Personal history of diabetes, genetic susceptibility to diabetes, and risk of brain glioma: a pooled analysis of observational studies.
Kitahara CM , Linet M , Brenner AV , Wang SS , Melin B , Wang Z , Inskip PD , Beane Freeman L , Braganza MZ , Carreon T , Feychting M , Gaziano JM , Peters U , Purdue MP , Ruder A , Sesso HD , Shu XO , Waters M , White E , Zheng W , Hoover RN , Fraumeni JF Jr , Chatterjee N , Yeager M , Chanock SJ , Hartge P , Rajaraman P . Cancer Epidemiol Biomarkers Prev 2013 23 (1) 47-54 BACKGROUND: Brain glioma is a relatively rare and fatal malignancy in adulthood with few known risk factors. Some observational studies have reported inverse associations between diabetes and subsequent glioma risk, but possible mechanisms are unclear. METHODS: We conducted a pooled analysis of original data from five nested case-control studies and two case-control studies from the U.S. and China that included 962 glioma cases and 2,195 controls. We examined self-reported diabetes history in relation to glioma risk, as well as effect modification by seven glioma risk-associated single-nucleotide polymorphisms (SNPs). We also examined the associations between 13 diabetes risk-associated SNPs, identified from genome-wide association studies, and glioma risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable-adjusted logistic regression models. RESULTS: We observed a 42% reduced risk of glioma for individuals with a history of diabetes (OR=0.58, 95% CI: 0.40-0.84). The association did not differ by sex, study design, or after restricting to glioblastoma, the most common histological sub-type. We did not observe any significant per-allele trends among the 13 diabetes-related SNPs examined in relation to glioma risk. CONCLUSION: These results support an inverse association between diabetes history and glioma risk. The role of genetic susceptibility to diabetes cannot be excluded, and should be pursued in future studies together with other factors that might be responsible for the diabetes-glioma association. IMPACT: These data suggest the need for studies that can evaluate, separately, the association between type 1 and type 2 diabetes and subsequent risk of adult glioma. |
RE: "prevalence of diagnosed and undiagnosed type 2 diabetes mellitus among US adolescents: results from the continuous NHANES, 1999-2010"
Saydah S , Imperatore G , Geiss L . Am J Epidemiol 2013 179 (3) 395-6 We read with great interest the article by Demmer et al. (1) recently published in the Journal. We agree that national surveillance efforts for diabetes among this age group are important to assess and monitor the burden of disease. | The National Health and Nutrition Examination Survey (NHANES) allows us to monitor and track the nation’s health. In fact, the Centers for Disease Control and Prevention (Atlanta, Georgia) rely on NHANES for our national estimates of the burden of diagnosed and undiagnosed diabetes among adults in the United States (2, 3). Estimates from NHANES for prevalence of diagnosed and undiagnosed diabetes among youth have not been included as part of the National Diabetes Surveillance System because of concerns with the low absolute number of cases precluding comparisons by demographic groups. | In fact, we are concerned with the reliability of many of the estimates presented by the authors and, subsequently, with many of the inferences the authors draw from the data. The NHANES Analytic Guidelines, published by the National Center for Health Statistics (Hyattsville, Maryland), state, “The minimum sample size is determined by the statistic to be estimated (e.g., mean, total, proportion …), the reliability criteria (e.g., 20 or 30 percent relative standard error), the Design Effect for the statistics (DEFF defined as the variance inflation factor), and the degrees of freedom for the standard error estimate” (4, p.10). |
Reference values and factors associated with exhaled nitric oxide: U.S. youth and adults
Brody DJ , Zhang X , Kit BK , Dillon CF . Respir Med 2013 107 (11) 1682-91 BACKGROUND: Normative values for fractional exhaled nitric oxide (FeNO) and the associated co-factors are important in understanding the role of FeNO as a biomarker in airway disease. The objective of this study is to establish reference FeNO values for youth and adult asymptomatic, lifetime nonsmokers in the United States, and to describe the factors affecting these levels. METHODS: Cross-sectional analyses of the National Health and Nutrition Examination Survey from 2007 to 2010. The analytic sample consisted of 4718 youth and adults, ages 6-79 years, who were lifelong nonsmokers, and free of asthma, and other respiratory conditions and symptoms. Loge FeNO values were used as dependent variables to test associations of demographic and health related-covariates. Multivariable regression models were used to assess the independent effect and covariate-adjusted contribution of the factors. RESULTS: The geometric mean FeNO level was 8.3, 12.1, and 16.2 ppb for males 6-11, 12-19, and 20-79 years, and 8.4, 10.9, and 12.6 ppb for females in the corresponding age groups. Overall, FeNO levels increased with increasing age (p < 0.001), and height (p < 0.001). In all age groups, FeNO levels were positively associated with eosinophil counts, and with testing in the morning. Among youths 6-11 and 12-19 years, non-Hispanics whites had lower FeNO values than non-Hispanic blacks and Hispanic youths. No race-ethnic difference in FeNO levels was evident for adults 20-79 years. Among adolescents and adults, FeNO levels were higher for males than for females, controlling for all other factors. CONCLUSIONS: These reference values and associated attributes in youths and adults are useful in evaluating the role of FeNO in airway diseases. |
A study of prospective surveillance for inhibitors among persons with haemophilia in the United States
Soucie JM , Miller CH , Kelly FM , Payne AB , Creary M , Bockenstedt PL , Kempton CL , Manco-Johnson MJ , Neff AT . Haemophilia 2013 20 (2) 230-7 Inhibitors are a rare but serious complication of treatment of patients with haemophilia. Phase III clinical trials enrol too few patients to adequately assess new product inhibitor risk. This project explores the feasibility of using a public health surveillance system to conduct national surveillance for inhibitors. Staff at 17 U.S. haemophilia treatment centres (HTC) enrolled patients with haemophilia A and B into this prospective study. HTC staff provided detailed historic data on product use and inhibitors at baseline, and postenrolment patients provided monthly detailed infusion logs. A central laboratory performed inhibitor tests on blood specimens that were collected at baseline, annually, prior to any planned product switch or when clinically indicated. The central laboratory also performed genotyping of all enrolled patients. From January 2006 through June 2012, 1163 patients were enrolled and followed up for 3329 person-years. A total of 3048 inhibitor tests were performed and 23 new factor VIII inhibitors were identified, 61% of which were not clinically apparent. Infusion logs were submitted for 113 205 exposure days. Genotyping revealed 431 distinct mutations causing haemophilia, 151 of which had not previously been reported elsewhere in the world. This study provided critical information about the practical issues that must be addressed to successfully implement national inhibitor surveillance. Centralized testing with routine monitoring and confirmation of locally identified inhibitors will provide valid and representative data with which to evaluate inhibitor incidence and prevalence, monitor trends in occurrence rates and identify potential inhibitor outbreaks associated with products. |
Lost productivity and burden of illness in cancer survivors with and without other chronic conditions
Dowling EC , Chawla N , Forsythe LP , de Moor J , McNeel T , Rozjabek HM , Ekwueme DU , Yabroff KR . Cancer 2013 119 (18) 3393-401 BACKGROUND: Cancer survivors may experience long-term and late effects from treatment that adversely affect health and limit functioning. Few studies examine lost productivity and disease burden in cancer survivors compared with individuals who have other chronic conditions or by cancer type. METHODS: We identified 4960 cancer survivors and 64,431 other individuals from the 2008-2010 Medical Expenditure Panel Survey and compared multiple measures of disease burden, including health status and lost productivity, between conditions and by cancer site for cancer survivors. All analyses controlled for the effects of age, sex, race/ethnicity, and number of comorbid conditions. RESULTS: Overall, in adjusted analyses in multiple models, cancer survivors with another chronic disease (heart disease or diabetes) experienced higher levels of burden compared with individuals with a history of cancer only, chronic disease only, and neither cancer, heart disease, nor diabetes across multiple measures (P < .05). Among cancer survivors, individuals with short survival cancers and multiple cancers consistently had the highest levels of burden across multiple measures (P < .0001). CONCLUSIONS: Cancer survivors who have another chronic disease experience more limitations and higher levels of burden across multiple measures. Limitations are particularly severe in cancer survivors with short survival cancer and multiple cancers. |
Neighborhood commuting environment and obesity in the United States: an urban-rural stratified multilevel analysis
Zhang X , Holt JB , Lu H , Onufrak S , Yang J , French SP , Sui DS . Prev Med 2013 59 31-6 OBJECTIVE: Automobile dependency and longer commuting are associated with current obesity epidemic. We aimed to examine the urban-rural differential effects of neighborhood commuting environment on obesity in the US. METHODS: The 1997-2005 National Health Interview Survey (NHIS) were linked to 2000 US Census data to assess the effects of neighborhood commuting environment: census tract-level automobile dependency and commuting time, on individual obesity status. RESULTS: Higher neighborhood automobile dependency was associated with increased obesity risk in urbanized areas (large central metro (OR 1.11[1.09, 1.12]), large fringe metro (OR 1.17[1.13, 1.22]), medium metro (OR 1.22[1.16, 1.29]), small metro (OR 1.11[1.04, 1.19]), and micropolitan (OR 1.09[1.00, 1.19])), but not in non-core rural areas (OR 1.00[0.92, 1.08]). Longer neighborhood commuting time was associated with increased obesity risk in large central metro (OR 1.09[1.04, 1.13]), and less urbanized areas (small metro (OR 1.08[1.01, 1.16]), micropolitan (OR 1.06[1.01, 1.12]), and non-core rural areas (OR 1.08[1.01, 1.17])), but not in (large fringe metro (OR 1.05[1.00, 1.11]), and medium metro (OR 1.04[0.98, 1.10])). CONCLUSION: The link between commuting environment and obesity differed across the regional urbanization levels. Urban and regional planning policies may improve current commuting environment and better support healthy behaviors and healthy community development. |
Protocol-based treatment of hypertension: a critical step on the pathway to progress
Frieden TR , King SM , Wright JS . JAMA 2013 311 (1) 21-2 Improved treatment of hypertension is among the most important—and quite possibly also the single most neglected—area of clinical medicine. Only half of Americans with hypertension have blood pressure less than 140/90 mm Hg, and more than 13%—an estimated 9 million people—have a systolic blood pressure of 160 mm Hg or higher and/or diastolic pressure of 100 mm Hg or higher.1 Much better control is possible: Canada has a rate of blood pressure control of more than 65%,2 and the Minneapolis-St Paul region has a level of blood pressure control more than 20 percentage points higher than the United States as a whole.3 The United States is making progress, but this progress is painfully slow—the rate of control is increasing only 1% per year.4 | In simple numbers, it is estimated that nearly 36 million US adults have uncontrolled blood pressure, with 2 major subgroups that would benefit from protocol-based care.1 The first is the large number of people—14 million—who are unaware of their hypertension.1 Most of these people are hiding in plain sight: they are in clinical treatment with elevated blood pressure documented, but hypertension neither diagnosed nor treated. High-performing systems can reduce by half the proportion of hypertensive patients unaware of their blood pressure and not being treated.5 The second group is the estimated 16 million people who know they have hypertension and are taking medication for it, but do not yet have it under control.1 |
Estimating the U.S. prevalence of chronic obstructive pulmonary disease using pre- and post-bronchodilator spirometry: the National Health and Nutrition Examination Survey (NHANES) 2007-2010
Tilert T , Dillon C , Paulose-Ram R , Hnizdo E , Doney B . Respir Res 2013 14 (1) 103 BACKGROUND: During 2007-2010, the National Health and Nutrition Examination Survey (NHANES) conducted a spirometry component which obtained pre-bronchodilator pulmonary lung function data on a nationally representative sample of US adults aged 6-79 years and post-bronchodilator pulmonary lung function data for the subset of adults with airflow limitation. The goals of this study were to 1) compute prevalence estimates of chronic obstructive pulmonary disease (COPD) using pre-bronchodilator and post-bronchodilator spirometry measurements and fixed ratio and lower limit of normal (LLN) diagnostic criteria and 2) examine the potential impact of nonresponse on the estimates. METHODS: This analysis was limited to those aged 40-79 years who were eligible for NHANES pre-bronchodilator spirometry (n=7,104). Examinees with likely airflow limitation were further eligible for post-bronchodilator testing (n=1,110). Persons were classified as having COPD based on FEV1/FVC < 70% (fixed ratio) or FEV1/FVC < lower limit of normal (LLN) based on person's age, sex, height, and race/ethnicity. Those without spirometry but self-reporting both daytime supplemental oxygen therapy plus emphysema and/or current chronic bronchitis were also classified as having COPD. The final analytic samples for pre-bronchodilator and post-bronchodilator analyses were 77.1% (n=5,477) and 50.8% (n=564) of those eligible, respectively. To account for non-response, NHANES examination weights were adjusted to the eligible pre-bronchodilator and post-bronchodilator subpopulations. RESULTS: In 2007-2010, using the fixed ratio criterion and pre-bronchodilator test results, COPD prevalence was 20.9% (SE 1.1) among US adults aged 40-79 years. Applying the same criterion to post-bronchodilator test results, prevalence was 14.0% (SE 1.0). Using the LLN criterion and pre-bronchodilator test results, the COPD prevalence was 15.4% (SE 0.8), while applying the same criterion to post-bronchodilator test results, prevalence was 10.2% (SE 0.8). CONCLUSIONS: The overall COPD prevalence among US adults aged 40-79 years varied from 10.2% to 20.9% based on whether pre- or post-bronchodilator values were used and which diagnostic criterion (fixed ratio or LLN) was applied. The overall prevalence decreased by approximately 33% when airflow limitation was based on post-bronchodilator as compared to pre-bronchodilator spirometry, regardless of which diagnostic criterion was used. |
Incidence of obesity among young US children living in low-income families, 2008-2011
Pan L , May AL , Wethington H , Dalenius K , Grummer-Strawn LM . Pediatrics 2013 132 (6) 1006-13 OBJECTIVE: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups .METHODS: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. CONCLUSIONS: The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs. |
CDC's winnable battles: improved nutrition, physical activity, and decreased obesity
Blanck HM , Collins J . Child Obes 2013 9 (6) 469-71 In fall 2010, the CDC, under Director Dr. Tom Frieden's leadership, identified six domestic winnable battles based on the magnitude of the public health burden and the ability to accelerate progress by expanding evidence-based practice.1 Nutrition, physical activity, and obesity along with food safety was identified as one of those battles in addition to human immunodeficiency virus, healthcare-associated infections, teen pregnancy, tobacco, and motor vehicle injuries. Since that time, the CDC has established 5-year goals, performance measures, and strategic plans for each winnable battle.2 Each battle area has identified optimal strategies and a process to leverage resources and partnerships to accelerate a measurable impact on health. CDC's current battle plan for nutrition, physical activity, and obesity focuses on working with partners in (1) improving maternity care practices to support women who choose to breastfeed, (2) reducing artificial transfat in the food supply, (3) reducing sodium in the food supply, (4) reducing consumption of calories from added sugars, and (5) improving the food, beverage, and activity environments of child care centers, schools, workplaces, and communities. Many of these focus areas and targets are also consistent with the nation's Healthy People 2020 objectives. |
Clinical oral examinations may not be predictive of dysplasia or oral squamous cell carcinoma
Cleveland JL , Robison VA . J Evid Based Dent Pract 2013 13 (4) 151-4 ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma. Epstein JB, Guneri P, Boyacioglu H, Abt E. JADA 2012;143(12);1332-42. REVIEWERS: Jennifer L. Cleveland, DDS, MPH, Valerie A. Robison, DDS, MPH, PhD PURPOSE/QUESTION: To assess the effectiveness of the clinical oral exam in predicting potentially malignant epithelial lesions or oral squamous cell carcinomas SOURCE OF FUNDING: None of the authors reported any external sources of funding to support this study TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data LEVEL OF EVIDENCE: Level 2: Limited-quality patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence. |
Prevalence and molecular characterization of pertactin-deficient Bordetella pertussis in the United States.
Pawloski LC , Queenan AM , Cassiday PK , Lynch AS , Harrison M , Shang W , Williams MM , Bowden KE , Burgos-Rivera B , Qin X , Messonnier N , Tondella ML . Clin Vaccine Immunol 2013 21 (2) 119-25 Pertussis has made a striking resurgence in the US, returning to record numbers of reported cases last observed in the 1950s. Bordetella pertussis isolates lacking pertactin, a key antigen component of the acellular pertussis vaccine, have been observed, suggesting that B. pertussis is losing pertactin in response to vaccine immunity. Screening of 1300 isolates from outbreak and surveillance studies (historical isolates collected from 1935 up to 2009, the 2010 California pertussis outbreak, US isolates from routine surveillance between 2010-2012, and the 2012 Washington pertussis outbreak) by conventional PCR and later by Western blot and prn sequencing analyses ultimately identified 306 pertactin-deficient isolates. Of these pertactin-deficient strains, 276 were identified as having an IS481 in the prn gene (prnIS481-positive). The first prnIS481-positive isolate was found in 1994, with the next prnIS481-positive isolates not detected until 2010. Pertactin-deficient isolates increased substantially to over 50% in 2012. Sequence analysis of pertactin-deficient isolates revealed various types of mutations in the prn gene, including two deletions, single nucleotide substitutions resulting in a stop codon, an inversion in the promoter, and a single nucleotide insertion resulting in a frame shift mutation. All but one mutation type were found in prn2 alleles. CDC013 was a predominant PFGE profile in the pertactin-positive isolates (203/994), but was found in only 5% (16/306) of the pertactin-deficient isolates. Interestingly, PFGE profiles CDC002 and CDC237 represented 55% (167/306) of the identified pertactin-deficient isolates. These results indicate that there has been a recent, dramatic increase in pertactin-deficient B. pertussis isolates throughout the US. |
The effect of the MDCK cell selected neuraminidase D151G mutation on the drug susceptibility assessment of influenza A(H3N2) viruses.
Mishin VP , Sleeman K , Levine M , Carney PJ , Stevens J , Gubareva LV . Antiviral Res 2013 101 93-6 Propagation of influenza A(H3N2) viruses in MDCK cells has been associated with the emergence of neuraminidase (NA) variants carrying a change at residue 151. In this study, the pyrosequencing assay revealed that approximately 90% of A(H3N2) virus isolates analyzed (n=150) contained more than one amino acid variant (D/G/N) at position 151. Susceptibilities of the virus isolates to zanamivir and oseltamivir were assessed using the chemiluminescent and fluorescent NA inhibition (NI) assays. In the chemiluminescent assay, which utilizes NA-Star(R) substrate, up to 13-fold increase in zanamivir-IC50 was detected for isolates containing a high proportion (>50%) of the G151 NA variant. However, an increase in zanamivir-IC50s was not seen in the fluorescent assay, which uses MUNANA as substrate. To investigate this discrepancy, recombinant NAs (rNAs) were prepared and tested in both NI assays. Regardless of the assay used, the zanamivir-IC50 for the rNA G151 was much greater (>1500-fold) than that for rNA D151 wild-type. However, zanamivir resistance conferred by the G151 substitution was masked in preparations containing the D151 NA which had much greater activity, especially against MUNANA. In conclusion, the presence of NA D151G variants in cell culture-grown viruses interferes with drug susceptibility assessment and therefore measures need to be implemented to prevent their emergence. |
Recruitment approaches to identifying newly diagnosed HIV infection among African American men who have sex with men
Ellen JM , McCree DH , Muvva R , Chung SE , Miazad RM , Arrington-Sanders R , Jones K , Burnett P , Fichtenberg C . Int J STD AIDS 2013 24 (5) 335-9 To determine effectiveness of alternate venue testing (AVT), social network strategy (SNS) and provider referral (PR) for identifying previously undiagnosed HIV-infected 18-64-year-old African American men who have sex with men (AA MSM) by a health department. For AVT, staff used a mobile clinic to conduct HIV testing. For PR, staff solicited contact information from HIV-infected AA MSM, located contacts and offered HIV testing. For SNS, HIV-positive AA MSM recruited network associates for HIV testing. Two hundred and eighteen self-identified AA MSM were tested through AVT (25.2% HIV positivity) of whom 20 were newly identified HIV-positive. Fourteen HIV-positive men participated in SNS; 22 AA MSM contacts were recruited through SNS, eight (36.4%) were HIV positive and none were new positives. Two HIV-infected men participated in the PR strategy, yielding two AA MSM sex partners (one previously positive). The results suggest the need for health departments to consider using several complimentary strategies for identifying previously undiagnosed HIV infections in AA MSM in urban environments such as Baltimore. |
Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009-2011
Cohen C , Moyes J , Tempia S , Groom M , Walaza S , Pretorius M , Dawood H , Chhagan M , Haffejee S , Variava E , Kahn K , Tshangela A , von Gottberg A , Wolter N , Cohen AL , Kgokong B , Venter M , Madhi SA . Emerg Infect Dis 2013 19 (11) 1766-74 Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009-2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4-8 times greater for HIV-infected (186-228/100,000) than for HIV-uninfected persons (26-54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2-7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination. |
Trichomoniasis: the "neglected" sexually transmitted disease
Meites E . Infect Dis Clin North Am 2013 27 (4) 755-64 Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million people in the United States. Although trichomoniasis is common, it has been considered a "neglected" sexually transmitted disease, due to limited knowledge of its sequelae and associated costs. This article reviews current epidemiology, pathophysiology, diagnostic methods, clinical management recommendations and special considerations, research on associated conditions and costs, prevention strategies, and controversies regarding trichomoniasis. |
Use of expedited partner therapy among chlamydia cases diagnosed at an urban Indian health centre, Arizona
Taylor MM , Reilley B , Yellowman M , Anderson L , de Ravello L , Tulloch S . Int J STD AIDS 2013 24 (5) 371-4 Chlamydia cases diagnosed in the women's clinic were more likely to receive expedited partner therapy (EPT) and to be re-tested as compared with urgent and emergent care settings. Fewer re-infections occurred among patients who received EPT. Disproportionate rates of chlamydia occur among American Indian (AI) populations. To describe use of EPT among chlamydia cases diagnosed at an urban Indian Health Service (IHS) facility in Arizona, health records were used to extract confirmed cases of chlamydia diagnosed between January 2009 and August 2011. Medical records of 492 patients diagnosed with chlamydia were reviewed. Among the 472 cases who received treatment, 246 (52%) received EPT. Receipt of EPT was significantly associated with being female (odds ratio (OR) 2.1, 1.03-4.4, P < 0.001) and receipt of care in the women's clinic (OR 9.9, 95% CI 6.0-16.2) or in a primary care clinic (OR 2.4, 95% CI 1.1-5.1). Compared with those receiving care in the women's clinic, the odds of receipt of EPT were significantly less in those attending the urgent/express care clinic (OR 0.1, 95% CI 0.06-0.2), and the emergency department (OR 0.1, 95% CI 0.05-0.2). Among treated patients who underwent re-testing (N = 323, 68% total treated) re-infection was less common among those that received EPT (13% versus 27%; OR 0.5, 95% CI 0.3-0.9). In this IHS facility, EPT was protective in preventing chlamydia re-infection. Opportunities to expand the use of EPT were identified in urgent and emergent care settings. |
Prevalence of HIV infection and risk behaviors among younger and older injecting drug users in the United States, 2009
Broz D , Pham H , Spiller M , Wejnert C , Le B , Neaigus A , Paz-Bailey G . AIDS Behav 2013 18 Suppl 3 284-96 This study compared HIV sero-prevalence and risk behaviors between younger and older injecting drug users (IDUs). IDUs aged ≥18 years were interviewed for the 2009 National HIV Behavioral Surveillance System. Using GEE regression, we assessed characteristics of younger (18-29 years) and older (≥30 years) IDUs, and factors associated with past 12-month receptive syringe sharing and unprotected sex (vaginal/anal). Of 10,090 participants, 10 % were younger. HIV sero-prevalence was lower among younger than older IDUs (4 vs. 10 %, p = 0.001). Younger IDUs were more likely (p ≤ 0.002) to be non-black race/ethnicity, report higher household income, homelessness, being arrested and to engage in receptive syringe sharing and unprotected sex. In multivariable models, age remained associated (p < 0.001) with receptive syringe sharing (aPR = 1.14, 95 % CI1.07-1.22) and unprotected sex (aPR = 1.10, 95 % CI1.06-1.14). Although younger IDUs had lower HIV prevalence, their behaviors place them at increased risk of HIV infection and could lead to a rapid spread in this susceptible population. |
Efficacy of tecovirimat (ST-246) in nonhuman primates infected with variola virus (smallpox)
Mucker EM , Goff AJ , Shamblin JD , Grosenbach DW , Damon IK , Mehal JM , Holman RC , Carroll D , Gallardo N , Olson VA , Clemmons CJ , Hudson P , Hruby DE . Antimicrob Agents Chemother 2013 57 (12) 6246-53 Naturally occurring smallpox has been eradicated but remains a considerable threat as a biowarfare/bioterrorist weapon (F. Fleck, Bull. World Health Organ. 81:917-918, 2003). While effective, the smallpox vaccine is currently not recommended for routine use in the general public due to safety concerns (http://www.bt.cdc.gov/agent/smallpox/vaccination). Safe and effective countermeasures, particularly those effective after exposure to smallpox, are needed. Currently, SIGA Technologies is developing the small-molecule oral drug, tecovirimat (previously known as ST-246), as a postexposure therapeutic treatment of orthopoxvirus disease, including smallpox. Tecovirimat has been shown to be efficacious in preventing lethal orthopoxviral disease in numerous animal models (G. Yang, D. C. Pevear, M. H. Davies, M. S. Collett, T. Bailey, et al., J. Virol. 79:13139-13149, 2005; D. C. Quenelle, R. M. Buller, S. Parker, K. A. Keith, D. E. Hruby, et al., Antimicrob. Agents Chemother., 51:689-695, 2007; E. Sbrana, R. Jordan, D. E. Hruby, R. I. Mateo, S. Y. Xiao, et al., Am. J. Trop. Med. Hyg. 76:768-773, 2007). Furthermore, in clinical trials thus far, the drug appears to be safe, with a good pharmacokinetic profile. In this study, the efficacy of tecovirimat was evaluated in both a prelesional and postlesional setting in nonhuman primates challenged intravenously with 1 x 10(8) PFU of Variola virus (VARV; the causative agent of smallpox), a model for smallpox disease in humans. Following challenge, 50% of placebo-treated controls succumbed to infection, while all tecovirimat-treated animals survived regardless of whether treatment was started at 2 or 4 days postinfection. In addition, tecovirimat treatment resulted in dramatic reductions in dermal lesion counts, oropharyngeal virus shedding, and viral DNA circulating in the blood. Although clinical disease was evident in tecovirimat-treated animals, it was generally very mild and appeared to resolve earlier than in placebo-treated controls that survived infection. Tecovirimat appears to be an effective smallpox therapeutic in nonhuman primates, suggesting that it is reasonably likely to provide therapeutic benefit in smallpox-infected humans. |
Evaluation of the national human immunodeficiency virus surveillance system for the 2011 diagnosis year
Karch DL , Chen M , Tang T . J Public Health Manag Pract 2013 20 (6) 598-607 CONTEXT: In 2009, the Centers for Disease Control and Prevention completed migration of all 59 surveillance project areas (PAs) from the case-based HIV/AIDS Reporting System to the document-based Enhanced HIV/AIDS Reporting System. OBJECTIVES: We conducted a PA-level assessment of Enhanced HIV/AIDS Reporting System process and outcome standards for HIV infection cases. DESIGN: Process standards were reported by PAs and outcome standards were calculated using standardized Centers for Disease Control and Prevention SAS code. SETTING: A total of 59 PAs including 50 US states, the District of Columbia, 6 separately funded cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco), and 2 territories (Puerto Rico and the Virgin Islands). PARTICIPANTS: Cases diagnosed or reported to the PA surveillance system between January 1, 2011, and December 31, 2011, using data collected through December 2012. MAIN OUTCOME MEASURES: Process standards for death ascertainment and intra- and interstate case de-duplication; outcome standards for completeness and timeliness of case reporting, data quality, intrastate duplication rate, risk factor ascertainment, and completeness of initial CD4 and viral load reporting. RESULTS: Fifty-five of 59 PAs (93%) reported linking cases to state vital records death certificates during 2012, 76% to the Social Security Death Master File, and 59% to the National Death Index. Seventy percent completed monthly intrastate, and 63% completed semiannual interstate de-duplication. Eighty-three percent met the 85% or more case ascertainment standard, and 92% met the 66% or more timeliness standard; 75% met the 97% or more data quality standard; all PAs met the 5% or more intrastate duplication rate; 41% met the 85% or more risk factor ascertainment standard; 90% met the 50% or more standard for initial CD4; and 93% met the same standard for viral load reporting. Overall, 7% of PAs met all 11 process and outcome standards. CONCLUSIONS: Findings support the need for continued improvement in HIV surveillance activities and monitoring of system outcomes. |
Hepatitis C virus: an overview for dental health care providers
Klevens RM , Moorman AC . J Am Dent Assoc 2013 144 (12) 1340-7 BACKGROUND AND OVERVIEW: Changes in the science of hepatitis C virus (HCV) infection and transmission in a private dental practice provide an opportunity to update dental health care providers about this pathogen. The authors' aims in this review were to create awareness of health care- associated transmission of hepatitis C and provide an update on the changes in testing and treatment. The authors include data from population-based epidemiologic surveys, clinical practice guidelines, surveillance reports and practice protocols. RESULTS: In the United States, the elevated prevalence of chronic HCV infection among baby boomers-people born during the period from 1945 through 1965-led the Centers for Disease Control and Prevention to release new national screening guidelines. The authors summarize information about the natural history and epidemiology of hepatitis C and describe the new guidelines and novel treatment options. In addition, the authors provide an overview of how outbreaks of health care-associated HCV are detected and prevented. Practical Implications. Because dental health care professionals likely will treat people with current infection, education in the current science of HCV infection is useful. |
HPV and HPV-associated diseases
Dunne EF , Park IU . Infect Dis Clin North Am 2013 27 (4) 765-78 Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV is associated with a significant burden of disease and cancer, including anogenital warts and recurrent respiratory papillomatosis, and anogenital and oropharyngeal cancers. Effective prevention is available, including primary prevention of cancers and anogenital warts through HPV vaccination, and secondary prevention of cervical cancer through screening and treatment of precancer. This article focuses on HPV infection and the clinical consequences of infection, with attention to cervical and anogenital squamous intraepithelial neoplasia and anogenital warts. |
Interlaboratory variability of caspofungin MICs for candida spp. using CLSI and EUCAST methods: should the clinical laboratory be testing this agent?
Espinel-Ingroff A , Arendrup MC , Pfaller MA , Bonfietti LX , Bustamante B , Canton E , Chryssanthou E , Cuenca-Estrella M , Dannaoui E , Fothergill A , Fuller J , Gaustad P , Gonzalez GM , Guarro J , Lass-Flörl C , Lockhart SR , Meis JF , Moore CB , Ostrosky-Zeichner L , Pelaez T , Pukinskas SR , St-Germain G , Szeszs MW , Turnidge J . Antimicrob Agents Chemother 2013 57 (12) 5836-42 Although Clinical and Laboratory Standards Institute (CLSI) clinical breakpoints (CBPs) are available for interpreting echinocandin MICs for Candida spp., epidemiologic cutoff values (ECVs) based on collective MIC data from multiple laboratories have not been defined. While collating CLSI caspofungin MICs for 145 to 11,550 Candida isolates from 17 laboratories (Brazil, Canada, Europe, Mexico, Peru, and the United States), we observed an extraordinary amount of modal variability (wide ranges) among laboratories as well as truncated and bimodal MIC distributions. The species-specific modes across different laboratories ranged from 0.016 to 0.5 mug/ml for C. albicans and C. tropicalis, 0.031 to 0.5 mug/ml for C. glabrata, and 0.063 to 1 mug/ml for C. krusei. Variability was also similar among MIC distributions for C. dubliniensis and C. lusitaniae. The exceptions were C. parapsilosis and C. guilliermondii MIC distributions, where most modes were within one 2-fold dilution of each other. These findings were consistent with available data from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (403 to 2,556 MICs) for C. albicans, C. glabrata, C. krusei, and C. tropicalis. Although many factors (caspofungin powder source, stock solution solvent, powder storage time length and temperature, and MIC determination testing parameters) were examined as a potential cause of such unprecedented variability, a single specific cause was not identified. Therefore, it seems highly likely that the use of the CLSI species-specific caspofungin CBPs could lead to reporting an excessive number of wild-type (WT) isolates (e.g., C. glabrata and C. krusei) as either non-WT or resistant isolates. Until this problem is resolved, routine testing or reporting of CLSI caspofungin MICs for Candida is not recommended; micafungin or anidulafungin data could be used instead. |
Cell culture-selected substitutions in influenza A(H3N2) neuraminidase affect drug susceptibility assessment
Tamura D , Nguyen HT , Sleeman K , Levine M , Mishin VP , Yang H , Guo Z , Okomo-Adhiambo M , Xu X , Stevens J , Gubareva LV . Antimicrob Agents Chemother 2013 57 (12) 6141-6 Assessment of drug susceptibility has become an integral part of influenza virus surveillance. In this study, we describe the drug resistance profile of influenza A(H3N2) virus, A/Mississippi/05/2011, collected from a patient treated with oseltamivir and detected via surveillance. An MDCK cell-grown isolate of this virus exhibited highly reduced inhibition by the neuraminidase (NA) inhibitors (NAIs) oseltamivir (8,005-fold), zanamivir (813-fold), peramivir (116-fold), and laninamivir (257-fold) in the NA inhibition assay. Sequence analysis of its NA gene revealed a known oseltamivir-resistance marker, the glutamic acid-to-valine substitution at position 119 (E119V), and an additional change, threonine to isoleucine at position 148 (T148I). Unlike E119V, T148I was not detected in the clinical sample but acquired during viral propagation in MDCK cells. Using recombinant proteins, T148I by itself was shown to cause only a 6-fold increase in the zanamivir 50% inhibitory concentration (IC50) and had no effect on inhibition by other drugs. The T148I substitution reduced NA activity by 50%, most likely by affecting the positioning of the 150 loop at the NA catalytic site. Using pyrosequencing, changes at T148 were detected in 35 (23%) of 150 MDCK cell-grown A(H3N2) viruses tested, which was lower than the frequency of changes at D151 (85%), an NA residue previously implicated in cell selection. We demonstrate that culturing of the A(H3N2) viruses (n = 11) at a low multiplicity of infection delayed the emergence of the NA variants with changes at position 148 and/or 151, especially when conducted in MDCK-SIAT1 cells. Our findings highlight the current challenges in monitoring susceptibility of influenza A(H3N2) viruses to the NAI class of antiviral drugs. |
Comparing influenza positivity rates by real-time RT-PCR, elisa and viral culture methods in Cote D'ivoire, West Africa, in 2009
Nzussouo NT , Kadjo HA , Coulibaly D , Ekaza E , Kouakou B , N'Golo DC , Tempia S , Davis R , Dosso M , Thompson M . Afr J Infect Dis 2013 7 (2) 31-35 Detection of circulating influenza strains is a key public health concern especially in limited-resource settings where diagnosis capabilities remain a challenge. As part of multi-site surveillance in Cote d'Ivoire during the 2009 influenza A(H1N1) pandemic, we had the opportunity to test respiratory specimens collected from patients with acute respiratory illness (ARI). We analyzed and compared the percentage of specimens testing positive using three laboratory methods (rtRT-PCR, ELISA, viral culture). From January to October 2009, 1,356 respiratory specimens were collected from patients with acute respiratory illness and shipped at the WHO NIC (Institut Pasteur) Cote d'Ivoire, and 453 (33%) tested positive for influenza by one or more laboratory methods. The proportion of positive influenza tests did not differ by the sex or age of the patient or presenting symptoms, but did differ depending on the timing and site of specimen collection. Of the 453 positive specimens, 424 (93.6%) were detected by PCR, 199 (43.9%) by ELISA and 40 (8.8%) by viral culture. While seasonal influenza A(H1N1) virus strains were prominent, only four 2009 pandemic influenza A(H1N1) cases were detected. Use of molecular biology method (rtRTPCR) increased sensitivity and diagnosis capabilities. Among all three methods used, rRT-PCR was the most sensitive and rapid method. More capacity building is still required for viral culture. Need to collect denominator data in order to have an accurate estimate of the burden of influenza. There was delayed introduction of pandemic influenza A(H1N1)2009 in Cote d'Ivoire. |
A cysteine protease inhibitor rescues mice from a lethal cryptosporidium parvum infection
Ndao M , Nath-Chowdhury M , Sajid M , Marcus V , Mashiyama ST , Sakanari J , Chow E , Mackey Z , Land KM , Jacobson MP , Kalyanaraman C , McKerrow JH , Arrowood MJ , Caffrey CR . Antimicrob Agents Chemother 2013 57 (12) 6063-73 Cryptosporidiosis, caused by the protozoan parasite Cryptosporidium parvum, can stunt infant growth and can be lethal in immunocompromised individuals. The most widely used drugs for treating cryptosporidiosis are nitazoxanide and paromomycin, although both exhibit limited efficacy. To investigate an alternative approach to therapy, we demonstrate that the clan CA cysteine protease inhibitor N-methyl piperazine-Phe-homoPhe-vinylsulfone phenyl (K11777) inhibits C. parvum growth in mammalian cell lines in a concentration-dependent manner. Further, using the C57BL/6 gamma interferon receptor knockout (IFN-gammaR-KO) mouse model, which is highly susceptible to C. parvum, oral or intraperitoneal treatment with K11777 for 10 days rescued mice from otherwise lethal infections. Histologic examination of untreated mice showed intestinal inflammation, villous blunting, and abundant intracellular parasite stages. In contrast, K11777-treated mice (210 mg/kg of body weight/day) showed only minimal inflammation and no epithelial changes. Three putative protease targets (termed cryptopains 1 to 3, or CpaCATL-1, -2, and -3) were identified in the C. parvum genome, but only two are transcribed in infected mammals. A homology model predicted that K11777 would bind to cryptopain 1. Recombinant enzymatically active cryptopain 1 was successfully targeted by K11777 in a competition assay with a labeled active-site-directed probe. K11777 exhibited no toxicity in vitro and in vivo, and surviving animals remained free of parasites 3 weeks after treatment. The discovery that a cysteine protease inhibitor provides potent anticryptosporidial activity in an animal model of infection encourages the investigation and development of this biocide class as a new, and urgently needed, chemotherapy for cryptosporidiosis. |
Development of a small animal peripheral challenge model of Japanese encephalitis virus using interferon deficient AG129 mice and the SA14-14-2 vaccine virus strain
Calvert AE , Dixon KL , Delorey MJ , Blair CD , Roehrig JT . Vaccine 2013 32 (2) 258-64 Japanese encephalitis virus (JEV) is the most common cause of viral encephalitis in Asia, and it is increasingly a global public health concern due to its recent geographic expansion. While commercial vaccines are available and used in some endemic countries, JEV continues to be a public health problem, with 50,000 cases reported annually. Research with virulent JEV in mouse models to develop new methods of prevention and treatment is restricted to BSL-3 containment facilities, confining these studies to investigators with access to these facilities. We have developed an adult small animal peripheral challenge model using interferon-deficient AG129 mice and the JEV live-attenuated vaccine SA14-14-2, thus requiring only BSL-2 containment. A low dose of virus (10PFU/0.1ml) induced 100% morbidity in infected mice. Increased body temperatures measured by implantable temperature transponders correlated with an increase in infectious virus and viral RNA in serum, spleen and brain as well as an increase in pro-inflammatory markers measured by a 58-biomarker multi-analyte profile (MAP) constructed during the course of infection. In the future, the MAP measurements can be used as a baseline for comparison in order to better assess the inhibition of disease progression by other prophylactic and therapeutic agents. The use of the AG129/JEV SA14-14-2 animal model makes vaccine and therapeutic studies feasible for laboratories with limited biocontainment facilities. |
Local health department activities to ensure access to care
Luo H , Sotnikov S , Shah G . Am J Prev Med 2013 45 (6) 720-7 BACKGROUND: Local health departments (LHDs) can play an important role in linking people to personal health services and ensuring the provision of health care when it is otherwise unavailable. However, the extent to which LHDs are involved in ensuring access to health care in its jurisdictions is not well known. PURPOSE: To provide nationally representative estimates of LHD involvement in specific activities to ensure access to healthcare services and to assess their association with macro-environment/community and LHD capacity and process characteristics. METHODS: Data used were from the 2010 National Profile of Local Health Departments Study, Area Resource Files, and the Association of State and Territorial Health Officials' 2010 Profile of State Public Health Agencies Survey. Data were analyzed in 2012. RESULTS: Approximately 66.0% of LHDs conducted activities to ensure access to medical care, 45.9% to dental care, and 32.0% to behavioral health care. About 28% of LHDs had not conducted activities to ensure access to health care in their jurisdictions in 2010. LHDs with higher per capita expenditures and larger jurisdiction population sizes were more likely to provide access to care services (p <0.05). CONCLUSIONS: There is substantial variation in LHD engagement in activities to ensure access to care. Differences in LHD capacity and the needs of the communities in which they are located may account for this variation. Further research is needed to determine whether this variation is associated with adverse population health outcomes. |
Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009
Rossen LM , Khan D , Warner M . Am J Prev Med 2013 45 (6) e19-25 BACKGROUND: Drug poisoning mortality has increased substantially in the U.S. over the past 3 decades. Previous studies have described state-level variation and urban-rural differences in drug-poisoning deaths, but variation at the county level has largely not been explored in part because crude county-level death rates are often highly unstable. PURPOSE: The goal of the study was to use small-area estimation techniques to produce stable county-level estimates of age-adjusted death rates (AADR) associated with drug poisoning for the U.S., 1999-2009, in order to examine geographic and temporal variation. METHODS: Population-based observational study using data on 304,087 drug-poisoning deaths in the U.S. from the 1999-2009 National Vital Statistics Multiple Cause of Death Files (analyzed in 2012). Because of the zero-inflated and right-skewed distribution of drug-poisoning death rates, a two-stage modeling procedure was used in which the first stage modeled the probability of observing a death for a given county and year, and the second stage modeled the log-transformed drug-poisoning death rate given that a death occurred. Empirical Bayes estimates of county-level drug-poisoning death rates were mapped to explore temporal and geographic variation. RESULTS: Only 3% of counties had drug-poisoning AADRs greater than ten per 100,000 per year in 1999-2000, compared to 54% in 2008-2009. Drug-poisoning AADRs grew by 394% in rural areas compared to 279% for large central metropolitan counties, but the highest drug-poisoning AADRs were observed in central metropolitan areas from 1999 to 2009. CONCLUSIONS: There was substantial geographic variation in drug-poisoning mortality across the U.S. |
Role of chelation during pregnancy in the lead poisoned patient
Brown MJ . J Med Toxicol 2013 9 (4) 344-6 Cultural and environmental factors can cause lead poisoning in the pregnant patient. The data regarding the reproductive risks associated with chelation during human pregnancy are sparse. Assessment of the exposure setting, including anticipatory counseling for each pregnant woman, would help assure the ideal outcome of no added lead intake. |
Spotlight on ATSDR: exposure investigations
Kowalski P , Anderson B , Moore S , Wilder L . J Environ Health 2013 76 (5) 40-42 One way that the Agency for Toxic Substances and Disease Registry (ATSDR) accomplishes its mission of serving the public by promoting healthy and safe environments and preventing harmful exposures is by investigating and evaluating the potential public health consequences of exposures to environmental contamination at a community or site-specific level (ATSDR, 2013a). The first step in this process often involves reviewing and analyzing existing environmental and exposure-related data to find out whether people have been, are being, or may be exposed to environmental contaminants. ATSDR typically relies on environmental and exposure-related data provided by state and federal partners. In cases where critical data are not available and may not be forthcoming from another agency, ATSDR can conduct a site-specific exposure investigation to fill an identified data gap. Exposure investigations may include collection of (1) environmental samples of soil, water, air, or biota (e.g., fish, crab, fruits, or vegetables that people consume) and/or (2) biological samples of a person’s urine or blood that may contain biomarkers suggesting exposure to a specific contaminant. | ATSDR uses the following criteria to determine whether a proposed exposure investigation is feasible: | Can an exposed population be identified? | Does a critical data gap exist that affects our ability to determine if a health hazard exists? | Can an exposure investigation be designed that will address the critical data gap? | Will the results of the exposure investigation affect the public health decision(s) for the site? |
The use of public health informatics to improve environmental health practice
Coleman E , Delea K . J Environ Health 2013 76 (5) 44-45 Reliable, accurate public health information technology is essential for monitoring health and for evaluating and improving the delivery of public health practice (AbouZahr & Boerma, 2005). As the complexity and interdependencies of environmental health issues have grown, environmental health programs have begun to identify the emerging need for the integration of data from diverse sources. Environmental health agencies find it beneficial to share data not only between programs and divisions within their own departments, but also with other agencies within the state, region, and nation (Ohio Department of Health, 2011). | Fragmentation of environmental health data directly affects the ability of environmental health programs to protect the communities they serve. Currently, the enormity of available data and the paucity of usable information from the data are a paradox that often frustrates federal, state, and local environmental health officials. The barriers to accessing and using environmental health data restrict the ability of public health officials to address emerging health problems, educate decision makers and the public on the full impact of specific environmental hazards, and evaluate the effectiveness of interventions (Public Health Foundation, 1997). In order for environmental health programs to be effective and grow, the programs need reliable, timely information to make information-driven decisions, improve communication, and improve tools to analyze and present new data (Friede, Blum, & McDonald, 1995). |
Onsite wastewater system nitrogen contributions to groundwater in coastal North Carolina
Humphrey Jr C , O'Driscoll M; , Deal N , Lindbo D , Thieme S , Zarate-Bermudez M . J Environ Health 2013 76 (5) 16-22 The objective of the study described in this article was | to evaluate the nitrogen contributions from two onsite wastewater systems (sites 1 and 2) to groundwater and adjacent surface waters in coastal Beaufort County, North Carolina. Groundwater levels and water quality parameters including total nitrogen, nitrogen species, temperature, and pH were monitored from October 2009 to May 2010. Nitrogen was also tested in groundwater from deeper irrigation or drinking water wells from the two sites and six additional neighboring residences. Mean total nitrogen concentrations | in groundwater beneath onsite wastewater systems 1 and 2 were | 34.3 ± 16.7 mg/L and 12.2 ± 2.9 mg/L, respectively, and significantly higher than background groundwater concentrations (<1 mg/L). Groundwater in the deeper wells appeared not to be influenced by the onsite systems. Groundwater nitrogen concentrations typically decreased with distance down-gradient from the systems, but were still elevated relative to background conditions more than 15 m from the systems and near the estuary. This was a pioneering effort to better understand the link of onsite systems, the fate of nitrogen in the environment, and public health. |
Airborne exposure patterns from a passenger source in aircraft cabins
Bennett JS , Jones BW , Hosni MH , Zhang Y , Topmiller JL , Dietrich WL . HVAC&R Res 2013 19 (8) 962-973 Airflow is a critical factor that influences air quality, airborne contaminant distribution, and disease transmission in commercial airliner cabins. The general aircraft-cabin air-contaminant transport effect model seeks to build exposure-spatial relationships between contaminant sources and receptors, quantify the uncertainty, and provide a platform for incorporation of data from a variety of studies. Knowledge of infection risk to flight crews and passengers is needed to form a coherent response to an unfolding epidemic, and infection risk may have an airborne pathogen exposure component. The general aircraft-cabin air-contaminant transport effect model was applied to datasets from the University of Illinois and Kansas State University and also to case study information from a flight with probable severe acute respiratory syndrome transmission. Data were fit to regression curves, where the dependent variable was contaminant concentration (normalized for source strength and ventilation rate), and the independent variable was distance between source and measurement locations. The data-driven model showed exposure to viable small droplets and post-evaporation nuclei at a source distance of several rows in a mock-up of a twin-aisle airliner with seven seats per row. Similar behavior was observed in tracer gas, particle experiments, and flight infection data for severe acute respiratory syndrome. The study supports the airborne pathway as part of the matrix of possible disease transmission modes in aircraft cabins. |
Analysis of a novel field dilution method for testing samples that exceed the analytic range of point-of-care blood lead analyzers
Neri AJ , Roy J , Jarrett J , Pan Y , Dooyema C , Caldwell K , Umar-Tsafe NT , Olubiyo R , Brown MJ . Int J Environ Health Res 2013 24 (5) 418-28 Investigators developed and evaluated a dilution method for the LeadCare II analyzer (LCII) for blood lead levels >65 mug/dL, the analyzer's maximum reporting value. Venous blood samples from lead-poisoned children were initially analyzed in the field using the dilution method. Split samples were analyzed at the US Centers for Disease Control and Prevention (CDC) laboratory using both the dilution method and inductively coupled plasma-mass spectrometry (ICP-MS). The concordance correlation coefficient of CDC LCII vs. ICP-MS values (N = 211) was 0.976 (95 % confidence interval (CI) 0.970-0.981); of Field LCII vs. ICP-MS (N = 68) was 0.910 (95% CI 0.861-0.942), and CDC LCII vs. Field LCII (N = 53) was 0.721 (95% CI 0.565-0.827). Sixty percent of CDC and 54% of Field LCII values were within +/-10% of the ICP-MS value. Results from the dilution method approximated ICP-MS values and were useful for field-based decision-making. Specific recommendations for additional evaluation are provided. |
Characterization of hospitalized community-onset staphylococcus aureus lower respiratory tract infections among generally healthy persons 50 years of age or younger
Tosh PK , Bulens SN , Nadle J , Dumyati G , Lynfield R , Schaffner W , Ray SM , Seema J , Scott F , Sievert D . Infect Dis Clin Pract (Baltim Md) 2013 21 (6) 359-365 BACKGROUND: Case series have described severe lower respiratory tract infection (LRI) in healthy, community-dwelling persons caused by methicillin-resistant Staphylococcus aureus (MRSA). Evaluating populations at risk is needed. METHODS: Surveillance for patients aged 50 years or younger hospitalized with LRI who had S aureus isolated from blood or respiratory specimen during September 2008 to August 2010 was performed at 25 hospitals in 5 US metropolitan areas. Persons with recent health care exposure were excluded. Lower respiratory tract infection diagnosis required supporting radiographic or clinical evidence. Clinical characteristics of LRI were compared by methicillin resistance phenotype. RESULTS: In total, 94 hospitalized community-onset S aureus LRI cases were identified. Lower respiratory tract infection cases were identified in both young adults and children (60%, 35-50 years; and 19%, younger than 17 years), without any seasonality or association with influenza circulation. Among the 94 case patients with LRI, 34 patients (36%) had bacteremia, 36 patients (40%) required ICU admission, and 6 patients (6%) died; proportions were similar between cases with methicillin-susceptible S aureus and MRSA. Lower respiratory tract infection cases with MRSA had longer median length of stay compared with those with methicillin-susceptible S aureus (9 vs. 6 days; P = 0.04). Lower respiratory tract infection cases with evidence of influenza infection had higher mortality compared with LRI cases without influenza infection (31% vs. 2%; P = 0.003). During influenza circulation, 35 (55%) of 64 case patients with LRI were tested for influenza, and 9 (26%) of the 35 case patients tested positive. CONCLUSIONS: S aureus LRI occurred in both adults and children, without any seasonality or association with MRSA and with and without evidence of influenza infection, although case fatality was higher among those with evidence of influenza infection. 2013 by Lippincott Williams & Wilkins. |
Characterizing concentrations of diethylene glycol and suspected metabolites in human serum, urine, and cerebrospinal fluid samples from the Panama DEG mass poisoning
Schier JG , Hunt DR , Perala A , McMartin KE , Bartels MJ , Lewis LS , McGeehin MA , Flanders WD . Clin Toxicol (Phila) 2013 51 (10) 923-9 CONTEXT: Diethylene glycol (DEG) mass poisoning is a persistent public health problem. Unfortunately, there are no human biological data on DEG and its suspected metabolites in poisoning. If present and associated with poisoning, the evidence for use of traditional therapies such as fomepizole and/or hemodialysis would be much stronger. OBJECTIVE: To characterize DEG and its metabolites in stored serum, urine, and cerebrospinal fluid (CSF) specimens obtained from human DEG poisoning victims enrolled in a 2006 case-control study. METHODS: In the 2006 study, biological samples from persons enrolled in a case-control study (42 cases with new-onset, unexplained AKI and 140 age-, sex-, and admission date-matched controls without AKI) were collected and shipped to the Centers for Disease Control and Prevention (CDC) in Atlanta for various analyses and were then frozen in storage. For this study, when sufficient volume of the original specimen remained, the following analytes were quantitatively measured in serum, urine, and CSF: DEG, 2-hydroxyethoxyacetic acid (HEAA), diglycolic acid, ethylene glycol, glycolic acid, and oxalic acid. Analytes were measured using low resolution GC/MS, descriptive statistics calculated and case results compared with controls when appropriate. Specimens were de-identified so previously collected demographic, exposure, and health data were not available. The Wilcoxon Rank Sum test (with exact p-values) and bivariable exact logistic regression were used in SAS v9.2 for data analysis. RESULTS: The following samples were analyzed: serum, 20 case, and 20 controls; urine, 11 case and 22 controls; and CSF, 11 samples from 10 cases and no controls. Diglycolic acid was detected in all case serum samples (median, 40.7 mcg/mL; range, 22.6-75.2) and no controls, and in all case urine samples (median, 28.7 mcg/mL; range, 14-118.4) and only five (23%) controls (median, < Lower Limit of Quantitation (LLQ); range, < LLQ-43.3 mcg/mL). Significant differences and associations were identified between case status and the following: 1) serum oxalic acid and serum HEAA (both OR = 14.6; 95% C I = 2.8-100.9); 2) serum diglycolic acid and urine diglycolic acid (both OR > 999; exact p < 0.0001); and 3) urinary glycolic acid (OR = 0.057; 95% C I = 0.001-0.55). Two CSF sample results were excluded and two from the same case were averaged, yielding eight samples from eight cases. Diglycolic acid was detected in seven (88%) of case CSF samples (median, 2.03 mcg/mL; range, < LLQ, 7.47). Discussion. Significantly elevated HEAA (serum) and diglycolic acid (serum and urine) concentrations were identified among cases, which is consistent with animal data. Low urinary glycolic acid concentrations in cases may have been due to concurrent AKI. Although serum glycolic concentrations among cases may have initially increased, further metabolism to oxalic acid may have occurred thereby explaining the similar glycolic acid concentrations in cases and controls. The increased serum oxalic acid concentration results in cases versus controls are consistent with this hypothesis. CONCLUSION: Diglycolic acid is associated with human DEG poisoning and may be a biomarker for poisoning. These findings add to animal data suggesting a possible role for traditional antidotal therapies. The detection of HEAA and diglycolic acid in the CSF of cases suggests a possible association with signs and symptoms of DEG-associated neurotoxicity. Further work characterizing the pathophysiology of DEG-associated neurotoxicity and the role of traditional toxic alcohol therapies such as fomepizole and hemodialysis is needed. |
Community health assessment following mercaptan spill: Eight Mile, Mobile County, Alabama, September 2012
Behbod B , Parker EM , Jones EA , Bayleyegn T , Guarisco J , Morrison M , McIntyre MG , Knight M , Eichold B , Yip F . J Public Health Manag Pract 2013 20 (6) 632-9 CONTEXT: In 2008, a lightning strike caused a leak of tert-butyl mercaptan from its storage tank at the Gulf South Natural Gas Pumping Station in Prichard, Alabama. On July 27, 2012, the Alabama Department of Public Health requested Centers for Disease Control and Prevention epidemiologic assistance investigating possible health effects resulting from airborne exposure to mercaptan from a contaminated groundwater spring, identified in January 2012. OBJECTIVE: To assess the self-reported health effects in the community, to determine the scope of the reported medical services received, and to develop recommendations for prevention and response to future incidents. DESIGN:: In September 2012, we performed a representative random sampling design survey of households, comparing reported exposures and health effects among residents living in 2 circular zones located within 1 and 2 miles from the contaminated source. SETTING: Eight Mile community, Prichard, Alabama. PARTICIPANTS: We selected 204 adult residents of each household (≥18 years) to speak for all household members. MAIN OUTCOME MEASURES: Self-reported mercaptan odor exposure, physical and mental health outcomes, and medical-seeking practices, comparing residents in the 1- and 2-mile zones. RESULTS:: In the past 6 months, 97.9% of respondents in the 1-mile zone and 77.6% in the 2-mile zone reported mercaptan odors. Odor severity was greater in the 1-mile zone, in which significantly more subjects reported exposures aggravating their physical and mental health including shortness of breath, eye irritations, and agitated behavior. Overall, 36.5% sought medical care for odor-related symptoms. CONCLUSIONS: Long-term odorous mercaptan exposures were reportedly associated with physical and psychological health complaints. Communication messages should include strategies to minimize exposures and advise those with cardiorespiratory conditions to have medications readily available. Health care practitioners should be provided information on mercaptan health effects and approaches to prevent exacerbating existing chronic diseases. |
How can we improve tracking of transplanted tissue in the United States?
Mahajan R , Kuehnert MJ . Cell Tissue Bank 2013 15 (3) 287-9 Currently an estimated two million tissues are distributed for transplantation annually. With increasing use of recovered tissue, clusters of transplant-transmitted infection have shown the difficulty of tracking tissues from an infected donor to the recipient. The challenge of tissue tracking to multiple transplant recipients was illustrated in a recent investigation of transmission of hepatitis C virus infection from a donor of organs and tissues. When a tissue bank issued a recall of the donated tissue, the Centers for Disease Control and Prevention was notified to assist public health authorities; the mean time to locate and notify the physicians who had transplanted the tissue was 13 days, while the mean time to notify, inform, and test the patients was 29 days. Lack of common coding and nomenclature was one of the key challenges in tracking tissue to the recipient. Some changes that could improve timeliness in the event of a recall includes: (1) standardized tissue nomenclature and coding through unique donor identifiers; (2) tissue traceability requirements using systems similar to that used for blood products; (3) a surveillance system for adverse events that provides feedback at the provider level. |
Recommendations for returning genomic incidental findings? We need to talk!
Burke W , Antommaria AH , Bennett R , Botkin J , Clayton EW , Henderson GE , Holm IA , Jarvik GP , Khoury MJ , Knoppers BM , Press NA , Ross LF , Rothstein MA , Saal H , Uhlmann WR , Wilfond B , Wolf SM , Zimmern R . Genet Med 2013 15 (11) 854-9 The American College of Medical Genetics and Genomics recently issued recommendations for reporting incidental findings from clinical whole-genome sequencing and whole-exome sequencing. The recommendations call for evaluating a specific set of genes as part of all whole-genome sequencing/whole-exome sequencing and reporting all pathogenic variants irrespective of patient age. The genes are associated with highly penetrant disorders for which treatment or prevention is available. The effort to generate a list of genes with actionable findings is commendable, but the recommendations raise several concerns. They constitute a call for opportunistic screening, through intentional effort to identify pathogenic variants in specified genes unrelated to the clinical concern that prompted testing. Yet for most of the genes, we lack evidence about the predictive value of testing, genotype penetrance, spectrum of phenotypes, and efficacy of interventions in unselected populations. Furthermore, the recommendations do not allow patients to decline the additional findings, a position inconsistent with established norms. Finally, the recommendation to return adult-onset disease findings when children are tested is inconsistent with current professional consensus, including other policy statements of the American College of Medical Genetics and Genomics. Instead of premature practice recommendations, we call for robust dialogue among stakeholders to define a pathway to normatively sound, evidence-based guidelines. |
Economic analyses of genetic tests in personalized medicine: clinical utility first, then cost utility.
Grosse SD . Genet Med 2013 16 (3) 225-7 In the current issue of Genetics in Medicine, Phillips et al.1 report a thorough systematic review of published cost-utility analyses (CUAs) of clinical molecular genetic tests, or personalized medicine tests as the authors refer to them. By analyzing the Tufts Cost-Effectiveness Analysis Registry, the authors identified 59 CUAs published from 1995 through to 2011 that were considered to fulfill the study criteria. One of those, however, evaluated the use of a biomarker, transferrin saturation, to test for hereditary hemochromatosis and was published in 1995,2 before the discovery of HFE in 1996. All the studies in the Cost-Effectiveness Analysis Registry use quality-adjusted life-years (QALYs) as the metric of health outcomes. The Cost-Effectiveness Analysis Registry is a comprehensive database of published CUAs that lends itself to systematic reviews with a high degree of completeness of coverage. The Cost-Effectiveness Analysis Registry has been used in numerous published analyses to study the evolution of economic evaluation in various areas of health, but this is the first analysis of the registry to focus on genomic or personalized medicine. Previous systematic reviews on economic evaluations of genetic testing have included other methods of economic evaluations in addition to CUA but may have had lesser sensitivity in identifying relevant publications. | The authors report that 20% (n = 12) of the 59 CUA studies in their sample (including a CUA of phenotypic cascade screening for hemochromatosis)2 reported negative incremental direct medical costs, i.e., cost saving. This is similar to the fraction of clinical preventive services recommended by the US Preventive Services Task Force calculated to be cost saving.3 An additional 60% of incremental cost-effectiveness ratios (ICERs) were positive, i.e., not cost saving, and less than US$100,000 per QALY, a threshold for assessing the cost effectiveness commonly cited in the US publications. |
Internal transcribed spacer rRNA gene sequencing analysis of fungal diversity in Kansas City indoor environments.
Rittenour WR , Ciaccio CE , Barnes CS , Kashon ML , Lemons AR , Beezhold DH , Green BJ . Environ Sci Process Impacts 2013 16 (1) 33-43 Compared to traditional methods of fungal exposure assessment, molecular methods have provided new insight into the richness of fungal communities present in both indoor and outdoor environments. In this study, we describe the diversity of fungi in the homes of asthmatic children located in Kansas City. Fungal diversity was determined by sequencing the internal transcribed spacer (ITS) regions of ribosomal RNA derived from fungi collected in air and dust samples from 31 homes participating in the Kansas City Safe and Healthy Homes Program (KCSHHP). Sequencing results were then compared to data obtained using viable and non-viable fungal exposure assessment methods. ITS clone libraries were predominantly derived from the phylum Ascomycota in both air (68%) and dust (92%) samples and followed by the Basidiomycota and Zygomycota. The majority of Ascomycota clones belonged to four orders including the Pleosporales, Eurotiales, Capnodiales, and Dothideales. ITS sequencing revealed the presence of a number of rarely documented fungal species placed in the Pleosporales. Several species placed in the Basidiomycota were detected in ITS clone libraries but not by viable or non-viable methods. The prevalence of organizational taxonomic units (OTUs) was significantly higher in air than in dust samples (p < 0.0001); however, no differences between OTUs in air samples collected in the subjects' room and basement were observed. These sequencing results demonstrate a much broader diversity of Ascomycota and Basidiomycota communities in KCSHHP indoor environments than previously estimated using traditional methods of assessment. |
Development of a loop-mediated isothermal amplification method for detection of Histoplasma capsulatum DNA in clinical samples.
Scheel CM , Zhou Y , Theodoro RC , Abrams B , Balajee SA , Litvintseva AP . J Clin Microbiol 2013 52 (2) 483-8 Improved methods for detection of Histoplasma capsulatum are needed in endemic regions with limited resources, where delayed diagnosis of progressive disseminated histoplasmosis (PDH) results in high mortality. We have investigated the use of a loop-mediated isothermal amplification (LAMP) assay to facilitate rapid, inexpensive, molecular diagnosis of this disease. Primers for LAMP were designed to amplify the Hcp100 locus of H. capsulatum. Sensitivity and limit of detection were evaluated using DNA extracted from 91 clinical isolates of known geographic subspecies, while assay specificity was determined using DNA extracted from 50 other fungi and Mycobacterium tuberculosis. Urines (n = 6) collected from HIV-positive individuals with culture and antigen-proven histoplasmosis were evaluated using the LAMP assay. Specimens from healthy persons (n = 10) without evidence of histoplasmosis were used as assay controls. The Hcp100 LAMP was 100% sensitive and specific when tested with DNA extracted from culture isolates. The median limit of detection was <= 30 genomes (Range: 1-30) for all but one geographic subspecies. The LAMP detected Hcp100 in 67% (4/6) of antigen-positive urines, and was negative for Hcp100 in all healthy control urines. We have shown that the Hcp100 LAMP is a rapid, affordable assay that can be used to expedite culture confirmation of H. capsulatum in PDH-endemic regions. Further, our results indicate proof-of-concept that the assay can be used to detect Histoplasma DNA in urine. Further evaluation of this assay using body fluids from a larger patient population is warranted. |
Indoor tanning among young non-Hispanic white females
Guy GP Jr , Berkowitz Z , Watson M , Holman DM , Richardson LC . JAMA Intern Med 2013 173 (20) 1920-2 Indoor tanning is associated with an increased risk of skin cancer, especially among frequent users and those initiating use at a young age.1,2 Indoor tanning before age 35 years increases melanoma risk by 59% to 75%,1 while use before age 25 years increases nonmelanoma skin cancer risk by 40% to 102%.2 Moreover, melanoma risk increases by 1.8% with each additional tanning session per year.1 Melanoma incidence rates are steadily increasing, especially among young non-Hispanic white females, which may be due, in part, to indoor tanning.1,3 Currently, prevalence estimates of indoor tanning among this population are limited. Therefore, we examined the prevalence of indoor tanning and frequent indoor tanning (≥10 times) using nationally representative data among non-Hispanic white female high school students and adults ages 18 to 34 years. |
Value of social media in reaching and engaging employers in Total Worker Health
Hudson H , Hall J . J Occup Environ Med 2013 55 S78-81 OBJECTIVE: To describe the initial use of social media by the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health (TWH) Program and the University of Iowa Healthier Workforce Center for Excellence (HWCE) Outreach Program. METHODS: Social media analytics tools and process evaluation methods were used to derive initial insights on the social media strategies used by the NIOSH and the HWCE. RESULTS: The on-line community size for the NIOSH TWH Program indicated 100% growth in 6 months; however, social media platforms have been slow to gain participation among employers. CONCLUSION: The NIOSH TWH Program and the HWCE Outreach Program have found social media tools as an effective way to expand reach, foster engagement, and gain understanding of audience interests around TWH concepts. More needs to be known about how to best use social media to reach and engage target audiences on issues relevant to TWH. |
Families matter! Presexual risk prevention intervention
Miller KS , Lasswell SM , Riley DB , Poulsen MN . Am J Public Health 2013 103 (11) e16-20 Parent-based HIV prevention programming may play an important role in reaching youths early to help establish lifelong patterns of safe and healthy sexual behaviors. Families Matter! is a 5-session, evidence-based behavioral intervention designed for primary caregivers of children aged 9 to 12 years to promote positive parenting and effective parent-child communication about sexuality and sexual risk reduction. The program's 5-step capacity-building model was implemented with local government, community, and faith-based partners in 8 sub-Saharan African countries with good intervention fidelity and high levels of participant retention. Families Matter! may be useful in other resource-constrained settings. |
Reaching children never previously vaccinated for influenza through a school-located vaccination program
Kansagra SM , Papadouka V , Geevarughese A , Hansen MA , Konty KJ , Zucker JR . Am J Public Health 2013 104 (1) e45-9 OBJECTIVES: We determined the success of the school-located vaccination (SLV) program, implemented in 2009 in New York City to deliver pandemic influenza A (H1N1) monovalent vaccine (pH1N1), versus provider offices in reaching children who had never previously received influenza vaccine. METHODS: We compared the immunization history of children vaccinated in school versus provider offices. We included records in the Citywide Immunization Registry with pH1N1 administered between October 2009 and March 2010 to elementary school-aged children. RESULTS: In total, 96 524 children received pH1N1 vaccine in schools, and 102 933 children received pH1N1 vaccine in provider offices. Of children vaccinated in schools, 34% had never received seasonal influenza vaccination in the past, compared with only 10% of children vaccinated at provider offices (P < .001). Children vaccinated in schools were more likely to have received a second dose of pH1N1 in 2009-2010 than those vaccinated in provider offices (80% vs 45%). CONCLUSIONS: The SLV program was more successful at reaching children who had never received influenza immunization in the past and should be considered as a strategy for delivering influenza vaccine in routine and emergency situations. |
Statewide pandemic influenza vaccination reminders for children with chronic conditions
Dombkowski KJ , Cowan AE , Potter RC , Dong S , Kolasa M , Clark SJ . Am J Public Health 2013 104 (1) e39-44 OBJECTIVES: We evaluated the use of a statewide immunization information system (IIS) to target influenza vaccine reminders to high-risk children during a pandemic. METHODS: We used Michigan's IIS to identify high-risk children (i.e., those with ≥ 1 chronic condition) aged 6 months to 18 years with no record of pH1N1 vaccination among children currently or previously enrolled in Medicaid (n = 202 133). Reminders were mailed on December 7, 2009. We retrospectively assessed children's eligibility for evaluation and compared influenza vaccination rates across 3 groups on the basis of their high-risk and reminder status. RESULTS: Of the children sent reminders, 53 516 were ineligible. Of the remaining 148 617 children, vaccination rates were higher among the 142 383 high-risk children receiving reminders than among the 6234 high-risk children with undeliverable reminders and the 142 383 control group children without chronic conditions who were not sent reminders. CONCLUSIONS: Midseason reminders to parents of unvaccinated high-risk children with current or past Medicaid enrollment were associated with increased pH1N1 and seasonal influenza vaccination rates. Future initiatives should consider strategies to expand targeting of high-risk groups and improve IIS reporting during pandemic events. |
A systematic evaluation of different methods for calculating adolescent vaccination levels using immunization information system data
Gowda C , Dong S , Potter RC , Dombkowski KJ , Stokley S , Dempsey AF . Public Health Rep 2013 128 (6) 489-97 OBJECTIVE: Immunization information systems (IISs) are valuable surveillance tools; however, population relocation may introduce bias when determining immunization coverage. We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS. METHODS: We performed a retrospective analysis of the Michigan State Care Improvement Registry (MCIR) for all adolescents aged 11-18 years registered in the MCIR as of October 2010. We explored four methods for determining denominators: (1) including all adolescents with MCIR records, (2) excluding adolescents with out-of-state residence, (3) further excluding those without MCIR activity ≥10 years prior to the evaluation date, and (4) using a denominator based on U.S. Census data. We estimated state- and county-specific coverage levels for four adolescent vaccines. RESULTS: We found a 20% difference in estimated vaccination coverage between the most inclusive and restrictive denominator populations. Although there was some variability among the four methods in vaccination at the state level (2%-11%), greater variation occurred at the county level (up to 21%). This variation was substantial enough to potentially impact public health assessments of immunization programs. Generally, vaccines with higher coverage levels had greater absolute variation, as did counties with smaller populations. CONCLUSION: At the county level, using the four denominator calculation methods resulted in substantial differences in estimated adolescent immunization rates that were less apparent when aggregated at the state level. Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data. |
Mumps vaccine effectiveness and risk factors for disease in households during an outbreak in New York City
Livingston KA , Rosen JB , Zucker JR , Zimmerman CM . Vaccine 2013 32 (3) 369-74 BACKGROUND AND OBJECTIVES: Mumps outbreaks have been reported among vaccinated populations, and declining mumps vaccine effectiveness (VE) has been suggested as one possible cause. During a large mumps outbreak in New York City, we assessed: (1) VE of measles-mumps-rubella vaccine (MMR) against mumps and (2) risk factors for acquiring mumps in households. METHODS: Cases of mumps were investigated using standard methods. Additional information on disease and vaccination status of household contacts was collected. Case households completed follow-up phone interviews 78-198 days after initial investigation to ascertain additional cases. Mumps cases meeting the study case definition were included in the analysis. Risk factors for mumps were assessed, and VE was calculated using secondary household attack rates. RESULTS: Three hundred and eleven households with 2176 residents were included in the analysis. The median age of residents was 13 years (range <1-85), and 462 (21.2%) residents met the study mumps case definition. Among 7-17 year olds, 89.7% received one or more doses of MMR vaccine, with 76.7% receiving two doses. Young adults aged 10-14 years (OR=2.4, CI=1.3-4.7) and 15-19 years (OR=2.5, CI=1.3-5.0) were at highest risk of mumps. The overall 2-dose VE for secondary contacts aged five and older was 86.3% (CI 63.3-94.9). CONCLUSIONS: The two-dose effectiveness of MMR vaccine against mumps was 86.3%, consistent with other published mumps VE estimates. Many factors likely contributed to this outbreak. Suboptimal MMR coverage in the affected population combined with VE may not have conferred adequate immunity to prevent transmission and may have contributed to this outbreak. Achieving high MMR coverage remains the best available strategy for prevention of mumps outbreaks. |
Population impact of HPV vaccines: summary of early evidence
Hariri S , Markowitz LE , Dunne EF , Unger ER . J Adolesc Health 2013 53 (6) 679-82 Human papillomavirus (HPV) vaccines are available in the United States and around the world to prevent HPV-associated diseases including cervical cancer and genital warts. HPV vaccination is currently recommended for adolescents: target ages for routine and catch-up vaccinations vary by country. Because the time from vaccination to cancer development can be several decades, many studies are evaluating more immediate outcomes. In the 4 years since the vaccine was introduced, reductions in HPV vaccine type prevalence and genital warts have been reported in young females in the United States and other countries. Many questions remain about the long-term impact, but the initial studies show promising results for the relatively new HPV vaccine. |
Effect of vaccination coordinators on socioeconomic disparities in immunization among the 2006 connecticut birth cohort
Kattan JA , Kudish KS , Cadwell BL , Soto K , Hadler JL . Am J Public Health 2013 104 (1) e74-81 OBJECTIVES:. We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan-funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months. METHODS: We examined predictors of underimmunization among the 2006 birth cohort (n = 34 568) in the state's Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses. RESULTS: Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization. CONCLUSIONS: SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities. |
Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: a population-based case-control study during the 2010-2011 and 2011-2012 influenza seasons
Thompson MG , Li DK , Shifflett P , Sokolow LZ , Ferber JR , Kurosky S , Bozeman S , Reynolds SB , Odouli R , Henninger ML , Kauffman TL , Avalos LA , Ball S , Williams JL , Irving SA , Shay DK , Naleway AL . Clin Infect Dis 2013 58 (4) 449-57 BACKGROUND: Although vaccination with trivalent inactivated influenza vaccine (TIV) is recommended for all pregnant women, no vaccine effectiveness (VE) studies of TIV in pregnant women have assessed laboratory-confirmed influenza outcomes. METHODS: We conducted a case-control study over two influenza seasons (2010-2011 and 2011-2012) among Kaiser Permanente health plan members in two metropolitan areas in California and Oregon. We compared the proportion vaccinated among 100 influenza cases (confirmed by RT-PCR) with the proportions vaccinated among 192 controls with acute respiratory illness (ARI) who tested negative for influenza and 200 controls without ARI (matched by season, site, and trimester). RESULTS: Among influenza cases, 42% were vaccinated during the study season compared to 58% and 63% vaccinated among influenza-negative controls and matched ARI-negative controls, respectively. The adjusted VE (95% confidence interval [CI]) of the current season vaccine against influenza A and B was 44% (5%-67%) using the influenza-negative controls and 53% (24%-72%) using the ARI-negative controls. Receipt of the prior season's vaccine, however, had an effect similar to receipt of the current season's vaccine. As such, vaccination in either or both seasons had statistically similar adjusted VE using influenza-negative controls (VE point estimates range=51%-76%) and ARI-negative controls (48%-76%). CONCLUSIONS: Influenza vaccination reduced the risk of ARI associated with laboratory-confirmed influenza among pregnant women by over one-half, similar to VE observed among all adults during these seasons. |
Acceptability of hypothetical dengue vaccines among travelers
Benoit CM , Macleod WB , Hamer DH , Sanchez-Vegas C , Chen LH , Wilson ME , Karchmer AW , Yanni E , Hochberg NS , Ooi WW , Kogelman L , Barnett ED . J Travel Med 2013 20 (6) 346-51 BACKGROUND: Dengue viruses have spread widely in recent decades and cause tens of millions of infections mostly in tropical and subtropical areas. Vaccine candidates are being studied aggressively and may be ready for licensure soon. METHODS: We surveyed patients with past or upcoming travel to dengue-endemic countries to assess rates and determinants of acceptance for four hypothetical dengue vaccines with variable efficacy and adverse event (AE) profiles. Acceptance ratios were calculated for vaccines with varied efficacy and AE risk. RESULTS: Acceptance of the four hypothetical vaccines ranged from 54% for the vaccine with lower efficacy and serious AE risk to 95% for the vaccine with higher efficacy and minor AE risk. Given equal efficacy, vaccines with lower AE risk were better accepted than those with higher AE risk; given equivalent AE risk, vaccines with higher efficacy were better accepted than those with lower efficacy. History of Japanese encephalitis vaccination was associated with lower vaccine acceptance for one of the hypothetical vaccines. US-born travelers were more likely than non-US born travelers to accept a vaccine with 75% efficacy and a risk of minor AEs (p = 0.003). Compared with North American-born travelers, Asian- and African-born travelers were less likely to accept both vaccines with 75% efficacy. CONCLUSIONS: Most travelers would accept a safe and efficacious dengue vaccine if one were available. Travelers valued fewer potential AEs over increased vaccine efficacy. |
Barriers to human papillomavirus vaccination among US adolescents: A systematic review of the literature
Holman DM , Benard V , Roland KB , Watson M , Liddon N , Stokley S . JAMA Pediatr 2013 168 (1) 76-82 IMPORTANCE: Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines. OBJECTIVE: To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage. EVIDENCE REVIEW: We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males. FINDINGS: Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine's effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children. CONCLUSIONS AND RELEVANCE: Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake. |
Travel-related behaviors, opinions, and concerns of U.S. adult drivers by race/ethnicity, 2010
Bhat G , Naumann RB . J Safety Res 2013 47 93-7 INTRODUCTION: The U.S. population is shifting to become both older and more racially and ethnically diverse. Our current understanding of U.S. drivers' travel-related needs and concerns by race/ethnicity is limited. METHODS: Data from the 2010 HealthStyles survey, an annual, cross-sectional, national mail-panel survey of persons ages 18years or older living in the United States, were used to calculate weighted percentages of travel-related behaviors, opinions, and concerns by race/ethnicity. Logistic regression was used to explore associations between race/ethnicity and specific travel-related concerns, while adjusting for other demographic characteristics. RESULTS: Adequate transportation alternatives to driving were reported by a greater percentage of persons in certain minority groups compared to whites (Hispanic: 34.7%; white: 23.4%). Concern for the availability of alternatives to driving in the future was greater among minority groups (black: 57.7%; Hispanic: 47.3%; other: 50.9%) compared to whites (37.5%). Additionally, among persons with a household income of $25,000+, minorities were generally more likely than whites to report concern about having alternative transportation options to driving, whereas concern was consistently high among all racial/ethnic groups for those earning less than $25,000 annually. In each racial/ethnic group, more than 10% of persons reported not knowing how they would get around if they could no longer drive. CONCLUSIONS: Important variations by race/ethnicity in both travel behaviors and concerns for adequate alternatives to driving were found, revealing the need for further research to better understand reasons for these differences and to identify ways to meet the transportation needs of the changing U.S. population demographics. IMPACT ON INDUSTRY: Further research on adequate alternatives to driving and transportation needs is needed. |
Non-robbery-related occupational homicides in the retail industry, 2003-2008
Konda S , Tiesman HM , Hendricks S , Gurka KK . Am J Ind Med 2013 57 (2) 245-53 BACKGROUND: The purpose of this study was to examine non-robbery-related occupational homicides in the retail industry from 2003 to 2008. METHODS: Data were abstracted from the Census of Fatal Occupational Injuries. Motive (robbery- or non-robbery-related) and workplace violence (WPV) typology (Type I-IV) were assigned using narrative text fields. Non-robbery-related homicide rates were calculated and compared among WPV types, demographic characteristics, and occupation. RESULTS: Twenty-eight percent of homicides that occurred in the retail industry were non-robbery-related. The leading event associated with non-robbery-related homicides was Type II (perpetrated by customers) (34%), followed by Type IV (perpetrated by personal relationship) (31%). The majority of homicides were due to arguments (50%). Security guards and workers in drinking establishments had the highest homicide rates per 100,000 workers (14.3 and 6.0, respectively). CONCLUSIONS: Non-robbery-related homicides comprised a meaningful proportion of workplace homicides in the retail industry. Research is needed to develop strategies to prevent non-robbery-related homicides specifically. |
Use of proficiency testing as a tool to improve quality in microbiology laboratories
Stang HL , Anderson NL . Clin Microbiol Newsl 2013 35 (18) 145-152 Proficiency testing (PT) is a valuable tool for assessing laboratory performance and verifying the accuracy and reliability of test results. Participation is required by the Clinical Laboratory Improvement Amendments (CLIA) of 1988 for each of the microbiology subspecialties (bacteriology, mycobacteriology, mycology, parasitology, and virology), and the regulations include specific PT requirements for each subspecialty. To determine the use and perceived value of PT beyond meeting CLIA requirements, the Centers for Disease Control and Prevention funded a cooperative agreement with the Association of Public Health Laboratories to convene a series of focus groups to query laboratory professionals responsible for PT. The seven focus groups were comprised of 60 laboratory professionals representing large and small clinical laboratories, microbiology subspecialties, and public health. While participants acknowledged the need to perform PT to meet regulatory requirements, many also cited benefits and challenges beyond regulatory compliance. |
Evaluating New York City's abortion reporting system: insights for public health data collection systems
Toprani A , Madsen A , Das T , Gambatese M , Greene C , Begier E . J Public Health Manag Pract 2013 20 (4) 392-400 CONTEXT: New York City (NYC) mandates reporting of all abortion procedures. These reports enable tracking of abortion incidence and underpin programs, policy, and research. Since January 2011, the majority of abortion facilities must report electronically. OBJECTIVES: We conducted an evaluation of NYC's abortion reporting system and its transition to electronic reporting. We summarize the evaluation methodology and results and draw lessons relevant to other vital statistics and public health reporting systems. DESIGN: The evaluation followed Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems. We interviewed key stakeholders and conducted a data provider survey. In addition, we compared the system's abortion counts with external estimates and calculated the proportion of missing and invalid values for each variable on the report form. Finally, we assessed the process for changing the report form and estimated system costs. SETTING: NYC Health Department's Bureau of Vital Statistics. MAIN OUTCOME MEASURES: Usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, timeliness, and stability of the abortion reporting system. RESULTS: Ninety-five percent of abortion data providers considered abortion reporting important; 52% requested training regarding the report form. Thirty percent reported problems with electronic biometric fingerprint certification, and 18% reported problems with the electronic system's stability. Estimated system sensitivity was 88%. Of 17 variables, education and ancestry had more than 5% missing values in 2010. Changing the electronic reporting module was costly and time-consuming. System operating costs were estimated at $80 136 to $89 057 annually. CONCLUSIONS: The NYC abortion reporting system is sensitive and provides high-quality data, but opportunities for improvement include facilitating biometric certification, increasing electronic platform stability, and conducting ongoing outreach and training for data providers. This evaluation will help data users determine the degree of confidence that should be placed on abortion data. In addition, the evaluation results are applicable to other vital statistics reporting and surveillance systems. |
Supporting healthful eating through retail environmental change: communities putting prevention to work
Moore LV . Prev Chronic Dis 2013 10 E189 More healthful eating patterns can help people achieve recommended nutrient intakes, control calorie intake, and reduce the risk of some of the leading causes of chronic illness and death in the United States such as cardiovascular disease, diabetes, and certain types of cancer (1). Making more healthful choices easily accessible may help people start and maintain more healthful eating patterns (2,3). Although research and programs dedicated to improving access to more healthful food choices are under way (4), there is little empirical evidence to identify what aspects of the retail environment require intervention to improve access (5). It is unclear whether efforts should focus on improving proximity to stores, improving the selection of healthful options within stores with limited stock, making more healthful items more affordable, improving the quality of goods within stores, introducing more healthful options to an area via other retail models like farmers markets, or some combination of the above. One recent initiative that may elucidate what aspects of the environments to change to improve the diet and health of community members is Communities Putting Prevention to Work (CPPW). During the 2-year funding period beginning in 2010, 39 of the 50 CPPW communities committed to enhancing access to healthful food and evaluating the effect of this increased access on behavior (6). CPPW presented an opportunity to evaluate changes to the environment that may support people in making more healthful dietary choices. | This collection of articles in Preventing Chronic Disease presents findings from the first 7 of those 39 communities to publish results from their CPPW retail food environment initiatives. Three communities focused their efforts on improving access in corner stores. The other 4 communities chose to improve access at farmers markets in low-income areas via incentive programs or increased acceptance of food assistance benefits. |
Associations between concentrations of uric acid with concentrations of vitamin A and beta-carotene among adults in the United States
Ford ES , Choi HK . Nutr Res 2013 33 (12) 995-1002 Our objective was to examine the cross-sectional associations between concentrations of vitamin A and beta-carotene, a major source of vitamin A, with concentrations of uric acid in a nationally representative sample of adults from the United States. We conducted a cross-sectional study using data from up to 10893 participants aged >=20 years of National Health and Nutrition Examination Survey from 2001 to 2006. Concentrations of uric acid adjusted for numerous covariates increased from 305.8 mumol/L in the lowest quintile of vitamin A to 335.3 mumol/L in the highest quintile (p for linear trend <0.001). The prevalence ratio for hyperuricemia also increased progressively across quintiles of serum vitamin A reaching 1.82 (95% confidence interval [CI]: 1.52, 2.16; p for linear trend <0.001) in the top quintile in the maximally adjusted model. Adjusted mean concentrations of uric acid decreased progressively from quintile 1 (333.8 mumol/L) through quintile 4 of concentrations of beta-carotene and were similar for quintiles 4 (313.5 mumol/L) and 5 (313.8 mumol/L). Concentrations of beta-carotene were inversely associated with hyperuricemia (adjusted prevalence ratio comparing highest with lowest quintile = 0.61; 95% CI: 0.52, 0.72; p for linear trend <0.001). Concentrations of uric acid were significantly and positively associated with concentrations of vitamin A and inversely with concentrations of beta-carotene. These cross-sectional findings require confirmation with experimental studies of vitamin A and beta-carotene supplementation. |
A comparison of fruit and vegetable intake estimates from three survey question sets to estimates from 24-hour dietary recall interviews
Eaton DK , Olsen EO , Brener ND , Scanlon KS , Kim SA , Demissie Z , Yaroch AL . J Acad Nutr Diet 2013 113 (9) 1165-74 BACKGROUND: Fruit and vegetable (F/V) intake surveillance can provide information critical to the design and evaluation of interventions and the assessment of progress toward national intake objectives. The CDC's Youth Risk Behavior Surveillance System (YRBSS) assesses F/V intake among high school students using six questions about the frequency of intake in times per day. It is not known whether F/V intake frequency in times per day can be used as a proxy for intake in servings per day. OBJECTIVE: To compare F/V intake estimates based on responses to three sets of survey questions, including the standard set of six YRBSS questions, with criterion F/V intake in servings per day based on data from 24-hour dietary recall interviews. PARTICIPANTS/SETTING: Study participants were 610 high school students who completed an in-class questionnaire and three telephone-administered 24-hour dietary recall interviews. The questionnaire asked students how many times they consumed 100% fruit juice and ate fruit, carrots, potatoes, green salad, and other vegetables during the "past 7 days" (set 1), the number of times they did so "yesterday" (set 2), and the number of cup-equivalents of fruits and vegetables they consumed per day (set 3). MAIN OUTCOME MEASURE: Mean estimated F/V intake either as "times/day" or "servings/day" and the percentage of students whose estimated F/V intake was ≥1, ≥2, and ≥3 times/day or servings/day. STATISTICAL ANALYSES PERFORMED: t tests and corrected Pearson correlations were used to compare F/V intake estimates based on survey question responses with estimates based on responses to the 24-hour dietary recall interviews. RESULTS: Mean F/V intake estimates (in times/day or servings/day) based on responses to all sets of survey questions were significantly more than servings/day estimates based on responses to the 24-hour dietary recall interviews, and the percentages of students meeting each intake cutpoint were also more. Of the three sets of survey questions, the standard YRBSS questions produced estimates and percentages that were most consistently closest to 24-hour dietary recall interview estimates. CONCLUSIONS: For brief self-administered questionnaires of high school students, the current YRBSS questions are recommended for monitoring F/V intake even though mean intake estimates in times/day will likely be higher than, and are not a proxy for, mean intake estimates in servings/day. |
The effects of vibration-reducing gloves on finger vibration
Welcome Daniel E , Dong Ren G , Xu Xueyan S , Warren Christopher , McDowell Thomas W . Int J Ind Ergon 2014 44 (1) 45-59 Vibration-reducing (VR) gloves have been used to reduce the hand-transmitted vibration exposures from machines and powered hand tools but their effectiveness remains unclear, especially for finger protection. The objectives of this study are to determine whether VR gloves can attenuate the vibration transmitted to the fingers and to enhance the understanding of the mechanisms of how these gloves work. Seven adult male subjects participated in the experiment. The fixed factors evaluated include hand force (four levels), glove condition (gel-filled, air bladder, no gloves), and location of the finger vibration measurement. A 3-D laser vibrometer was used to measure the vibrations on the fingers with and without wearing a glove on a 3-D hand-arm vibration test system. This study finds that the effect of VR gloves on the finger vibration depends on not only the gloves but also their influence on the distribution of the finger contact stiffness and the grip effort. As a result, the gloves increase the vibration in the fingertip area but marginally reduce the vibration in the proximal area at some frequencies below 100. Hz. On average, the gloves reduce the vibration of the entire fingers by less than 3% at frequencies below 80. Hz but increase at frequencies from 80 to 400. Hz. At higher frequencies, the gel-filled glove is more effective at reducing the finger vibration than the air bladder-filled glove. The implications of these findings are discussed. Relevance to industry: Prolonged, intensive exposure to hand-transmitted vibration can cause hand-arm vibration syndrome. Vibration-reducing gloves have been used as an alternative approach to reduce the vibration exposure. However, their effectiveness for reducing finger-transmitted vibrations remains unclear. This study enhanced the understanding of the glove effects on finger vibration and provided useful information on the effectiveness of typical VR gloves at reducing the vibration transmitted to the fingers. The new results and knowledge can be used to help select appropriate gloves for the operations of powered hand tools, to help perform risk assessment of the vibration exposure, and to help design better VR gloves. 2013 . |
Work-related spirometric restriction in flavoring manufacturing workers
Kreiss K . Am J Ind Med 2013 57 (2) 129-37 BACKGROUND: Flavoring-exposed workers are at risk for occupational lung disease. METHODS: We examined serial spirometries from corporate medical surveillance of flavoring production workers to assess abnormality compared to the U.S. population; mean decline in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC); and excessive declines in FEV1. RESULTS: Of 106 workers, 30 had spirometric restriction, 3 had obstruction, 1 had both, and 13 (of 70, 19%) had excessive declines in FEV1. The adjusted prevalence of restriction was 3.7 times expected. Employees with higher potential for flavorings exposure had 3.0 times and 2.4 times greater average annual declines in FEV1 and FVC respectively, and had 5.8 times higher odds of having excessive FEV1 declines than employees with lower potential for exposure. CONCLUSION: Exposure-related spirometric abnormalities consistent with a restrictive process evolved during employment, suggesting that exposures in flavoring production are associated with a range of pathophysiology. |
A quantitative assessment of the total inward leakage of NaCl aerosol representing submicron size bioaerosol through N95 filtering facepiece respirators and surgical masks
Rengasamy S , Eimer BC , Szalajda J . J Occup Environ Hyg 2013 11 (6) 388-96 Respiratory protection provided by a particulate respirator is a function of particle penetration through filter media and through faceseal leakage. Faceseal leakage largely contributes to the penetration of particles through respirator and compromises protection. When faceseal leaks arise, filter penetration is assumed to be negligible. The contribution of filter penetration and faceseal leakage to total inward leakage (TIL) of submicron size bioaerosols is not well studied. To address this issue, TIL values for two N95 filtering facepiece respirator (FFR) models and two surgical mask (SM) models sealed to a manikin were measured at 8 L and 40 L breathing minute volumes with different artificial leak sizes. TIL values for different size (20-800 nm, electrical mobility diameter) NaCl particles representing submicron size bioaerosols were measured using a scanning mobility particle sizer. Efficiency of filtering devices was assessed by measuring the penetration against NaCl aerosol similar to the method used for NIOSH particulate filter certification. Results showed that the most penetrating particle size (MPPS) was approximately 45 nm for both N95 FFR models and one of the two SM models, and approximately 350 nm for the other SM model at sealed condition with no leaks as well as with different leak sizes. TIL values increased with increasing leak sizes and breathing minute volumes. Relatively, higher efficiency N95 and SM models showed lower TIL values. Filter efficiency of FFRs and SMs influenced the TIL at different flow rates and leak sizes. Overall, the data indicate that good fitting higher efficiency FFRs may offer higher protection against submicron size bioaerosols. |
Effect of upper strap downward displacement on N95 filtering facepiece respirator fit factors: a pilot study
Roberge RJ , Palmiero AJ , Liu Y , Kim JH , Zhuang Z . J Occup Environ Hyg 2013 11 (5) 338-41 Fifteen subjects underwent three replicates of quantitative respirator fit testing with N95 filtering facepiece respirators that were donned with the upper strap high on the occiput, as per the manufacturers' donning instructions. Each fit test was immediately followed by repeat fit testing with the upper strap downwardly displaced to the level of the ear sulcus in order to determine any change in fit factors that might occur with upper strap downward slippage. A total of 35/45 (78%) initial fit tests had a passing score (fit factor ≥100) with the top strap high on the occiput and 33/35 (94%) of these passed subsequent fit testing after the top strap was displaced downward to the ear sulcus. Geometric mean fit factors for the initial passed fit tests, and following downward strap displacement, were 217+/-1.6 and 207+/-1.9, respectively (p = 0.64). Downward displacement of the top strap did not significantly impact fit factors of N95 FFRs that had previously passed fit testing. |
Examining national trends in worker health with the National Health Interview Survey
Luckhaupt SE , Sestito JP . J Occup Environ Med 2013 55 S58-62 OBJECTIVE: To describe data from the National Health Interview Survey (NHIS), both the annual core survey and periodic occupational health supplements (OHSs), available for examining national trends in worker health. METHODS: The NHIS is an annual in-person household survey with a cross-sectional multistage clustered sample design to produce nationally representative health data. The 2010 NHIS included an OHS. RESULTS: Prevalence rates of various health conditions and health behaviors among workers based on multiple years of NHIS core data are available. In addition, the 2010 NHIS-OHS data provide prevalence rates of selected health conditions, work organization factors, and occupational exposures among US workers by industry and occupation. CONCLUSIONS: The publicly available NHIS data can be used to identify areas of concern for various industries and for benchmarking data from specific worker groups against national averages. |
Integration of health protection and health promotion: rationale, indicators, and metrics
Sorensen G , McLellan D , Dennerlein JT , Pronk NP , Allen JD , Boden LI , Okechukwu CA , Hashimoto D , Stoddard A , Wagner GR . J Occup Environ Med 2013 55 S12-8 OBJECTIVE: To offer a definition of an "integrated" approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization. METHODS: Guided by the question-How will we know it when we see it?-we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches. RESULTS: A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers. CONCLUSIONS: A shared understanding of what is meant by integrated approaches to protect and promote worker health has the potential to improve dialogue among researchers and facilitate the research-to-practice process. |
B95: a new respirator for health care personnel
Gosch ME , Shaffer RE , Eagan AE , Roberge RJ , Davey VJ , Radonovich LJ Jr . Am J Infect Control 2013 41 (12) 1224-30 BACKGROUND: Respiratory protection relies heavily on user compliance to be effective, but compliance among health care personnel is less than ideal. METHODS: In 2008, the Department of Veterans Affairs formed the Project Better Respiratory Equipment using Advanced Technologies for Healthcare Employees (BREATHE) Working Group, composed of a variety of federal stakeholders, to discuss strategies for improving respirator compliance, including the need for more comfortable respirators. RESULTS: The Working Group developed 28 desirable performance characteristics that can be grouped into 4 key themes: (1) respirators should perform their intended function safely and effectively; (2) respirators should support, not interfere, with occupational activities; (3) respirators should be comfortable and tolerable for the duration of wear; and (4) respiratory protective programs should comply with federal/state standards and guidelines and local policies. As a necessary next step, the Working Group identified the need for a new class of respirators, to be called "B95," which would better address the unique needs of health care personnel. CONCLUSION: This article summarizes the outputs of the Project BREATHE Working Group and provides a national strategy to develop clinically validated respirator test methods, to promulgate B95 respirator standards, and to invent novel design features, which together will lead to commercialized B95 respirators. |
Environmental impact on the magnetic field distribution of a magnetic proximity detection system in an underground coal mine
Li J , Carr J , Waynert J , Kovalchik P . J Electromagn Waves Appl 2013 27 (18) 2416-29 A magnetic proximity detection system mounted on an underground mobile mining machine detects whether a worker is hazardously close to the machine. The system generates magnetic fields covering the extended spaces around the machine. A magnetic detector worn by the worker measures the magnetic field flux density and determines the distance from it to the machine. The system is frequently in close proximity to coal as the machine moves, causing the magnetic field flux, in part, to enter massive in situ coal. This has the potential to have an adverse effect on the accuracy of the system and on the safety of the worker if the coal were to significantly alter the magnetic flux density distribution. Two experiments were conducted to study the impact of in situ coal on these magnetic fields. Measurements in one mine show that coal mass has no significant impact on the magnetic field flux distribution. 2013 This work was authored as part of the Contributors' official duties as Employees of the United States Government and is therefore a work of the United States Government. In accordance with 17 USC. 105, no copyright protection is available for such works under US Law. |
The NIOSH total worker health program: an overview
Schill AL , Chosewood LC . J Occup Environ Med 2013 55 S8-11 OBJECTIVE: The objective of this article was to provide an overview of the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health (TWH) Program that was launched by the institute in 2011. METHODS: This article describes the TWH concept, relevant issues, and the NIOSH Program. Examples of the concept are provided. RESULTS: Total Worker Health is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. CONCLUSIONS: The NIOSH TWH Program responds to demands for information and practical solutions to the health, safety, and well-being challenges that workers and their employers face. It also addresses issues related to the nation's need to sustain a globally competitive workforce. |
Six components necessary for effective public health program implementation
Frieden TR . Am J Public Health 2013 104 (1) 17-22 Public health programs succeed and survive if organizations and coalitions address 6 key areas. (1) Innovation to develop the evidence base for action; (2) a technical package of a limited number of high-priority, evidence-based interventions that together will have a major impact; (3) effective performance management, especially through rigorous, real-time monitoring, evaluation, and program improvement; (4) partnerships and coalitions with public- and private-sector organizations; (5) communication of accurate and timely information to the health care community, decision makers, and the public to effect behavior change and engage civil society; and (6) political commitment to obtain resources and support for effective action. Programs including smallpox eradication, tuberculosis control, tobacco control, polio eradication, and others have made progress by addressing these 6 areas. |
Prevalence and correlates of quitline awareness and utilization in the United States: an update from the 2009-2010 National Adult Tobacco Survey
Schauer GL , Malarcher AM , Zhang L , Engstrom MC , Zhu SH . Nicotine Tob Res 2013 16 (5) 544-53 INTRODUCTION: Tobacco quitlines are evidence-based cessation resources but have been underutilized. The purpose of this study is to provide population-level data about quitline awareness and utilization in the United States and to assess correlates of awareness and utilization. METHODS: Data were from the 2009-2010 National Adult Tobacco Survey. Descriptive statistics were produced for national- and state-level quitline awareness and for national quitline utilization. Bivariate and multivariable logistic regressions were used to identify correlates of quitline awareness and utilization. RESULTS: Quitline awareness among the total sample was 33.9% (current smokers 53.9%, former smokers 34.0%, never-smokers 27.0%). Awareness varied by state (range: 35.8%-84.6% for current smokers). Among current smokers who tried to quit in the past year, correlates of lower awareness included being Black, non-Hispanic, and making <$50,000 annually; correlates of higher awareness included having seen a health professional, higher state tobacco program expenditures, and being female. Among smokers who made at least one quit attempt in the previous year and were aware of the quitline, quitline utilization was 7.8%. Higher state tobacco program expenditure, health professional advice, and being Black, non-Hispanic were correlated with higher utilization; older age was correlated with lower utilization. Awareness was significantly associated with use at the state level (r = .98, p < .01). CONCLUSION: Although the majority of smokers in the United States are aware of quitlines, only a small percentage of those trying to quit utilize them. State tobacco program expenditures and receipt of advice from a health professional were associated with both higher quitline awareness and higher utilization. |
Heavy alcohol use as a risk factor for severe outcomes among adults hospitalized with laboratory-confirmed influenza, 2005-2012
Greenbaum A , Chaves SS , Perez A , Aragon D , Bandyopadhyay A , Bennett N , Fowler B , Hancock E , Lynfield R , McDonald-Hamm C , Reingold A , Ryan P , Schaffner W , Sharangpani R , Spencer M , Thomas A , Yousey-Hindes K , Zansky S , Finelli L . Infection 2013 42 (1) 165-70 We examined heavy alcohol use as a risk factor for severe influenza (intensive care admission or death) among hospitalized adults. In <65- and ≥65-year-olds, heavy alcohol use increased disease severity [relative risk (RR) 1.34; 95 % confidence interval (CI): 1.04-1.74, and RR 2.47; 95 % CI: 1.69-3.60, respectively]. Influenza vaccination and early, empiric antiviral treatment should be emphasized in this population. |
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