Prevalence of nonrefractive visual impairment in US adults and associated risk factors, 1999-2002 and 2005-2008
Ko F , Vitale S , Chou CF , Cotch MF , Saaddine J , Friedman DS . JAMA 2012 308 (22) 2361-8 CONTEXT: Over the past decade, chronic illnesses with ophthalmic sequelae such as diabetes and diabetic retinopathy have increased. OBJECTIVES: To estimate prevalence of nonrefractive visual impairment and to describe its relationship with demographic and systemic risk factors including diagnosed diabetes. DESIGN, SETTING, AND PARTICIPANTS: The National Health and Nutrition Examination Survey (NHANES) examined a representative sample of the US noninstitutionalized population. In 1999-2002 and 2005-2008, 9471 and 10,480 participants aged 20 years or older received questionnaires, laboratory tests, and physical examinations. Visual acuity of less than 20/40 aided by autorefractor was classified as nonrefractive visual impairment. MAIN OUTCOME MEASURE: Nonrefractive visual impairment. RESULTS: Weighted prevalence of nonrefractive visual impairment increased 21% among US adults aged 20 years and older from 1.4% in 1999-2002 to 1.7% in 2005-2008 (P = .03); and increased 40% among non-Hispanic whites aged 20-39 years from 0.5% to 0.7% (P = .008). In multivariable analyses, statistically significant risk factors for nonrefractive visual impairment in 1999-2002 included age (per year odds ratio [OR], 1.07; 95% CI, 1.05-1.09), poverty (OR, 2.18; 95% CI, 1.31-3.64), lack of insurance (OR, 1.85; 95% CI, 1.16-2.95), and diabetes with 10 or more years since diagnosis (OR, 1.93; 95% CI, 1.15-3.25). In 2005-2008, risk factors included age (OR, 1.05; 95% CI, 1.04-1.07), poverty (OR, 2.23; 95% CI, 1.55-3.22), education less than high school (OR, 2.11; 95% CI, 1.54-2.90), and diabetes with 10 or more years since diagnosis (OR, 2.67; 95% CI, 1.64-4.37). Prevalence of diabetes with 10 or more years since diagnosis increased 22% overall from 2.8% to 3.6% (P = .02); and 133% among non-Hispanic whites aged 20-39 years from 0.3% to 0.7% (P < .001). CONCLUSION: Prevalence of nonrefractive visual impairment was significantly higher in 2005-2008 than in 1999-2002 and may be attributable, in part, to higher prevalence of diabetes, an associated risk factor that increased in prevalence during this time period. |
Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: dynamic modeling of incidence, mortality, and population growth
Imperatore G , Boyle JP , Thompson TJ , Case D , Dabelea D , Hamman RF , Lawrence JM , Liese AD , Liu LL , Mayer-Davis EJ , Rodriguez BL , Standiford D . Diabetes Care 2012 35 (12) 2515-2520 OBJECTIVE: To forecast the number of U.S. individuals aged <20 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) through 2050, accounting for changing demography and diabetes incidence. RESEARCH DESIGN AND METHODS: We used Markov modeling framework to generate yearly forecasts of the number of individuals in each of three states (diabetes, no diabetes, and death). We used 2001 prevalence and 2002 incidence of T1DM and T2DM from the SEARCH for Diabetes in Youth study and U.S. Census Bureau population demographic projections. Two scenarios were considered for T1DM and T2DM incidence: 1) constant incidence over time; 2) for T1DM yearly percentage increases of 3.5, 2.2, 1.8, and 2.1% by age-groups 0-4 years, 5-9 years, 10-14 years, and 15-19 years, respectively, and for T2DM a yearly 2.3% increase across all ages. RESULTS: Under scenario 1, the projected number of youth with T1DM rises from 166,018 to 203,382 and with T2DM from 20,203 to 30,111, respectively, in 2010 and 2050. Under scenario 2, the number of youth with T1DM nearly triples from 179,388 in 2010 to 587,488 in 2050 (prevalence 2.13/1,000 and 5.20/1,000 [+144% increase]), with the greatest increase in youth of minority racial/ethnic groups. The number of youth with T2DM almost quadruples from 22,820 in 2010 to 84,131 in 2050; prevalence increases from 0.27/1,000 to 0.75/1,000 (+178% increase). CONCLUSIONS: A linear increase in diabetes incidence could result in a substantial increase in the number of youth with T1DM and T2DM over the next 40 years, especially those of minority race/ethnicity. |
Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test
Drenkard C , Dunlop-Thomas C , Easley K , Bao G , Brady T , Lim S . Lupus 2012 21 (14) 1586-93 Minorities with systemic lupus erythematosus (SLE) are at high risk of poor disease outcomes and may face challenges in effectively self-managing multiple health problems. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based intervention that improves the health of people with chronic illnesses. Although the CDSMP is offered by organizations throughout the United States and many countries around the world, it has not been tested among SLE patients. We pilot tested the benefits of the CDSMP in low-income African American patients with SLE. CDSMP workshops were delivered to 49 African American women with SLE who received medical care at a public lupus clinic in Atlanta, Georgia, US. We compared pre-post CDSMP changes (from baseline to 4 months after the start of the intervention) in health status, self-efficacy and self-management behaviors using self-reported measures. Additionally, we assessed health care utilization changes using electronic administrative records in the 6-month periods before and after the intervention. We observed significant improvements post-intervention in the SF-36 physical health component summary (mean change=2.4, p=0.032); self-efficacy (mean change=0.5, p=0.035); and several self-management behaviors: cognitive symptoms management (mean change=0.3, p=0.036); communication with physicians (mean change=0.4, p=0.01); and treatment adherence (mean change=0.4, p=0.01). The median number of outpatient visits decreased from 3 to 1 (p<.0001). The CDSMP is a promising intervention for low-income African Americans with SLE. It is an inexpensive program with growing availability around the world that should be further evaluated as a resource to improve patient-centered outcomes and decrease health service utilization among SLE patients. |
Circulating carotenoids and risk of breast cancer: pooled analysis of eight prospective studies
Eliassen AH , Hendrickson SJ , Brinton LA , Buring JE , Campos H , Dai Q , Dorgan JF , Franke AA , Gao YT , Goodman MT , Hallmans G , Helzlsouer KJ , Hoffman-Bolton J , Hulten K , Sesso HD , Sowell AL , Tamimi RM , Toniolo P , Wilkens LR , Winkvist A , Zeleniuch-Jacquotte A , Zheng W , Hankinson SE . J Natl Cancer Inst 2012 104 (24) 1905-16 BACKGROUND: Carotenoids, micronutrients in fruits and vegetables, may reduce breast cancer risk. Most, but not all, past studies of circulating carotenoids and breast cancer have found an inverse association with at least one carotenoid, although the specific carotenoid has varied across studies. METHODS: We conducted a pooled analysis of eight cohort studies comprising more than 80% of the world's published prospective data on plasma or serum carotenoids and breast cancer, including 3055 case subjects and 3956 matched control subjects. To account for laboratory differences and examine population differences across studies, we recalibrated participant carotenoid levels to a common standard by reassaying 20 plasma or serum samples from each cohort together at the same laboratory. Using conditional logistic regression, adjusting for several breast cancer risk factors, we calculated relative risks (RRs) and 95% confidence intervals (CIs) using quintiles defined among the control subjects from all studies. All P values are two-sided. RESULTS: Statistically significant inverse associations with breast cancer were observed for alpha-carotene (top vs bottom quintile RR = 0.87, 95% CI = 0.71 to 1.05, Ptrend = .04), beta-carotene (RR = 0.83, 95% CI = 0.70 to 0.98, Ptrend = .02), lutein+zeaxanthin (RR = 0.84, 95% CI = 0.70 to 1.01, Ptrend = .05), lycopene (RR = 0.78, 95% CI = 0.62 to 0.99, Ptrend = .02), and total carotenoids (RR = 0.81, 95% CI = 0.68 to 0.96, Ptrend = .01). beta-Cryptoxanthin was not statistically significantly associated with risk. Tests for heterogeneity across studies were not statistically significant. For several carotenoids, associations appeared stronger for estrogen receptor negative (ER(-)) than for ER(+) tumors (eg, beta-carotene: ER(-): top vs bottom quintile RR = 0.52, 95% CI = 0.36 to 0.77, Ptrend = .001; ER(+): RR = 0.83, 95% CI = 0.66 to 1.04, Ptrend = .06; Pheterogeneity = .01). CONCLUSIONS: This comprehensive prospective analysis suggests women with higher circulating levels of alpha-carotene, beta-carotene, lutein+zeaxanthin, lycopene, and total carotenoids may be at reduced risk of breast cancer. |
Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis
Marrone MT , Venkataramanan V , Goodman M , Hill AC , Jereb JA , Mase SR . Int J Tuberc Lung Dis 2013 17 (1) 6-16 BACKGROUND: With the emergence of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), surgery, which had been replaced by short-course chemotherapy, is again being considered a viable treatment option. OBJECTIVE: To assess the literature on the effectiveness of surgical interventions in the treatment of drug-resistant TB. METHODS: Medline, EMBASE, and PubMed were searched from 1975 to April 2012 in addition to hand searching reference lists, and the International Journal of Tuberculosis and Lung Disease. Potentially relevant studies were assessed according to pre-defined eligibility criteria: MDR- and XDR-TB patients undergoing surgical and non-surgical treatment. Treatment outcomes were extracted according to internationally accepted definitions and included in meta-analyses using random effects models. RESULTS: Summary meta-analysis of 24 comparison studies revealed a significant association between surgery and successful treatment compared to non-surgical interventions (OR 2.24, 95%CI 1.68-2.97). A meta-analysis from 23 single-arm studies demonstrated that respectively 92% (95%CI 88.1-95) and 87% (95%CI 83-91) of surgical patients achieved successful short- and long-term outcomes. Subgroup analyses showed that favorable surgical outcomes were associated with increased drug resistance in studies reporting surgical and non-surgical treatment outcomes. CONCLUSIONS: While the results suggest that surgical intervention is associated with successful treatment outcomes in patients with drug-resistant TB, there is insufficient evidence to recommend surgery plus chemotherapy over chemotherapy alone, to evaluate the potential harm from surgery and to determine the optimal conditions for surgery. Controlled studies are needed to better assess the effectiveness of surgery and to investigate other contextual issues. |
Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011
Fanfair RN , Benedict K , Bos J , Bennett SD , Lo YC , Adebanjo T , Etienne K , Deak E , Derado G , Shieh WJ , Drew C , Zaki S , Sugerman D , Gade L , Thompson EH , Sutton DA , Engelthaler DM , Schupp JM , Brandt ME , Harris JR , Lockhart SR , Turabelidze G , Park BJ . N Engl J Med 2012 367 (23) 2214-25 BACKGROUND: Mucormycosis is a fungal infection caused by environmentally acquired molds. We investigated a cluster of cases of cutaneous mucormycosis among persons injured during the May 22, 2011, tornado in Joplin, Missouri. METHODS: We defined a case as a soft-tissue infection in a person injured during the tornado, with evidence of a mucormycete on culture or immunohistochemical testing plus DNA sequencing. We conducted a case-control study by reviewing medical records and conducting interviews with case patients and hospitalized controls. DNA sequencing and whole-genome sequencing were performed on clinical specimens to identify species and assess strain-level differences, respectively. RESULTS: A total of 13 case patients were identified, 5 of whom (38%) died. The patients had a median of 5 wounds (range, 1 to 7); 11 patients (85%) had at least one fracture, 9 (69%) had blunt trauma, and 5 (38%) had penetrating trauma. All case patients had been located in the zone that sustained the most severe damage during the tornado. On multivariate analysis, infection was associated with penetrating trauma (adjusted odds ratio for case patients vs. controls, 8.8; 95% confidence interval [CI], 1.1 to 69.2) and an increased number of wounds (adjusted odds ratio, 2.0 for each additional wound; 95% CI, 1.2 to 3.2). Sequencing of the D1-D2 region of the 28S ribosomal DNA yielded Apophysomyces trapeziformis in all 13 case patients. Whole-genome sequencing showed that the apophysomyces isolates were four separate strains. CONCLUSIONS: We report a cluster of cases of cutaneous mucormycosis among Joplin tornado survivors that were associated with substantial morbidity and mortality. Increased awareness of fungi as a cause of necrotizing soft-tissue infections after a natural disaster is warranted. |
Neurologic manifestations associated with an outbreak of typhoid fever, Malawi - Mozambique, 2009: an epidemiologic investigation
Sejvar J , Lutterloh E , Naiene J , Likaka A , Manda R , Nygren B , Monroe S , Khaila T , Lowther SA , Capewell L , Date K , Townes D , Redwood Y , Schier J , Barr BT , Demby A , Mallewa M , Kampondeni S , Blount B , Humphrys M , Talkington D , Armstrong GL , Mintz E . PLoS One 2012 7 (12) e46099 BACKGROUND: The bacterium Salmonella enterica serovar Typhi causes typhoid fever, which is typically associated with fever and abdominal pain. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness. OBJECTIVE: Describe neurologic features complicating typhoid fever during an outbreak in Malawi-Mozambique METHODS: Persons meeting a clinical case definition were identified through surveillance, with laboratory confirmation of typhoid by antibody testing or blood/stool culture. We gathered demographic and clinical information, examined patients, and evaluated a subset of patients 11 months after onset. A sample of persons with and without neurologic signs was tested for vitamin B6 and B12 levels and urinary thiocyanate. RESULTS: Between March - November 2009, 303 cases of typhoid fever were identified. Forty (13%) persons had objective neurologic findings, including 14 confirmed by culture/serology; 27 (68%) were hospitalized, and 5 (13%) died. Seventeen (43%) had a constellation of upper motor neuron findings, including hyperreflexia, spasticity, or sustained ankle clonus. Other neurologic features included ataxia (22, 55%), parkinsonism (8, 20%), and tremors (4, 10%). Brain MRI of 3 (ages 5, 7, and 18 years) demonstrated cerebral atrophy but no other abnormalities. Of 13 patients re-evaluated 11 months later, 11 recovered completely, and 2 had persistent hyperreflexia and ataxia. Vitamin B6 levels were markedly low in typhoid fever patients both with and without neurologic signs. CONCLUSIONS: Neurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas. |
Human parechovirus in respiratory specimens from children in Kansas City, Missouri
Sharp J , Bell J , Harrison CJ , Nix WA , Oberste MS , Selvarangan R . J Clin Microbiol 2012 50 (12) 4111-3 We detected a 3% prevalence rate for human parechovirus (HPeV) in 720 respiratory specimens collected from 637 children seen in our hospital in 2009. Fifteen of 20 were HPeV-3 and two were HPeV-1. Only nonspecific, modest respiratory symptoms were evident in patients with detectable HPeV in respiratory specimens. Seven patients had concurrent respiratory and central nervous system (CNS) HPeV-3 infection, suggesting a possible respiratory route of acquisition. |
Innate immune function and mortality in critically ill children with influenza: a multicenter study*
Hall MW , Geyer SM , Guo CY , Panoskaltsis-Mortari A , Jouvet P , Ferdinands J , Shay DK , Nateri J , Greathouse K , Sullivan R , Tran T , Keisling S , Randolph AG . Crit Care Med 2012 41 (1) 224-36 OBJECTIVE: To prospectively evaluate relationships among serum cytokine levels, innate immune responsiveness, and mortality in a multicenter cohort of critically ill children with influenza infection. DESIGN: Prospective, multicenter, observational study. SETTING: Fifteen pediatric ICUs among members of the Pediatric Acute Lung Injury and Sepsis Investigators network. PATIENTS: Patients ≤18 yrs old admitted to a PICU with community-acquired influenza infection. A control group of outpatient children was also evaluated. INTERVENTIONS: ICU patients underwent sampling within 72 hrs of ICU admission for measurement of a panel of 31 serum cytokine levels and quantification of whole blood ex vivo lipopolysaccharide-stimulated tumor necrosis factor-alpha production capacity using a standardized stimulation protocol. Outpatient control subjects also underwent measurement of tumor necrosis factor-alpha production capacity. MEASUREMENTS AND MAIN RESULTS: Fifty-two patients (44 survivors, eight deaths) were sampled. High levels of serum cytokines (granulocyte macrophage colony-stimulating factor, interleukin-6, interleukin-8, interferon-inducible protein-10, monocyte chemotactic protein-1, and macrophage inflammatory protein-1alpha) were associated with mortality (p < 0.0016 for each comparison) as was the presence of secondary infection with Staphylococcus aureus (p = 0.007), particularly methicillin-resistant S. aureus (p < 0.0001). Nonsurvivors were immunosuppressed with leukopenia and markedly reduced tumor necrosis factor-alpha production capacity compared with outpatient control subjects (n = 21, p < 0.0001) and to ICU survivors (p < 0.0001). This association remained after controlling for multiple covariables. A tumor necrosis factor-alpha response <250 pg/mL was highly predictive of death and longer duration of ICU stay (p < 0.0001). Patients with S. aureus coinfection demonstrated the greatest degree of immunosuppression (p < 0.0001). CONCLUSIONS: High serum levels of cytokines can coexist with marked innate immune suppression in children with critical influenza. Severe, early innate immune suppression is highly associated with both S. aureus coinfection and mortality in this population. Multicenter innate immune function testing is feasible and can identify these high-risk children. |
Capacity building in response to pandemic influenza threats: Lao PDR case study
Phommasack B , Moen A , Vongphrachanh P , Tsuyuoka R , Cox N , Khamphaphongphanh B , Phonekeo D , Kasai T , Ketmayoon P , Lewis H , Kounnavong B , Khanthamaly V , Corwin A . Am J Trop Med Hyg 2012 87 (6) 965-971 The Lao People's Democratic Republic (PDR) committed to pandemic detection and response preparations when faced with the threat of avian influenza. Since 2006, the National Center for Laboratory and Epidemiology of Lao PDR has developed credible laboratory, surveillance, and epidemiological (human) capacity and as a result was designated a World Health Organization National Influenza Center in 2010. The Lao PDR experience in building influenza capacities provides a case study of the considerable crossover effect of such investments to augment the capacity to combat emerging and re-emerging diseases other than influenza. |
Carriage of Neisseria lactamica in 1- to 29-year-old people in Burkina Faso: epidemiology and molecular characterization
Kristiansen PA , Diomande F , Ouedraogo R , Sanou I , Sangare L , Ouedraogo AS , Ba AK , Kandolo D , Thomas JD , Clark TA , Preziosi MP , Laforce FM , Caugant DA . J Clin Microbiol 2012 50 (12) 4020-7 Neisseria lactamica is a true commensal bacterium occupying the same ecological niche as the pathogenic Neisseria meningitidis, which is responsible for outbreaks and large epidemics, especially in sub-Saharan Africa. To better understand the epidemiology of N. lactamica in Africa and its relationship to N. meningitidis, we studied N. lactamica carriage in 1- to 29-year-old people living in three districts of Burkina Faso from 2009 to 2011. N. lactamica was detected in 18.2% of 45,847 oropharyngeal samples. Carriage prevalence was highest among the 2-year-olds (40.1%) and decreased with age. Overall prevalence was higher for males (19.1%) than females (17.5%) (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.04 to 1.18), while among the 18- to 29-year-olds, carriage prevalence was significantly higher in women (9.1%) than in men (3.9%) (OR, 2.49; 95% CI, 1.94 to 3.19). Carriage prevalence of N. lactamica was remarkably homogeneous in the three districts of Burkina Faso and stable over time, in comparison with carriage of N. meningitidis (P. A. Kristiansen et al., Clin. Vaccine Immunol. 18:435-443, 2011). There was no significant seasonal variation of N. lactamica carriage and no significant change in carriage prevalence after introduction of the serogroup A meningococcal conjugate vaccine, MenAfriVac. Multilocus sequence typing was performed on a selection of 142 isolates. The genetic diversity was high, as we identified 62 different genotypes, of which 56 were new. The epidemiology of N. lactamica carriage and the molecular characteristics of carried isolates were similar to those reported from industrialized countries, in contrast to the particularities of N. meningitidis carriage and disease epidemiology in Burkina Faso. |
High SNP density in the blacklegged tick, Ixodes scapularis, the principal vector of Lyme disease spirochetes.
Van Zee J , Black WCth , Levin M , Goddard J , Smith J , Piesman J . Ticks Tick Borne Dis 2012 4 63-71 Single-nucleotide polymorphisms (SNPs) are the most widespread type of sequence variation in genomes. SNP density and distribution varies among different organisms and genes. Here, we report the first estimates of SNP distribution and density in the genome of the blacklegged tick (Ixodes scapularis), an important vector of the pathogens causing Lyme disease, human granulocytic anaplasmosis and human babesiosis in North America. We sampled 10 individuals from each of 4 collections from New Jersey, Virginia, Georgia, and Mississippi and analyzed the sequences of 9 nuclear genes and the mitochondrial 16S gene. SNPs are extremely abundant (one SNP per every 14 bases). This is the second highest density so far reported in any eukaryotic organism. Population genetic analyses based either on haplotype frequencies or the 372 SNPs in these 9 genes showed that the 40 ticks formed 3 genetic groups. In agreement with earlier population genetic studies, northern ticks from New Jersey and Virginia formed a homogeneous group with low genetic diversity, whereas southern ticks from Georgia and Mississippi consisted of 2 separate groups, each with high genetic diversity. |
Effect of coding rules on reporting of hypertension mortality
Lu TH , Anderson RN , Kawachi I . Epidemiology 2013 24 (1) 168-9 Official mortality statistics are based on the underlying cause of death selected according to coding rules developed by the World Health Organization as part of the International Classification of Diseases.1,2 An understanding of cause-of-death certification practices and coding rules is important for the analysis and interpretation of mortality statistics. Some diseases or conditions are less likely than others to be selected as the underlying cause of death for mortality tabulation depending on how they are reported on the death certificate. Hypertension is a good example, as it is selected as the underlying cause of death for mortality tabulation in less than one fourth of cases in which hypertension is mentioned anywhere on the death certificate.3 | In cases where a generalized disease such as hypertension is reported as the underlying cause of death or selected as a tentative underlying cause of death and other significant diseases such as ischemic heart disease or cerebrovascular disease are mentioned, the coding rules require reselection of the underlying cause of death preferring ischemic heart disease or cerebrovascular disease over hypertension. The eAppendix 1 (https://links.lww.com/EDE/A638) presents the coding rules pertaining to hypertension and eAppendix 2 (https://links.lww.com/EDE/A638) illustrates some examples. |
Reproductive number and serial interval of the first wave of influenza A(H1N1)pdm09 virus in South Africa
Archer BN , Tempia S , White LF , Pagano M , Cohen C . PLoS One 2012 7 (11) e49482 BACKGROUND/OBJECTIVE: Describing transmissibility parameters of past pandemics from diverse geographic sites remains critical to planning responses to future outbreaks. We characterize the transmissibility of influenza A(H1N1)pdm09 (hereafter pH1N1) in South Africa during 2009 by estimating the serial interval (SI), the initial effective reproductive number (initial R(t)) and the temporal variation of R(t). METHODS: We make use of data from a central registry of all pH1N1 laboratory-confirmed cases detected throughout South Africa. Whenever date of symptom onset is missing, we estimate it from the date of specimen collection using a multiple imputation approach repeated 100 times for each missing value. We apply a likelihood-based method (method 1) for simultaneous estimation of initial R(t) and the SI; estimate initial R(t) from SI distributions established from prior field studies (method 2); and the Wallinga and Teunis method (method 3) to model the temporal variation of R(t). RESULTS: 12,360 confirmed pH1N1 cases were reported in the central registry. During the period of exponential growth of the epidemic (June 21 to August 3, 2009), we simultaneously estimate a mean R(t) of 1.47 (95% CI: 1.30-1.72) and mean SI of 2.78 days (95% CI: 1.80-3.75) (method 1). Field studies found a mean SI of 2.3 days between primary cases and laboratory-confirmed secondary cases, and 2.7 days when considering both suspected and confirmed secondary cases. Incorporating the SI estimate from field studies using laboratory-confirmed cases, we found an initial R(t) of 1.43 (95% CI: 1.38-1.49) (method 2). The mean R(t) peaked at 2.91 (95% CI: 0.85-2.91) on June 21, as the epidemic commenced, and R(t)>1 was sustained until August 22 (method 3). CONCLUSIONS: Transmissibility characteristics of pH1N1 in South Africa are similar to estimates reported by countries outside of Africa. Estimations using the likelihood-based method are in agreement with field findings. |
Investigating the effect of high spring incidence of pandemic influenza A(H1N1) on early autumn incidence
Burkom H , Kniss K , Meltzer M , Brammer L , Elbert Y , Finelli L , Swerdlow D . Epidemiol Infect 2012 140 (12) 2210-22 SUMMARY: A pandemic H1N1 infection wave in the USA occurred during spring 2009. Some hypothesized that for regions affected by the spring wave, an autumn outbreak would be less likely or delayed compared to unaffected regions because of herd immunity. We investigated this hypothesis using the Outpatient Influenza-like Illness (ILI) Network, a collaboration among the Centers for Disease Control and Prevention, health departments, and care providers. We evaluated the likelihood of high early autumn incidence given high spring incidence in core-based statistical areas (CBSAs). Using a surrogate incidence measure based on influenza-related illness ratios, we calculated the odds of high early autumn incidence given high spring incidence. CBSAs with high spring ILI ratios proved more likely than unaffected CBSAs to have high early autumn ratios, suggesting that elevated spring illness did not protect against early autumn increases. These novel methods are applicable to planning and studies involving other infectious diseases. |
Added value of a household-level study during an outbreak investigation of Salmonella serotype Saintpaul infections, New Mexico 2008
Boore AL , Jungk J , Russo ET , Redd JT , Angulo FJ , Williams IT , Cheek JE , Gould LH . Epidemiol Infect 2012 141 (10) 1-6 SUMMARY: In 2008, nationwide investigations of a Salmonella serotype Saintpaul outbreak led first to consumer warnings for Roma and red round tomatoes, then later for jalapeno and serrano peppers. In New Mexico, where there were a large number of cases but no restaurant-based clusters, the NM Department of Health and the Indian Health Service participated with CDC in individual-level and household-level case-control studies of infections in New Mexico and the Navajo Nation. No food item was associated in the individual-level study. In the household-level study, households with an ill member were more likely to have had jalapeno peppers present during the exposure period and to have reported ever having serrano peppers in the household. This report illustrates the complexity of this investigation, the limitations of traditional individual-level case-control studies when vehicles of infection are ingredients or commonly eaten with other foods, and the added value of a household-level study. |
Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults
Kahn HS , Bullard KM , Barker LE , Imperatore G . PLoS One 2012 7 (11) e50428 BACKGROUND: Adiposity predicts health outcomes, but this relationship could depend on population characteristics and adiposity indicator employed. In a representative sample of 11,437 US adults (National Health and Nutrition Examination Survey, 1988-1994, ages 18-64) we estimated associations with all-cause mortality for body mass index (BMI) and four abdominal adiposity indicators (waist circumference [WC], waist-to-height ratio [WHtR], waist-to-hip ratio [WHR], and waist-to-thigh ratio [WTR]). In a fasting subsample we considered the lipid accumulation product (LAP; [WC enlargement*triglycerides]). METHODS AND FINDINGS: For each adiposity indicator we estimated linear and categorical mortality risks using sex-specific, proportional-hazards models adjusted for age, black ancestry, tobacco exposure, and socioeconomic position. There were 1,081 deaths through 2006. Using linear models we found little difference among indicators (adjusted hazard ratios [aHRs] per SD increase 1.2-1.4 for men, 1.3-1.5 for women). Using categorical models, men in adiposity midrange (quartiles 2+3; compared to quartile 1) were not at significantly increased risk (aHRs<1.1) unless assessed by WTR (aHR 1.4 [95%CI 1.0-1.9]). Women in adiposity midrange, however, tended toward elevated risk (aHRs 1.2-1.5), except for black women assessed by BMI, WC or WHtR (aHRs 0.7-0.8). Men or women in adiposity quartile 4 (compared to midrange) were generally at risk (aHRs>1.1), especially black men assessed by WTR (aHR 1.9 [1.4-2.6]) and black women by LAP (aHR 2.2 [1.4-3.5]). Quartile 4 of WC or WHtR carried no significant risk for diabetic persons (aHRs 0.7-1.1), but elevated risks for those without diabetes (aHRs>1.5). For both sexes, quartile 4 of LAP carried increased risks for tobacco-exposed persons (aHRs>1.6) but not for non-exposed (aHRs<1.0). CONCLUSIONS: Predictions of mortality risk associated with top-quartile adiposity vary with the indicator used, sex, ancestry, and other characteristics. Interpretations of adiposity should consider how variation in the physiology and expandability of regional adipose-tissue depots impacts health. |
The influence of television advertisements on promoting calls to telephone quitlines
Farrelly M , Mann N , Watson K , Pechacek T . Health Educ Res 2012 28 (1) 15-22 The aim of the study was to assess the relative effectiveness of cessation, secondhand smoke and other tobacco control television advertisements in promoting quitlines in nine states from 2002 through 2005. Quarterly, the number of individuals who used quitlines per 10 000 adult smokers in a media market are measured. Negative binomial regression analysis was used to link caller rates to market-level exposure to tobacco control television advertisements overall and by message theme. The relationship between caller rates and advertising exposure was positive and statistically significant (P < 0.001). Advertisements that focus on promoting cessation (P < 0.001), highlighting the dangers of secondhand smoke (P = 0.037), and all other tobacco countermarketing advertisements (P = 0.027) were significantly associated with quitline caller rates. For every 10% increase in exposure to cessation, secondhand smoke and other tobacco countermarketing advertisements, caller rates increased by 1.1, 0.2 and 0.4%, respectively. Caller rates significantly increased in quarters when cigarette excise tax increased (P < 0.001) and when the percentage of the population covered by comprehensive smoke-free air laws increased (P = 0.022). Although advertisements promoting cessation are the most effective in driving quitline use, other topics, such as messages highlighting the dangers of secondhand smoke, also prompt their quitlines. |
Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010
Sievert DM , Ricks P , Edwards JR , Schneider A , Patel J , Srinivasan A , Kallen A , Limbago B , Fridkin S . Infect Control Hosp Epidemiol 2013 34 (1) 1-14 OBJECTIVE: To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) during 2009-2010. METHODS: Central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections were included. Pooled mean proportions of isolates interpreted as resistant (or, in some cases, nonsusceptible) to selected antimicrobial agents were calculated by type of HAI and compared to historical data. RESULTS: Overall, 2,039 hospitals reported 1 or more HAIs; 1,749 (86%) were general acute care hospitals, and 1,143 (56%) had fewer than 200 beds. There were 69,475 HAIs and 81,139 pathogens reported. Eight pathogen groups accounted for about 80% of reported pathogens: Staphylococcus aureus (16%), Enterococcus spp. (14%), Escherichia coli (12%), coagulase-negative staphylococci (11%), Candida spp. (9%), Klebsiella pneumoniae (and Klebsiella oxytoca; 8%), Pseudomonas aeruginosa (8%), and Enterobacter spp. (5%). The percentage of resistance was similar to that reported in the previous 2-year period, with a slight decrease in the percentage of S. aureus resistant to oxacillins (MRSA). Nearly 20% of pathogens reported from all HAIs were the following multidrug-resistant phenotypes: MRSA (8.5%); vancomycin-resistant Enterococcus (3%); extended-spectrum cephalosporin-resistant K. pneumoniae and K. oxytoca (2%), E. coli (2%), and Enterobacter spp. (2%); and carbapenem-resistant P. aeruginosa (2%), K. pneumoniae/oxytoca (<1%), E. coli (<1%), and Enterobacter spp. (<1%). Among facilities reporting HAIs with 1 of the above gram-negative bacteria, 20%-40% reported at least 1 with the resistant phenotype. CONCLUSION: While the proportion of resistant isolates did not substantially change from that in the previous 2 years, multidrug-resistant gram-negative phenotypes were reported from a moderate proportion of facilities. |
Bacteriophages are synergistic with bacterial interference for the prevention of Pseudomonas aeruginosa biofilm formation on urinary catheters
Liao KS , Lehman SM , Tweardy DJ , Donlan RM , Trautner BW . J Appl Microbiol 2012 113 (6) 1530-9 AIMS: We hypothesized that pretreating urinary catheters with benign Escherichia coli HU2117 plus an antipseudomonal bacteriophage (PhiE2005-A) would prevent Pseudomonas aeruginosa biofilm formation on catheters - a pivotal event in the pathogenesis of catheter-associated urinary tract infection (CAUTI). METHODS AND RESULTS: Silicone catheter segments were exposed to one of four pretreatments (sterile media; E. coli alone; phage alone; E. coli plus phage), inoculated with P. aeruginosa and then incubated up to 72 h in human urine before rinsing and sonicating to recover adherent bacteria. Pseudomonas aeruginosa adherence to catheters was almost 4 log(10) units lower when pretreated with E. coli plus phage compared to no pretreatment (P < 0.001) in 24-h experiments and more than 3 log(10) units lower in 72-h experiments (P < 0.05). Neither E. coli nor phage alone generated significant decreases. CONCLUSIONS: The combination of phages with a pre-established biofilm of E. coli HU2117 was synergistic in preventing catheter colonization by P. aeruginosa. SIGNIFICANCE AND IMPACT OF THE STUDY: We describe a synergistic protection against colonization of urinary catheters by a common uropathogen. Escherichia coli-coated catheters are in clinical trials; adding phage may offer additional benefit. |
No risk of Guillain-Barre syndrome found after meningococcal conjugate vaccination in two large cohort studies
Yih WK , Weintraub E , Kulldorff M . Pharmacoepidemiol Drug Saf 2012 21 (12) 1359-60 The large cohort study conducted by Dr. Velentgas and colleagues reported in this journal1 allayed concerns that had emerged in 2005 from the Vaccine Adverse Event Reporting System about a possible association between the meningococcal conjugate vaccine Menactra (MCV4) and Guillain–Barré syndrome (GBS) among adolescents.2 In an adolescent cohort comprising more than 1.4 million MCV4 vaccinations, no confirmed cases of GBS occurred in the 6 weeks after vaccination. The upper bound of the one-sided 95% confidence interval for the attributable risk of GBS in MCV4 vaccine recipients was found to be 1.5 excess cases per million vaccinees. | The Vaccine Safety Datalink (VSD) is the nation's most established and respected population-based vaccine safety surveillance system. With weekly data feeds and analyses, VSD conducted active surveillance for GBS after MCV4 among adolescents3 without detecting any safety problem. Of the five instances of the GBS diagnostic code found after MCV4 vaccination in the electronic data, upon chart review, none was confirmed as new-onset GBS occurring during the pre-specified 42-day risk window after vaccination. |
Causality assessment of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS)
Loughlin AM , Marchant CD , Adams W , Barnett E , Baxter R , Black S , Casey C , Dekker C , Edwards KM , Klein J , Klein NP , Larussa P , Sparks R , Jakob K . Vaccine 2012 30 (50) 7253-9 Adverse events following immunization (AEFI) reported to the national Vaccine Adverse Event Reporting System (VAERS) represent true causally related events, as well as events that are temporally, but not necessarily causally related to vaccine. OBJECTIVE: We sought to determine if the causal relationships between the vaccine and the AEFI reported to VAERS could be assessed through expert review. DESIGN: A stratified random sample of 100 VAERS reports received in 2004 contained 13 fatal cases, 19 cases with non-fatal disabilities, 39 other serious non-fatal cases and 29 non-serious cases. Experts knowledgeable about vaccines and clinical outcomes, reviewed each VAERS report and available medical records. MAIN OUTCOME MEASURES: Modified World Health Organization criteria were used to classify the causal relationship between vaccines and AEFI as definite, probable, possible, unlikely or unrelated. Five independent reviewers evaluated each report. If they did not reach a majority agreement on causality after initial review, the report was discussed on a telephone conference to achieve agreement. RESULTS: 108 AEFIs were identified in the selected 100 VAERS reports. After initial review majority agreement was achieved for 83% of the AEFI and 17% required further discussion. In the end, only 3 (3%) of the AEFI were classified as definitely causally related to vaccine received. Of the remaining AEFI 22 (20%) were classified as probably and 22 (20%) were classified as possibly related to vaccine received; a majority (53%) were classified as either unlikely or unrelated to a vaccine received. CONCLUSIONS: Using VAERS reports and additional documentation, causality could be assessed by expert review in the majority of VAERS reports. Assessment of VAERS reports identified that causality was thought to be probable or definite in less than one quarter of reports, and these were dominated by local reactions, allergic reactions, or symptoms known to be associated with the vaccine administered. |
Isolation and phylogenetic analysis of Bartonella species from wild carnivores of the suborder Caniformia in Japan.
Sato S , Kabeya H , Miura T , Suzuki K , Bai Y , Kosoy M , Sentsui H , Kariwa H , Maruyama S . Vet Microbiol 2012 161 130-6 The prevalence of Bartonella species was investigated among wild carnivores of the suborder Caniformia, including 15 Japanese badgers (Meles anakuma), 8 Japanese martens (Martes melampus), 2 Japanese weasels (Mustela itatsi), 1 Siberian weasel (Mustela sibirica), 171 raccoon dogs (Nyctereutes procyonoides), and 977 raccoons (Procyon lotor) in Japan. Bartonella bacteria were isolated from one Japanese badger (6.7%) and from one Japanese marten (12.5%); however, no Bartonella species was found in other representatives of Caniformia. Phylogenetic analysis was based on concatenated sequences of six housekeeping genes (16S rRNA, ftsZ, gltA, groEL, ribC, and rpoB) and sequence of the 16S-23S internal transcribed spacer region. The sequence analysis indicated that the isolate derived from the Japanese badger (strain JB-15) can represent a novel Bartonella species and the isolate from the Japanese marten (strain JM-1) was closely related to Bartonella washoensis. This is the first report on isolation of Bartonella from badger and marten. |
Sequential triplex real-time PCR assay for detecting 21 pneumococcal capsular serotypes that account for a high global disease burden.
Pimenta FC , Roundtree A , Soysal A , Bakir M , du Plessis M , Wolter N , von Gottberg A , McGee L , Carvalho MG , Beall B . J Clin Microbiol 2012 51 (2) 647-52 We developed and validated a real-time PCR assay consisting of 7 triplexed reactions to identify 11 individual serotypes plus 10 small serogroups representing the majority of disease-causing isolates of Streptococcus pneumoniae. This assay targets the 13 serotypes included within the 13-valent conjugate vaccine and 8 additional key serotypes or serogroups. Advantages over other serotyping assays are described. The assay will be expanded to 40 serotypes/serogroups. We will provide periodic updates at our protocol web site. |
Swab protocol for rapid laboratory diagnosis of cutaneous anthrax
Dauphin LA , Marston CK , Bhullar V , Baker D , Rahman M , Hossain MJ , Chakraborty A , Khan SU , Hoffmaster AR . J Clin Microbiol 2012 50 (12) 3960-7 The clinical laboratory diagnosis of cutaneous anthrax is generally established by conventional microbiological methods, such as culture and directly straining smears of clinical specimens. However, these methods rely on recovery of viable Bacillus anthracis cells from swabs of cutaneous lesions and often yield negative results. This study developed a rapid protocol for detection of B. anthracis on clinical swabs. Three types of swabs, flocked-nylon, rayon, and polyester, were evaluated by 3 extraction methods, the swab extraction tube system (SETS), sonication, and vortex. Swabs were spiked with virulent B. anthracis cells, and the methods were compared for their efficiency over time by culture and real-time PCR. Viability testing indicated that the SETS yielded greater recovery of B. anthracis from 1-day-old swabs; however, reduced viability was consistent for the 3 extraction methods after 7 days and nonviability was consistent by 28 days. Real-time PCR analysis showed that the PCR amplification was not impacted by time for any swab extraction method and that the SETS method provided the lowest limit of detection. When evaluated using lesion swabs from cutaneous anthrax outbreaks, the SETS yielded culture-negative, PCR-positive results. This study demonstrated that swab extraction methods differ in their efficiency of recovery of viable B. anthracis cells. Furthermore, the results indicated that culture is not reliable for isolation of B. anthracis from swabs at ≥7 days. Thus, we recommend the use of the SETS method with subsequent testing by culture and real-time PCR for diagnosis of cutaneous anthrax from clinical swabs of cutaneous lesions. |
Toxicological analysis of limonene reaction products using an in vitro exposure system
Anderson SE , Khurshid SS , Meade BJ , Lukomska E , Wells JR . Toxicol In Vitro 2012 27 (2) 721-30 Epidemiological investigations suggest a link between exposure to indoor air chemicals and adverse health effects. Consumer products contain reactive chemicals which can form secondary pollutants which may contribute to these effects. The reaction of limonene and ozone is a well characterized example of this type of indoor air chemistry. The studies described here characterize an in vitro model using an epithelial cell line (A549) or differentiated epithelial tissue (MucilAir). The model is used to investigate adverse effects following exposure to combinations of limonene and ozone. In A549 cells, exposure to both the parent compounds and reaction products resulted in alterations in inflammatory cytokine production. A one hour exposure to limonene + ozone resulted in decreased proliferation when compared to cells exposed to limonene alone. Repeated dose exposures of limonene or limonene + ozone were conducted on MucilAir tissue. No change in proliferation was observed but increases in cytokine production were observed for both the parent compounds and reaction products. Factors such as exposure duration, chemical concentration, and sampling time point were identified to influence result outcome. These findings suggest that exposure to reaction products may produce more severe effects compared to the parent compound. |
Longitudinal monitoring of the development of antifilarial antibodies and acquisition of Wuchereria bancrofti in a highly endemic area of Haiti
Hamlin KL , Moss DM , Priest JW , Roberts J , Kubofcik J , Gass K , Streit TG , Nutman TB , Eberhard ML , Lammie PJ . PLoS Negl Trop Dis 2012 6 (12) e1941 Antifilarial antibody testing has been established as a sensitive and specific method of diagnosing lymphatic filariasis. However, the development of serological responses to specific filarial antigens and their relationship to acquisition of infection is poorly understood. In order to evaluate whether the development of antigen specific antifilarial antibodies precedes microfilaremia and antigenemia, we compared the antibody responses of serum samples collected between 1990 and 1999 from a cohort of 142 Haitian children followed longitudinally. Antigen status was determined using the Og4C3 ELISA and the presence of microfilaremia was detected using microscopy. Antibody responses to Wb123, a Wuchereria bancrofti L3 antigen, were measured using a Luciferase Immunoprecipitation System (LIPS) assay. Antibody responses to Bm14 and Bm33, Brugia malayi antigens and to a major surface protein (WSP) from Wolbachia were analyzed using a multiplex bead assay. Over follow-up, 80 (56%) of the children became antigen-positive and 30 (21%) developed microfilaremia. Detectable antibody responses to Bm14, Bm33, Wb123, and WSP developed in 95%, 100%, 92%, and 29% of children, respectively. With the exception of WSP, the development of antibody responses generally preceded detection of filarial antigen. Our results show that antifilarial antibody responses can serve as an important epidemiological indicator in a sentinel population of young children and thus, may be valuable as tool for surveillance in the context of lymphatic filariasis elimination programs. |
Lower-sensitivity and avidity modifications of the vitros anti-HIV 1+2 assay for detection of recent HIV infections and incidence estimation
Keating SM , Hanson D , Lebedeva M , Laeyendecker O , Ali-Napo NL , Owen SM , Stramer SL , Moore RD , Norris PJ , Busch MP . J Clin Microbiol 2012 50 (12) 3968-76 Recent-infection testing assays/algorithms (RITAs) have been developed to exploit the titer and avidity of HIV antibody evolution following seroconversion for incidence estimation. The Vitros Anti-HIV 1+2 assay (Ortho-Clinical Diagnostics) was approved by the FDA to detect HIV-1 and HIV-2 infections. We developed a less-sensitive (LS) and an avidity-modified version of this assay to detect recent HIV infection. Seroconversion panels (80 subjects, 416 samples) were tested to calculate the mean duration of recent infection (MDR) for these assays. A panel from known long-term (2+ years) HIV-infected subjects on highly active antiretroviral therapy (HAART) (n = 134) and subjects with low CD4 counts (AIDS patients [n = 140]) was used to measure the false-recent rate (FRR) of the assays. Using a signal-to-cutoff ratio of 20 and the LS-Vitros assay gave a RITA MDR of 215 days (95% confidence interval [95% CI], +/-65 days) and using an avidity index (AI) of 0.6 gave an MDR of 170 days (+/-44 days), while a combination of the two assays yielded a MDR of 146 days (+/-38.6) and an FRR of 8%. Misclassifying subjects with known long-term infection as recently infected occurred in 14% of AIDS patients and 29% (95% CI, 22, 38) of HAART subjects and 3% (95% CI, 0.8, 7.2) and 42% (95% CI, 33, 51), respectively, for the LS- and avidity-modified Vitros assays, with a misclassification rate of 15% (95% CI, 11, 20) overall using a dual-assay algorithm. Both modified Vitros assays can be used to estimate the length of time since seroconversion and in calculations for HIV incidence. Like other RITAs, they are subject to high FRR in subjects on HAART or with AIDS. |
Prevention of vaginal SHIV transmission in macaques by a coitally-dependent Truvada regimen
Radzio J , Aung W , Holder A , Martin A , Sweeney E , Mitchell J , Bachman S , Pau CP , Heneine W , Garcia-Lerma JG . PLoS One 2012 7 (12) e50632 BACKGROUND: Daily pre-exposure prophylaxis (PrEP) with Truvada (a combination of emtricitabine (FTC) and tenofovir (TFV) disoproxil fumarate (TDF)) is a novel HIV prevention strategy recently found to prevent HIV transmission in men who have sex with men and heterosexual couples. We previously showed that a coitally-dependent Truvada regimen protected macaques against rectal SHIV transmission. Here we examined FTC and tenofovir TFV exposure in vaginal tissues after oral dosing and assessed if peri-coital Truvada also protects macaques against vaginal SHIV infection. METHODS: The pharmacokinetic profile of emtricitabine (FTC) and tenofovir (TFV) was evaluated at first dose. FTC and TFV levels were measured in blood plasma, rectal, and vaginal secretions. Intracellular concentrations of FTC-triphosphate (FTC-TP) and TFV-diphosphate (TFV-DP) were measured in PBMCs, rectal tissues, and vaginal tissues. Efficacy of Truvada in preventing vaginal SHIV infection was assessed using a repeat-exposure vaginal SHIV transmission model consisting of weekly exposures to low doses of SHIV162p3. Six pigtail macaques with normal menstrual cycles received Truvada 24 h before and 2 h after each weekly virus exposure and six received placebo. Infection was monitored by serology and PCR amplification of SHIV RNA and DNA. RESULTS: As in humans, the concentration of FTC was higher than the concentration of TFV in vaginal secretions. Also as in humans, TFV levels in vaginal secretions were lower than in rectal secretions. Intracellular TFV-DP concentrations were also lower in vaginal tissues than in rectal tissues. Despite the low vaginal TFV exposure, all six treated macaques were protected from infection after 18 exposures or 4 full menstrual cycles. In contrast, all 6 control animals were infected. CONCLUSIONS: We modeled a peri-coital regimen with two doses of Truvada and showed that it fully protected macaques from repeated SHIV exposures. Our results open the possibility for simplified PrEP regimens to prevent vaginal HIV transmission in women. |
Pseudo-outbreak of Lecanicillium and Acremonium species in orthopedic surgery patients
Neal CO , Deak E , Chang LS , Gilmartin H , Gade L , Imanishi M , Price C , Brandt ME , Chiller T , Balajee SA . J Clin Microbiol 2012 50 (12) 4103-6 Acremonium species cause a variety of human infections, while Lecanicillium species have not been reported as human pathogens. We describe a pseudo-outbreak involving both organisms, highlighting the role and limitations of molecular methods in the characterization of rare fungal isolates. Repeated isolation of these fungi from patient tissue samples raises concerns about exogenous contamination in the hospital environment. |
Effect of temperature and duration of storage on the stability of polyfluoroalkyl chemicals in human serum
Kato K , Wong LY , Basden BJ , Calafat AM . Chemosphere 2012 91 (2) 115-7 We assessed the potential impact of temperature on the long-term stability of several polyfluoroalkyl chemicals in serum. We evaluated the concentrations of perfluorooctane sulfonate, perfluorohexane sulfonate, perfluorooctanoate and perfluorononanoate in 16 human serum samples stored at room temperature, 5 degrees C, -20 degrees C and -70 degrees C at several time points during an eight month period. Concentrations of the target analytes remained unchanged under all studied conditions, even when serum was kept at room temperature for 10 days. |
Effect of topical vaginal products on the detection of prostate-specific antigen, a biomarker of semen exposure, using ABAcards
Snead MC , Kourtis AP , Black CM , Mauck CK , Brown TM , Penman-Aguilar A , Melendez JH , Gallo MF , Jamieson DJ , Macaluso M . Contraception 2012 88 (3) 382-6 BACKGROUND: Prostate-specific antigen (PSA) is a biomarker of recent semen exposure. There is currently only limited information on whether topical vaginal products affect PSA assays. We investigated this question using various dilutions of several vaginal products (lubricants and spermicides) and the Abacus ABAcard for PSA detection. STUDY DESIGN: Pooled semen controls and various dilutions of nonoxynol-9 (N9), carboxymethyl cellulose (CMC), Replens, Gynol 2, K-Y jelly, Astroglide, Surgilube, combined with pooled semen dilutions, were tested for PSA using the Abacus ABAcard. RESULTS: N9 (2% with saline) and CMC did not appear to affect the results of testing with the ABAcard, but not all semen dilutions were tested. The other products (including Replens and Gynol, which is 2% N9 with propylene glycol, K-Y, Astroglide and Surgilube) at some of the dilutions tested either affected or gave invalid results with PSA testing using the ABAcard. Both Gynol 2 and K-Y at 1:10 dilution gave false-positive results. CONCLUSIONS: Some vaginal products affect PSA results obtained by using the semiquantitative ABAcard. In vivo confirmation is necessary to further optimize PSA detection when topical vaginal products are present. |
Evaluating the prognostic value of positron-emission tomography myocardial perfusion imaging using automated software to calculate perfusion defect size
Williams BA , Dorn JM , Lamonte MJ , Donahue RP , Trevisan M , Leonard DA , Greene RS , Merhige ME . Clin Cardiol 2012 35 (11) E14-21 BACKGROUND: Myocardial perfusion imaging by positron-emission tomography (PET MPI) is regarded as a valid technique for the diagnosis of coronary artery disease (CAD), but the incremental prognostic value of PET MPI among individuals with known or suspected CAD is not firmly established. HYPOTHESIS: Myocardial perfusion defect sizes as measured by PET MPI using automated software will provide incremental prognostic value for cardiac and all-cause mortality. METHODS: This study included 3739 individuals who underwent rest-stress rubidium-82 PET MPI for the evaluation of known or suspected CAD. Rest, stress, and stress-induced myocardial perfusion defect sizes were determined objectively by automated computer software. Study participants were followed for a mean of 5.2 years for cardiac and all-cause mortality. Cox proportional hazards models were developed to evaluate the incremental prognostic value of PET MPI. RESULTS: A strong correlation was observed between perfusion defect sizes assessed visually and by automated software (r = 0.76). After adjusting for cardiac risk factors, known CAD, noncoronary vascular disease, and use of cardioprotective medications, stress perfusion defect size was strongly associated with cardiac death (P < 0.001). Rest perfusion defects demonstrated a stronger association with cardiac death (P < 0.001) than stress-induced perfusion defects (P = 0.01), yet both were highly significant. Similar patterns held for all-cause death. CONCLUSIONS: The current study is the largest to date demonstrating PET MPI provides incremental prognostic value among individuals with known or suspected CAD. Automated calculation of perfusion defect sizes may provide valuable supplementary information to visual assessment. This work was partially funded by a predoctoral fellowship grant awarded to the first author by the American Heart Association's Founders' Affiliate. Additional funding was provided by Niagara Falls Memorial Medical Center, Positron Corporation, the University at Buffalo, and Niagara University. The authors have no other funding, financial relationships, or conflicts of interest to disclose. |
Generation of dried tube specimen for HIV-1 viral load proficiency test panels: a cost-effective alternative for external quality assessment programs
Ramos A , Nguyen S , Garcia A , Subbarao S , Nkengasong JN , Ellenberger D . J Virol Methods 2012 188 1-5 Participation in external quality assessment programs is critical to ensure quality clinical laboratory testing. Commercially available proficiency test panels for HIV-1 virus load testing that are used commonly in external quality assessment programs remain a financial obstacle to resource-limited countries. Maintaining cold-chain transportation largely contributes to the cost of traditional liquid proficiency test panels. Therefore, we developed and evaluated a proficiency test panel using dried tube specimens that can be shipped and stored at ambient temperature. This dried tube specimens panel consisted of 20mcl aliquots of a HIV-1 stock that were added to 2ml tubes and left uncapped for drying, as a preservation method. The stability of dried tube specimens at concentrations ranging from 10(2) to 10(6.5) RNA copies/ml was tested at different temperatures over time, showing no viral load reduction at 37 degrees C and a decrease in viral load smaller than 0.5 Log(10) at 45 degrees C for up to eight weeks when compared to initial results. Eight cycles of freezing-thawing had no effect on the stability of the dried tube specimens. Comparable viral load results were observed when dried tube specimen panels were tested on Roche CAPTAQ, Abbott m2000, and Biomerieux easyMAG viral load systems. Preliminary test results of dried proficiency test panels shipped to four African countries at ambient temperature demonstrated a low inter assay variation (SD range: 0.29-0.41 Log(10) RNA copies/ml). These results indicated that HIV-1 proficiency test panels generated by this methodology might be an acceptable alternative for laboratories in resource-limited countries to participate in external quality assessment programs. |
Glutathione conjugation of busulfan produces a hydroxyl radical-trapping dehydroalanine metabolite
Peer CJ , Younis IR , Leonard SS , Gannett PM , Minarchick VC , Kenyon AJ , Rojanasakul Y , Callery PS . Xenobiotica 2012 42 (12) 1170-7 The Phase 2 drug metabolism of busulfan yields a glutathione conjugate that undergoes a beta-elimination reaction. The elimination product is an electrophilic metabolite that is a dehydroalanine-containing tripeptide, gamma-glutamyldehydroalanylglycine (EdAG). In the process, glutathione lacks thiol-related redox properties and gains a radical scavenging dehydroalanine group. EdAG scavenged hydroxyl radical generated in the Fenton reaction in a concentration-dependent manner was monitored by electron paramagnetic resonance (EPR) spectroscopy. The apparent rate of hydroxyl radical scavenging was in the same range as published values for known antioxidants, including N-acyl dehydroalanines. A captodatively stabilized carbon-centered radical intermediate was spin trapped in the reaction of EdAG with hydroxyl radical. The proposed structure of a stable product in the Fenton reaction with EdAG was consistent with that of a gamma-glutamylserylglycyl dimer. Observation of the hydroxyl trapping properties of EdAG suggests that the busulfan metabolite EdAG may contribute to or mitigate redox-related cytotoxicity associated with the therapeutic use of busulfan, and reaffirms indicators that support a role in free radical biology for dehydroalanine-containing peptides and proteins. |
Human monoclonal antibodies against highly conserved HR1 and HR2 domains of the SARS-CoV spike protein are more broadly neutralizing
Elshabrawy HA , Coughlin MM , Baker SC , Prabhakar BS . PLoS One 2012 7 (11) e50366 Immune sera from convalescent patients have been shown to be effective in the treatment of patients infected with Severe Acute Respiratory Syndrome Virus (SARS-CoV) making passive immune therapy with human monoclonal antibodies an attractive treatment strategy for SARS. Previously, using Xenomouse (Amgen British Columbia Inc), we produced a panel of neutralizing Human monoclonal antibodies (HmAbs) that could specifically bind to the ectodomain of the SARS-CoV spike (S) glycoprotein. Some of the HmAbs were S1 domain specific, while some were not. In this study, we describe non-S1 binding neutralizing HmAbs that can specifically bind to the conserved S2 domain of the S protein. However, unlike the S1 specific HmAbs, the S2 specific HmAbs can neutralize pseudotyped viruses expressing different S proteins containing receptor binding domain sequences of various clinical isolates. These data indicate that HmAbs which bind to conserved regions of the S protein are more suitable for conferring protection against a wide range of SARS-CoV variants and have implications for generating therapeutic antibodies or subunit vaccines against other enveloped viruses. |
Influence of inorganic ions on aggregation and adsorption behaviors of human adenovirus
Wong K , Mukherjee B , Kahler AM , Zepp R , Molina M . Environ Sci Technol 2012 46 (20) 11145-53 In this study, we investigated the influence of inorganic ions on the aggregation and deposition (adsorption) behavior of human adenovirus (HAdV). Experiments were conducted to determine the surface charge and size of HAdV and viral adsorption capacity of sand in different salt conditions. The interfacial potential energy was calculated using extended Derjaguin and Landau, Verwey and Overbeek (XDLVO) and steric hindrance theories to interpret the experimental results. Results showed that different compositions of inorganic ions have minimal effect on varying the iso-electric point pH (pH(iep)) of HAdV (ranging from 3.5 to 4.0). Divalent cations neutralized/shielded virus surface charge much more effectively than monovalent cations at pH above pH(iep). Consequently, at neutral pH the presence of divalent cations enhanced the aggregation of HAdV as well as its adsorption to sand. Aggregation and adsorption behaviors generally agreed with XDLVO theory; however, in the case of minimal electrostatic repulsion, steric force by virus' fibers can increase the energy barrier and distance of secondary minimum, resulting in limited aggregation and deposition. Overall, our results indicated that subsurface water with low hardness residing in sandy soils may have a higher potential of being contaminated by HAdV. |
Comparison of nasal and nasopharyngeal swabs for influenza detection in adults
Irving SA , Vandermause MF , Shay DK , Belongia EA . Clin Med Res 2012 10 (4) 215-8 OBJECTIVE: Examine differences in the detection of influenza by specimen and test type using paired nasal and nasopharyngeal swabs. DESIGN: Prospective study. SETTING: Enrollment took place between January and March 2007 in a central Wisconsin population. PARTICIPANTS: Adult patients were screened and enrolled by trained research coordinators following medical encounters for acute respiratory illnesses of <10 days duration. METHODS: Paired nasal and nasopharyngeal swabs were collected from consenting patients and tested by both real-time reverse transcriptase polymerase chain reaction (rRT-PCR) and viral culture. A composite measure of positivity was used as the gold standard; cases included any positive result by rRT-PCR or viral culture from either specimen type. RESULTS: Paired samples were collected from 240 adults; 33 (14%) individuals tested positive for influenza by rRT-PCR. Using rRT-PCR, the sensitivity of the nasal swab was 89% (95% CI, 78%-99%) and the sensitivity of the nasopharyngeal swab was 94% (95% CI, 87%-100%), compared to a composite gold standard. CONCLUSION: Test sensitivity did not vary significantly by swab type when using a highly sensitive molecular diagnostic test, but power was limited to detect modest differences. |
Concentrations of bisphenol A and seven other phenols in pooled sera from 3-11 year old children: 2001-2002 National Health and Nutrition Examination Survey
Ye X , Zhou X , Wong LY , Calafat AM . Environ Sci Technol 2012 46 (22) 12664-71 Concerns exist regarding children's exposure to bisphenol A (BPA) and other phenols because of the higher sensitivity, compared to adults, of children's developing organs to endocrine disruptors. Several studies reported the urinary concentrations of these phenols in children, but data on levels of these compounds in children's serum are limited. We present here the total (free plus conjugated) and free concentrations of BPA and seven other phenols in 24 pooled serum samples prepared from individual specimens collected from 936 children 3-11 years old who participated in the 2001-2002 National Health and Nutrition Examination Survey. We detected benzophenone-3, triclosan, 2,4-dichlorophenol, 2,5- dichlorophenol, and three parabens in at least 60% of the pools suggesting children's exposure to these compounds or their precursors. Conjugated phenols were the major species. However, although many previous studies have shown widespread detection of BPA in children's urine, we only detected total or free BPA in 3 and 2 pooled serum samples, respectively, at concentrations of 0.1-0.2 mcg/L. The nonpersistent nature of BPA and the phenols examined and the likely episodic nature of the exposures to these compounds (or their precursors) suggest that for general population biomonitoring of these nonpersistent phenols, urine, not serum or plasma, is the preferred matrix. |
Diagnostic microbiologic methods in the GEMS-1 case/control study
Panchalingam S , Antonio M , Hossain A , Mandomando I , Ochieng B , Oundo J , Ramamurthy T , Tamboura B , Zaidi AK , Petri W , Houpt E , Murray P , Prado V , Vidal R , Steele D , Strockbine N , Sansonetti P , Glass RI , Robins-Browne RM , Tauschek M , Svennerholm AM , Kotloff K , Levine MM , Nataro JP . Clin Infect Dis 2012 55 Suppl 4 S294-302 To understand the etiology of moderate-to-severe diarrhea among children in high mortality areas of sub-Saharan Africa and South Asia, we performed a comprehensive case/control study of children aged <5 years at 7 sites. Each site employed an identical case/control study design and each utilized a uniform comprehensive set of microbiological assays to identify the likely bacterial, viral and protozoal etiologies. The selected assays effected a balanced consideration of cost, robustness and performance, and all assays were performed at the study sites. Identification of bacterial pathogens employed streamlined conventional bacteriologic biochemical and serological algorithms. Diarrheagenic Escherichia coli were identified by application of a multiplex polymerase chain reaction assay for enterotoxigenic, enteroaggregative, and enteropathogenic E. coli. Rotavirus, adenovirus, Entamoeba histolytica, Giardia enterica, and Cryptosporidium species were detected by commercially available enzyme immunoassays on stool samples. Samples positive for adenovirus were further evaluated for adenovirus serotypes 40 and 41. We developed a novel multiplex assay to detect norovirus (types 1 and 2), astrovirus, and sapovirus. The portfolio of diagnostic assays used in the GEMS study can be broadly applied in developing countries seeking robust cost-effective methods for enteric pathogen detection. |
Diagnostic performance of the BinaxNow Influenza A&B rapid antigen test in ED patients
Self WH , McNaughton CD , Grijalva CG , Zhu Y , Chappell JD , Williams JV , Talbot HK , Shay DK , Griffin MR . Am J Emerg Med 2012 30 (9) 1955-61 OBJECTIVE: The objective of this study is to evaluate the diagnostic performance of the BinaxNow Influenza A&B rapid antigen test (RAT) in emergency department (ED) patients. METHODS: We prospectively enrolled a systematic sample of ED patients older than 6 months with acute respiratory symptoms or nonlocalizing fever during 3 consecutive influenza seasons (2008-2011). Nasal and throat swabs collected by research personnel were tested for influenza by real-time reverse transcription-polymerase chain reaction (RT-PCR). Clinicians independently ordered RATs during clinical care; these specimens were collected by clinical staff and tested for influenza using the BinaxNow RAT. Patients with both a research RT-PCR and clinical RAT were included in the study. Rapid antigen test diagnostic performance was evaluated using RT-PCR as a criterion standard, with preplanned, stratified analysis for subject age, duration of symptoms, influenza subtype, and polymerase chain reaction cycle threshold, which provides a semiquantitative estimate of viral load. RESULTS: Of 561 subjects enrolled, 131 (23.4%) had a positive RT-PCR, and 37 (6.6%) had a positive RAT. Overall, RAT performance included sensitivity of 24.4% (95% confidence interval [CI], 17.5%-32.9%), specificity of 98.8% (95% CI, 97.1%-99.6%), positive predictive value of 86.5% (95% CI, 70.4%-94.9%), negative predictive value of 81.1% (95% CI, 77.4%-84.3%). Rapid antigen test sensitivities were low for all categories of subject age, symptom duration, influenza subtype, and cycle threshold. CONCLUSION: The BinaxNow RAT demonstrated high specificity and poor sensitivity in ED patients selected by treating clinicians for influenza testing. A negative RAT is a poor predictor for the absence of influenza in the ED and should not be used as a criterion to withhold antiviral medications. |
Health care utilisation in the first year of life among infants of mothers with perinatal depression or anxiety
Farr SL , Dietz PM , Rizzo JH , Vesco KK , Callaghan WM , Bruce FC , Bulkley JE , Hornbrook MC , Berg CJ . Paediatr Perinat Epidemiol 2013 27 (1) 81-8 BACKGROUND: Limited information is available on associations between maternal depression and anxiety and infant health care utilisation. METHODS: We analysed data from 24 263 infants born between 1998 and 2007 who themselves and their mothers were continuously enrolled for the infant's first year in Kaiser Permanente Northwest. We used maternal depression and anxiety diagnoses during pregnancy and postpartum to categorise infants into two depression and anxiety groups and examined effect modification by timing of diagnosis (pregnancy only, postpartum only, pregnancy and postpartum). Using generalised estimating equations in multivariable log-linear regression, we estimated adjusted risk ratios (RR) between maternal depression and anxiety and well baby visits (<5 and ≥5), up to date immunisations (yes/no), sick/emergency visits (<6 and ≥6) and infant hospitalisation (any/none). RESULTS: Infants of mothers with perinatal depression or anxiety were as likely to attend well baby visits and receive immunisations as their counterparts (RR = 1.0 for all). Compared with no depression or anxiety, infants of mothers with prenatal and postpartum depression or anxiety, or postpartum depression or anxiety only were 1.1 to 1.2 times more likely to have ≥6 sick/emergency visits. Infants of mothers with postpartum depression only had marginally increased risk of hospitalisation (RR = 1.2 [95% confidence interval 1.0, 1.4]); 70% of diagnoses occurred after the infant's hospitalisation. CONCLUSIONS: An understanding of the temporality of the associations between maternal depression and anxiety and infant acute care is needed and will guide strategies to decrease maternal mental illness and improve infant care for this population. |
Promoting women's health in hospitals: a focus on breastfeeding and lactation support for employees and patients
Belay B , Allen J , Williams N , Dooyema C , Foltz J . J Womens Health (Larchmt) 2012 22 (1) 1-4 Hospitals often are one of the largest employers in communities, and nationwide, they employ more than 6.3 million employees. Hospitals also serve tens of millions of inpatients annually. Hospitals, therefore, can be leaders in worksite wellness and promoting breastfeeding and lactation support for new mothers. By adopting model standards and practices that promote breastfeeding, hospitals can influence women's health. This article focuses on the efforts of the Centers for Disease Control and Prevention's Division of Nutrition, Physical Activity, and Obesity to promote breastfeeding and lactation support for hospital employees and patients. |
The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study
Kotloff KL , Blackwelder WC , Nasrin D , Nataro JP , Farag TH , van Eijk A , Adegbola RA , Alonso PL , Breiman RF , Golam Faruque AS , Saha D , Sow SO , Sur D , Zaidi AK , Biswas K , Panchalingam S , Clemens JD , Cohen D , Glass RI , Mintz ED , Sommerfelt H , Levine MM . Clin Infect Dis 2012 55 Suppl 4 S232-45 BACKGROUND: Diarrhea is a leading cause of illness and death among children aged <5 years in developing countries. This paper describes the clinical and epidemiological methods used to conduct the Global Enteric Multicenter Study (GEMS), a 3-year, prospective, age-stratified, case/control study to estimate the population-based burden, microbiologic etiology, and adverse clinical consequences of acute moderate-to-severe diarrhea (MSD) among a censused population of children aged 0-59 months seeking care at health centers in sub-Saharan Africa and South Asia. METHODS: GEMS was conducted at 7 field sites, each serving a population whose demography and healthcare utilization practices for childhood diarrhea were documented. We aimed to enroll 220 MSD cases per year from selected health centers serving each site in each of 3 age strata (0-11, 12-23, and 24-59 months), along with 1-3 matched community controls. Cases and controls supplied clinical, epidemiologic, and anthropometric data at enrollment and again approximately 60 days later, and provided enrollment stool specimens for identification and characterization of potential diarrheal pathogens. Verbal autopsy was performed if a child died. Analytic strategies will calculate the fraction of MSD attributable to each pathogen and the incidence, financial costs, nutritional consequences, and case fatality overall and by pathogen. CONCLUSIONS: When completed, GEMS will provide estimates of the incidence, etiology, and outcomes of MSD among infants and young children in sub-Saharan Africa and South Asia. This information can guide development and implementation of public health interventions to diminish morbidity and mortality from diarrheal diseases. |
Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: experience in the United States and implications for a potential group B streptococcal vaccine
Schrag SJ , Verani JR . Vaccine 2012 31 Suppl 4 D20-6 Group B Streptococcus (GBS) emerged as the leading cause of newborns infection in the United States in the 1970s. In the 1980s clinical trials demonstrated that giving intrapartum intravenous ampicillin or penicillin to mothers at risk was highly effective at preventing invasive GBS disease in the first week of life (early-onset). In 1996, the first national guidelines for the prevention of perinatal GBS disease were issued; these recommended either antenatal screening for GBS colonization and intrapartum antimicrobial prophylaxis (IAP) to colonized women, or targeting IAP to women with certain obstetric risk factors during labor. In 2002, revised guidelines recommended universal antenatal GBS screening. A multistate population-based review of labor and delivery records in 2003-2004 found 85% of women had documented antenatal GBS screening; 98% of screened women had a colonization result available at labor. However, missed opportunities for prevention were identified among women delivering preterm and among those with penicillin allergy, and more false negative GBS screening results were observed than expected. The incidence of invasive early-onset GBS disease decreased by more than 80% from 1.8 cases/1000 live births in the early 1990s to 0.26 cases/1000 live births in 2010; from 1994 to 2010 we estimate that over 70,000 cases of EOGBS invasive disease were prevented in the United States. IAP effectiveness is similar and high among term (92%) and preterm (87%) infants when first line therapy is received for at least 4h. However, early-onset disease incidence among preterm infants remains twice that of term infants; moreover disease among infants after the first week of life (late-onset disease) has not been impacted by IAP. The US experience demonstrates that universal screening and IAP for GBS-colonized women comprise a highly effective strategy against early-onset GBS infections. Maximizing adherence to recommended practices holds promise to further reduce the burden of early-onset GBS disease. Yet there are also inherent limitations to universal screening and IAP. Some of these could potentially be addressed by an efficacious maternal GBS vaccine. |
Evaluations of a noise control for roof bolting machines
Azman AS , Yantek DS , Alcorn lA . Min Eng 2012 64 (12) 64-70 In collaboration with Kennametal Inc. and Corry Rubber Corporation, the U.S. National Institute for Occupational Safety and Health (NIOSH) developed a drill bit isolator to address noise overexposures associated with roof bolting machines in underground coal mines. NIOSH laboratory studies confirmed that the drill bit isolator reduces noise during drilling. Field studies were needed to confirm that a noise reduction could be obtained under working conditions and that the device was sufficiently durable. This paper reports results of field tests of the device conducted at five underground coal mines. Noise reduction was assessed by comparing the operator’s noise exposure during drilling with and without the drill bit isolator. Durability was assessed by recording the number of holes and total feet drilled with each bit isolator until either the test period ended or the device failed. The results from these tests showed that the device is an effective noise control in a mine environment. The field-tested drill bit isolators provided a noise reduction of 3-5 dB(A). Of nine devices tested for durability, five exceeded 610 m (2,000 ft) drilled and two exceeded 762 m (2,500 ft) drilled before failure. Durability issues found in the field tests led to final production optimizations that have resulted in a commercially available product for drilling with 35-mm- (1.3-in.-) diameter roof bits and hexagonal drill steels. |
Using urinary biomarkers of polycyclic aromatic compound exposure to guide exposure-reduction strategies among asphalt paving workers
McClean MD , Osborn LV , Snawder JE , Olsen LD , Kriech AJ , Sjodin A , Li Z , Smith JP , Sammons DL , Herrick RF , Cavallari JM . Ann Occup Hyg 2012 56 (9) 1013-24 INTRODUCTION: Paving workers are exposed to polycyclic aromatic compounds (PACs) while working with hot-mix asphalt (HMA). Further characterization of the source and route of these exposures is necessary to guide exposure-reduction strategies. METHODS: Personal air (n = 144), hand-wash (n = 144), and urine (n = 480) samples were collected from 12 paving workers over 3 workdays during 4 workweeks. Urine samples were collected at preshift, postshift, and bedtime and analyzed for 10 hydroxylated PACs (1-OH-pyrene; 1-, 2-, 3-, 4-OH-phenanthrene; 1-, 2-OH-naphthalene; 2-, 3-, 9-OH-fluorene) by an immunochemical quantification of PACs (I-PACs). The air and hand-wash samples were analyzed for the parent compounds corresponding to the urinary analytes. Using a crossover study design, each of the 4 weeks represented a different exposure scenario: a baseline week (normal conditions), a dermal protection week (protective clothing), a powered air-purifying respirator (PAPR) week, and a biodiesel substitution week (100% biodiesel provided to replace the diesel oil normally used by workers to clean tools and equipment). The urinary analytes were analyzed using linear mixed-effects models. RESULTS: Postshift and bedtime concentrations were significantly higher than preshift concentrations for most urinary biomarkers. Compared with baseline, urinary analytes were reduced during the dermal protection (29% for 1-OH-pyrene, 15% for I-PACs), the PAPR (24% for 1-OH-pyrene, 15% for I-PACs), and the biodiesel substitution (15% for 1-OH-pyrene) weeks. The effect of PACs in air was different by exposure scenario (biodiesel substitution > dermal protection > PAPR and baseline) and was still a significant predictor of most urinary analytes during the week of PAPR use, suggesting that PACs in air were dermally absorbed. The application temperature of HMA was positively associated with urinary measures, such that an increase from the lowest application temperature (121 degrees C) to the highest (154 degrees C) was associated with a 72% increase in SigmaOH-fluorene and 1-OH-pyrene and an 82% increase in SigmaOH-phenanthrene. Though PACs in hand-wash samples were not predictors of urinary analytes, the effects observed during the PAPR scenario and the week of increased dermal protection provide evidence of dermal absorption. CONCLUSIONS: Our results provide evidence that PACs in air are dermally absorbed. Reducing the application temperature of asphalt mix appears to be a promising strategy for reducing PAC exposure among paving workers. Additional reductions may be achieved by requiring increased dermal coverage of workers and by substituting biodiesel for diesel oil as a cleaning agent. |
Maternal occupational exposure to polycyclic aromatic hydrocarbons and congenital heart defects among offspring in the National Birth Defects Prevention Study
Lupo PJ , Symanski E , Langlois PH , Lawson CC , Malik S , Gilboa SM , Lee LJ , Agopian AJ , Desrosiers TA , Waters MA , Romitti PA , Correa A , Shaw GM , Mitchell LE . Birth Defects Res A Clin Mol Teratol 2012 94 (11) 875-81 BACKGROUND: There is evidence in experimental model systems that exposure to polycyclic aromatic hydrocarbons (PAHs) results in congenital heart defects (CHDs); however, to our knowledge, this relationship has not been examined in humans. Therefore, we conducted a case-control study assessing the association between estimated maternal occupational exposure to PAHs and CHDs in offspring. METHODS: Data on CHD cases and control infants were obtained from the National Birth Defects Prevention Study for the period of 1997 to 2002. Exposure to PAHs was assigned by industrial hygienist consensus, based on self-reported maternal occupational histories from 1 month before conception through the third month of pregnancy. Logistic regression was used to evaluate the association between maternal occupational PAH exposure and specific CHD phenotypic subtypes among offspring. RESULTS: The prevalence of occupational PAH exposure was 4.0% in CHD case mothers (76/1907) and 3.6% in control mothers (104/2853). After adjusting for maternal age, race or ethnicity, education, smoking, folic acid supplementation, and study center, exposure was not associated with conotruncal defects (adjusted odds ratio [AOR], 0.98; 95% confidence interval [CI], 0.58-1.67), septal defects (AOR, 1.28; 95% CI, 0.86-1.90), or with any isolated CHD subtype. CONCLUSIONS: Our findings do not support an association between potential maternal occupational exposure to PAHs and various CHDs in a large, population-based study. For CHD phenotypic subtypes in which modest nonsignificant associations were observed, future investigations could be improved by studying populations with a higher prevalence of PAH exposure and by incorporating information on maternal and fetal genotypes related to PAH metabolism. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
International environmental and occupational health: from individual scientists to networked science hubs
Rosenthal J , Jessup C , Felknor S , Humble M , Bader F , Bridbord K . Am J Ind Med 2012 55 (12) 1069-77 For the past 16 years, the International Training and Research in Environmental and Occupational Health program (ITREOH) has supported projects that link U.S. academic scientists with scientists from low- and middle-income countries in diverse research and research training activities. Twenty-two projects of varied duration have conducted training to enhance the research capabilities of scientists at 75 institutions in 43 countries in Asia, Africa, Eastern Europe, and Latin America, and have built productive research relationships between these scientists and their U.S. partners. ITREOH investigators and their trainees have produced publications that have advanced basic sciences, developed methods, informed policy outcomes, and built institutional capacity. Today, the changing nature of the health sciences calls for a more strategic approach. Data-rich team science requires greater capacity for information technology and knowledge synthesis at the local institution. More robust systems for ethical review and administrative support are necessary to advance population-based research. Sustainability of institutional research capability depends on linkages to multiple national and international partners. In this context, the Fogarty International Center, the National Institute of Environmental Sciences and the National Institute for Occupational Safety and Health, have reengineered the ITREOH program to support and catalyze a multi-national network of regional hubs for Global Environmental and Occupational Health Sciences (GEOHealth). We anticipate that these networked science hubs will build upon previous investments by the ITREOH program and will serve to advance locally and internationally important health science, train and attract first-class scientists, and provide critical evidence to guide policy discussions. (Am. J. Ind. Med. 55:1069-1077, 2012. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Interventions to prevent occupational noise-induced hearing loss
Verbeek JH , Kateman E , Morata TC , Dreschler WA , Mischke C . Cochrane Database Syst Rev 2012 10 CD006396 BACKGROUND: Millions of workers worldwide are exposed to noise levels that increase their risk of hearing impairment. Little is known about the effectiveness of hearing loss prevention interventions. OBJECTIVES: To assess the effectiveness of non-pharmaceutical interventions for preventing occupational noise exposure or occupational hearing loss compared to no intervention or alternative interventions. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; and OSH update to 25 January 2012. SELECTION CRITERIA: We included randomised controlled trials (RCT), controlled before-after studies (CBA) and interrupted time-series (ITS) of non-clinical hearing loss prevention interventions under field conditions among workers exposed to noise. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and risk of bias and extracted data. MAIN RESULTS: We included 25 studies. We found no controlled studies on engineering controls for noise exposure but one study evaluated legislation to reduce noise exposure in a 12-year time-series analysis. Eight studies with 3,430 participants evaluated immediate and long-term effects of personal hearing protection devices (HPDs) and sixteen studies with 82,794 participants evaluated short and long-term effects of hearing loss prevention programmes (HLPPs). The overall quality of studies was low to very low.The one ITS study that evaluated the effect of new legislation in reducing noise exposure found that the median noise level decreased by 27.7 dB(A) (95% confidence interval (CI) -36.1 to -19.3 dB) immediately after the implementation of stricter legislation and that this was associated with a favourable downward trend in time of -2.1 dB per year (95% CI -4.9 to 0.7).Hearing protection devices attenuated noise with about 20 dB(A) with variation among brands and types but for ear plugs these findings depended almost completely on proper instruction of insertion. Noise attenuation ratings of hearing protection under field conditions were consistently lower than the ratings provided by the manufacturers.One cluster-RCT compared a three-year information campaign as part of a hearing loss prevention programme for agricultural students to audiometry only with three and 16-year follow-up but there were no significant differences in hearing loss. Another study compared a HLPP, which provided regular personal noise exposure information, to a programme without this information in a CBA design. Exposure information was associated with a favourable but non-significant reduction of the rate of hearing loss of -0.82 dB per year (95% CI -1.86 to 0.22). Another cluster-RCT evaluated the effect of extensive on-site training sessions and the use of personal noise-level indicators versus information only on noise levels but did not find a significant difference after four months follow-up (Mean Difference (MD) -0.30 dB(A) (95%CI -3.95 to 3.35).There was very low quality evidence in four very long-term studies, that better use of HPDs as part of a HLPP decreased the risk of hearing loss compared to less well used hearing protection in HLPPs. Other aspects of the HLPP such as training and education of workers or engineering controls did not show a similar effect.In four long-term studies, workers in a HLPP still had a 0.5 dB greater hearing loss at 4 kHz than workers that were not exposed to noise (95% CI -0.5 to 1.7) which is about the level of hearing loss caused by exposure to 85 dB(A). In addition, two other studies showed substantial risk of hearing loss in spite of the protection of a HLPP compared to non-exposed workers. AUTHORS' CONCLUSIONS: There is low quality evidence that implementation of stricter legislation can reduce noise levels in workplaces. Even though case studies show that substantial reductions in noise levels in the workplace can be achieved, there are no controlled studies of the effectiveness of such measures. The effectiveness of hearing protection devices depends on training and their proper use. There is very low quality evidence that the better use of hearing protection devices as part of HLPPs reduces the risk of hearing loss, whereas for other programme components of HLPPs we did not find such an effect. Better implementation and reinforcement of HLPPs is needed. Better evaluations of technical interventions and long-term effects are needed. |
Evaluation of laser-induced breakdown spectroscopy (LIBS) for measurement of silica on filter samples of coal dust
Stipe CB , Miller AL , Brown J , Guevara E , Cauda E . Appl Spectrosc 2012 66 (11) 1286-93 Airborne silica dust (quartz) is common in coal mines and represents a respiratory hazard that can lead to silicosis, a potentially fatal lung disease. With an eye toward developing a portable monitoring device for rapid analysis of silica dust, laser-induced breakdown spectroscopy (LIBS) was used to quantify quartz in coal dust samples collected on filter media. Pure silica (Min-U-Sil(TM) 5), Georgia kaolin, and Pittsburgh-4 and Illinois-6 coal dusts were deposited separately and at multiple mass loadings onto 37-mm polyvinylchloride (PVC) filters. LIBS-generated silicon emission was monitored at 288.16 nm, and non-silica contributions to that signal from kaolinite were removed by simultaneously detecting aluminum. Measurements of the four samples were used to calculate limits of detection (LOD) for silicon and aluminum of approximately 0.08 mug/cm(2) and 0.05 mug/cm(2), respectively (corresponding to 0.16 mug/cm(2) and 0.20 mug/cm(2) for silica and kaolinite, respectively). Relative errors of prediction are around 10%. Results demonstrate that LIBS can dependably quantify silica on filter samples of coal dust and confirm that accurate quantification can be achieved for very lightly loaded samples, which supports the potential application of LIBS for rapid, in-field monitoring. |
Rationale for short course primaquine in Africa to interrupt malaria transmission
Eziefula AC , Gosling R , Hwang J , Hsiang MS , Bousema T , von Seidlein L , Drakeley C . Malar J 2012 11 (1) 360 ABSTRACT: Following the recent successes of malaria control in sub-Saharan Africa, the gametocytocidal drug primaquine needs evaluation as a tool to further reduce the transmission of Plasmodium falciparum malaria. The drug has scarcely been used in Africa because of concerns about its safety in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The evidence base for the use of primaquine as a transmission blocker is limited by a lack of comparable clinical and parasitological endpoints between trials. In March 2012, a group of experts met in London to discuss the existing evidence on the ability of primaquine to block malaria transmission, to define the roadblocks to the use of primaquine in Africa and to develop a roadmap to enable its rapid, safe and effective deployment. The output of this meeting is a strategic plan to optimize trial design to reach desired goals efficiently. The roadmap includes suggestions for a series of phase 1, 2, 3 and 4 studies to address specific hurdles to primaquine's deployment. These include ex-vivo studies on efficacy, primaquine pharmacokinetics and pharmacodynamics and dose escalation studies for safety in high-risk groups. Phase 3 community trials are proposed, along with Phase 4 studies to evaluate safety, particularly in pregnancy, through pharmacovigilance in areas where primaquine is already deployed. In parallel, efforts need to be made to address issues in drug supply and regulation, to map G6PD deficiency and to support the evaluation of alternative gametocytocidal compounds. |
A review of toxoplasmosis in humans and animals in Ethiopia
Dubey JP , Tiao N , Gebreyes WA , Jones JL . Epidemiol Infect 2012 140 (11) 1935-8 Toxoplasmosis caused by the protozoan parasite, Toxoplasma gondii, is a worldwide zoonosis. In this paper published information on toxoplasmosis in humans and other animals in Ethiopia is reviewed. Limited data indicate that the prevalence of T. gondii in humans in Ethiopia is very high, up to 41% of children aged 1-5 years were reported to be seropositive. There is little information on seroprevalence data in pregnant women and no data on congenital toxoplasmosis in children. About 1 million adults in Ethiopia are considered to be infected with HIV with less than one-third likely receive highly active antiviral therapy. Based on a conservative T. gondii seroprevalence of 50%, thousands might die of concurrent opportunistic infections, including toxoplasmosis. However, exact figures are not available, and most serological surveys are not current. Serological surveys indicate up to 79% of goats and sheep have T. gondii antibodies. However, there is no information on losses due to toxoplasmosis in livestock or the presence of viable T. gondii in any host in Ethiopia. |
Improving the implementation of a condom availability program in urban high schools
De Rosa CJ , Jeffries RA , Afifi AA , Cumberland WG , Chung EQ , Kerndt PR , Ethier KA , Martinez E , Loya RV , Dittus PJ . J Adolesc Health 2012 51 (6) 572-9 PURPOSE: We conducted an intervention to improve the implementation of a high school condom availability program, and evaluated its effect on students' awareness of the program and acquisition of condoms. METHODS: Twelve public high schools in the Los Angeles, CA area participated, half each in the intervention and control conditions. Project staff facilitated intervention schools' self-assessment of compliance with the school district's condom availability policy, creating an action plan by determining which mandatory program elements were lacking and identifying steps to improve compliance. Staff provided technical assistance and follow-up to assist schools in improving program implementation. From 2005 to 2009 (T1-T5), 29,823 students were randomly selected by classroom and they completed surveys. We tested for changes in students' awareness and acquisition of condoms over time between conditions using mixed model logistic regression analyses. Records of condom orders by schools also were reviewed. RESULTS: Awareness increased significantly among intervention versus control participants from T1 to T3 (adjusted odds ratio [AOR]: 1.28; 95% confidence interval [CI]: 1.01, 1.62), T4 (AOR: 2.17; 95% CI: 1.70, 2.76), and T5 (AOR: 2.78; 95% CI: 2.18, 3.56). Acquisition of condoms increased significantly among intervention versus control participants from T1 to T4 (AOR: 1.69; 95% CI: 1.23, 2.32) and T5 (AOR: 1.81; 95% CI: 1.32, 2.49). Results were similar across gender and different levels of sexual experience. Orders of condoms increased markedly in intervention schools by T5. CONCLUSIONS: Feasible minor enhancements to condom availability program implementation improved program delivery, resulting in increased student awareness of the program and acquisition of condoms. |
Neural tube defects and maternal intake of micronutrients related to one-carbon metabolism or antioxidant activity
Chandler AL , Hobbs CA , Mosley BS , Berry RJ , Canfield MA , Qi YP , Siega-Riz AM , Shaw GM . Birth Defects Res A Clin Mol Teratol 2012 94 (11) 864-74 BACKGROUND: Maternal nutritional status has been evaluated to clarify its role in development of neural tube defects (NTDs). Maternal folate intake during pregnancy has been closely evaluated for its association with NTDs. The study objective was to examine associations between NTDs and other dietary periconceptional micronutrient intake, particularly nutrients involved in one-carbon metabolism or antioxidant activity. METHODS: Using data from the National Birth Defects Prevention Study, 1997-2005, logistic regression models were used to estimate the relative risk of NTDs based on maternal micronutrient intake. RESULTS: Results were stratified according to folic acid supplement use, race/ethnicity, and maternal body mass index. Analyses included 954 cases (300 with anencephaly, 654 with spina bifida) and 6268 controls. Higher intakes of folate, thiamin, betaine, iron, and vitamin A were associated with decreased risk of anencephaly among some ethnic and clinical groups. In some groups, higher intakes of thiamin, riboflavin, vitamin B(6) , vitamin C, vitamin E, niacin, and retinol were associated with decreased risk of spina bifida. CONCLUSION: In addition to folic acid, other micronutrients, including thiamin, betaine, riboflavin, vitamin B(6) , vitamin C, vitamin E, niacin, iron, retinol, and vitamin A, may decrease the risk of NTD occurrence. (Birth Defects Research (Part A) 2012. (c) 2012 Wiley Periodicals, Inc.) |
Neural tube defects on the Texas-Mexico border: what we've learned in the 20 years since the Brownsville cluster
Suarez L , Felkner M , Brender JD , Canfield M , Zhu H , Hendricks KA . Birth Defects Res A Clin Mol Teratol 2012 94 (11) 882-92 We reviewed the published findings from the Texas Neural Tube Defect Project, a 6-year case-control study (1995-2000) of neural tube defects (NTDs) on the Texas-Mexico border. In this review, we highlight what was learned about environmental, genetic, and nutritional factors (i.e., those related to the folate and other metabolic pathways) and the novel putative risk factors that emerged from this study of Mexican American women living on the Texas-Mexico border. Our investigations of the micronutrients and metabolic pathways involved confirmed the findings of other researchers that increased folate intake has a protective effect and that low serum B(12) , high serum homocysteine levels, and obesity independently contribute to risk. Studies of this population also have implicated hyperinsulinemia and low ferritin, metabolic risk factors, which require additional study to elucidate their physiologic mechanism. Environmental contaminants such as heavy metals, pesticides, and polychlorinated biphenyls (PCBs), which were of community concern, did little to explain NTD risk. Studies in this folic acid deficit-population also revealed several novel risk factors, namely, diarrhea, stress, fumonisins, and the combination of nitrosatable drug exposure with high nitrate/nitrite intake. In conclusion, the 23 studies among the Mexican American women living along the Texas-Mexico border have demonstrated the multifactorial nature of NTDs and that a population deficient in folic acid will be vulnerable to a variety of insults whether brought on by individual behaviors (e.g., obesity) or through the surrounding environment (e.g., fumonisins). (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Prevalence of esophageal atresia among 18 international birth defects surveillance programs
Nassar N , Leoncini E , Amar E , Arteaga-Vazquez J , Bakker MK , Bower C , Canfield MA , Castilla EE , Cocchi G , Correa A , Csaky-Szunyogh M , Feldkamp ML , Khoshnood B , Landau D , Lelong N , Lopez-Camelo JS , Lowry RB , McDonnell R , Merlob P , Metneki J , Morgan M , Mutchinick OM , Palmer MN , Rissmann A , Siffel C , Sipek A , Szabova E , Tucker D , Mastroiacovo P . Birth Defects Res A Clin Mol Teratol 2012 94 (11) 893-9 BACKGROUND: The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS: The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS: Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35-2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS: On average, EA affected 1 in 4099 births (95% CI, 1 in 3954-4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Love and hooking up in the new millennium: communication technology and relationships among urban African American and Puerto Rican young adults
Bergdall AR , Kraft JM , Andes K , Carter M , Hatfield-Timajchy K , Hock-Long L . J Sex Res 2012 49 (6) 570-82 Communication technology is a central feature of young people's lives, but its role in romantic and sexual relationships has not been thoroughly examined. This article describes how young adults use communication technology for partnering across relationship stages (formation, maintenance, and dissolution) and types (serious/casual), and proposes implications of usage in relationships. This study analyzed qualitative data from a five-week, prospective, coital diary method with related debriefing interviews (N=70) of African American and Puerto Rican men and women aged 18 to 25 years in Hartford and Philadelphia. Cell phones, including calls, text messaging, and mobile Internet, were the most common forms of communication technology used for partnering goals. Participants reported using cell phones to pursue partnering goals across all relationship stages, including formation (meeting, screening, and getting to know new partners), maintaining existing relationships, and breaking up. Cell phone uses depended on the type of relationship (serious/casual) and the participants' intentions and desires. Results indicated that cell phones are an important element of communication among young adults in romantic and sexual relationships. Specific features of cell phone communication shape the process and context of partnering. Future research should explore emerging communication technologies and implications for psychosocial development, dating violence, and sexual behavior. |
Genotypic characterization of Streptococcus infantarius subsp. coli isolates from sea otters with infective endocarditis and/or septicemia and from environmental mussel samples.
Counihan-Edgar KL , Gill VA , Doroff AM , Burek KA , Miller WA , Shewmaker PL , Jang S , Goertz CE , Tuomi PA , Miller MA , Jessup DA , Byrne BA . J Clin Microbiol 2012 50 (12) 4131-3 Pulsed-field gel electrophoresis (PFGE) was used to type 128 Streptococcus infantarius subsp. coli isolates from sea otters and mussels. Six SmaI PFGE groups were detected, with one predominant group representing 57% of the isolates collected over a wide geographic region. Several sea otter and mussel isolates were highly related, suggesting that an environmental infection source is possible. |
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