt during these critical periods of development may affect growth and health outcomes throughout the lifespan. Until recently, the frequency of food consumption among an adequate sample size of young children, especially those younger than age 2 years, was not well established. FITS was developed to address this gap by describing infant and toddler food consumption patterns (7). |
In memoriam: Jocelyn Anne Rankin (1946-2010)
Popovic T . Emerg Infect Dis 2010 16 (12) 2023 Jocelyn Anne Rankin, PhD, chief of the Information Center at the Centers for Disease Control and Prevention (CDC), died on September 19, 2010, at age 63 in her Florida home. Similar to the health professionals in the organization Medecins Sans Frontieres, Jocelyn was a humanitarian and a librarian sans frontieres. Although some make a difference by what they do, others, like Jocelyn, also make a difference by how they do it. She was a true leader and a mentor to many librarians (and not only to librarians but also to scientists and public health professionals) throughout the nation. These colleagues will remain profoundly grateful for her contributions to the world of information science, and will, just as deeply, cherish memories of how she made her professional mark-quietly, respectfully, and selflessly, yet with clear vision, determination, and passion. |
Occupational distribution of persons with confirmed 2009 H1N1 influenza
Suarthana E , McFadden JD , Laney AS , Kreiss K , Anderson HA , Hunt DC , Neises D , Goodin K , Thomas A , Vandermeer M , Storey E . J Occup Environ Med 2010 52 (12) 1212-6 OBJECTIVE: To assess the distribution of illness by industry sector and occupation reflected in early 2009 H1N1 influenza surveillance. METHODS: We analyzed data reported for April to July 2009, for 1361 laboratory-confirmed 2009 H1N1 influenza-infected persons 16 years or older, with work status information from four states. A North American Industry Classification System 2007 code was assigned to each employed person. For a subset, an occupation code was assigned. RESULTS: Of 898 employed individuals, 611 (68.0%) worked in the non-health care sector. The largest proportions worked in public administration, educational services, and accommodation and food services. In Wisconsin health care personnel, 53.6% were paraprofessionals, 33.6% professionals, and 12.7% other workers; 26.9% worked in ambulatory settings, 46.2% in hospitals, and 26.9% in nursing or residential care facilities. CONCLUSIONS: Our findings suggest that industry sectors and occupations should be explored systematically in future influenza surveillance. |
Interpreting screening questionnaires: specific respiratory symptoms and their relationship to objective test results
Petsonk EL , Wang ML . J Occup Environ Med 2010 52 (12) 1225-9 OBJECTIVE: To better delineate the relationship between responses to screening respiratory symptom questionnaires and various pulmonary function test results. METHODS: Spirometry, methacholine challenge, standardized questionnaires, smoking, medical, and work histories were recorded at initial and 5-year follow-up surveys among 411 participants. Percent-predicted forced expiratory volume in 1 second (ppFEV1), 5-year FEV1 decline, and proportion of methacholine responders (% hyper-responders) were compared with questionnaire responses utilizing generalized estimating equations modeling and analysis of variance. RESULTS: Significant associations were found between ppFEV1 and cough, phlegm, dyspnea, or ever wheezing; between greater percentage of hyper-responders and dyspnea with wheezing, ever/persistent wheezing, or history of asthma/hay fever; and between accelerated FEV1 decline and new onset dyspnea with wheezing, phlegm, or persistent wheeze. CONCLUSIONS: Particular respiratory symptoms reported on screening questionnaires are associated with specific physiologic abnormalities, enhancing questionnaire utility in workplace health surveillance. |
Associations of workplace aggression with work-related well-being among nurses in the Philippines
Fujishiro K , Gee GC , de Castro AB . Am J Public Health 2010 101 (5) 861-7 OBJECTIVES: We examined whether workplace aggression was associated with self-rated health and work-related injury and illness among nurses in the Philippines. METHODS: Our data came from a cross-sectional survey of nurses (n=687) in the Philippines. We assessed the associations of self-reported physical assault and verbal abuse with self-rated health, work-related injury and illness, and missed workdays with Poisson regression. Control variables included demographic and work characteristics (e.g., hours worked, work setting, shift). RESULTS: Verbal abuse was associated with poor general health (prevalence ratio [PR]=1.94; 95% confidence interval [CI]=1.09, 3.45). Both physical assault and verbal abuse were associated with work-related injury (PR=1.48; 95% CI=1.00, 2.20; PR=1.72; 95% CI=1.34, 2.23, respectively) and work-related illness (PR=1.46; 95% CI=0.99, 2.15; PR=1.68; 95% CI=1.32, 2.14, respectively) after demographic and work characteristics were accounted for in the model. In addition, physical assault was associated with missed workdays (PR=1.56; 95% CI=1.02, 2.33). CONCLUSIONS: Workplace aggression was associated with increased risks of poor general health and adverse work-related health outcomes among nurses in the Philippines. (Am J Public Health. Published online ahead of print November 18, 2010: e1-e7. doi:10.2105/AJPH.2009.188144). |
Detection of airborne Lactococcal bacteriophages in cheese plants
Verreault D , Gendron L , Rousseau GM , Veillette M , Masse D , Lindsley WG , Moineau S , Duchaine C . Appl Environ Microbiol 2010 77 (2) 491-7 The dairy industry adds starter bacterial cultures to heat-treated milk to control the fermentation process during the manufacture of many cheeses. These highly concentrated bacterial populations are susceptible to virulent phages that are ubiquitous in cheese factories. In this study, the dissemination of these phages by the airborne route and their presence on working surfaces were investigated in a cheese factory. Several surfaces were swabbed and five air samplers (polytetrafluoroethylene filter, polycarbonate filter, BioSampler, Coriolis cyclone sampler and NIOSH two-stage cyclone bioaerosol personal sampler) were tested. Samples were then analyzed for the presence of two Lactococcus lactis phage groups (936 and c2) and quantification was done by qPCR. Both lactococcal phage groups were found on most swabbed surfaces while airborne phages were detected at concentrations of at least 10(3) genomes/m(3) of air. The NIOSH sampler had the highest rate of air samples with detectable levels of lactococcal phages. This study demonstrates that virulent phages can circulate through the air and that they are ubiquitous in cheese manufacturing facilities. |
Shrinking the malaria map: progress and prospects
Feachem RG , Phillips AA , Hwang J , Cotter C , Wielgosz B , Greenwood BM , Sabot O , Rodriguez MH , Abeyasinghe RR , Ghebreyesus TA , Snow RW . Lancet 2010 376 (9752) 1566-78 In the past 150 years, roughly half of the countries in the world eliminated malaria. Nowadays, there are 99 endemic countries-67 are controlling malaria and 32 are pursuing an elimination strategy. This four-part Series presents evidence about the technical, operational, and financial dimensions of malaria elimination. The first paper in this Series reviews definitions of elimination and the state that precedes it: controlled low-endemic malaria. Feasibility assessments are described as a crucial step for a country transitioning from controlled low-endemic malaria to elimination. Characteristics of the 32 malaria-eliminating countries are presented, and contrasted with countries that pursued elimination in the past. Challenges and risks of elimination are presented, including Plasmodium vivax, resistance in the parasite and mosquito populations, and potential resurgence if investment and vigilance decrease. The benefits of elimination are outlined, specifically elimination as a regional and global public good. Priorities for the next decade are described. |
Operational strategies to achieve and maintain malaria elimination
Moonen B , Cohen JM , Snow RW , Slutsker L , Drakeley C , Smith DL , Abeyasinghe RR , Rodriguez MH , Maharaj R , Tanner M , Targett G . Lancet 2010 376 (9752) 1592-603 Present elimination strategies are based on recommendations derived during the Global Malaria Eradication Program of the 1960s. However, many countries considering elimination nowadays have high intrinsic transmission potential and, without the support of a regional campaign, have to deal with the constant threat of imported cases of the disease, emphasising the need to revisit the strategies on which contemporary elimination programmes are based. To eliminate malaria, programmes need to concentrate on identification and elimination of foci of infections through both passive and active methods of case detection. This approach needs appropriate treatment of both clinical cases and asymptomatic infections, combined with targeted vector control. Draining of infectious pools entirely will not be sufficient since they could be replenished by imported malaria. Elimination will thus additionally need identification and treatment of incoming infections before they lead to transmission, or, more realistically, embarking on regional initiatives to dry up importation at its source. |
Emergence of Onchocerca volvulus from skin mimicking Dracunculiasis medinensis
Eberhard ML , Ruiz-Tiben E , Korkor AS , Roy SL , Downs P . Am J Trop Med Hyg 2010 83 (6) 1348-51 We describe 11 cases of suspected Dracunculus medinensis infection in which the worm recovered was identified as Onchocerca volvulus. Identification was based on morphology of the examined specimen. |
Health workers' use of malaria rapid diagnostic tests (RDTs) to guide clinical decision making in rural dispensaries, Tanzania
Masanja MI , McMorrow M , Kahigwa E , Kachur SP , McElroy PD . Am J Trop Med Hyg 2010 83 (6) 1238-41 Rapid diagnostic tests (RDTs) were developed as an alternative to microscopy for malaria diagnosis. The RDTs detect malaria parasite antigen(s) in whole blood with high sensitivity and specificity. We assessed health worker malaria treatment practices after the introduction of RDTs in peripheral health facilities without microscopy. From December 2007 to October 2008, we introduced histidine-rich protein II (HRP-2)-based ParaHIT RDTs for routine use in 12 health facilities in Rufiji District, Tanzania. Health workers received training on how to perform RDTs for patients 5 years of age or older with fever or suspected malaria. Children < 5 years of age were to be treated empirically per national guidelines. Among the 30,195 patients seen at these 12 health facilities, 10,737 (35.6%) were tested with an RDT for malaria. 88.3% (9,405/10,648) of tested patients reported fever or history of fever and 2.7% (289/10,677) of all tested individuals were children < 5 years of age. The RDT results were recorded for 10,650 patients (99.2%). Among the 5,488 (51.5%) RDT-positive patients, 5,256 (98.6%) were treated with an appropriate first-line antimalarial per national guidelines (artemether-lumefantrine or quinine). Among the 5,162 RDT-negative patients, only 205 (4.0%) were treated with an antimalarial. Other reported treatments included antibiotics and antipyretics. Implementation of RDTs in rural health facilities resulted in high adherence to national treatment guidelines. Patients testing negative by RDT were rarely treated with antimalarials. Unapproved antimalarials were seldom used. Health workers continued to follow guidelines for the empiric treatment of febrile children. |
Correlates of children and parents being physically active together
Lee SM , Nihiser A , Strouse D , Das B , Michael S , Huhman M . J Phys Act Health 2010 7 (6) 776-83 BACKGROUND: Co-physical activity (between parents and children), as an outcome variable, and its correlates have not been examined previously. The purpose of this study was to investigate correlates of co-physical activity among a nationally representative sample of 9- to 13-year-old children and their parents. METHODS: Data were from the 2004 Youth Media Campaign Longitudinal Survey, a national survey of 5177 child-parent dyads. Parents of 9- to 13-year-old children were asked to report co-physical activity. Parents and children responded to a series of sociodemographic, behavioral, and psychosocial measures. Co-physical activity was treated as a dichotomous variable (ie, some or none). Logistic regression was used to assess associations of correlates directly and possible interactions between correlates. RESULTS: More than three-quarters of parents reported co-physical activity at least 1 day in the prior week. Age, race/ethnicity, sports team participation, eating meals together, parental confidence to influence the child's organized activity, and the child's perception of parental support were significantly associated with co-physical activity. CONCLUSION: The majority of respondents reported participating in co-physical activity, and multiple sociodemographic, behavioral, and psychosocial correlates were significantly associated with co-physical activity. This study provides insight for physical activity interventions that might involve parents. |
Prescription drug laws, drug overdoses, and drug sales in New York and Pennsylvania
Paulozzi LJ , Stier DD . J Public Health Policy 2010 31 (4) 422-32 Drug overdose mortality nearly doubled in the United States from 1999 to 2004, with most of the increase due to prescription drug overdoses. Studying mortality rates in states that did not experience such increases may identify successful prescription overdose prevention strategies. We compared New York, a state that did not experience an overdose increase, with its neighbor, Pennsylvania. New York and Pennsylvania had prescription drug monitoring programs (PDMPs), but New York's PDMP was better funded and made use of serialized, tamperproof prescription forms. Per capita usage of the major prescription opioids in New York was two-thirds that of Pennsylvania. The drug overdose death rate in Pennsylvania was 1.6 times that of New York in 2006. Differences between New York and Pennsylvania might be due to the regulatory environment in New York State. |
Stronger national public health institutes for global health
Frieden TR , Koplan JP . Lancet 2010 376 (9754) 1721-2 Although strengthening health-care systems is receiving increased attention, strengthening public health systems and institutions could save far more lives at lower cost. Public health institutes monitor, implement, and oversee programmes to prevent disease. Life-saving and cost-saving programmes include immunisations, control of communicable diseases including diarrhoeal disease, reduction of motor-vehicle crashes, and tobacco control. Over the past decade, many countries have considered, strengthened, or created national public health institutes (NPHIs), often following a major event such as the outbreak of severe acute respiratory syndrome.1, 2 | The core function of an NPHI is monitoring and responding to health threats. Monitoring requires reference laboratories and surveillance. Response requires outbreak control and implementation of evidence-based public health actions. NPHIs can include disease-specific control programmes, support to state, provincial, or local public health entities, surveillance and control for non-communicable diseases and injuries, occupational and environmental health, and vital registration (table ).3 These functions can be done by more than one institution in a country, and some countries have collaborated to establish regional institutions. Effective public health responses often require a multidisciplinary team, including skills needed for communicable and non-communicable disease control programmes. For example, the response to biosecurity threats involves expertise in infectious diseases, chemical hazards, engineering, environmental remediation, and risk communication. |
Common abnormal results of pap and human papillomavirus cotesting: what physicians are recommending for management
Berkowitz Z , Saraiya M , Benard V , Yabroff KR . Obstet Gynecol 2010 116 (6) 1332-40 OBJECTIVE: To evaluate the association between physician and practice characteristics and adherence to management guidelines to better understand the factors associated with different screening recommendations by primary care physicians. METHODS: We used a cross-sectional nationally representative survey of 950 primary care physicians familiar with human papillomavirus (HPV) testing to assess adherence to management guidelines by analyzing responses to two clinical vignettes of a 35-year-old woman who had Pap and HPV tests results: 1) discordant (normal Pap and positive HPV) or 2) mildly abnormal (atypical squamous cells of undetermined significance Pap and negative HPV). Analyses included multivariable logistic regression. RESULTS: For the discordant test results, 54.3% (95% confidence interval [CI] 51-57.6%) of physicians recommended both Pap and HPV testing in 6-12 months, adhering to management guidelines. For the mildly abnormal results, only 12.2% (95% CI 10-14.7%) had a guideline-adherent recommendation of Pap testing in 12 months with no HPV test. In multivariable analyses, no significant difference among physicians' specialties was observed for the discordant results. For the mildly abnormal results, physician specialty was associated with guideline adherence in which obstetrician-gynecologists had the highest percent of adherence (19.8%) compared with family and general practitioners (9.3%) and internists (11%) (P<.001). CONCLUSION: Even for the most common abnormal results, many physicians reported recommendations that did not adhere to current management guidelines. Evidence-based interventions are needed to improve adherence to management guidelines for the newer HPV DNA test. LEVEL OF EVIDENCE: III. |
National ambulatory medical care survey: 2007 summary
Hsiao CJ , Cherry DK , Beatty PC , Rechtsteiner EA . Natl Health Stat Report 2010 (27) 1-32 OBJECTIVES: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. METHODS: The data presented in this report were collected in the 2007 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to nonfederal office-based physicians in the United States. Sample data are weighted to produce annual national estimates of physician visits. RESULTS: During 2007, an estimated 994.3 million visits were made to physician offices in the United States, an overall rate of 335.6 visits per 100 persons. About one-third of office visits, 34.9 percent, were made to practices with all or partial electronic medical records systems, while 85.1 percent of the visits were made to practices with all or partial electronic submission of claims. From 1997 to 2007, the percentage of visits to physicians who were solo practitioners decreased 21 percent. During the same period, visits to physicians who were part of a group practice with 6-10 physicians increased 46 percent. There were an estimated 106.5 million injury- or poisoning-related office visits in 2007, representing 10.7 percent of all visits. Medications were ordered, supplied, or administered at 727.7 million office visits, accounting for 73.2 percent of all office visits. In 2007, about 2.3 billion drugs were ordered, supplied, or administered, resulting in an average of 226.3 drug mentions per 100 visits. |
National hospital discharge survey: 2007 summary
Hall MJ , DeFrances CJ , Williams SN , Golosinskiy A , Schwartzman A . Natl Health Stat Report 2010 (29) 1-20, 24 OBJECTIVES: This report presents national estimates of hospital inpatient care in the United States during 2007 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex. METHODS: The estimates are based on data collected through the 2007 National Hospital Discharge Survey, an annual national probability sample survey of discharges from nonfederal, general, and short-stay hospitals. Sample data are weighted to produce annual estimates of inpatient care, excluding newborns. Diagnoses and procedures are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS: In 2007, there were an estimated 34.4 million hospital discharges, excluding newborns. The total hospitalization rate leveled off from 1995 to 2007 after declining during the period from 1980 to 1995. Throughout the period from 1970 to 2007 the rates for those aged 65 years and over were significantly higher than the rates for the younger groups. Although those aged 65 years and over accounted for only 13 percent of the total population, they comprised 37 percent of hospital discharges and 43 percent of hospital days. One-quarter of inpatients under age 15 years were hospitalized for respiratory diseases. There were 45 million inpatient procedures during 2007 and 15 percent of these were cardiovascular. Males aged 45-64 and 65 years and over had higher cardiac catheterization rates than females in these age groups each year from 1997 to 2007. From 2002 to 2007 the rate of inpatient cardiac catheterization procedures declined. |
Comparison of home health and hospice care agencies by organizational characteristics and services provided: United States, 2007
Park-Lee EY , Decker FH . Natl Health Stat Report 2010 (30) 1-23 OBJECTIVE: This report presents national estimates of the organizational characteristics of home health and hospice care agencies in 2007. Comparisons of organizational characteristics and provision of selected services are made by agency type. A comparison of selected characteristics between 1996 and 2007 is also provided to highlight changes that have occurred leading to the current composition of the home health and hospice care sector. METHODS: Estimates are based on data collected on agencies from the 1996, 2000, and 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are derived from data collected during interviews with administrators and staff designated by the administrators. RESULTS: In 2007, there were 14,500 home health and hospice care agencies in the United States, an increase from 11,400 in 2000. Three-quarters of these agencies provided home health care only, 15% provided hospice care only, and 10% provided both home health and hospice care (mixed). The percentage of proprietary home health care only and hospice care only agencies increased during 1996-2007, whereas the percentage of proprietary mixed agencies remained relatively stable. The average number of home health care patients that home health care only and mixed agencies served decreased, while the average number of hospice care patients that hospice care only agencies served increased across years. Among mixed agencies, no significant changes were observed in the average number of hospice care patients being served. The percentage of home health care only agencies offering certain therapeutic and nonmedical services declined over the years. There was an increase in the proportion of hospice care only agencies' providing many core and noncore hospice care services during 1996-2007. Also during this time, the proportion of mixed agencies providing selected nonmedical services decreased. |
2009 cervical cytology guidelines and Chlamydia testing among sexually active young women
Tao G , Hoover KW , Kent CK . Obstet Gynecol 2010 116 (6) 1319-23 OBJECTIVE: An American College of Obstetricians and Gynecologists Practice Bulletin published in 2009 recommended that cervical cancer screening should begin at age 21 years and women younger than 30 years should be rescreened every 2 years rather than annually. The purpose of this study is to estimate the effect that decreased frequency of cervical cancer screening would have on chlamydia screening, which is recommended annually for sexually active women aged 25 years or younger. METHODS: Using an administrative database of medical claims from commercially insured girls and women, we compared annual chlamydia screening rates of sexually active adolescent girls and young women aged 15 to 25 years in 2007 among those who underwent cervical cancer screening and those who were not screened for cervical cancer. RESULTS: We identified 701,193 sexually active adolescent girls and young women aged 15 to 25 years. Chlamydia screening rates were significantly higher among adolescent girls and young women who underwent cervical cancer screening compared with those who did not: 43.6% compared with 9.5% for adolescent girls and young women aged 15 to 20 years and 36.1% compared with 12.2% for women aged 21 to 25 years. Among adolescent girls and young women identified as sexually active in 2007, 90.5% had visits for reproductive health services other than cervical cancer screening that could provide opportunities for chlamydia screening. CONCLUSION: Although the revised American College of Obstetricians and Gynecologists Practice Bulletin recommending less frequent cervical cancer screening will likely reduce chlamydia screening rates in adolescent girls and young women, health care providers should be aware of other opportunities for chlamydial testing. Options include patient self-collected vaginal swabs and urine specimens collected during visits at which adolescent girls and young women seek other reproductive health or preventive services. LEVEL OF EVIDENCE: II. |
Chronic heart disease and severe obstetric morbidity among hospitalisations for pregnancy in the USA: 1995-2006
Kuklina E , Callaghan W . BJOG 2010 118 (3) 345-52 OBJECTIVES: To describe changes in characteristics of delivery and postpartum hospitalisations with chronic heart disease from 1995 to 2006. DESIGN: Cross-sectional study. SETTING: USA, nationwide hospital discharge data. POPULATION: A total of 47,882,817 delivery hospitalisations and 660 038 postpartum hospitalisations. METHODS: Adjusted odds ratios describing the associations between chronic maternal heart disease and severe obstetric complications were obtained from multivariable logistic models. The contribution of chronic heart disease to severe morbidity was estimated using adjusted population-attributable fractions. MAIN OUTCOME MEASURES: Prevalence and trends in chronic heart disease, rate and risk of severe obstetric complications. RESULTS: In 2004-2006, about 1.4% of delivery hospitalisations were complicated with chronic heart disease. No substantial changes in the overall prevalence of chronic heart disease among hospitalisations for delivery were observed from 1995-1997 to 2004-2006. Even so, a linear increase was found for specific congenital heart disease, cardiac dysrhythmias, and cardiomyopathy and congestive heart failure (P < 0.01). During this same period the rate of postpartum hospitalisations with chronic heart disease tripled (P < 0.01). Severe complications during hospitalisations for delivery among women with chronic heart disease were more common in 2004-2006 than in 1995-1997. In 2004-2006, 64.5% of the cases of acute myocardial infarction, 57.5% of the instances of cardiac arrest/ventricular fibrillation, 27.8% of in-hospital mortality and 26.0% of the cases of adult respiratory distress syndrome were associated with hospitalisations with chronic heart disease. CONCLUSIONS: In the USA chronic heart disease among women hospitalised during pregnancy may have increased in severity from 1995 to 2006. |
Multiple imputation of missing dual-energy X-ray absorptiometry data in the National Health and Nutrition Examination Survey
Schenker N , Borrud LG , Burt VL , Curtin LR , Flegal KM , Hughes J , Johnson CL , Looker AC , Mirel L . Stat Med 2010 30 (3) 260-76 In 1999, dual-energy x-ray absorptiometry (DXA) scans were added to the National Health and Nutrition Examination Survey (NHANES) to provide information on soft tissue composition and bone mineral content. However, in 1999-2004, DXA data were missing in whole or in part for about 21 per cent of the NHANES participants eligible for the DXA examination; and the missingness is associated with important characteristics such as body mass index and age. To handle this missing-data problem, multiple imputation of the missing DXA data was performed. Several features made the project interesting and challenging statistically, including the relationship between missingness on the DXA measures and the values of other variables; the highly multivariate nature of the variables being imputed; the need to transform the DXA variables during the imputation process; the desire to use a large number of non-DXA predictors, many of which had small amounts of missing data themselves, in the imputation models; the use of lower bounds in the imputation procedure; and relationships between the DXA variables and other variables, which helped both in creating and evaluating the imputations. This paper describes the imputation models, methods, and evaluations for this publicly available data resource and demonstrates properties of the imputations via examples of analyses of the data. The analyses suggest that imputation helps to correct biases that occur in estimates based on the data without imputation, and that it helps to increase the precision of estimates as well. Moreover, multiple imputation usually yields larger estimated standard errors than those obtained with single imputation. Published in 2010 by John Wiley & Sons, Ltd. |
Tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in smokers in the United States: NHANES 2007-2008
Xia Y , Bernert JT , Jain RB , Ashley DL , Pirkle JL . Biomarkers 2010 16 (2) 112-9 The tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the tobacco-specific nitrosamine (TSNA) 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), has been measured in urine samples from all participants aged 6 years and older from the National Health and Nutrition Examination Survey 2007-2008. Participants with a serum cotinine concentration of ≥10 ng/mL were identified as tobacco users, primarily cigarette smokers. Regression models were developed to calculate geometric mean NNAL concentrations adjusted for serum cotinine, urinary creatinine, cigarettes per day, and Federal Trade Commission tar values of the cigarettes smoked. Significant differences were found by gender (p = 0.003) and race/ethnicity (p = 0.022 for non-Hispanic white versus non-Hispanic black smokers), but not by menthol type of the cigarettes. Females and non-Hispanic white smokers had the highest adjusted means for urinary NNAL (353 and 336 pg/mL, respectively). The results from this study demonstrated significant relationships between NNAL concentrations and serum cotinine (p < 0.001) and urine creatinine (p < 0.001). The joint effect of linear and quadratic terms for number of cigarettes smoked per day was also statistically significant (p = 0.001). In addition to addressing current NNK exposure levels, these results will form a baseline for future estimates of tobacco users' exposure to this carcinogen. |
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