Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-21 (of 21 Records) |
Query Trace: Cunningham SA[original query] |
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Factors influencing knowledge of COVID-19 prevention in Eastern Ethiopia
Dheresa M , Madewell ZJ , Muir JA , Getachew T , Daraje G , Mengesha G , Whitney CG , Assefa N , Cunningham SA . SAGE Open 2024 14 (3) This study examined coronavirus disease 2019 (COVID-19) prevention knowledge among community residents in Eastern Ethiopia to support public health interventions and vaccination coverage. A cross-sectional survey in August-September 2021 recruited 880 participants from households in a Health and Demographic Surveillance System (HDSS) in Harari and Oromia, Ethiopia. Participants were randomly selected and interviewed in person using tablets and a standardized questionnaire. Principal components analysis was used to create a score representing COVID-19 prevention knowledge. Quasi-Poisson regression was used to examine associations between demographic characteristics and COVID-19 prevention knowledge. The survey also assessed awareness of community/government COVID-19 prevention measures and healthcare services for under-5 children and pregnant women. The most cited COVID-19 prevention measures were handwashing with soap (91.5%) and wearing facemasks (89.2%); least mentioned were avoiding travel (22.2%) and wearing medical gloves (20.3%). Commonly recognized community/government measures included school closures (77.0%), avoiding gatherings (75.2%), and staying home (62.3%). Adjusted analyses demonstrated higher COVID-19 prevention knowledge among rural participants, those aged ≥65 years (reference: <25), with secondary education (reference: no education), with monthly income of ≥2,001 Birr (reference: 0–1,200), and were farmers, domestic/subsistence workers, or government employees (reference: unemployed). Knowledge was lower among households with ≥5 household members. Of households with under-5 children and pregnant women, 9.4% and 12.3% missed medical care visits since mid-March 2020 consequent to the pandemic. Public health interventions to reduce COVID-19 transmission rely on risk perception and knowledge. Understanding these factors can help Ethiopian authorities design effective health education programs to control community and household SARS-CoV-2 transmission. © The Author(s) 2024. |
Comparison of causes of stillbirth and child deaths as determined by verbal autopsy and minimally invasive tissue sampling
Assefa N , Scott A , Madrid L , Dheresa M , Mengesha G , Mahdi S , Mahtab S , Dangor Z , Myburgh N , Mothibi LK , Sow SO , Kotloff KL , Tapia MD , Onwuchekwa UU , Djiteye M , Varo R , Mandomando I , Nhacolo A , Sacoor C , Xerinda E , Ogbuanu I , Samura S , Duduyemi B , Swaray-Deen A , Bah A , El Arifeen S , Gurley ES , Hossain MZ , Rahman A , Chowdhury AI , Quique B , Mutevedzi P , Cunningham SA , Blau D , Whitney C . PLOS Glob Public Health 2024 4 (7) e0003065 In resource-limited settings where vital registration and medical death certificates are unavailable or incomplete, verbal autopsy (VA) is often used to attribute causes of death (CoD) and prioritize resource allocation and interventions. We aimed to determine the CoD concordance between InterVA and CHAMPS's method. The causes of death (CoDs) of children <5 were determined by two methods using data from seven low- and middle-income countries (LMICs) enrolled in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. The first CoD method was from the DeCoDe panel using data from Minimally Invasive Tissue Sampling (MITS), whereas the second method used Verbal Autopsy (VA), which utilizes the InterVA software. This analysis evaluated the agreement between the two using Lin's concordance correlation coefficient. The overall concordance of InterVA4 and DeCoDe in assigning causes of death across surveillance sites, age groups, and causes of death was poor (0.75 with 95% CI: 0.73-0.76) and lacked precision. We found substantial differences in agreement by surveillance site, with Mali showing the lowest and Mozambique and Ethiopia the highest concordance. The InterVA4 assigned CoD agrees poorly in assigning causes of death for U5s and stillbirths. Because VA methods are relatively easy to implement, such systems could be more useful if algorithms were improved to more accurately reflect causes of death, for example, by calibrating algorithms to information from programs that used detailed diagnostic testing to improve the accuracy of COD determination. |
Coronavirus awareness and household hardship survey data for the CHAMPS HDSS network: Data collected between April 2021 and February 2022 in the Manhiça HDSS, Mozambique
Muir JA , Matsena T , Madewell ZJ , Keiri F , Sacoor CN , Jamisse EL , Xerinda EG , Hunguana AM , Bassat Q , Mandomando I , Nhacolo A , Cunningham SA . Data Brief 2024 55 Data collection was implemented through an initiative by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network to assess whether lockdowns and other social distancing policies during COVID-19 had implications for household economic status, maternal and child health, and healthcare accessibility for pregnant women and children. The data were collected from April 2021 until February 2022 from a population living in a rural community of Mozambique. This rural community is located within a Health and Demographic Surveillance System (HDSS) that operates in the Manhiça district of Maputo province. The survey instrument used for data collection was specifically designed to examine household awareness, knowledge, and prevalence of COVID-19; it was also designed to document hardships experienced by households during the pandemic period such as food insecurity, job losses and/or business closures of household members, and access to healthcare. The data are generalizable to a contiguous community in Manhiça, Mozambique of approximately 200,000 inhabitants. © 2024 The Author(s) |
Coronavirus awareness, prevention, and household hardship survey data for the CHAMPS HDSS network: Data collected between August and September of 2022 from the Bamako HDSS, Mali
Muir JA , Onwuchekwa UU , Madewell ZJ , Traore MO , Kourouma M , Keiri F , Cunningham SA , Sow SO , Tapia MD , Kotloff KL . Data Brief 2024 55 Data were gathered through a collaborative initiative to investigate impacts of the COVID-19 pandemic and related lockdowns on child and maternal health, economic hardships, and access to care for children and pregnant women by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network. The data were gathered in Bamako, the capital city of Mali (population ∼2.9 million) between August and September of 2022 through a Health and Demographic Surveillance System (HDSS). Data collectors used a survey instrument specifically designed to measure household awareness, knowledge, and prevalence of COVID-19, as well as hardships that households experienced since the onset of the pandemic in March of 2020. The data are from two neighborhoods of Bamako, Banconi and Djicoroni; the Health and Demographic Surveillance System (HDSS) operating in these neighborhoods tracks the health of approximately 235,000 inhabitants. The data were collected using a stratified random sample of 454 households. © 2024 The Author(s) |
Prevalence of food insecurity amid COVID-19 lockdowns and sociodemographic indicators of household vulnerability in Harar and Kersa, Ethiopia
Muir JA , Dheresa M , Madewell ZJ , Getachew T , Daraje G , Mengesha G , Whitney CG , Assefa N , Cunningham SA . BMC Nutr 2024 10 (1) 7 BACKGROUND: The COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in resource-limited countries, we examine food insecurity during the pandemic period. METHODS: We conducted a cross-sectional study and used logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. The study is set in two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and included a random sample of 880 households. RESULTS: Roughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income. CONCLUSIONS: After taking individual and household level sociodemographic characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings suggest a need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households. |
Knowledge of COVID-19 symptoms, transmission, and prevention: Evidence from health and demographic surveillance in Southern Mozambique
Nhacolo A , Madewell ZJ , Muir JA , Sacoor C , Xerinda E , Matsena T , Jamisse E , Bassat Q , Whitney CG , Mandomando I , Cunningham SA . PLOS Glob Public Health 2023 3 (11) e0002532 Understanding community members' knowledge of SARS-CoV-2 transmission and prevention is essential for directing public health interventions to reduce disease spread and improve vaccination coverage. Here, we describe knowledge of COVID-19 transmission, prevention, and symptoms among community residents in Mozambique. We conducted a cross-sectional survey among 33,087 households in a Health and Demographic Surveillance System in Manhiça, Mozambique. Participants were recruited in April 2021 before the Delta variant wave to the peak of Omicron cases in February 2022. Principal components analysis was used to create scores representing knowledge of COVID-19 symptoms, transmission, and prevention. Multiple imputation and quasi-Poisson regression were used to examine associations between demographic characteristics and sources of COVID-19 information, and knowledge of COVID-19 symptoms, transmission, and prevention. We examined whether sources of COVID-19 information mediated the relationship between educational attainment and knowledge of symptoms, transmission, and prevention. Across this rural community, 98.2%, 97.0%, and 85.1% of respondents reported knowing how COVID-19 could be prevented, that SARS-CoV-2 can cause disease, and how SARS-CoV-2 is transmitted, respectively. The most recognized COVID-19 symptoms were cough (51.2%), headaches (44.9%), and fever (44.5%); transmission mechanisms were saliva droplets (50.5%) or aerosol (46.9%) from an infected person; and prevention measures were handwashing (91.9%) and mask-wearing (91.8%). Characteristics associated with greater knowledge of symptoms, transmission, and prevention included having at least primary education, older age, employment, higher wealth, and Christian religion. Respondents who had experienced COVID-19 symptoms were also more likely to possess knowledge of symptoms, transmission, and prevention. Receiving information from television, WhatsApp, radio, and hospital, mediated the relationship between educational attainment and knowledge scores. These findings support the need for outreach and for community-engaged messaging to promote prevention measures, particularly among people with low education. |
Household hardships and responses to COVID-19 pandemic-related shocks in Eastern Ethiopia
Muir JA , Dheresa M , Madewell ZJ , Getachew T , Daraje G , Mengesha G , Whitney CG , Assefa N , Cunningham SA . BMC Public Health 2023 23 (1) 2086 BACKGROUND: COVID-19 resulted in enormous disruption to life around the world. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships. METHODS: We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia. RESULTS: Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships. CONCLUSIONS: Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks. |
COVID-19 impact data for the CHAMPS HDSS network: Data from Harar and Kersa, Ethiopia
Muir JA , Dheresa M , Madewell ZJ , Getachew T , Daraje G , Mengesha G , Whitney CG , Assefa N , Cunningham SA . Data Brief 2023 50 109508 Data were collected as part of the Child Health and Mortality Prevention Surveillance (CHAMPS) network to learn about the effects of COVID-19 lockdowns on child health and access to care. Data were collected between August and September 2021 through a Health and Demographic Surveillance System (HDSS) operating in Eastern Ethiopia using a survey instrument focused on knowledge about COVID-19 and changes in food availability and healthcare services during the COVID-19 related lockdown. The data are representative of two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and consist of a random sample of 880 households. |
Food Insecurity amid COVID-19 Lockdowns: Assessing Sociodemographic Indicators of Vulnerability in Harar and Kersa, Ethiopia (preprint)
Muir JA , Dheresa M , Madewell ZJ , Getachew T , Mengesha G , Whitney CG , Assefa N , Cunningham SA . medRxiv 2023 02 Objective The COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in lower-income countries, we examine food insecurity during the pandemic period. Design Cross-sectional study using logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. Setting The study is set in two communities in Eastern Ethiopia, one rural and one urban. Participants A random sample of 880 households residing in Kersa and Harar. Results Roughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income. Discussion After taking other characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings point to the need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Household Hardships and Responses to COVID-19 Pandemic-Related Shocks in Eastern Ethiopia (preprint)
Muir JA , Dheresa M , Madewell ZJ , Getachew T , Daraje G , Mengesha G , Whitney CG , Assefa N , Cunningham SA . medRxiv 2023 02 Background: COVID-19 caused enormous disruption to life in the 21st century. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships. Method(s): We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia. Result(s): Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships. Conclusion(s): Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Knowledge of COVID-19 Symptoms, Transmission, and Prevention: Evidence from Health and Demographic Surveillance in Southern Mozambique (preprint)
Nhacolo AQ , Madewell ZJ , Muir JA , Sacoor CN , Xerinda EG , Matsena T , Bassat Q , Whitney CG , Mandomando IM , Cunningham SA . medRxiv 2023 03 Over 230,000 COVID-19 cases and over 2,200 deaths have been reported in Mozambique though May 2023. Understanding community members' knowledge of SARS-CoV-2 transmission and prevention is essential for directing public health interventions to reduce disease spread and improve vaccination coverage. Here, we describe knowledge of COVID-19 transmission, prevention, and symptoms among community residents in Mozambique. We conducted a cross-sectional survey among 33,087 households in a Health and Demographic Surveillance System in Manhica, Mozambique. Participants were recruited at the tail end of the Delta variant wave in September 2021 to the peak of Omicron cases in January 2022. Principal components analysis was used to create scores representing knowledge of COVID-19 symptoms, transmission, and prevention. Multiple imputation and quasi-Poisson regression were used to examine associations between demographic characteristics and sources of COVID-19 information, and knowledge of COVID-19 symptoms, transmission, and prevention. We examined whether sources of COVID-19 information mediated the relationship between educational attainment and knowledge of symptoms, transmission, and prevention. Across this rural community, 98.2%, 97.0%, and 85.1% of respondents reported knowing how COVID-19 could be prevented, that SARS-CoV-2 can cause disease, and how SARS-CoV-2 is transmitted, respectively. Most cited symptoms were cough (51.2%), headaches (44.9%), and fever (44.5%); transmission mechanisms were droplets (50.5%) or aerosol (<5 microm diameter) (46.9%) from an infected person; and prevention measures were handwashing (91.9%) and mask-wearing (91.8%). Characteristics associated with greater knowledge of symptoms, transmission, and prevention included having at least primary education, older age, employment, higher wealth, and Christian religion. Respondents who had had COVID-19 symptoms were also more likely to have knowledge of symptoms, transmission, and prevention. Gathering information from TV, WhatsApp, radio, and hospital mediated the relationship between educational attainment and knowledge scores. These findings support the need for outreach and for community-engaged messaging to promote prevention measures, particularly among people with low education. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Declines in health and support between parents and adult children: Insights from diabetes
Cunningham SA , Beckles GL , Nielsen J . Popul Res Policy Rev 2022 41 (4) 1699-1723 We investigate associations between a diabetes diagnosis and financial and instrumental transfers between parents and adult children.Data are from the Panel Study of Income Dynamics, a nationally representative household cohort from the USA with prospective data on diabetes and cross-sectional data on transfers for households in which the head and partner had adult children (n = 4210) or surviving parents (n = 6930). We used survey-adjusted multivariate logistic regressions to compare the probabilities of receiving and giving intergenerational transfers in households where the head and/or partner were recently diagnosed with diabetes or had diabetes-related limitations in daily activities. Households with a diabetes diagnosis in the previous 2years were less likely than those without diabetes to give money to adult children (OR = 0.46, p < 0.01). While recent onset of diabetes was not consistently associated with receiving transfers, transfers were more likely with progressing disease: households in which the head or partner had been diagnose more than 5years earlier were more likely to receive instrumental help from an adult child (OR = 1.24; p < 0.05); those with diabetes-related limitations were more likely to receive assistance, especially instrumental help from adult children (OR = 1.43; p < 0.01) than households without diabetes. The onset of a chronic health condition affects not only individuals own health and financial wellbeing; it also has implications for their adult children and parents, for family relations, time allocation, and financial resources. These broader implications of chronic disease may perpetuate health and economic inequalities across generations. 2022, The Author(s), under exclusive licence to Springer Nature B.V. |
Examination of sleep and obesity in children and adolescents in the United States
Chehal PK , Shafer L , Cunningham SA . Am J Health Promot 2021 36 (1) 46-54 PURPOSE: This study contributes to the growing literature on the association between sleep and obesity by examining the associations between hours of sleep, consistency of bedtime, and obesity among children in the US. DESIGN: Analysis of a nationally representative sample of non-institutionalized children from the 2016-17 National Survey of Children's Health. SETTING: US, national. SUBJECTS: Children ages 10-17 years (n = 34,640). MEASURES: Parent reported weeknight average hours of sleep and consistency of bedtime. Body mass index classified as underweight, normal, overweight or obesity using parent-reported child height and weight information, classified using CDC BMI-for-Age Growth Charts. ANALYSIS: Multivariate logistic regression models were used to estimate associations between measures of sleep and body mass index weight category adjusting for individual, household and neighborhood characteristics. RESULTS: An additional hour of sleep was associated with 10.8% lower odds of obesity, net of consistency in bedtime. After controlling for sleep duration, children who usually went to bed at the same time on weeknights had lower odds of obesity (24.8%) relative to children who always went to bed at the same time. CONCLUSION: Sleep duration is predictive of lower odds of obesity in US children and adolescents. Some variability in weeknight bedtime is associated with lower odds of obesity, though there were no additional benefits to extensive variability in bedtime. |
Extrapolating sparse gold standard cause of death designations to characterize broader catchment areas
Lyles RH , Cunningham SA , Kundu S , Bassat Q , Mandomando I , Sacoor C , Akelo V , Onyango D , Zielinski-Gutierrez E , Taylor AW . Epidemiol Methods 2020 9 (1) ![]() The Child Health and Mortality Prevention Surveillance (CHAMPS) Network is designed to elucidate and track causes of under-5 child mortality and stillbirth in multiple sites in sub-Saharan Africa and South Asia using advanced surveillance, laboratory and pathology methods. Expert panels provide an arguable gold standard determination of underlying cause of death (CoD) on a subset of child deaths, in part through examining tissue obtained via minimally invasive tissue sampling (MITS) procedures. We consider estimating a population-level distribution of CoDs based on this sparse but precise data, in conjunction with data on subgrouping characteristics that are measured on the broader population of cases and are potentially associated with selection for MITS and with cause-specific mortality. We illustrate how estimation of each underlying CoD proportion using all available data can be addressed equivalently in terms of a Horvitz-Thompson adjustment or a direct standardization, uncovering insights relevant to the designation of appropriate subgroups to adjust for non-representative sampling. Taking advantage of the functional form of the result when expressed as a multinomial distribution-based maximum likelihood estimator, we propose small-sample adjustments to Bayesian credible intervals based on Jeffreys or related weakly informative Dirichlet prior distributions. Our analyses of early data from CHAMPS sites in Kenya and Mozambique and accompanying simulation studies demonstrate the validity of the adjustment approach under attendant assumptions, together with marked performance improvements associated with the proposed adjusted Bayesian credible intervals. Adjustment for non-representative sampling of those validated via gold standard diagnostic methods is a critical endeavor for epidemiologic studies like CHAMPS that seek extrapolation of CoD proportion estimates. |
Health and demographic surveillance systems within the Child Health and Mortality Prevention Surveillance Network
Cunningham SA , Shaikh NI , Nhacolo A , Raghunathan PL , Kotloff K , Naser AM , Mengesha MM , Adedini SA , Misore T , Onuwchekwa UU , Worrell MC , El Arifeen S , Assefa N , Chowdhury AI , Kaiser R , Madhi SA , Mehta A , Obor D , Sacoor C , Sow SO , Tapia MD , Wilkinson AL , Breiman RF . Clin Infect Dis 2019 69 S274-s279 Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role. |
County-level contextual factors associated with diabetes incidence in the United States
Cunningham SA , Patel SA , Beckles GL , Geiss LS , Mehta N , Xie H , Imperatore G . Ann Epidemiol 2017 28 (1) 20-25 e2 PURPOSE: Health and administrative systems are facing spatial clustering in chronic diseases such as diabetes. This study explores how geographic distribution of diabetes in the United States is associated with socioeconomic and built environment characteristics and health-relevant policies. METHODS: We compiled nationally representative county-level data from multiple data sources. We standardized characteristics to a mean = 0 and a SD = 1 and modeled county-level age-adjusted diagnosed diabetes incidence in 2013 using 2-level hierarchical linear regression. RESULTS: Incidence of age-standardized diagnosed diabetes in 2013 varied across U.S. counties (n = 3109), ranging from 310 to 2190 new cases/100,000, with an average of 856.4/100,000. Socioeconomic and health-related characteristics explained approximately 42% of the variation in diabetes incidence across counties. After accounting for other characteristics, counties with higher unemployment, higher poverty, and longer commutes had higher incidence rates than counties with lower levels. Counties with more exercise opportunities, access to healthy food, and primary care physicians had fewer diabetes cases. CONCLUSIONS: Features of the socioeconomic and built environment were associated with diabetes incidence; identifying the salient modifiable features of counties can inform targeted policies to reduce diabetes incidence. |
Genotypic analysis of Tropheryma whipplei from patients with Whipple disease in the Americas.
Rollin DC , Paddock CD , Pritt BS , Cunningham SA , Denison AM . J Clin Pathol 2017 70 (10) 891-895 ![]() Tropheryma whipplei, the agent of Whipple disease, causes a rare bacterial disease that may be fatal if not treated. The classical form of the disease includes diarrhoea, weight loss, arthritis, endocarditis and neurological manifestations. Genotyping studies done in Europe, Africa and Asia showed high genetic diversity with no correlation between genotypes and clinical features, but contributed to a better understanding of the epidemiology of the disease. More than 70 genotypes have been described. No similar assessment of T. whipplei in the USA and the Caribbean has been performed. In this study, we describe genetic analysis of DNA from histopathological samples obtained from 30 patients from the Americas with Whipple disease and compare the genotypes with those previously identified. Complete genotypes were obtained from 18 patients (60%). Only 4 genotypes were previously described, and 14 were newly reported, confirming the diversity of T. whipplei strains. |
Multicenter performance assessment of the Carba NP Test
Cunningham SA , Limbago B , Traczewski M , Anderson K , Hackel M , Hindler J , Sahm D , Alyanak E , Lawsin A , Gulvik CA , de Man TJ , Mandrekar JN , Schuetz AN , Jenkins S , Humphries R , Palavecino E , Vasoo S , Patel R . J Clin Microbiol 2017 55 (6) 1954-1960 Eighty Gram-negative bacilli (54 Enterobacteriaceae and 26 non-fermenting Gram-negative bacilli), obtained from multiple institutions in the United States were distributed in a blinded manner to seven testing laboratories to compare the performance of a test for detection of carbapenemase production, the Carba NP test. The Carba NP test was performed by all laboratories, following the Clinical and Laboratory Standards Institute (CLSI) procedure. Site-versus-site comparisons demonstrated a high level of consistency for the Carba NP assay with just 3/21 site comparisons yielding a difference in sensitivity (p<0.05). Previously described limitations with blaOXA-48-like carbapenemases and blaOXA carbapenemases associated with Acinetobacter baumannii were noted. Based on these data, we demonstrate that the Carba NP test, when implemented with the standardized CLSI methodology, provides reproducible results across multiple sites for detection of carbapenemases. |
Individual, family, and community predictors of overweight and obesity among Colombian children and adolescents
Gonzalez-Casanova I , Sarmiento OL , Pratt M , Gazmararian JA , Martorell R , Cunningham SA , Stein A . Prev Chronic Dis 2014 11 E134 INTRODUCTION: Information from high-income countries is often used to design childhood obesity prevention interventions in low- and middle-income countries, even though determinants may differ greatly between settings. METHODS: We examined the associations of individual, family (household), and community (municipality) characteristics with body mass index (BMI) z scores and likelihood of overweight among children aged 5 to 18 years measured for the Colombian National Nutrition surveys of 2005 (n = 9,119) and 2010 (n = 21,520). We used 3-level hierarchical linear models with child as level 1, household as level 2, and municipality as level 3. RESULTS: The prevalence of combined overweight and obesity among Colombian children and adolescents was 15.7% in 2005 and 16.6% in 2010. The household level explained 40% in 2005 and 31% in 2010 of the variability in BMI z scores. Wealth was positively associated with BMI in 2005 (0.09 increase in z score per wealth quintile) and 2010 (0.13 increase in z score per wealth quintile) (P < .01). Children and adolescents from extended families had higher BMI z scores than those from nuclear families; BMI z scores were inversely associated with the number of family members living in the same household. The municipality level explained only between 2% and 3% of the variability in BMI. Income inequality was positively associated with BMI z scores in 2010. CONCLUSION: These patterns differ from those commonly described in high-income countries and suggest more appropriate opportunities for interventions to prevent child and adolescent obesity in Colombia and other Latin American settings and populations. |
Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009.
Pritt BS , Sloan LM , Johnson DK , Munderloh UG , Paskewitz SM , McElroy KM , McFadden JD , Binnicker MJ , Neitzel DF , Liu G , Nicholson WL , Nelson CM , Franson JJ , Martin SA , Cunningham SA , Steward CR , Bogumill K , Bjorgaard ME , Davis JP , McQuiston JH , Warshauer DM , Wilhelm MP , Patel R , Trivedi VA , Eremeeva ME . N Engl J Med 2011 365 (5) 422-9 ![]() BACKGROUND: Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia chaffeensis and E. ewingii have been thought to cause ehrlichiosis in humans in the United States. Patients with suspected ehrlichiosis routinely undergo testing to ensure proper diagnosis and to ascertain the cause. METHODS: We used molecular methods, culturing, and serologic testing to diagnose and ascertain the cause of cases of ehrlichiosis. RESULTS: On testing, four cases of ehrlichiosis in Minnesota or Wisconsin were found not to be from E. chaffeensis or E. ewingii and instead to be caused by a newly discovered ehrlichia species. All patients had fever, malaise, headache, and lymphopenia; three had thrombocytopenia; and two had elevated liver-enzyme levels. All recovered after receiving doxycycline treatment. At least 17 of 697 Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerase-chain-reaction testing. Genetic analyses revealed that this new ehrlichia species is closely related to E. muris. CONCLUSIONS: We report a new ehrlichia species in Minnesota and Wisconsin and provide supportive clinical, epidemiologic, culture, DNA-sequence, and vector data. Physicians need to be aware of this newly discovered close relative of E. muris to ensure appropriate testing, treatment, and regional surveillance. (Funded by the National Institutes of Health and the Centers for Disease Control and Prevention.). |
Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents
Welsh JA , Sharma A , Cunningham SA , Vos MB . Circulation 2011 123 (3) 249-57 BACKGROUND: Whereas increased carbohydrate and sugar consumption has been associated with higher cardiovascular disease risk among adults, little is known about the impact of high consumption of added sugars (caloric sweeteners) among US adolescents. METHODS AND RESULTS: In a cross-sectional study of 2157 US adolescents in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, dietary data from one 24-hour recall were merged with added sugar content data from the US Department of Agriculture MyPyramid Equivalents databases. Measures of cardiovascular disease risk were estimated by added sugar consumption level (<10%, 10 to <15%, 15 to <20%, 20 to <25%, 25 to <30%, and ≥30% of total energy). Multivariable means were weighted to be representative of US adolescents and variances adjusted for the complex sampling methods. Daily consumption of added sugars averaged 21.4% of total energy. Added sugars intake was inversely correlated with mean high-density lipoprotein cholesterol levels (mmol/L) which were 1.40 (95% confidence interval [CI] 1.36 to 1.44) among the lowest consumers and 1.28 (95% CI 1.23 to 1.33) among the highest (P trend =0.001). Added sugars were positively correlated with low-density lipoproteins (P trend =0.01) and geometric mean triglycerides (P trend =0.05). Among the lowest and highest consumers, respectively, low-density lipoproteins (mmol/L) were 2.24 (95% CI 2.12 to 2.37) and 2.44 (95% CI 2.34 to 2.53), and triglycerides (mmol/L) were 0.81 (95% CI 0.74, 0.88) and 0.89 (95% CI 0.83 to 0.96). Among those overweight/obese (≥85th percentile body-mass-index), added sugars were positively correlated with the homeostasis model assessment (P linear trend =0.004). CONCLUSION: Consumption of added sugars among US adolescents is positively associated with multiple measures known to increase cardiovascular disease risk. |
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