Hospitalization costs associated with hypertension as a secondary diagnosis among insured patients aged 18-64 years
Wang G , Zhang Z , Ayala C . Am J Hypertens 2009 23 (3) 275-81 BACKGROUND: We estimated the hospitalization costs associated with hypertension as a secondary diagnosis among insured adults aged 18-64 years by using data from 2005 MarketScan Commercial Claims and Encounters (CCAE) inpatient admissions. METHODS: We analyzed costs for four patient groups (N = 455,944): (i) all selected patients; (ii) patients with the primary diagnosis of ischemic heart disease (IHD); (iii) patients with the primary diagnosis of cerebrovascular disease; and (iv) patients with neither IHD nor cerebrovascular disease as the primary diagnosis. We conducted propensity score matching to control possible bias in cost estimates due to sample selections and estimated the costs of hypertension by using a regression model on the matched populations that controlled for subjects' age, sex, length of hospital stay, Charlson comorbidity index (CCI), region of residence, and urbanization of residence. RESULTS: For all patients with hypertension as a secondary diagnosis, the estimated average annual hospitalization cost per patient was $21,094, of which $2,734 (13%; P < 0.01) was associated with hypertension. The estimated average costs were $31,106 for patients with a primary diagnosis of IHD, $17,298 for those with a primary diagnosis of cerebrovascular disease, and $18,693 for those without a primary diagnosis of IHD or cerebrovascular disease; hypertension-associated costs for these patients were $3,540 (11.4%; P < 0.01), $1,133 (6.5%; P < 0.01), and $2,254 (12.1%; P < 0.01), respectively. CONCLUSIONS: Hypertension-associated hospitalization costs are substantial among insured US patients aged 18-64 years with hypertension as a secondary diagnosis and suggest a need for cost-effective programs to prevent, manage, and control hypertension.American Journal of Hypertension 2009; doi:10.1038/ajh.2009.241. |
Regionally limited or rare infections: prevention after hematopoietic cell transplantation
Gea-Banacloche J , Masur H , Arns da Cuhna C , Chiller T , Kirchoff L , Shaw P , Tomblyn M , Cordonnier C . Bone Marrow Transplant 2009 44 (8) 489-94 This section covers infections that are prevalent only in certain geographical areas, or that occur uncommonly among hematopoietic cell transplant (HCT) recipients. Diseases covered are tuberculosis (TB), Pneumocystis jiroveci pneumonia (PCP), toxoplasmosis, strongyloidiasis, Chagas disease, leishmaniasis, malaria and Nocardia infection. Other infections, such as babesiosis, can be transmitted in the course of transplant through blood, in addition to hematopoietic cell graft.449 Guidelines for the prevention of these graft-transmissible infections are found in the Hematopoietic Cell Safety Section. |
Fungal infection prevention after hematopoietic cell transplantation
Marr KA , Bow E , Chiller T , Maschmeyer G , Ribaud P , Segal B , Steinbach W , Wingard JR , Nucci M . Bone Marrow Transplant 2009 44 (8) 483-7 Hematopoietic cell transplantation (HCT) recipients and candidates undergoing conditioning therapy should avoid substances, including certain foods (Table 7) that increase the risk of exposure to fungi (DIII). | Preventing disease | Growth factors (for example, GM-CSF and G-CSF) shorten the duration of neutropenia after HCT.412 However, a meta-analysis showed that use of growth factors did not reduce the attack rate of invasive fungal disease165 and, therefore, no recommendation can be made for the use of growth factors for prophylaxis against invasive fungal disease (CI). | Topical antifungal drugs applied onto the skin or mucosa (for example, nystatin or clotrimazole) might reduce colonization by yeasts and molds in the area of application. However, these agents have not been proven to prevent locally invasive or disseminated yeast or mold infections and their use for prophylaxis is unclear (CIII). Performing fungal surveillance cultures is not indicated for asymptomatic HCT recipients (DII).413,414 | Other recommendations | Patients receiving antifungal prophylaxis who develop clinical signs or symptoms of infection should be evaluated for breakthrough bloodstream or pulmonary fungal infections (AIII). Such infections may occur because the prophylactic drug has no activity against the organism; because the organism has developed resistance to the drug; or because of other factors, such as severe immunosuppression or low serum levels of the prophylactic agent.415 |
Global trends in typhoid and paratyphoid fever
Crump JA , Mintz ED . Clin Infect Dis 2009 50 (2) 241-6 Typhoid and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in south-central and Southeast Asia, where enteric fever is associated with poor sanitation and unsafe food and water. High-quality incidence data from Asia are underpinning efforts to expand access to typhoid vaccines. Efforts are underway to develop vaccines that are immunogenic in infants after a single dose and that can be produced locally in countries of endemicity. The growing importance of Salmonella enterica serotype Paratyphi A in Asia is concerning. Antimicrobial resistance has sequentially emerged to traditional first-line drugs, fluoroquinolones, and third-generation cephalosporins, posing patient treatment challenges. Azithromycin has proven to be an effective alternative for treatment of uncomplicated typhoid fever. The availability of full genome sequences for S. enterica serotype Typhi and S. enterica serotype Paratyphi A confirms their place as monomorphic, human-adapted pathogens vulnerable to control measures if international efforts can be redoubled. |
Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective. Preface
Tomblyn M , Chiller T , Einsele H , Gress R , Sepkowitz K , Storek J , Wingard JR , Young JA , Boeckh MJ . Bone Marrow Transplant 2009 44 (8) 453-5 This report, cosponsored by Center for International Blood & Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), European Group for Blood and Marrow Transplantation (EBMT), American Society for Blood and Marrow Transplantation (ASBMT), Canadian Blood and Marrow Transplant Group (CBMTG), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Association of Medical Microbiology and Infectious Disease (AMMI), Centers for Disease Control (CDC) and the Health Resources and Services Administration, represents an update of the guidelines published in 2000 for preventing infections among hematopoietic cell transplant (HCT) recipients.1 An international group of experts in infectious diseases, hematopoietic cell transplantation and public health worked together to compile this document with four goals in mind: (1) to summarize the current available data in the field; (2) to provide evidence-based recommendations regarding the prevention of infectious complications among HCT patients; (3) to serve as a reference for health-care providers worldwide who care for HCT recipients; and (4) to serve as a reference for HCT recipients and their nonmedical caregivers. In updating these guidelines, the committee sought to summarize the currently available data and present them as concisely as possible in an evidence-based manner. |
HIV-associated extrapulmonary tuberculosis in Thailand: epidemiology and risk factors for death
Kingkaew N , Sangtong B , Amnuaiphon W , Jongpaibulpatana J , Mankatittham W , Akksilp S , Sirinak C , Nateniyom S , Burapat C , Kittikraisak W , Monkongdee P , Varma JK . Int J Infect Dis 2009 13 (6) 722-9 BACKGROUND: We conducted a prospective, multicenter observational cohort study in Thailand to characterize the epidemiology of extrapulmonary tuberculosis (TB) in HIV-infected persons and to identify risk factors for death. METHODS: From May 2005 to September 2006, we enrolled, interviewed, examined, and performed laboratory tests on HIV-infected adult TB patients and followed them from TB treatment initiation until the end of TB treatment. We conducted multivariate proportional hazards analysis to identify factors associated with death. RESULTS: Of the 769 patients, pulmonary TB only was diagnosed in 461 (60%), both pulmonary and extrapulmonary TB in 78 (10%), extrapulmonary TB at one site in 223 (29%), and extrapulmonary TB at more than one site in seven (1%) patients. Death during TB treatment occurred in 59 of 308 patients (19%) with any extrapulmonary involvement. In a proportional hazards model, patients with extrapulmonary TB had an increased risk of death if they had meningitis, and a CD4+ T-lymphocyte count <200 cells/microl. Patients who received co-trimoxazole, fluconazole, and antiretroviral therapy during TB treatment had a lower risk of death. CONCLUSIONS: Among HIV-infected patients with TB, extrapulmonary disease occurred in 40% of the patients, particularly in those with advanced immune suppression. Death during TB treatment was common, but the risk of death was reduced in patients who took co-trimoxazole, fluconazole, and antiretroviral therapy. |
Mating competitiveness of Anopheles arabiensis males as a function of transgenic state and genetic similarity to females
Howell PI , Benedict MQ . J Insect Behav 2009 22 (6) 477-491 We conducted mating competitions between wild-type and heterozygous transgenic Anopheles arabiensis males that were produced by repeated backcrosses of a transposable element expressing the β2-tubulin eGFP marker into two genetic backgrounds. These competed for genetically similar or dissimilar females in ratios of 1:1:3. We analyzed the effect of genetic similarity, transgenic state and stock on mating frequency. We observed no differences in the competitiveness of the wild and transgenic heterozygotes, no effect of genetic relatedness, nor a clear benefit of the out-crossing strategy to increase competitiveness. A decrease in the development rate of all phenotypic classes was observed among progeny of transgenic males but the rate of adult emergence of transgenic individuals was in most cases slightly faster than wild-type siblings. |
First record of the Turkestan cockroach, Blatta lateralis (Walker), in Georgia (USA)
Petersen W , Cobb K . J Entomol Sci 2009 44 (4) 415-416 A male Turkestan cockroach (Blatta lateralis) was collected inside a brick office building on 8 July 2005 at Fort McPherson, Fulton Co., Georgia, USA and a female carrying an ootheca was collected outside on a brick wall of the same office building on 28 September 2006. This is the first record of this species in Georgia. The extent of the presence of Turkestan cockroach at Fort McPherson and the surrounding areas is unknown. |
Lead and cognitive function in VDR genotypes in the third National Health and Nutrition Examination Survey.
Krieg EF Jr , Butler MA , Chang MH , Liu T , Yesupriya A , Lindegren ML , Dowling N , CDC NCI NHANES III Genomics Working Group . Neurotoxicol Teratol 2009 32 (2) 262-72 The relationship between the blood lead concentration and cognitive function in children and adults with different VDR genotypes who participated in the third National Health and Nutrition Examination Survey was investigated. The relationship between blood lead and serum homocysteine concentrations was also investigated. In children 12 to 16years old, performance on the digit span and arithmetic tests as a function of the blood lead concentration varied by VDR rs2239185 and VDR rs731236 genotypes. Decreases in performance occurred in some genotypes, but not in others. In adults 20 to 59years old, performance on the symbol-digit substitution test as a function of the blood lead concentration varied by VDR rs2239185-rs731236 haplotype. In the 12 to 16year old children and adults 60 or more years old, the relationship between the serum homocysteine and blood lead concentrations varied by VDR genotype. The mean blood lead concentrations of the children and adults did not vary by VDR genotype. |
Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001-2004
Sanchez CA , Thomas KE , Malilay J , Annest JL . Fam Community Health 2010 33 (1) 3-10 Exposure to adverse natural and environmental events (eg, extreme temperatures and disasters) poses a public health burden when resulting in injuries requiring emergency care. We examined the incidence and characteristics of persons with environmental exposure-related injuries treated in US-based hospital emergency departments during 2001 to 2004 by using the National Electronic Injury Surveillance System-All Injury Program. An estimated 26 527 (95% CI = 18 664-34 390) injuries were treated annually-78% were heat-related. People with heat-related conditions were men (P < 0.001) and had a median age of 34 years (range = <1 month-94 years). Targeting vulnerable populations in community-wide response measures may reduce injuries from adverse environmental exposures, especially heat. |
A new reality for environmental health
Blake R . J Environ Health 2009 72 (5) 42-46 Today’s economic situation presents a | new reality for environmental health | (EH). The flexibility of the system | may have extended beyond its ability to perform. As a result, EH professionals need to | think hard about broadening environmental | health’s scope and type of practice because | returning to the status quo of recent years is | unlikely. This column will focus on | the tremendous EH workforce issues facing the U.S., | the efforts of the Environmental Health | Services Branch (EHSB) at the Centers for Disease Control and Prevention (CDC) | over the past year to favorably affect these | workforce issues, and possible initiatives for EH practitioners to | broaden the scope of practice in the new reality of the field. |
Removal of waterborne particles by electrofiltration: pilot-scale testing
Li Y , Ehrhard R , Biswas P , Kulkarni P , Carns K , Patterson C , Krishnan R , Sinha R . Environ Eng Sci 2009 26 (12) 1795-1803 Theoretical analysis using a trajectory approach indicated that in the presence of an external electric field, charged waterborne particles are subject to an additional migration velocity that increases their deposition on the surface of collectors (e. g., sand filter). Although researchers conducted bench-scale experiments to verify the effectiveness of electrofiltration, few studies have reported on the applications of electrofiltration in larger scale facilities. In this study, a prototype pilot-scale electrofiltration unit, consisting of an acrylic tank (0.3 x 0.3 x 1.2 m) with vertically placed stainless steel mesh electrodes embedded in a sand filter was tested at a local drinking water plant. Presedimentation basin water was used as the influent with a turbidity ranging from 12 to 37 NTU. At an approach velocity of 0.84 mm/s, an electrode voltage at 8 and 12V increased the particle removal coefficient pC* [defined as -log(C-out/C-in)] to 1.79 and 1.86, respectively, compared to 1.48 when there was no electric field. Reducing the approach velocity from 0.84 to 0.42 mm/s increased pC* from 1.48 to 1.64, when the electrode velocity was 16 V. Repetitive experiments were conducted and the results were in agreement with those calculated by a theoretical trajectory analysis. The electrofiltration process was demonstrated to be more effective for removal of smaller particles (< 4 mu m), the size range of many waterborne bacteria. A voltage of 8-12V was shown to be the most cost-effective range, considering both the energy cost and filtration performance. The findings from this pilot-scale study are important for full-scale applications of the electrofiltration technology. |
Leveraging geospatial data, technology, and methods for improving the health of communities: priorities and strategies from an expert panel convened by the CDC
Elmore K , Flanagan B , Jones NF , Heitgerd JL . J Community Health 2009 35 (2) 165-71 In 2008, CDC convened an expert panel to gather input on the use of geospatial science in surveillance, research and program activities focused on CDC's Healthy Communities Goal. The panel suggested six priorities: spatially enable and strengthen public health surveillance infrastructure; develop metrics for geospatial categorization of community health and health inequity; evaluate the feasibility and validity of standard metrics of community health and health inequities; support and develop GIScience and geospatial analysis; provide geospatial capacity building, training and education; and, engage non-traditional partners. Following the meeting, the strategies and action items suggested by the expert panel were reviewed by a CDC subcommittee to determine priorities relative to ongoing CDC geospatial activities, recognizing that many activities may need to occur either in parallel, or occur multiple times across phases. Phase A of the action items centers on developing leadership support. Phase B focuses on developing internal and external capacity in both physical (e.g., software and hardware) and intellectual infrastructure. Phase C of the action items plan concerns the development and integration of geospatial methods. In summary, the panel members provided critical input to the development of CDC's strategic thinking on integrating geospatial methods and research issues across program efforts in support of its Healthy Communities Goal. |
Medical surveillance, exposure registries, and epidemiologic research for workers exposed to nanomaterials
Trout DB , Schulte PA . Toxicology 2009 269 128-35 While there is a growing body of information about hazards of nanomaterials, little is known about the risks to workers exposed to them. However, workers are the first people in society that are being exposed to the growing inventory of "nano-enabled" products in commerce. The number of workers involved in the investigation, manufacture, production, and disposal of these types of products is growing. Although toxicologic research is still the highest priority, it is time to actively anticipate the health needs of workers. To date, precautionary risk management approaches have been widely advocated. Now there is a need to initiate an evolving process to identify the issues in medical surveillance, utilization of exposure registries, and the conduct of epidemiologic research. Each of these are complex endeavors that build on the toxicologic evidence and extent of exposure. There is a need to assess the scientific basis and research needs for determining early functional changes, organ system and disease responses for use in targeted medical surveillance. There is also need for development of criteria for extrapolating toxicological data in biological systems to predict the risk of adverse outcomes in humans. In the meantime, exposure registries may be pivotal in helping societies act in the face of uncertainty in a precautionary manner, but legal, ethical, and logistical issues need resolution. Epidemiologic research will build on these efforts and may ultimately contribute critical definitive rationale for medical monitoring, risk assessment and management. |
National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009
Edwards JR , Peterson KD , Mu Y , Banerjee S , Allen-Bridson K , Morrell G , Dudeck MA , Pollock DA , Horan TC . Am J Infect Control 2009 37 (10) 783-805 This report is a summary of Device-Associated (DA) and Procedure-Associated (PA) module data collected and reported by hospitals and ambulatory surgical centers participating in the National Healthcare Safety Network (NHSN) from January 2006 through December 2008 as reported to the Centers for Disease Control and Prevention (CDC) by July 6, 2009. This report updates previously published DA and PA module data from the NHSN.1 | The NHSN was established in 2005 to integrate and supersede 3 legacy surveillance systems at the CDC: the National Nosocomial Infections Surveillance (NNIS) system, the Dialysis Surveillance Network (DSN), and the National Surveillance System for Healthcare Workers (NaSH). Similar to the NNIS system, NHSN facilities voluntarily report their health care–associated infection (HAI) surveillance data for aggregation into a single national database for the following purposes: | • | Estimation of the magnitude of HAIs | • | Monitoring of HAI trends | • | Facilitation of interfacility and intrafacility comparisons with risk-adjusted data that can be used for local quality improvement activities | • | Assistance to facilities in developing surveillance and analysis methods that permit timely recognition of patient safety problems and prompt intervention with appropriate measures. | | In addition, many facilities use these same data to comply with state reporting mandates. Identity of all NHSN facilities is kept confidential by the CDC in accordance with Sections 304, 306, and 308(d) of the Public Health Service Act [42 USC 242b, 242k, and 242m(d)]. |
Much meat, much malady: changing perceptions of the epidemiology of hepatitis E
Teo CG . Clin Microbiol Infect 2010 16 (1) 24-32 Hepatitis E, which is caused by hepatitis E virus (HEV), may now be considered a zoonosis as well as an anthroponosis. Pigs, boars and deer have been identified as reservoirs, and their flesh and entrails--as meat and offal--as vehicles of HEV transmission. Shellfish also act as vehicles. Dietary, gastronomic and culinary preferences influence how extensively HEV conveyed by these vehicles can be inactivated before their ingestion by the host. Another route of infection is paved by HEV that is enterically shed by humans and by live animals into the environment. Although anthroponotic transmission of HEV is primarily environmental, zoonotic transmission may proceed along both foodborne and environmental routes. |
STrengthening the REporting of Genetic Association Studies (STREGA)--an extension of the STROBE statement.
Little J , Higgins JP , Ioannidis JP , Moher D , Gagnon F , von Elm E , Khoury MJ , Cohen B , Davey-Smith G , Grimshaw J , Scheet P , Gwinn M , Williamson RE , Zou GY , Hutchings K , Johnson CY , Tait V , Wiens M , Golding J , van Duijn C , McLaughlin J , Paterson A , Wells G , Fortier I , Freedman M , Zecevic M , King R , Infante-Rivard C , Stewart A , Birkett N . Genet Epidemiol 2009 33 (7) 581-98 Making sense of rapidly evolving evidence on genetic associations is crucial to making genuine advances in human genomics and the eventual integration of this information in the practice of medicine and public health. Assessment of the strengths and weaknesses of this evidence, and hence the ability to synthesize it, has been limited by inadequate reporting of results. The STrengthening the REporting of Genetic Association studies (STREGA) initiative builds on the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) Statement and provides additions to 12 of the 22 items on the STROBE checklist. The additions concern population stratification, genotyping errors, modelling haplotype variation, Hardy-Weinberg equilibrium, replication, selection of participants, rationale for choice of genes and variants, treatment effects in studying quantitative traits, statistical methods, relatedness, reporting of descriptive and outcome data, and the volume of data issues that are important to consider in genetic association studies. The STREGA recommendations do not prescribe or dictate how a genetic association study should be designed but seek to enhance the transparency of its reporting, regardless of choices made during design, conduct, or analysis. |
Translation research is an essential but not sufficient ingredient for translation of genomic medicine into population health benefits
Khoury MJ . Genet Med 2009 11 (12) 899 I appreciate and agree with the comments of Zimmern and Brice1 on the recent article describing the Genomic Applications in Practice and Prevention Network.2 Translation of genomic advances into population health benefits is a shared goal for the medical and public health communities. The premise of GAPPNet is that translation research, such as comparative effectiveness research,3 will make translation more evidence based. Translation research is a necessary but not sufficient ingredient for translation. From other fields of medicine, we know that many evidence-based applications seem to be “lost in translation” and do not make the desired impact on population health.4 GAPPNet will address translation in the context of translation research and the need for explicit processes of guidelines, policy, and service development. One of the four components of GAPPNet are nonresearch translation programs such as the ones that Centers for Disease Control and Prevention recently funded.5 I agree that “achieving translation of genomic medicine requires the movement of knowledge from the academic and research arena into a world of policy makers, clinical practitioners and health service managers, a community with different objectives, reward strategies and culture.” As a stakeholder-driven enterprise, GAPPNet will attempt to do the kind of knowledge brokering that the authors allude to6., 7., 8. by bringing the stakeholders together to consider their priorities, concerns, and constraints, in the context of social, ethical, legal, and financial implications of innovations. I look forward to an active GAPPNet stakeholder process that should be enhanced by translation research and evaluation, leading to appropriate use of genomic knowledge for the benefit of population health. |
Adapting the logical basis of tests for Hardy-Weinberg Equilibrium to the real needs of association studies in human and medical genetics
Goddard KA , Ziegler A , Wellek S . Genet Epidemiol 2009 33 (7) 569-80 The standard procedure to assess genetic equilibrium is a chi(2) test of goodness-of-fit. As is the case with any statistical procedure of that type, the null hypothesis is that the distribution underlying the data is in agreement with the model. Thus, a significant result indicates incompatibility of the observed data with the model, which is clearly at variance with the aim in the majority of applications: to exclude the existence of gross violations of the equilibrium condition. In current practice, we try to avoid this basic logical difficulty by increasing the significance bound to the P-value (e.g. from 5 to 10%) and inferring compatibility of the data with Hardy Weinberg Equilibrium (HWE) from an insignificant result. Unfortunately, such direct inversion of a statistical testing procedure fails to produce a valid test of the hypothesis of interest, namely, that the data are in sufficiently good agreement with the model under which the P-value is calculated. We present a logically unflawed solution to the problem of establishing (approximate) compatibility of an observed genotype distribution with HWE. The test is available in one- and two-sided versions. For both versions, we provide tools for exact power calculation. We demonstrate the merits of the new approach through comparison with the traditional chi(2) goodness-of-fit test in 2x60 genotype distributions from 43 published genetic studies of complex diseases where departure from HWE was noted in either the case or control sample. In addition, we show that the new test is useful for the analysis of genome-wide association studies. |
Hospital-based surveillance for DR-TB: necessary but not sufficient
Beavers SF , Holtz TH , Garrett DO . Int J Tuberc Lung Dis 2010 14 (1) 5 IN THIS MONTH’S Journal, Brito and colleagues | describe a survey quantifying drug-resistant tuberculosis (DR-TB) in six hospitals that together care for | approximately half of the TB cases in Rio de Janeiro | State during a one-year period.1 Their study is to be | commended for contributing to the awareness and | understanding of DR-TB in Brazil. In Brazil, which | ranks fourteenth in the list of high-burden countries | for TB, there were an estimated 1019 multidrugr esistant tuberculosis (MDR-TB) cases among the estimated 70 143 new pulmonary TB cases reported countrywide in 2007.2 Hospitals play an important role in | case fi nding, early detection, reduced transmission, and | entry into appropriate care for persons with MDR-TB. | The authors note the importance of careful monitoring for anti-tuberculosis drug resistance.1 The | World Health Organization (WHO) recommends that | drug resistance surveys be performed regularly in | high-burden countries, not only to determine the level | of DR-TB, but also to strengthen laboratory capacity.3 In the context of monitoring for drug resistance; | however, this paper raises other important issues: | 1) universal availability of drug susceptibility testing | (DST), needed for rapid and accurate diagnosis of | drug resistance, is often lacking in high-burden countries; 2) laboratory quality assurance systems, both | internal and external, are needed to maintain profi - | ciency and ensure correct diagnoses; and 3) an accurate history of previous TB treatment (especially rifamycins) is important and necessary. Of note, the WHO | also recommends that all persons with TB with a history of previous TB treatment undergo sputum culture and DST, a policy that was well followed in this | study |
How much will it hurt? HPV vaccine side effects and influence on completion of the three-dose regimen
Reiter PL , Brewer NT , Gottlieb SL , McRee AL , Smith JS . Vaccine 2009 27 (49) 6840-4 We examined the prevalence of reported pain following human papillomavirus (HPV) vaccination and whether it differed from that for other adolescent vaccines or affected completion of the HPV vaccine regimen. In 2008, we conducted cross-sectional surveys with parents of adolescent girls aged 11-20 living in areas of North Carolina with elevated cervical cancer rates who had received at least one dose of HPV vaccine. Pain from HPV vaccination, while commonly reported by parents, was less frequent compared to other adolescent vaccines and did not appear to affect vaccine regimen completion. These findings may be important to increase HPV vaccination coverage. |
Skeletal muscle injury versus adaptation with aging: novel insights on perplexing paradigms
Baker BA , Cutlip RG . Exerc Sport Sci Rev 2010 38 (1) 10-16 A growing body of data supports a view that skeletal muscle's response after mechanical loading does not always result in the classically reported "injury response." Furthermore, current evidence supports a model of muscle adaptation and/or maladaptation, distinct from overt injury, in which myofiber degeneration and inflammation do not contribute as significantly as once reported even in aged populations. |
Molecular characterization of human rotavirus vaccine strain CDC-9 during sequential passages in Vero cells
Esona MD , Foytich K , Wang Y , Shin G , Wei G , Gentsch JR , Glass RI , Jiang B . Hum Vaccin 2010 6 (3) 10409 We have developed several candidate human rotavirus vaccine strains with common serotypes via adaptation in Vero cells, adhering to the Good Laboratory Practice (GLP) guidelines. We sequenced the entire genome of a G1P[8] strain CDC-9 in original stool and passaged materials from Vero cells and examined its genetic relatedness to the prototype human rotavirus KU and other strains. With the exception of VP3 gene which was closely related to that of strain DS-1, the culture-adapted CDC-9 strain shared moderate to high nt (range 83.4%-95.1%) and deduced aa (range 81.3%-97.9%) sequence identities with the KU and other G1P[8] strains. Alignments of the deduced aa sequences of 11 gene segments of the wild-type and culture-adapted CDC-9 showed complete sequence identity in genes encoding NSP2, NSP3, NSP4, VP1, VP2, VP3 and VP7, a single aa change in genes coding for NSP1, NSP5 and VP6 and several scattered aa changes in the VP4 gene during the passage in Vero cells. Two of the VP4 aa substitutions (385 and 388) are within sites associated with neutralization resistant mutants selected by cross-reactive monoclonal antibodies. Although some sequence changes were evident, we do not know if these changes contribute to the possible attenuation of this strain. Further testing of this vaccine strain in clinical trials is justified. |
Molecular identification of mutations associated with anti-tuberculosis drug resistance among strains of Mycobacterium tuberculosis
Abbadi SH , Sameaa GA , Morlock G , Cooksey RC . Int J Infect Dis 2009 13 (6) 673-8 BACKGROUND: Understanding the etiologic organism, antimicrobial resistance mechanisms, and transmission of multidrug-resistant tuberculosis (MDR-TB) can be of great value in optimizing strategies to control and prevent its development and transmission. METHODS: One hundred and fifty-five Mycobacterium tuberculosis complex isolates from patients with pulmonary tuberculosis (TB) in Cairo, Egypt were studied. In vitro drug susceptibility testing against rifampin (RIF), isoniazid (INH), streptomycin (SM), ethambutol (EMB), and pyrazinamide (PZA) was performed. Resistance was studied by the standard agar proportion method. Single strand conformation polymorphism (SSCP) and DNA sequence analysis were used to detect mutations in the genes that encode resistance to rpoB, katG, rpsL, and embB. RESULTS: Among 155 consecutive M. tuberculosis isolates, 25 (16.1%) were MDR-TB; 13 of these were from newly diagnosed untreated cases, 12 were from re-treated cases, and none of the MDR-TB isolates had matching IS6110 fingerprints. Among the MDR-TB isolates, rpoB mutations were found in 76% of RIF-resistant isolates, katG mutations were found in 47.1% of INH-resistant isolates, rpsL mutations were found in 55.6% of SM-resistant isolates, and embB mutations were found in 36.4% of EMB-resistant isolates. CONCLUSIONS: No major differences were found in the frequencies of mutations or types of amino acid substitution between newly diagnosed untreated cases and re-treated cases. The high prevalence of MDR-TB at this hospital underscores the need for continuous monitoring of strains and antimicrobial resistance. |
Surveillance of fungal allergic sensitization using the fluorescent halogen immunoassay
Green BJ , Tovey ER , Beezhold DH , Perzanowski MS , Acosta LM , Divjan AI , Chew GL . J Mycol Med 2009 19 (4) 253-261 OBJECTIVE: Conidia derived from a small number of common fungal genera are widely accepted as the etiological agents responsible for fungal allergic sensitization. The contribution of fungal conidia, spores, airborne hyphae, and subcellular fragments from other uncharacterized fungal genera remains unclear. In this proof-of-concept study, we examined the composition of mycoaerosols that atopic women were exposed and sensitized to in their own indoor environment using the fluorescent halogen immunoassay (fHIA).PATIENTS AND METHODS: Mycoaerosols were collected onto mixed cellulose ester protein binding membranes (PBMs) for 30 min with volumetric air sampling pumps. The PBMs were laminated with an adhesive cover slip and indirectly immunostained with individual patient serum IgE using the fHIA. Samples were examined using confocal laser scanning microscopy and immunostained particles were expressed as a percentage of total particles.RESULTS: All air samples contained a broad spectrum of fungal spores, conidia, hyphae, and other fungal particulates. Airborne concentrations varied between individual study participant environments. Positively immunostained conidia belonging to moniliaceous amerospores, Cladosporium, Alternaria, and many unknown species were observed in the majority of air samples. Other fungal genera including Bipolaris, Curvularia, Pithomyces, and Stachybotrys, in addition to, ascospore genera and dematiaceous hyphal fragments released detectable allergen. Twelve percent of all fHIA haloes quantified in the analysis were directed towards fungal particles. No immunostaining was detected to conidia belonging to Epicoccum, Fusarium, and Spegazzinia species.CONCLUSION: In addition to characterized fungal aeroallergens, we observed a wider composition of fungi that bound human IgE. Field surveillance studies that utilize immunodiagnostic techniques such as the fHIA will provide further insight into the diversity of fungi that function as aeroallergen sources in individual study participant environments. |
Toll-like receptor 7-induced immune response to cutaneous West Nile virus infection
Welte T , Reagan K , Fang H , Machain-Williams C , Zheng X , Mendell N , Chang GJ , Wu P , Blair CD , Wang T . J Gen Virol 2009 90 2660-8 The Toll-like receptor (TLR) 7 response represents a vital host-defence mechanism in a murine model of systemic West Nile virus (WNV) infection. Here, we investigated the role of the TLR7-induced immune response following cutaneous WNV infection. We found that there was no difference in susceptibility to WNV encephalitis between wild-type and TLR7(-/-) mice upon intradermal injection or infected mosquito feeding. Viral load analysis revealed similar levels of WNV RNA in the peripheral tissues and brains of these two groups of mice following intradermal infection. There was a higher level of cytokines in the blood of wild-type mice at early stages of infection; however, this difference was diminished in the blood and brains at later stages. Langerhans cells (LCs) are permissive to WNV infection and migrate from the skin to draining lymph nodes upon intradermal challenge. Our data showed that WNV infection of TLR7(-/-) keratinocytes was significantly higher than that of wild-type keratinocytes. Infection of wild-type keratinocytes induced higher levels of alpha interferon and interleukin-1beta (IL-1beta), IL-6 and IL-12, which might promote LC migration from the skin. Co-culture of naive LCs of wild-type mice with WNV-infected wild-type keratinocytes resulted in the production of more IL-6 and IL-12 than with TLR7(-/-) keratinocytes or by cultured LCs alone. Moreover, LCs in the epidermis were reduced in wild-type mice, but not in TLR7(-/-) mice, following intradermal WNV infection. Overall, our results suggest that the TLR7 response following cutaneous infection promotes LC migration from the skin, which might compromise its protective effect in systemic infection. |
Virulence factors encoded by Legionella longbeachae identified on the basis of the genome sequence analysis of clinical isolate D-4968
Kozak NA , Buss M , Lucas CE , Frace M , Govil D , Travis T , Olsen-Rasmussen M , Benson RF , Fields BS . J Bacteriol 2009 192 (4) 1030-44 Legionella longbeachae causes most cases of legionellosis in Australia and may be under-reported worldwide due to the lack of L. longbeachae-specific diagnostic tests. L. longbeachae displays distinctive differences in intracellular trafficking, caspase-1 activation, and infection of mouse models compared to L. pneumophila, yet both species have an indistinguishable clinical presentation in humans. Unlike other legionellae, which inhabit fresh water systems, L. longbeachae is found predominantly in moist soil. In this study, we sequenced and annotated the genome of a L. longbeachae clinical isolate, D-4968, from Oregon, US, and compared it to the published genomes of L. pneumophila. The study revealed that the D-4968 genome is larger with a gene order that is different from L. pneumophila. Genes encoding structural components of type II, type IV Lvh, and type IV Icm/Dot secretion systems are conserved. In contrast, only 42/140 homologs of L. pneumophila Icm/Dot substrates have been found in the D-4968 genome. L. longbeachae encodes numerous proteins with eukaryotic motifs and eukaryotic-like proteins unique to this species, including 16 ankyrin repeat-containing proteins and a novel U-box protein. We predict that these proteins are secreted by the L. longbeachae Icm/Dot secretion system. In contrast to L. pneumophila, the L. longbeachae D-4968 genome does not carry flagellar biosynthesis genes, yet contains a chemotaxis operon. The lack of a flagellum explains the failure of L. longbeachae to activate caspase-1 and trigger pyroptosis in murine macrophages. These unique features of the L. longbeachae genome may reflect adaptation of this species to life in soil. |
Correlation of genotype and in vitro susceptibilities of Cryptococcus gattii from the Pacific Northwest of the United States
Iqbal N , Debess EE , Wohrle R , Sun B , Nett RJ , Ahlquist AM , Chiller T , Lockhart SR , Cryptococcus gattii Public Health Working Group . J Clin Microbiol 2009 48 (2) 539-44 Cryptococcus gattii emerged in North America in 1999 as a human and veterinary pathogen on Vancouver Island, British Columbia. The emergent subtype, VGIIa, and the closely related subtype VGIIb can now be found in the US in Washington, Oregon, and California. We performed multilocus sequence typing and antifungal susceptibility testing on 43 isolates of C. gattii from human patients in Oregon, Washington, California and Idaho. In contrast to Vancouver Island, VGIIa was the most frequent but not the predominant subtype in the northwest US. Antifungal susceptibility testing showed statistically significant differences in minimum inhibitory concentration (MIC) values between the subtypes. This is the first study to apply antifungal susceptibility testing to C. gattii isolates from the Pacific Northwest and the first to make direct comparisons between subtypes. |
BirthStats: Percentage of mothers receiving epidural/spinal anesthesia by age, race, and hispanic origin of mother: total of 18 U.S. reporting areas, singletons only, 2006
Osterman MJ . Birth 2009 36 (4) 340-1 Data from a new item describing the characteristics of labor and delivery on the 2003 revision of the U.S. Standard Certificate of Live Birth (1) show that about 60 percent of women in the reporting area received epidural or spinal anesthesia for pain relief during labor and delivery in 2006 (2) (Fig. 1). As defined on the birth certificate, epidural or spinal anesthesia represents the administration to the mother of a regional anesthesia to control the pain of labor and delivery (3). As of January 1, 2006, the 18 states that collected this information were California, Delaware, Florida, Idaho, Kansas, Kentucky, New Hampshire, Nebraska, New York (excluding New York City), North Dakota, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, and Wyoming. These states comprised nearly 2 million births (45% of total births) in the United States in 2006 (2). |
In memoriam: Jonathan S. Allan, DVM (1952-2009)
Chapman LE . Arch Virol 2009 155 (1) 3-5 Jonathan S. Allan, DVM, a 57-year-old internationally respected bioscientist and former mayor of Helotes, Texas, died peacefully at home on 28 September 2009. Jon was diagnosed with a stage 4 glioblastoma, a brain cancer, about 14 months earlier. Jon is survived by two brothers, his mother in New Hampshire, his beloved dog Millie, the wild hogs surrounding his Texas hill country cabin, and a wide community of friends who often met Jon through his science but remained connected primarily because of his humanity. | A native of Boston, Jon earned a Bachelor’s degree at Purdue University in W. Lafayette, Indiana, a Master’s degree in Microbiology at Vanderbilt School of Medicine in Nashville, Tennessee, and a degree in Veterinary Medicine from Michigan State University in East Lansing, Michigan. He returned to Boston in the mid-1980s to complete post-doctoral work in Virology at Harvard University School of Public Health. |
Nanoparticle Emission Assessment Technique (NEAT) for the identification and measurement of potential inhalation exposure to engineered nanomaterials - part A
Methner M , Hodson L , Geraci C . J Occup Environ Hyg 2010 7 (3) 127-132 There are currently no exposure limits specific to engineered nanomaterial nor any national or international consensus standards on measurement techniques for nanomaterials in the workplace. However, facilities engaged in the production and use of engineered nanomaterials have expressed an interest in learning whether the potential for worker exposure exists. To assist with answering this question, the National Institute for Occupational Safety and Health established a nanotechnology field research team whose primary goal was to visit facilities and evaluate the potential for release of nanomaterials and worker exposure. The team identified numerous techniques to measure airborne nanomaterials with respect to particle size, mass, surface area, number concentration, and composition. However, some of these techniques lack specificity and field portability and are difficult to use and expensive when applied to routine exposure assessment. This article describes the nanoparticle emission assessment technique (NEAT) that uses a combination of measurement techniques and instruments to assess potential inhalation exposures in facilities that handle or produce engineered nanomaterials. The NEAT utilizes portable direct-reading instrumentation supplemented by a pair of filter-based air samples (source-specific and personal breathing zone). The use of the filter-based samples are crucial for identification purposes because particle counters are generally insensitive to particle source or composition and make it difficult to differentiate between incidental and process-related nanomaterials using number concentration alone. Results from using the NEAT at 12 facilities are presented in the companion article (Part B) in this issue. |
Physiological monitoring in firefighter ensembles: wearable plethysmographic sensor vest versus standard equipment
Coca A , Roberge RJ , Williams WJ , Landsittel DP , Powell JB , Palmiero A . J Occup Environ Hyg 2010 7 (2) 109-114 We evaluated the accuracy of a wearable sensor vest for real-time monitoring of physiological responses to treadmill exercise. Ten subjects in standard firefighter ensembles, treadmill exercising at 50% VO(2) max, had heart rate (HR), respiratory rate (RR), skin temperature (T(sk)), oxygen saturation (SaO(2)), tidal volume (V(T)), and minute ventilation (V(E)) recorded concurrently by a wearable plethysmographic sensor vest and standard laboratory physiological monitoring equipment for comparison. A high degree of correlation was noted for most of the measured variables [HR (r = 0.99), RR (r = 0.98), T(sk) (r = 0.98), V(E) (r = 0.88), and SaO(2) (r = 0.79)]. V(T) (r = 0.60) had a moderate correlation, although a paired differences analysis showed a mean paired difference of -0.03 L. This mean paired difference represents a 1.92% variation for V(T). Data from the wearable sensor vest is comparable to data captured from standard laboratory physiological monitoring equipment on subjects wearing standard firefighter ensembles while exercising at a moderate work rate. This study demonstrates the accuracy of the wearable sensor technology for these physiological parameters under these conditions and suggests that it could be useful for actual field studies of firefighters in traditional firefighting gear. |
Pesticide use and adult-onset asthma among male farmers in the Agricultural Health Study
Hoppin JA , Umbach DM , London SJ , Henneberger PK , Kullman GJ , Coble J , Alavanja MC , Beane Freeman LE , Sandler DP . Eur Respir J 2009 34 (6) 1296-303 Although specific pesticides have been associated with wheeze in farmers, little is known about pesticides and asthma. Data from 19,704 male farmers in the Agricultural Health Study were used to evaluate lifetime use of 48 pesticides and prevalent adult-onset asthma, defined as doctor-diagnosed asthma after the age of 20 yrs. Asthma cases were categorised as allergic (n = 127) and nonallergic (n = 314) based on their history of eczema or hay fever. Polytomous logistic regression, controlling for age, state, smoking and body mass, was used to assess pesticide associations. High pesticide exposure events were associated with a doubling of both allergic and nonallergic asthma. For ever-use, 12 individual pesticides were associated with allergic asthma and four with nonallergic asthma. For allergic asthma, coumaphos (OR 2.34; 95% CI 1.49-3.70), heptachlor (OR 2.01; 95% CI 1.30-3.11), parathion (OR 2.05; 95% CI 1.21-3.46), 80/20 mix (carbon tetrachloride/carbon disulfide) (OR 2.15; 95% CI 1.23-3.76) and ethylene dibromide (OR 2.07; 95% CI 1.02-4.20) all showed ORs of >2.0 and significant exposure-response trends. For nonallergic asthma, DDT (dichlorodiphenyltrichloroethane) showed the strongest association (OR 1.41; 95% CI 1.09-1.84), but with little evidence of increasing asthma with increasing use. Current animal handling and farm activities did not confound these results. There was little evidence that allergy alone was driving these associations. In conclusion, pesticides may be an overlooked contributor to asthma risk among farmers. |
Estimated daily intake of phthalates in occupationally exposed groups
Hines CJ , Hopf NB , Deddens JA , Silva MJ , Calafat AM . J Expo Sci Environ Epidemiol 2009 21 (2) 133-41 Improved analytical methods for measuring urinary phthalate metabolites have resulted in biomarker-based estimates of phthalate daily intake for the general population, but not for occupationally exposed groups. In 2003-2005, we recruited 156 workers from eight industries where materials containing diethyl phthalate (DEP), dibutyl phthalate (DBP), and/or di(2-ethylhexyl) phthalate (DEHP) were used as part of the worker's regular job duties. Phthalate metabolite concentrations measured in the workers' end-shift urine samples were used in a simple pharmacokinetic model to estimate phthalate daily intake. DEHP intake estimates based on three DEHP metabolites combined were 0.6-850 mug/kg/day, with the two highest geometric mean (GM) intakes in polyvinyl chloride (PVC) film manufacturing (17 mug/kg/day) and PVC compounding (12 mug/kg/day). All industries, except phthalate manufacturing, had some workers whose DEHP exposure exceeded the U.S. reference dose (RfD) of 20 mug/kg/day. A few workers also exceeded the DEHP European tolerable daily intake (TDI) of 50 mug/kg/day. DEP intake estimates were 0.5-170 mug/kg/day, with the highest GM in phthalate manufacturing (27 mug/kg/day). DBP intake estimates were 0.1-76 mug/kg/day, with the highest GMs in rubber gasket and in phthalate manufacturing (17 mug/kg/day, each). No DEP or DBP intake estimates exceeded their respective RfDs. The DBP TDI (10 mug/kg/day) was exceeded in three rubber industries and in phthalate manufacturing. These intake estimates are subject to several uncertainties; however, an occupational contribution to phthalate daily intake is clearly indicated in some industries.Journal of Exposure Science and Environmental Epidemiology advance online publication, 16 December 2009; doi:10.1038/jes.2009.62. |
Physical activity surveillance: providing public health data for decision makers
Galuska DA , Fulton JE . J Phys Act Health 2009 6 S1-2 In today’s world, the term surveillance brings to mind | images of military intelligence gathering information to | guide military planning or security companies monitor- | ing homes or businesses. Public health surveillance | resembles these types of activities insofar as it also | involves the collection of data for decision making. As | defined by Thacker and Berkelman, public health sur- | veillance is “the ongoing systematic collection, analy- | sis, and interpretation of outcome-specific data for use | in the planning, implementation, and evaluation of | public health practice.”1 This supplement highlights the | various aspects of public health surveillance of physical | activity. | Two important components of the Thacker and | Berkelman definition merit further consideration. First, | surveillance requires ongoing and systematic data col- | lection. Ongoing refers to the periodic assessment of the | outcomes of interest over time. In this way surveillance | differs from the single 1-time survey. Because data col- | lection is done multiple times, it must be systematic; the | same information needs to be collected in the same way. | Even slight changes in survey questions or data collec- | tion methodology can alter the interpretation of the find- | ings both within a surveillance system and across sys- | tems. This is highlighted in the article by Carlson and | colleagues that illustrates how differences in the survey | questions and methodology for 3 U.S. surveillance sys- | tems for physical activity affect prevalence estimates | and trends. |
Physical activity: an investment that pays multiple health dividends: comment on "combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men," "physical activity and survival in male colorectal cancer survival," "effects of a television viewing reduction on energy intake and expenditure in overweight and obese adults," and "physical activity and rapid decline in kidney function among older adults"
Fulton JE , Simons-Morton DG , Galuska DA . Arch Intern Med 2009 169 (22) 2124-7 During difficult economic times, it is especially important to invest limited resources wisely. Choosing an investment strategy that will ultimately garner rewards requires strategies that turn low-risk investments into high-yield returns. This economic analogy is relevant to strategies for investing not only in the stock market but also in our health. |
Prevalence of self-reported aerobic physical activity among U.S. States and territories--Behavioral Risk Factor Surveillance System, 2007
Loustalot F , Carlson SA , Fulton JE , Kruger J , Galuska DA , Lobelo F . J Phys Act Health 2009 6 S9-17 BACKGROUND: Accurate surveillance data on physical activity prevalence is important for U.S. states and territories as they develop programs and interventions to increase physical activity participation. METHODS: Using 2007 data from the Behavioral Risk Factor Surveillance System, we estimated the percentage of U.S. adults in each U.S. state and territory who met minimum aerobic activity criteria using the 2008 Physical Activity Guidelines for Americans (2008 Guidelines) and the Healthy People 2010 criteria for physical activity. SUDAAN was used to calculate prevalence estimates and 95% confidence intervals. RESULTS: The estimated prevalence of recommended aerobic activity in U.S. states and territories ranged from 44.5% to 73.3% according to 2008 Guidelines and from 30.8% to 60.0% according to Healthy People 2010 criteria. Absolute percent differences in prevalence among U.S. states and territories ranged from 11.7% to 19.1%, and relative percent differences ranged from 20.8% to 44.6%. CONCLUSIONS: In all U.S. states and territories, a larger proportion of U.S. adults met minimum aerobic activity criteria in the 2008 Guidelines than met corresponding criteria in Healthy People 2010. This difference, however, does not reflect an actual change in the amount of aerobic activity, but a change to the criteria for meeting 2008 Guidelines. |
Staying on task: challenges of global physical activity surveillance
Pratt M , Fulton JE . J Phys Act Health 2009 6 S3-4 As this special issue demonstrates we are in the midst of an exciting period of creativity and growth in research methods related to the assessment of physical activity (PA). A few years ago diversity in assessment of PA was likely to refer only to a large number of shor tand long questionnaires on individual PA behavior. We no have even more such questionnaires from around the world tailored to language, culture, and context: a plethora of approaches to assessing perceptions of environmental and policy factors associated with PA; environmental audit tools and policy check lists; protocols for pedometers and accelerometers to objectively measure certain types of PA, direct observation systems for school and community settings, and the application of many combinations of ever more afforable and available technologies such as GIS, cell phones, and interactive digital systems. Even better from a research perspective has been the attention to reliability, validity and cultural tailoring of many of the instruments and assessments methods. The large number of reliable and valid options for assessing PA coupled with increasingly sophisticated analytic techniques gives hope for new and better approaches to tackle the surprisngly challenging task of PA surveillance. |
Television viewing, computer use, and BMI among U.S. children and adolescents
Fulton JE , Wang X , Yore MM , Carlson SA , Galuska DA , Caspersen CJ . J Phys Act Health 2009 6 S28-35 BACKGROUND: To examine the prevalence of television (TV) viewing, computer use, and their combination and associations with demographic characteristics and body mass index (BMI) among U.S. youth. METHODS: The 1999 to 2006 National Health and Nutrition Examination Survey (NHANES) was used. Time spent yesterday sitting and watching television or videos (TV viewing) and using the computer or playing computer games (computer use) were assessed by questionnaire. RESULTS: Prevalence (%) of meeting the U.S. objective for TV viewing (< or =2 hours/day) ranged from 65% to 71%. Prevalence of no computer use (0 hours/day) ranged from 23% to 45%. Non-Hispanic Black youth aged 2 to 15 years were less likely than their non-Hispanic White counterparts to meet the objective for TV viewing. Overweight or obese school-age youth were less likely than their normal weight counterparts to meet the objective for TV viewing. CONCLUSIONS: Computer use is prevalent among U.S. youth; more than half of youth used a computer on the previous day. The proportion of youth meeting the U.S. objective for TV viewing is less than the target of 75%. Time spent in sedentary behaviors such as viewing TV may contribute to overweight and obesity among U.S. youth. |
Differences in physical activity prevalence and trends from 3 U.S. surveillance systems: NHIS, NHANES, and BRFSS
Carlson SA , Densmore D , Fulton JE , Yore MM , Kohl HW 3rd . J Phys Act Health 2009 6 S18-27 BACKGROUND: Three U.S. surveillance systems-National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and Behavioral Risk Factor Surveillance System (BRFSS)--estimate physical activity prevalence. METHODS: Survey differences were examined qualitatively. Prevalence estimates by sex, age, and race/ethnicity were assessed for comparable survey periods. Trends were examined from NHIS 1998 to 2007, NHANES 1999 to 2006, and BRFSS 2001 to 2007. RESULTS: Age-adjusted prevalence estimates appeared most similar for NHIS 2005 (physically active: 30.2%, inactive: 40.7%) and NHANES 2005 to 2006 (physically active: 33.5%, inactive: 32.4%). In BRFSS 2005, prevalence of being physically active was 48.3% and inactive was 13.9%. Across all systems, men were more likely to be active than women; non-Hispanic whites were most likely to be active; as age increased, overall prevalence of being active decreased. Prevalence of being active exhibited a significant increasing trend only in BRFSS 2001 to 2007 (P < .001), while prevalence of being inactive decreased significantly in NHANES 1999 to 2006 (P < .001) and BRFSS 2001 to 2007 (P < .001). CONCLUSIONS: Different ways of assessing physical activity in surveillance systems result in different prevalence estimates. Before comparing estimates from different systems, all aspects of data collection and data analysis should be examined to determine if comparisons are appropriate. |
Healthy people 2010 objectives for physical activity, physical education, and television viewing among adolescents: national trends from the Youth Risk Behavior Surveillance System, 1999-2007
Lowry R , Lee SM , Fulton JE , Kann L . J Phys Act Health 2009 6 S36-45 BACKGROUND: To help inform policies and programs, a need exists to understand the extent to which Healthy People 2010 objectives for physical activity, physical education (PE), and television (TV) viewing among adolescents are being achieved. METHODS: As part of the Youth Risk Behavior Surveillance System, 5 national school-based surveys were conducted biennially from 1999 through 2007. Each survey used a 3-stage cross-sectional sample of students in grades 9 to 12 and provided self-reported data from approximately 14,000 students. Logistic regression models that controlled for sex, race/ethnicity, and grade were used to analyze secular trends. RESULTS: During 1999 to 2007, prevalence estimates for regular participation in moderate and vigorous physical activity, participation in daily PE classes, and being physically active in PE classes did not change significantly among female, male, white, black, or Hispanic students. In contrast, the prevalence of TV viewing for 2 or fewer hours on a school day increased significantly among female, male, white, black, and Hispanic students and among students in every grade except 12th grade. CONCLUSIONS: Among US adolescents, no significant progress has been made toward increasing participation in physical activity or school PE classes; however, improvements have been made in reducing TV viewing time. |
Qualitative analysis of immunization programs with most improved childhood vaccination coverage from 2001 to 2004
Groom H , Kennedy A , Evans V , Fasano N . J Public Health Manag Pract 2010 16 (1) E1-E8 State and urban immunization programs are responsible for the implementation of comprehensive programs to vaccinate populations within their geographic area. Given the variability in immunization coverage rates between geographic areas, the purpose of this two-phase study was to first identify the state and urban areas that achieved the highest increases in coverage, and then those with the highest sustained coverage, between two designated periods, and to interview key program staff members and their community counterparts to capture their perspectives on what factors may have contributed to increasing and sustaining high rates. In this article, we describe phase 1, in which we visited the seven sites that achieved the largest increases in coverage from 2001 to 2004. Results describe outcomes from the 71 semistructured key informant interviews with internal staff and external partners at the site's immunization programs. Interview transcripts were analyzed qualitatively, using a general inductive approach. Common challenges encountered among the seven sites included increasing reluctance among parents and overcoming barriers to accessing care. Common strategies to address these and other challenges included collecting and using data on immunization coverage, developing communication and education efforts, and continuously reaching out and collaborating with immunization partners. Lessons learned from these programs may help inform others who are working to improve childhood immunization delivery and coverage in their own programs. |
A qualitative analysis of immunization programs with sustained high coverage, 2000-2005
Kennedy A , Groom H , Evans V , Fasano N . J Public Health Manag Pract 2010 16 (1) E9-E17 Despite record-high immunization coverage nationally, there is considerable variation across state and local immunization programs, which are responsible for the implementation of vaccine recommendations in their jurisdictions. The objectives of this study were to describe activities of state and local immunization programs that sustained high coverage levels across several years and to identify common themes and practical examples for sustaining childhood vaccination coverage rates that could be applied elsewhere. We conducted 95 semi-structured key informant interviews with internal staff members and external partners at the 10 immunization programs with the highest sustained childhood immunization coverage from 2000 to 2005, as measured by the National Immunization Survey. Interview transcripts were analyzed qualitatively using a general inductive approach. Common themes across the 10 programs included maintaining a strong program infrastructure, using available data to drive planning and decision making, a commitment to building and sustaining relationships, and a focus on education and communication. Given the challenges of an increasingly complex immunization system, the lessons learned from these programs may help inform others who are working to improve childhood immunization delivery and coverage in their own programs. |
The National Public Health Performance Standards: driving quality improvement in public health systems
Corso LC , Lenaway D , Beitsch LM , Landrum LB , Deutsch H . J Public Health Manag Pract 2010 16 (1) 19-23 Since its inception in 1998, the Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has helped lay the groundwork for public health quality improvement (QI) activities at the state and local levels. This article describes how the NPHPSP has promoted QI through its instruments and guidance and how it has continually strengthened the focus on QI over the years. The NPHPSP Version 2 instruments and enhanced guidance have been designed to more strongly reinforce QI and catalyze the transition from assessment to action. Despite positive reports from some state and local users that emphasize the value the NPHPSP holds for those that do successfully move forward with improvement actions, 2005 evaluation results from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials indicated challenges in transitioning the assessments results into performance improvement. More recent data are promising; a 2009 postassessment survey of early Version 2 respondents indicates that the majority (75% of all respondents) report action in one or more performance improvement steps. The NPHPSP has played an important role in fostering QI in many states and local jurisdictions. Furthermore, its experiences and lessons learned in supporting QI have helped to pave the way for other initiatives, such as the emerging national accreditation system for state and local health departments. |
Quality improvement and performance: CDC's strategies to strengthen public health
Lenaway D , Corso LC , Buchanan S , Thomas C , Astles R . J Public Health Manag Pract 2010 16 (1) 11-13 This article comments on Centers for Disease Control and Prevention's strategies to strengthen public health and its system components in order to create the necessary operational capacity and infrastructure vital to the success of all public health prevention, protection, and wellness activities. | Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people. | President Barack Obama | Within the context of health reform, the Obama administration's ambitious goal of integrating prevention, public health, and healthcare delivery systems anticipates greatly expanding prevention and wellness activities as the primary means to reduce the burden of disease, injury, and disability in the United States. This prescription for change represents a significant challenge. If public health is to succeed in delivering on the “promise of prevention,” as well as exert our leadership role, then we need to counter with bold initiatives that promote accountability, performance, and improvements in public health. The reason is clear—without a high-performing public health system, we will not be able to attain the goals of the new administration and, most important, the health aspirations of communities across the nation. |
Defining quality improvement in public health
Riley WJ , Moran JW , Corso LC , Beitsch LM , Bialek R , Cofsky A . J Public Health Manag Pract 2010 16 (1) 5-7 Many industries commonly use quality improvement (QI) techniques to improve service delivery and process performance. Yet, there has been scarce application of these proven methods to public health settings and the public health field has not developed a set of shared principles or a common definition for quality improvement. This article discusses a definition of quality improvement in public health and describes a continuum of quality improvement applications for public health departments. Quality improvement is a distinct management process and set of tools and techniques that are coordinated to ensure that departments consistently meet the health needs of their communities. |
Outcome-based workforce development and education in public health
Koo D , Miner K . Annu Rev Public Health 2009 31 253-69 The broad scope of the public health mission leads to an increasingly diverse workforce. Given the range of feeder disciplines and the reality that much of the workforce does not have formal training in public health science and practice, a pressing need exists for training and education throughout the workforce. Just as we in public health take a rigorous approach to our science, so too should we take a rigorous, evidence-driven approach to workforce development. In this review, we recommend a framework for workforce education in public health, integrating three critical conceptual approaches: (a) adult learning theory; (b) competency-based education; and (c) the expanded Dreyfus model in public health, an addition to the Dreyfus model of professional skills progression. We illustrate the application of this framework in practice, using the field of applied epidemiology. This framework provides a context for designing and developing high-quality, outcome-based workforce development efforts and evaluating their impact, with implications for academic and public health practice efforts to educate the public health workforce. Expected final online publication date for the Annual Review of Public Health Volume 31 is March 17, 2010. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates. |
Lifestyle behaviors and receipt of preventive health care services among hypertensive Americans aged 45 years or older in 2007
Fan AZ , Mallawaarachchi DS , Gilbertz D , Li Y , Mokdad AH . Prev Med 2009 50 (3) 138-42 OBJECTIVE: To explore opportunities for more effective interventions on lifestyle modifications among hypertensives. METHODS: Using 2007 data from the Behavioral Risk Factor Surveillance System from the United States, we assessed the prevalence of various lifestyle behaviors and receipt of preventive health care services among US adults aged 45 years or older based on hypertension and treatment status (n=218,228). RESULTS:. Compared with non-hypertensives, hypertensives were significantly less likely to engage in recommended levels of physical activity and to be more obese regardless of treatment status. Compared to non-hypertensives, hypertensives on medical treatment were less likely to consume five or more servings of fruit and vegetables per day, be current smokers, and binge drinkers. Hypertensives not on medical treatment were more likely to be current smokers, binge and heavy drinkers. Hypertensives on medical treatment were more likely to have routine health check-up, have blood cholesterol check-up within previous five years and have a flu shot within the previous year than hypertensives not on treatment. CONCLUSION: Different patterns of lifestyle behaviors and use of preventive health care services were found based on treatment status among hypertensives. Intervention programs should be tailored accordingly to achieve optimal outcome on lifestyle modification. |
Predictors of compliance with a mass drug administration programme for lymphatic filariasis in Orissa State, India 2008
Cantey PT , Rao G , Rout J , Fox LM . Trop Med Int Health 2009 15 (2) 224-31 OBJECTIVES: To assess the performance of an educational campaign to increase adherence to a mass-administered DEC regimen against lymphatic filariasis (LF) in Orissa, and to identify factors that could enhance future campaigns. METHOD: Randomized cluster survey, comparing areas that did and did not receive the educational campaign, using a household coverage survey and knowledge, attitudes and practices (KAP) survey. RESULTS: LF MDA coverage for the entire population (n = 3449) was 56% (95% CI: 50.0-61.9). There was no statistical difference between the areas that did and did not receive the educational campaign. The most common barriers to adherence were fear of medication side effects (47.4%) and lack of recognition of one's risk for LF (15.8%). Modifiable, statistically significant, multivariable predictors of adherence were knowing that DEC prevents LF (aOR = 2.6, 95% CI: 1.4-5.1), knowing that mosquitoes transmit LF (aOR = 1.9, 95% CI: 1.1-3.2), and knowing both about the mass drug administration (MDA) in advance and that mosquitoes transmit LF (aOR = 5.4, 95% CI: 2.8-10.4). CONCLUSIONS: India needs to increase compliance with MDA programmes to reach its goal of interrupting LF transmission. Promoting a simple public health message before MDA distribution, which takes into account barriers to and predictors of adherence, could raise compliance with the LF MDA programme. |
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