Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 32 Records) |
Query Trace: Frederick J[original query] |
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Highly pathogenic avian influenza A(H5N1) virus of clade 2.3.4.4b isolated from a human case in Chile causes fatal disease and transmits between co-housed ferrets
Pulit-Penaloza JA , Brock N , Belser JA , Sun X , Pappas C , Kieran TJ , Thakur PB , Zeng H , Cui D , Frederick J , Fasce R , Tumpey TM , Maines TR . Emerg Microbes Infect 2024 2332667 Clade 2.3.4.4b highly pathogenic avian influenza A(H5N1) viruses have caused large outbreaks within avian populations on five continents, with concurrent spillover into a variety of mammalian species. Mutations associated with mammalian adaptation have been sporadically identified in avian isolates, and more frequently among mammalian isolates following infection. Reports of human infection with A(H5N1) viruses following contact with infected wildlife have been reported on multiple continents, highlighting the need for pandemic risk assessment of these viruses. In this study, the pathogenicity and transmissibility of A/Chile/25945/2023 HPAI A(H5N1) virus, a novel reassortment with four gene segments (PB1, PB2, NP, MP) from North America lineage, isolated from a severe human case in Chile, was evaluated in vitro and using the ferret model. This virus possessed a high capacity to cause fatal disease, characterized by high morbidity and extrapulmonary spread in virus-inoculated ferrets. The virus was capable of transmission to naïve contacts in a direct contact setting, with contact animals similarly exhibiting severe disease, but did not exhibit productive transmission in respiratory droplet or fomite transmission models. Our results indicate that the virus would need to acquire an airborne transmissible phenotype in mammals to potentially cause a pandemic. Nonetheless, this work warrants continuous monitoring of mammalian adaptations in avian viruses, especially in strains isolated from humans, to aid pandemic preparedness efforts. |
Fatal primary amebic meningoencephalitis in Nebraska: Case report and environmental investigation, August 2022
Maloney P , Mowrer C , Jansen L , Karre T , Bedrnicek J , Obaro SK , Iwen PC , McCutchen E , Wetzel C , Frederick J , Ashraf MS , Donahue M . Am J Trop Med Hyg 2023 109 (2) 322-326 Primary amebic meningoencephalitis (PAM) is a rare and lethal infection caused by Naegleria fowleri. We report an epidemiological and environmental investigation relating to a case of PAM in a previously healthy boy age 8 years. An interview of the patient's family was conducted to determine the likely exposure site and to assess risk factors. Data from the United States Geological Survey site at Waterloo, NE, on the Elkhorn River were used to estimate water temperature and streamflow at the time and site of exposure. Data from the National Weather Service were used to estimate precipitation and ambient air temperature at the time and site of exposure. Despite conventional treatment, the patient died 2 days after hospital admission. The patient participated in recreational water activities in the Elkhorn River in northeastern Nebraska 5 days before symptom onset. In the week before exposure, water and ambient air high temperatures reached annual highs, averaging 32.4°C and 35.8°C, respectively. The day before infection, 2.2 cm of precipitation was reported. Streamflow was low (407 ft3/s). Infections in several northern states, including Nebraska, suggest an expanding geographic range of N. fowleri transmission, which may lead to increased incidence of PAM in the United States. Similar environmental investigations at suspected exposure sites of future cases will allow data aggregation, enabling investigators to correlate environmental factors with infection risk accurately. |
Case ascertainment of sickle cell disease using surveillance or single administrative database case definitions
Reeves SL , Horiuchi S , Zhou M , Paulukonis S , Snyder A , Wilson-Frederick S , Hulihan M . Public Health Rep 2023 333549231166465 OBJECTIVE: In the absence of access to surveillance system data, single-source administrative databases are often used to study health care utilization and health outcomes among people with sickle cell disease (SCD). We compared the case definitions from single-source administrative databases with a surveillance case definition to identify people with SCD. MATERIALS AND METHODS: We used data from Sickle Cell Data Collection programs in California and Georgia (2016-2018). The surveillance case definition for SCD developed for the Sickle Cell Data Collection programs uses multiple databases, including newborn screening, discharge databases, state Medicaid programs, vital records, and clinic data. Case definitions for SCD in single-source administrative databases varied by database (Medicaid and discharge) and years of data (1, 2, and 3 years). We calculated the proportion of people meeting the surveillance case definition for SCD that was captured by each single administrative database case definition for SCD, by birth cohort, sex, and Medicaid enrollment. RESULTS: In California, 7117 people met the surveillance case definition of SCD from 2016 through 2018; 48% of this group was captured by the Medicaid case definition and 41% by the discharge case definition. In Georgia, 10 448 people met the surveillance case definition of SCD from 2016 through 2018; 45% of this group was captured by the Medicaid case definition and 51% by the discharge case definition. These proportions differed by years of data, birth cohort, and length of Medicaid enrollment. PRACTICE IMPLICATIONS: The surveillance case definition identified twice as many people with SCD as the single-source administrative database definitions during the same period, but trade-offs exist in using single administrative databases for decisions on policy and program expansion for SCD. |
Travel history among persons infected with SARS-CoV-2 variants of concern in the United States, December 2020-February 2021.
Dunajcik A , Haire K , Thomas JD , Moriarty LF , Springer Y , Villanueva JM , MacNeil A , Silk B , Nemhauser JB , Byrkit R , Taylor M , Queen K , Tong S , Lee J , Batra D , Paden C , Henderson T , Kunkes A , Ojo M , Firestone M , Martin Webb L , Freeland M , Brown CM , Williams T , Allen K , Kauerauf J , Wilson E , Jain S , McDonald E , Silver E , Stous S , Wadford D , Radcliffe R , Marriott C , Owes JP , Bart SM , Sosa LE , Oakeson K , Wodniak N , Shaffner J , Brown Q , Westergaard R , Salinas A , Hallyburton S , Ogale Y , Offutt-Powell T , Bonner K , Tubach S , Van Houten C , Hughes V , Reeb V , Galeazzi C , Khuntia S , McGee S , Hicks JT , Dinesh Patel D , Krueger A , Hughes S , Jeanty F , Wang JC , Lee EH , Assanah-Deane T , Tompkins M , Dougherty K , Naqvi O , Donahue M , Frederick J , Abdalhamid B , Powers AM , Anderson M . PLOS Glob Public Health 2023 3 (3) e0001252 The first three SARS-CoV-2 phylogenetic lineages classified as variants of concern (VOCs) in the United States (U.S.) from December 15, 2020 to February 28, 2021, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1) lineages, were initially detected internationally. This investigation examined available travel history of coronavirus disease 2019 (COVID-19) cases reported in the U.S. in whom laboratory testing showed one of these initial VOCs. Travel history, demographics, and health outcomes for a convenience sample of persons infected with a SARS-CoV-2 VOC from December 15, 2020 through February 28, 2021 were provided by 35 state and city health departments, and proportion reporting travel was calculated. Of 1,761 confirmed VOC cases analyzed, 1,368 had available data on travel history. Of those with data on travel history, 1,168 (85%) reported no travel preceding laboratory confirmation of SARS-CoV-2 and only 105 (8%) reported international travel during the 30 days preceding a positive SARS-CoV-2 test or symptom onset. International travel was reported by 92/1,304 (7%) of persons infected with the Alpha variant, 7/55 (22%) with Beta, and 5/9 (56%) with Gamma. Of the first three SARS-CoV-2 lineages designated as VOCs in the U.S., international travel was common only among the few Gamma cases. Most persons infected with Alpha and Beta variant reported no travel history, therefore, community transmission of these VOCs was likely common in the U.S. by March 2021. These findings underscore the importance of global surveillance using whole genome sequencing to detect and inform mitigation strategies for emerging SARS-CoV-2 VOCs. |
The second HPV serology meeting: Progress and challenges in standardization of human papillomavirus serology assays
Park I , Unger ER , Kemp TJ , Pinto LA . Vaccine 2023 41 (6) 1177-1181 The HPV Serology Laboratory in the Frederick National Laboratory for Cancer Research is working in partnership with the scientific community with the goal of standardizing and harmonizing current HPV serology assay platforms in response to the increasing number of immunobridging trials relying on serology data for approval of new vaccine dosing schedules and new formulations. A virtual meeting was held on June 29-30, 2021, to review the progress of the standardization initiative thus far and to bridge scientific gaps and outstanding questions. The main aims and outcomes of the meeting were to discuss: 1) standardization of assays and reagents; 2) International Standard calibration procedures; 3) assay cut-off values; 4) current immunobridging clinical trials; and 5) gaps and challenges in standardization of HPV serology. |
A 2019 Outbreak Investigation of Hepatitis A Virus Infections in the United States Linked to Imported Fresh Blackberries.
McClure M , Nsubuga J , Montgomery MP , Jenkins E , Crosby A , Schoelen D , Basler C , Ramachandran S , Lin Y , Xia GL , Khudaykov Y , Suktankar V , Wagley A , Thomas V , Woods J , Hintz L , Oliveira J , Sandoval AL , Frederick J , Hendrickson B , Gieraltowski L , Viazis S . Food Environ Virol 2022 14 (3) 236-245 Globally, hepatitis A virus (HAV) is one of the most common agents of acute viral hepatitis and causes approximately 1.4 million cases and 90,000 deaths annually despite the existence of an effective vaccine. In 2019, federal, state, and local partners investigated a multi-state outbreak of HAV infections linked to fresh blackberries sourced from multiple suppliers in Michoacn, Mexico. A total of 20 individuals with outbreak-related HAV infection were reported in seven states, including 11 hospitalizations, and no deaths. The Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and Nebraska State and Douglas County Health Departments conducted a traceback investigation for fresh blackberries reportedly purchased by 16 ill persons. These individuals reported purchasing fresh blackberries from 11 points of service from September 16 through 29, 2019 and their clinical isolates assessed through next-generation sequencing and phylogenetic analysis were genetically similar. The traceback investigation did not reveal convergence on a common grower or packing house within Mexico, but all of the blackberries were harvested from growers in Michoacn, Mexico. FDA did not detect the pathogen after analyzing fresh blackberry samples from four distributors, one consumer, and from nine importers at the port of entry as a result of increased screening. Challenges included gaps in traceability practices and the inability to recover the pathogen from sample testing, which prohibited investigators from determining the source of the implicated blackberries. This multi-state outbreak illustrated the importance of food safety practices for fresh produce that may contribute to foodborne illness outbreaks. |
A Trans-Governmental Collaboration to Independently Evaluate SARS-CoV-2 Serology Assays.
Pinto LA , Shawar RM , O'Leary B , Kemp TJ , Cherry J , Thornburg N , Miller CN , Gallagher PS , Stenzel T , Schuck B , Owen SM , Kondratovich M , Satheshkumar PS , Schuh A , Lester S , Cassetti MC , Sharpless NE , Gitterman S , Lowy DR . Microbiol Spectr 2022 10 (1) e0156421 The emergence of SARS-CoV-2 created a crucial need for serology assays to detect anti-SARS-CoV-2 antibodies, which led to many serology assays entering the market. A trans-government collaboration was created in April 2020 to independently evaluate the performance of commercial SARS-CoV-2 serology assays and help inform U.S. Food and Drug Administration (FDA) regulatory decisions. To assess assay performance, three evaluation panels with similar antibody titer distributions were assembled. Each panel consisted of 110 samples with positive (n = 30) serum samples with a wide range of anti-SARS-CoV-2 antibody titers and negative (n = 80) plasma and/or serum samples that were collected before the start of the COVID-19 pandemic. Each sample was characterized for anti-SARS-CoV-2 antibodies against the spike protein using enzyme-linked immunosorbent assays (ELISA). Samples were selected for the panel when there was agreement on seropositivity by laboratories at National Cancer Institute's Frederick National Laboratory for Cancer Research (NCI-FNLCR) and Centers for Disease Control and Prevention (CDC). The sensitivity and specificity of each assay were assessed to determine Emergency Use Authorization (EUA) suitability. As of January 8, 2021, results from 91 evaluations were made publicly available (https://open.fda.gov/apis/device/covid19serology/, and https://www.cdc.gov/coronavirus/2019-ncov/covid-data/serology-surveillance/serology-test-evaluation.html). Sensitivity ranged from 27% to 100% for IgG (n = 81), from 10% to 100% for IgM (n = 74), and from 73% to 100% for total or pan-immunoglobulins (n = 5). The combined specificity ranged from 58% to 100% (n = 91). Approximately one-third (n = 27) of the assays evaluated are now authorized by FDA for emergency use. This collaboration established a framework for assay performance evaluation that could be used for future outbreaks and could serve as a model for other technologies. IMPORTANCE The SARS-CoV-2 pandemic created a crucial need for accurate serology assays to evaluate seroprevalence and antiviral immune responses. The initial flood of serology assays entering the market with inadequate performance emphasized the need for independent evaluation of commercial SARS-CoV-2 antibody assays using performance evaluation panels to determine suitability for use under EUA. Through a government-wide collaborative network, 91 commercial SARS-CoV-2 serology assay evaluations were performed. Three evaluation panels with similar overall antibody titer distributions were assembled to evaluate performance. Nearly one-third of the assays evaluated met acceptable performance recommendations, and two assays had EUAs revoked and were removed from the U.S. market based on inadequate performance. Data for all serology assays evaluated are available at the FDA and CDC websites (https://open.fda.gov/apis/device/covid19serology/, and https://www.cdc.gov/coronavirus/2019-ncov/covid-data/serology-surveillance/serology-test-evaluation.html). |
Outpatient Healthcare Personnel Knowledge and Attitudes Towards Infection Prevention Measures for Protection from Respiratory Infections
Bessesen MT , Rattigan S , Frederick J , Cummings DAT , Gaydos CA , Gibert CL , Gorse GJ , Nyquist AC , Price CS , Reich NG , Simberkoff MS , Brown AC , Radonovich LJ Jr , Perl TM , Rodriguez-Barradas MC . Am J Infect Control 2021 49 (11) 1369-1375 BACKGROUND: Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. METHODS: Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. RESULTS: The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. CONCLUSIONS: Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study. |
Portable Rabies Virus Sequencing in Canine Rabies Endemic Countries Using the Oxford Nanopore MinION.
Gigante CM , Yale G , Condori RE , Costa NC , Long NV , Minh PQ , Chuong VD , Tho ND , Thanh NT , Thin NX , Hanh NTH , Wambura G , Ade F , Mito O , Chuchu V , Muturi M , Mwatondo A , Hampson K , Thumbi SM , Thomae BG , de Paz VH , Meneses S , Munyua P , Moran D , Cadena L , Gibson A , Wallace RM , Pieracci EG , Li Y . Viruses 2020 12 (11) As countries with endemic canine rabies progress towards elimination by 2030, it will become necessary to employ techniques to help plan, monitor, and confirm canine rabies elimination. Sequencing can provide critical information to inform control and vaccination strategies by identifying genetically distinct virus variants that may have different host reservoir species or geographic distributions. However, many rabies testing laboratories lack the resources or expertise for sequencing, especially in remote or rural areas where human rabies deaths are highest. We developed a low-cost, high throughput rabies virus sequencing method using the Oxford Nanopore MinION portable sequencer. A total of 259 sequences were generated from diverse rabies virus isolates in public health laboratories lacking rabies virus sequencing capacity in Guatemala, India, Kenya, and Vietnam. Phylogenetic analysis provided valuable insight into rabies virus diversity and distribution in these countries and identified a new rabies virus lineage in Kenya, the first published canine rabies virus sequence from Guatemala, evidence of rabies spread across an international border in Vietnam, and importation of a rabid dog into a state working to become rabies-free in India. Taken together, our evaluation highlights the MinION's potential for low-cost, high volume sequencing of pathogens in locations with limited resources. |
Risk factors for occupational heat-related illness among California workers, 2000-2017
Heinzerling A , Laws RL , Frederick M , Jackson R , Windham G , Materna B , Harrison R . Am J Ind Med 2020 63 (12) 1145-1154 BACKGROUND: As climate change increases global temperatures, heat-related morbidity and mortality are projected to rise. Outdoor workers and those who perform exertional tasks are particularly susceptible to heat-related illness (HRI). Using workers' compensation data, we aimed to describe rates of occupational HRI in California and identify demographic and occupational risk factors to inform prevention efforts. METHODS: We identified HRI cases during 2000-2017 in the California Workers' Compensation Information System (WCIS) using International Classification of Diseases Ninth and Tenth Revision codes, WCIS nature and cause of injury codes, and HRI keywords. We assigned industry and occupation codes using the NIOSH Industry and Occupation Computerized Coding System (NIOCCS). We calculated HRI rates by sex, age group, year, county, industry, and occupation, and estimated confidence intervals using generalized linear models. RESULTS: We identified 15,996 HRI cases during 2000-2017 (6.0 cases/100,000 workers). Workers aged 16-24 years had the highest HRI rate (7.6) among age groups, and men (8.1) had a higher rate than women (3.5). Industry sectors with the highest HRI rates were Agriculture, Farming, Fishing, and Forestry (38.6), and Public Administration (35.3). Occupational groups with the highest HRI rates were Protective Services (56.6) and Farming, Fishing, and Forestry (36.6). Firefighters had the highest HRI rate (389.6) among individual occupations. CONCLUSIONS: Workers in certain demographic and occupational groups are particularly susceptible to HRI. Additional prevention efforts, including outreach and enforcement targeting high-risk groups, are needed to reduce occupational HRI. Workers' compensation data can provide timely information about temporal trends and risk factors for HRI. |
Rates of carpal tunnel syndrome in a state workers' compensation information system, by industry and occupation - California, 2007-2014
Jackson R , Beckman J , Frederick M , Musolin K , Harrison R . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1094-1097 Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed as it passes through the wrist within the carpal tunnel, resulting in pain, tingling, weakness, or numbness in the hand or the wrist. Occupational risk factors for CTS include engaging in work activities that require forceful, repetitive tasks, prolonged use of the hands or wrists in an awkward posture, or vibration (1). To assess trends and identify high-risk industries and occupations for CTS, the California Department of Public Health (CDPH) analyzed California workers' compensation claims for CTS by industry (2007-2014) and occupation (2014) and calculated rates per full-time equivalent (FTE) worker. During 2007-2014, a total of 139,336 CTS cases were reported (incidence = 6.3 cases per 10,000 FTE) in California workers; the rate among women (8.2) was 3.3 times higher than that among men (2.5). Industries with the highest rates of CTS were textile, fabric finishing, and coating mills (44.9), apparel accessories and other apparel manufacturing (43.1), and animal slaughtering and processing (39.8). Industries with high rates of CTS should consider implementing intervention measures, including ergonomic evaluations and development of tools and instruments that require less repetition and force and that correct awkward postures. |
Protecting healthcare personnel in outpatient settings: The influence of mandatory versus nonmandatory influenza vaccination policies on workplace absenteeism during multiple respiratory virus seasons
Frederick J , Brown AC , Cummings DA , Gaydos CA , Gibert CL , Gorse GJ , Los JG , Nyquist AC , Perl TM , Price CS , Radonovich LJ , Reich NG , Rodriguez-Barradas MC , Bessesen MT , Simberkoff MS . Infect Control Hosp Epidemiol 2018 39 (4) 1-10 OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;1-10. |
Racial/ethnic health disparities among rural adults - United States, 2012-2015
James CV , Moonesinghe R , Wilson-Frederick SM , Hall JE , Penman-Aguilar A , Bouye K . MMWR Surveill Summ 2017 66 (23) 1-9 PROBLEM/CONDITION: Rural communities often have worse health outcomes, have less access to care, and are less diverse than urban communities. Much of the research on rural health disparities examines disparities between rural and urban communities, with fewer studies on disparities within rural communities. This report provides an overview of racial/ethnic health disparities for selected indicators in rural areas of the United States. REPORTING PERIOD: 2012-2015. DESCRIPTION OF SYSTEM: Self-reported data from the 2012-2015 Behavioral Risk Factor Surveillance System were pooled to evaluate racial/ethnic disparities in health, access to care, and health-related behaviors among rural residents in all 50 states and the District of Columbia. Using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties to assess rurality, this analysis focused on adults living in noncore (rural) counties. RESULTS: Racial/ethnic minorities who lived in rural areas were younger (more often in the youngest age group) than non-Hispanic whites. Except for Asians and Native Hawaiians and other Pacific Islanders (combined in the analysis), more racial/ethnic minorities (compared with non-Hispanic whites) reported their health as fair or poor, that they had obesity, and that they were unable to see a physician in the past 12 months because of cost. All racial/ethnic minority populations were less likely than non-Hispanic whites to report having a personal health care provider. Non-Hispanic whites had the highest estimated prevalence of binge drinking in the past 30 days. INTERPRETATION: Although persons in rural communities often have worse health outcomes and less access to health care than those in urban communities, rural racial/ethnic minority populations have substantial health, access to care, and lifestyle challenges that can be overlooked when considering aggregated population data. This study revealed difficulties among non-Hispanic whites as well, primarily related to health-related risk behaviors. Across each population, the challenges vary. PUBLIC HEALTH ACTION: Stratifying data by different demographics, using community health needs assessments, and adopting and implementing the National Culturally and Linguistically Appropriate Services Standards can help rural communities identify disparities and develop effective initiatives to eliminate them, which aligns with a Healthy People 2020 overarching goal: achieving health equity. |
Effect of stratum corneum heterogeneity, anisotropy, asymmetry and follicular pathway on transdermal penetration
Barbero AM , Frederick Frasch H . J Control Release 2017 260 234-246 The impact of the complex structure of the stratum corneum on transdermal penetration is not yet fully described by existing models. A quantitative and thorough study of skin permeation is essential for chemical exposure assessment and transdermal delivery of drugs. The objective of this study is to analyze the effects of heterogeneity, anisotropy, asymmetry, follicular diffusion, and location of the main barrier of diffusion on percutaneous permeation. In the current study, the solution of the transient diffusion through a two-dimensional-anisotropic brick-and-mortar geometry of the stratum corneum is obtained using the commercial finite element program COMSOL Multiphysics. First, analytical solutions of an equivalent multilayer geometry are used to determine whether the lipids or corneocytes constitute the main permeation barrier. Also these analytical solutions are applied for validations of the finite element solutions. Three illustrative compounds are analyzed in these sections: diethyl phthalate, caffeine and nicotine. Then, asymmetry with depth and follicular diffusion are studied using caffeine as an illustrative compound. The following findings are drawn from this study: the main permeation barrier is located in the lipid layers; the flux and lag time of diffusion through a brick-and-mortar geometry are almost identical to the values corresponding to a multilayer geometry; the flux and lag time are affected when the lipid transbilayer diffusivity or the partition coefficients vary with depth, but are not affected by depth-dependent corneocyte diffusivity; and the follicular contribution has significance for low transbilayer lipid diffusivity, especially when flux between the follicle and the surrounding stratum corneum is involved. This study demonstrates that the diffusion is primarily transcellular and the main barrier is located in the lipid layers. |
Increasing walking in the Hartsfield-Jackson Atlanta International Airport: The Walk to Fly Study
Fulton JE , Frederick GM , Paul P , Omura JD , Carlson SA , Dorn JM . Am J Public Health 2017 107 (7) e1-e7 OBJECTIVES: To test the effectiveness of a point-of-decision intervention to prompt walking, versus motorized transport, in a large metropolitan airport. METHODS: We installed point-of-decision prompt signage at 4 locations in the airport transportation mall at Hartsfield-Jackson Atlanta International Airport (Atlanta, GA) at the connecting corridor between airport concourses. Six ceiling-mounted infrared sensors counted travelers entering and exiting the study location. We collected traveler counts from June 2013 to May 2016 when construction was present and absent (preintervention period: June 2013-September 2014; postintervention period: September 2014-May 2016). We used a model that incorporated weekly walking variation to estimate the intervention effect on walking. RESULTS: There was an 11.0% to 16.7% relative increase in walking in the absence of airport construction where 580 to 810 more travelers per day chose to walk. Through May 2016, travelers completed 390 000 additional walking trips. CONCLUSIONS: The Walk to Fly study demonstrated a significant and sustained increase in the number of airport travelers choosing to walk. Providing signage about options to walk in busy locations where reasonable walking options are available may improve population levels of physical activity and therefore improve public health. (Am J Public Health. Published online ahead of print May 18, 2017: e1-e7. doi:10.2105/AJPH.2017.303766). |
Developing point-of-decision prompts to encourage airport walking: The Walk to Fly Study
Frederick GM , Paul P , Bachtel Watson K , Dorn JM , Fulton J . J Phys Act Health 2016 13 (4) 419-27 BACKGROUND: Point-of-decision prompts may be appropriate to promote walking, instead of using a mechanized mode of transport, such as a train, in airports. To our knowledge, no current studies describe the development of messages for prompts in this setting. METHODS: In-person interviews were conducted with 150 randomly selected airport travelers who rode the train to their departure gate. Travelers reported various reasons for riding the train to their gate. They were asked about messages that would encourage them to walk. Exploratory factor analysis was conducted for reasons for riding the train. Confirmatory factor analysis was conducted for messages to encourage walking to the departure gate. RESULTS: Travelers reported not knowing walking was an option (23.8%), seeing others riding the train (14.4%), and being afraid of getting lost (9.2%) as reasons for riding the train. Many indicated that directional signs and prompts promoting walking as exercise would encourage them to walk instead of riding the train. CONCLUSIONS: Some reasons for riding the train in an airport may be modifiable by installing point-of-decision prompts. Providing directional signs to travelers may prompt them to walk to their gate instead of riding the train. Similar prompts may also be considered in other community settings. |
Effectiveness of insecticide-treated bednets in malaria prevention in Haiti: a case-control study
Steinhardt LC , Jean YS , Impoinvil D , Mace KE , Wiegand R , Huber CS , Alexandre JS , Frederick J , Nkurunziza E , Jean S , Wheeler B , Dotson E , Slutsker L , Kachur SP , Barnwell JW , Lemoine JF , Chang MA . Lancet Glob Health 2016 5 (1) e96-e103 BACKGROUND: Insecticide-treated bednets (ITNs) are effective in preventing malaria where vectors primarily bite indoors and late at night, but their effectiveness is uncertain where vectors bite outdoors and earlier in the evening. We studied the effectiveness of ITNs following a mass distribution in Haiti from May to September, 2012, where the Anopheles albimanus vector bites primarily outdoors and often when people are awake. METHODS: In this case-control study, we enrolled febrile patients presenting to outpatient departments at 17 health facilities throughout Haiti from Sept 4, 2012, to Feb 27, 2014, who were tested with malaria rapid diagnostic tests (RDTs), and administered questionnaires on ITN use and other risk factors. Cases were defined by positive RDT and controls were febrile patients from the same clinic with a negative RDT. Our primary analysis retrospectively matched cases and controls by age, sex, location, and date, and used conditional logistic regression on the matched sample. A sensitivity analysis used propensity scores to match patients on ITN use propensity and analyse malaria among ITN users and non-users. Additional ITN bioefficacy and entomological data were collected. FINDINGS: We enrolled 9317 patients, including 378 (4%) RDT-positive cases. 1202 (13%) patients reported ITN use. Post-hoc matching of cases and controls yielded 362 cases and 1201 matched controls, 19% (333) of whom reported consistent campaign net use. After using propensity scores to match on consistent campaign ITN use, 2298 patients, including 138 (7%) RDT-positive cases, were included: 1149 consistent campaign ITN users and 1149 non-consistent campaign ITN users. Both analyses revealed that ITNs did not significantly protect against clinical malaria (odds ratio [OR]=0.95, 95% CI 0.68-1.32, p=0.745 for case-control analysis; OR=0.95, 95% CI 0.45-1.97, p=0.884 for propensity score analysis). ITN and entomological data indicated good ITN physical integrity and bioefficacy, and no permethrin resistance among local mosquitoes. INTERPRETATION: We found no evidence that mass ITN campaigns reduce clinical malaria in this observational study in Haiti; alternative malaria control strategies should be prioritised. FUNDING: The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the US-based Centers for Disease Control and Prevention (CDC). |
Malaria vector research and control in Haiti: a systematic review
Frederick J , Saint Jean Y , Lemoine JF , Dotson EM , Mace KE , Chang M , Slutsker L , Le Menach A , Beier JC , Eisele TP , Okech BA , Beau de Rochars VM , Carter KH , Keating J , Impoinvil DE . Malar J 2016 15 (1) 376 BACKGROUND: Haiti has a set a target of eliminating malaria by 2020. However, information on malaria vector research in Haiti is not well known. This paper presents results from a systematic review of the literature on malaria vector research, bionomics and control in Haiti. METHODS: A systematic search of literature published in French, Spanish and English languages was conducted in 2015 using Pubmed (MEDLINE), Google Scholar, EMBASE, JSTOR WHOLIS and Web of Science databases as well other grey literature sources such as USAID, and PAHO. The following search terms were used: malaria, Haiti, Anopheles, and vector control. RESULTS: A total of 132 references were identified with 40 high quality references deemed relevant and included in this review. Six references dealt with mosquito distribution, seven with larval mosquito ecology, 16 with adult mosquito ecology, three with entomological indicators of malaria transmission, eight with insecticide resistance, one with sero-epidemiology and 16 with vector control. In the last 15 years (2000-2015), there have only been four published papers and three-scientific meeting abstracts on entomology for malaria in Haiti. Overall, the general literature on malaria vector research in Haiti is limited and dated. DISCUSSION: Entomological information generated from past studies in Haiti will contribute to the development of strategies to achieve malaria elimination on Hispaniola. However it is of paramount importance that malaria vector research in Haiti is updated to inform decision-making for vector control strategies in support of malaria elimination. |
Rv3351c, a Mycobacterium tuberculosis gene that affects bacterial growth and alveolar epithelial cell viability.
Pavlicek RL , Fine-Coulson K , Gupta T , Quinn FD , Posey JE , Willby M , Castro-Garza J , Karls RK . Can J Microbiol 2015 61 (12) 1-10 Despite the interactions known to occur between various lower respiratory tract pathogens and alveolar epithelial cells (AECs), few reports examine factors influencing the interplay between Mycobacterium tuberculosis bacilli and AECs during infection. Importantly, in vitro studies have demonstrated that the M. tuberculosis hbha and esxA gene products HBHA and ESAT6 directly or indirectly influence AEC survival. In this report, we identify Rv3351c as another M. tuberculosis gene that impacts the fate of both the pathogen and AEC host. Intracellular replication of an Rv3351c mutant in the human AEC type II pneumocyte cell line A549 was markedly reduced relative to the complemented mutant and parent strain. Deletion of Rv3351c diminished the release of lactate dehydrogenase and decreased uptake of trypan blue vital stain by host cells infected with M. tuberculosis bacilli, suggesting attenuated cytotoxic effects. Interestingly, an isogenic hbha mutant displayed reductions in AEC killing similar to those observed for the Rv3351c mutant. This opens the possibility that multiple M. tuberculosis gene products interact with AECs. We also observed that Rv3351c aids intracellular replication and survival of M. tuberculosis in macrophages. This places Rv3351c in the same standing as HBHA and ESAT6, which are important factors in AECs and macrophages. Defining the mechanism(s) by which Rv3351c functions to aid pathogen survival within the host may lead to new drug or vaccine targets. |
The global burden of listeriosis: a systematic review and meta-analysis.
de Noordhout CM , Devleesschauwer B , Angulo FJ , Verbeke G , Haagsma J , Kirk M , Havelaar A , Speybroeck N . Lancet Infect Dis 2014 14 (11) 1073-1082 BACKGROUND: Listeriosis, caused by Listeria monocytogenes, is an important foodborne disease that can be difficult to control and commonly results in severe clinical outcomes. We aimed to provide the first estimates of global numbers of illnesses, deaths, and disability-adjusted life-years (DALYs) due to listeriosis, by synthesising information and knowledge through a systematic review. METHODS: We retrieved data on listeriosis through a systematic review of peer-reviewed and grey literature (published in 1990-2012). We excluded incidence data from before 1990 from the analysis. We reviewed national surveillance data where available. We did a multilevel meta-analysis to impute missing country-specific listeriosis incidence rates. We used a meta-regression to calculate the proportions of health states, and a Monte Carlo simulation to generate DALYs by WHO subregion. FINDINGS: We screened 11 722 references and identified 87 eligible studies containing listeriosis data for inclusion in the meta-analyses. We estimated that, in 2010, listeriosis resulted in 23 150 illnesses (95% credible interval 6061-91 247), 5463 deaths (1401-21 497), and 172 823 DALYs (44 079-676 465). The proportion of perinatal cases was 20.7% (SD 1.7). INTERPRETATION: Our quantification of the global burden of listeriosis will enable international prioritisation exercises. The number of DALYs due to listeriosis was lower than those due to congenital toxoplasmosis but accords with those due to echinococcosis. Urgent efforts are needed to fill the missing data in developing countries. We were unable to identify incidence data for the AFRO, EMRO, and SEARO WHO regions. FUNDING: WHO Foodborne Diseases Epidemiology Reference Group and the Universite catholique de Louvain. |
U.S. adults' participation in specific activities, Behavioral Risk Factor Surveillance System - 2011
Watson KB , Frederick GM , Harris CD , Carlson SA , Fulton JE . J Phys Act Health 2014 12 Suppl 1 S3-10 BACKGROUND: There is little information on national estimates for participation in types of aerobic activities among U.S. adults. Current estimates are important to develop appropriate and effective interventions to promote physical activity and interpret bias for some activities measured with devices. METHODS: The percentage of adults participating in specific aerobic activities was estimated overall and by demographic subgroups. The 2011 Behavioral Risk Factor Surveillance System respondents (N = 446,216) reported up to two aerobic activities they spent the most time doing during the past month. RESULTS: Overall, walking (47%) was the most common activity reported and was reported more by women (54%) than men (41%). Participation in most activities declined with increasing age (P < 0.006). There were a number of differences in participation between race/ethnic subgroups. Participation increased with more education (P for trend < 0.006) for all activities. Participation in most activities was different (P < 0.002) across BMI subgroups. CONCLUSIONS: Walking is the most common activity, overall and among most subgroups. Other activity profiles differ by demographic subgroup. Physical activity promotion strategies that focus on identifying and addressing personal and environmental barriers and understanding demographic subgroup differences could lead to more tailored interventions and public health programs. |
Isoniazid preventive treatment in children in two districts of South India: does practice follow policy?
Shivaramakrishna HR , Frederick A , Shazia A , Murali L , Satyanarayana S , Nair SA , Kumar AM , Moonan PK . Int J Tuberc Lung Dis 2014 18 (8) 919-924 SETTING: Two districts of Tamil Nadu, India OBJECTIVES: To determine the proportion of household contacts aged <6 years of patients with tuberculosis (TB) with positive sputum microscopy results who initiated and completed isoniazid preventive treatment (IPT), and to determine reasons for non-initiation and non-completion of IPT. DESIGN: Household visits were conducted on a random sample of adult patients registered during January-June 2012 to identify household contacts aged <6 years. RESULTS: Among 271 children living with 691 index patients, 218 (80%) were evaluated and 9 (4%) were diagnosed with TB. Of 209 remaining contacts, 70 (33%) started IPT and 16 (22.9%) completed a full course of IPT. Of 139 contacts who did not start IPT, five developed TB disease. Reasons for non-initiation of IPT included no home visit by the field staff (19%) and no education about IPT (61%). Reasons for noncompletion included isoniazid not provided (52%) and long duration of treatment (28%). CONCLUSION: This study shows that Revised National TB Programme guidance was not being followed and IPT implementation was poor. Poor IPT uptake represents a missed opportunity to prevent future TB cases. Provision of IPT may be improved through training, improved logistics and enhanced supervision and monitoring. |
Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine.
Venkatesan M , Gadalla NB , Stepniewska K , Dahal P , Nsanzabana C , Moriera C , Price RN , Martensson A , Rosenthal PJ , Dorsey G , Sutherland CJ , Guerin P , Davis TM , Menard D , Adam I , Ademowo G , Arze C , Baliraine FN , Berens-Riha N , Bjorkman A , Borrmann S , Checchi F , Dhorda MD , Djimde AA , El-Sayed BB , Eshetu T , Eyase F , Falade C , Faucher JF , Froberg G , Grivoyannis A , Hamour S , Houze S , Johnson J , Kamugisha E , Kariuki S , Kiechel JR , Kironde F , LeBras PE , Malmberg M , Mwai L , Ngasala B , Nosten F , Nsobya SL , Oguike AN , Otienoburu SD , Ogutu B , Ouedraogo JB , Piola P , Rombo L , Schramm B , Some AF , Thwing J , Ursing J , Wong RP , Zeynudin A , Zongo I , Plowe CV , Sibley CH . Am J Trop Med Hyg 2014 91 (4) 833-843 Adequate clinical and parasitologic cure by artemisinin combination therapies relies on the artemisinin component and the partner drug. Polymorphisms in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes are associated with decreased sensitivity to amodiaquine and lumefantrine, but effects of these polymorphisms on therapeutic responses to artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) have not been clearly defined. Individual patient data from 31 clinical trials were harmonized and pooled by using standardized methods from the WorldWide Antimalarial Resistance Network. Data for more than 7,000 patients were analyzed to assess relationships between parasite polymorphisms in pfcrt and pfmdr1 and clinically relevant outcomes after treatment with AL or ASAQ. Presence of the pfmdr1 gene N86 (adjusted hazards ratio = 4.74, 95% confidence interval = 2.29 - 9.78, P < 0.001) and increased pfmdr1 copy number (adjusted hazards ratio = 6.52, 95% confidence interval = 2.36-17.97, P < 0.001: were significant independent risk factors for recrudescence in patients treated with AL. AL and ASAQ exerted opposing selective effects on single-nucleotide polymorphisms in pfcrt and pfmdr1. Monitoring selection and responding to emerging signs of drug resistance are critical tools for preserving efficacy of artemisinin combination therapies; determination of the prevalence of at least pfcrt K76T and pfmdr1 N86Y should now be routine. |
Temporal changes in prevalence of molecular markers mediating antimalarial drug resistance in a high malaria transmission setting in Uganda.
Mbogo GW , Nankoberanyi S , Tukwasibwe S , Baliraine FN , Nsobya SL , Conrad MD , Arinaitwe E , Kamya M , Tappero J , Staedke SG , Dorsey G , Greenhouse B , Rosenthal PJ . Am J Trop Med Hyg 2014 91 (1) 54-61 Standard therapy for malaria in Uganda changed from chloroquine to chloroquine + sulfadoxine-pyrimethamine in 2000, and artemether-lumefantrine in 2004, although implementation of each change was slow. Plasmodium falciparum genetic polymorphisms are associated with alterations in drug sensitivity. We followed the prevalence of drug resistance-mediating P. falciparum polymorphisms in 982 samples from Tororo, a region of high transmission intensity, collected from three successive treatment trials conducted during 2003-2012, excluding samples with known recent prior treatment. Considering transporter mutations, prevalence of the mutant pfcrt 76T, pfmdr1 86Y, and pfmdr1 1246Y alleles decreased over time. Considering antifolate mutations, the prevalence of pfdhfr 51I, 59R, and 108N, and pfdhps 437G and 540E were consistently high; pfdhfr 164L and pfdhps 581G were uncommon, but most prevalent during 2008-2010. Our data suggest sequential selective pressures as different treatments were implemented, and they highlight the importance of genetic surveillance as treatment policies change over time. |
Unusual Enterocytozoon bieneusi genotypes and Cryptosporidium hominis subtypes in HIV-infected patients on highly active antiretroviral therapy.
Akinbo FO , Okaka CE , Omoregie R , Adamu H , Xiao L . Am J Trop Med Hyg 2013 89 (1) 157-61 Abstract. Human immunodeficiency virus (HIV)-infected persons are commonly infected with Cryptosporidium species and Enterocytozoon bieneusi in both developed and developing countries, particularly patients with CD4+ cell counts below 200 cells/muL; 285 HIV-infected patients on highly active antiretroviral therapy (HAART) were enrolled in this study, and both stool and blood specimens were collected from participants. The stool specimens were analyzed and typed for E. bieneusi and Cryptosporidium spp. by polymerase chain reaction (PCR) and DNA sequencing. CD4 count was analyzed using flow cytometry. E. bieneusi and Cryptosporidium were detected in 18 (6.3%) and 4 (1.4%) patients, respectively. The E. bieneusi detected mostly belonged to a new genotype group that, thus far, has only been found in a few humans: genotype Nig4 in 2 patients and two new genotypes related to Nig4 in 12 patients. The Cryptosporidium detected included C. hominis (two patients), C. parvum (one patient), and C. felis (one patient), with the two C. hominis infections belonging to an unusual subtype family. Additional studies are required to determine whether some E. bieneusi genotypes and C. hominis subtypes are more prevalent in HIV patients on HAART. |
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Vos Theo , Flaxman Abraham D , Naghavi Mohsen , Lozano Rafael , Michaud Catherine , Ezzati Majid , Shibuya Kenji , Salomon Joshua A , Abdalla Safa , Aboyans Victor , Abraham Jerry , Ackerman Ilana , Aggarwal Rakesh , Ahn Stephanie Y , Ali Mohammed K , Alvarado Miriam , Anderson H Ross , Anderson Laurie M , Andrews Kathryn G , Atkinson Charles , Baddour Larry M , Bahalim Adil N , Barker-Collo Suzanne , Barrero Lope H , Bartels David H , Basanez Maria-Gloria , Baxter Amanda , Bell Michelle L , Benjamin Emelia J , Bennett Derrick , Bernabe Eduardo , Bhalla Kavi , Bhandari Bishal , Bikbov Boris , Bin Abdulhak Aref , Birbeck Gretchen , Black James A , Blencowe Hannah , Blore Jed D , Blyth Fiona , Bolliger Ian , Bonaventure Audrey , Boufous Soufiane , Bourne Rupert , Boussinesq Michel , Braithwaite Tasanee , Brayne Carol , Bridgett Lisa , Brooker Simon , Brooks Peter , Brugha Traolach S , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Buckle Geoffrey , Budke Christine M , Burch Michael , Burney Peter , Burstein Roy , Calabria Bianca , Campbell Benjamin , Canter Charles E , Carabin Helene , Carapetis Jonathan , Carmona Loreto , Cella Claudia , Charlson Fiona , Chen Honglei , Cheng Andrew Tai-Ann , Chou David , Chugh Sumeet S , Coffeng Luc E , Colan Steven D , Colquhoun Samantha , Colson K Ellicott , Condon John , Connor Myles D , Cooper Leslie T , Corriere Matthew , Cortinovis Monica , de Vaccaro Karen Courville , Couser William , Cowie Benjamin C , Criqui Michael H , Cross Marita , Dabhadkar Kaustubh C , Dahiya Manu , Dahodwala Nabila , Damsere-Derry James , Danaei Goodarz , Davis Adrian , De Leo Diego , Degenhardt Louisa , Dellavalle Robert , Delossantos Allyne , Denenberg Julie , Derrett Sarah , Des Jarlais Don C , Dharmaratne Samath D , Dherani Mukesh , Diaz-Torne Cesar , Dolk Helen , Dorsey E Ray , Driscoll Tim , Duber Herbert , Ebel Beth , Edmond Karen , Elbaz Alexis , Ali Suad Eltahir , Erskine Holly , Erwin Patricia J , Espindola Patricia , Ewoigbokhan Stalin E , Farzadfar Farshad , Feigin Valery , Felson David T , Ferrari Alize , Ferri Cleusa P , Fevre Eric M , Finucane Mariel M , Flaxman Seth , Flood Louise , Foreman Kyle , Forouzanfar Mohammad H , Fowkes Francis Gerry R , Franklin Richard , Fransen Marlene , Freeman Michael K , Gabbe Belinda J , Gabriel Sherine E , Gakidou Emmanuela , Ganatra Hammad A , Garcia Bianca , Gaspari Flavio , Gillum Richard F , Gmel Gerhard , Gosselin Richard , Grainger Rebecca , Groeger Justina , Guillemin Francis , Gunnell David , Gupta Ramyani , Haagsma Juanita , Hagan Holly , Halasa Yara A , Hall Wayne , Haring Diana , Haro Josep Maria , Harrison James E , Havmoeller Rasmus , Hay Roderick J , Higashi Hideki , Hill Catherine , Hoen Bruno , Hoffman Howard , Hotez Peter J , Hoy Damian , Huang John J , Ibeanusi Sydney E , Jacobsen Kathryn H , James Spencer L , Jarvis Deborah , Jasrasaria Rashmi , Jayaraman Sudha , Johns Nicole , Jonas Jost B , Karthikeyan Ganesan , Kassebaum Nicholas , Kawakami Norito , Keren Andre , Khoo Jon-Paul , King Charles H , Knowlton Lisa Marie , Kobusingye Olive , Koranteng Adofo , Krishnamurthi Rita , Lalloo Ratilal , Laslett Laura L , Lathlean Tim , Leasher Janet L , Lee Yong Yi , Leigh James , Lim Stephen S , Limb Elizabeth , Lin John Kent , Lipnick Michael , Lipshultz Steven E , Liu Wei , Loane Maria , Ohno Summer Lockett , Lyons Ronan , Ma Jixiang , Mabweijano Jacqueline , MacIntyre Michael F , Malekzadeh Reza , Mallinger Leslie , Manivannan Sivabalan , Marcenes Wagner , March Lyn , Margolis David J , Marks Guy B , Marks Robin , Matsumori Akira , Matzopoulos Richard , Mayosi Bongani M , McAnulty John H , McDermott Mary M , McGill Neil , McGrath John , Medina-Mora Maria Elena , Meltzer Michele , Mensah George A , Merriman Tony R , Meyer Ana-Claire , Miglioli Valeria , Miller Matthew , Miller Ted R , Mitchell Philip B , Mocumbi Ana Olga , Moffitt Terrie E , Mokdad Ali A , Monasta Lorenzo , Montico Marcella , Moradi-Lakeh Maziar , Moran Andrew , Morawska Lidia , Mori Rintaro , Murdoch Michele E , Mwaniki Michael K , Naidoo Kovin , Nair M Nathan , Naldi Luigi , Narayan K M Venkat , Nelson Paul K , Nelson Robert G , Nevitt Michael C , Newton Charles R , Nolte Sandra , Norman Paul , Norman Rosana , O'Donnell Martin , O'Hanlon Simon , Olives Casey , Omer Saad B , Ortblad Katrina , Osborne Richard , Ozgediz Doruk , Page Andrew , Pahari Bishnu , Pandian Jeyaraj Durai , Rivero Andrea Panozo , Patten Scott B , Pearce Neil , Padilla Rogelio Perez , Perez-Ruiz Fernando , Perico Norberto , Pesudovs Konrad , Phillips David , Phillips Michael R , Pierce Kelsey , Pion Sebastien , Polanczyk Guilherme V , Polinder Suzanne , Pope C Arden 3rd , Popova Svetlana , Porrini Esteban , Pourmalek Farshad , Prince Martin , Pullan Rachel L , Ramaiah Kapa D , Ranganathan Dharani , Razavi Homie , Regan Mathilda , Rehm Jurgen T , Rein David B , Remuzzi Guiseppe , Richardson Kathryn , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , De Leon Felipe Rodriguez , Ronfani Luca , Room Robin , Rosenfeld Lisa C , Rushton Lesley , Sacco Ralph L , Saha Sukanta , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Schwebel David C , Scott James Graham , Segui-Gomez Maria , Shahraz Saeid , Shepard Donald S , Shin Hwashin , Shivakoti Rupak , Singh David , Singh Gitanjali M , Singh Jasvinder A , Singleton Jessica , Sleet David A , Sliwa Karen , Smith Emma , Smith Jennifer L , Stapelberg Nicolas J C , Steer Andrew , Steiner Timothy , Stolk Wilma A , Stovner Lars Jacob , Sudfeld Christopher , Syed Sana , Tamburlini Giorgio , Tavakkoli Mohammad , Taylor Hugh R , Taylor Jennifer A , Taylor William J , Thomas Bernadette , Thomson W Murray , Thurston George D , Tleyjeh Imad M , Tonelli Marcello , Towbin Jeffrey A , Truelsen Thomas , Tsilimbaris Miltiadis K , Ubeda Clotilde , Undurraga Eduardo A , van der Werf Marieke J , van Os Jim , Vavilala Monica S , Venketasubramanian N , Wang Mengru , Wang Wenzhi , Watt Kerrianne , Weatherall David J , Weinstock Martin A , Weintraub Robert , Weisskopf Marc G , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Sean R M , Witt Emma , Wolfe Frederick , Woolf Anthony D , Wulf Sarah , Yeh Pon-Hsiu , Zaidi Anita K M , Zheng Zhi-Jie , Zonies David , Lopez Alan D , Murray Christopher J L , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2163-96 BACKGROUND: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). METHODS: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. FINDINGS: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0.37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. INTERPRETATION: Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. FUNDING: Bill & Melinda Gates Foundation. |
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lim Stephen S , Vos Theo , Flaxman Abraham D , Danaei Goodarz , Shibuya Kenji , Adair-Rohani Heather , Amann Markus , Anderson H Ross , Andrews Kathryn G , Aryee Martin , Atkinson Charles , Bacchus Loraine J , Bahalim Adil N , Balakrishnan Kalpana , Balmes John , Barker-Collo Suzanne , Baxter Amanda , Bell Michelle L , Blore Jed D , Blyth Fiona , Bonner Carissa , Borges Guilherme , Bourne Rupert , Boussinesq Michel , Brauer Michael , Brooks Peter , Bruce Nigel G , Brunekreef Bert , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Bull Fiona , Burnett Richard T , Byers Tim E , Calabria Bianca , Carapetis Jonathan , Carnahan Emily , Chafe Zoe , Charlson Fiona , Chen Honglei , Chen Jian Shen , Cheng Andrew Tai-Ann , Child Jennifer Christine , Cohen Aaron , Colson K Ellicott , Cowie Benjamin C , Darby Sarah , Darling Susan , Davis Adrian , Degenhardt Louisa , Dentener Frank , Des Jarlais Don C , Devries Karen , Dherani Mukesh , Ding Eric L , Dorsey E Ray , Driscoll Tim , Edmond Karen , Ali Suad Eltahir , Engell Rebecca E , Erwin Patricia J , Fahimi Saman , Falder Gail , Farzadfar Farshad , Ferrari Alize , Finucane Mariel M , Flaxman Seth , Fowkes Francis Gerry R , Freedman Greg , Freeman Michael K , Gakidou Emmanuela , Ghosh Santu , Giovannucci Edward , Gmel Gerhard , Graham Kathryn , Grainger Rebecca , Grant Bridget , Gunnell David , Gutierrez Hialy R , Hall Wayne , Hoek Hans W , Hogan Anthony , Hosgood H Dean 3rd , Hoy Damian , Hu Howard , Hubbell Bryan J , Hutchings Sally J , Ibeanusi Sydney E , Jacklyn Gemma L , Jasrasaria Rashmi , Jonas Jost B , Kan Haidong , Kanis John A , Kassebaum Nicholas , Kawakami Norito , Khang Young-Ho , Khatibzadeh Shahab , Khoo Jon-Paul , Kok Cindy , Laden Francine , Lalloo Ratilal , Lan Qing , Lathlean Tim , Leasher Janet L , Leigh James , Li Yang , Lin John Kent , Lipshultz Steven E , London Stephanie , Lozano Rafael , Lu Yuan , Mak Joelle , Malekzadeh Reza , Mallinger Leslie , Marcenes Wagner , March Lyn , Marks Robin , Martin Randall , McGale Paul , McGrath John , Mehta Sumi , Mensah George A , Merriman Tony R , Micha Renata , Michaud Catherine , Mishra Vinod , Hanafiah Khayriyyah Mohd , Mokdad Ali A , Morawska Lidia , Mozaffarian Dariush , Murphy Tasha , Naghavi Mohsen , Neal Bruce , Nelson Paul K , Nolla Joan Miquel , Norman Rosana , Olives Casey , Omer Saad B , Orchard Jessica , Osborne Richard , Ostro Bart , Page Andrew , Pandey Kiran D , Parry Charles D H , Passmore Erin , Patra Jayadeep , Pearce Neil , Pelizzari Pamela M , Petzold Max , Phillips Michael R , Pope Dan , Pope C Arden 3rd , Powles John , Rao Mayuree , Razavi Homie , Rehfuess Eva A , Rehm Jurgen T , Ritz Beate , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , Rodriguez-Portales Jose A , Romieu Isabelle , Room Robin , Rosenfeld Lisa C , Roy Ananya , Rushton Lesley , Salomon Joshua A , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Sapkota Amir , Seedat Soraya , Shi Peilin , Shield Kevin , Shivakoti Rupak , Singh Gitanjali M , Sleet David A , Smith Emma , Smith Kirk R , Stapelberg Nicolas J C , Steenland Kyle , Stockl Heidi , Stovner Lars Jacob , Straif Kurt , Straney Lahn , Thurston George D , Tran Jimmy H , Van Dingenen Rita , van Donkelaar Aaron , Veerman J Lennert , Vijayakumar Lakshmi , Weintraub Robert , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Warwick , Wilson Nicholas , Woolf Anthony D , Yip Paul , Zielinski Jan M , Lopez Alan D , Murray Christopher J L , Ezzati Majid , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2224-60 BACKGROUND: Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS: We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS: In 2010, the three leading risk factors for global disease burden were high blood pressure (7.0% [95% uncertainty interval 6.2-7.7] of global DALYs), tobacco smoking including second-hand smoke (6.3% [5.5-7.0]), and alcohol use (5.5% [5.0-5.9]). In 1990, the leading risks were childhood underweight (7.9% [6.8-9.4]), household air pollution from solid fuels (HAP; 7.0% [5.6-8.3]), and tobacco smoking including second-hand smoke (6.1% [5.4-6.8]). Dietary risk factors and physical inactivity collectively accounted for 10.0% (95% UI 9.2-10.8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0.9% (0.4-1.6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION: Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING: Bill & Melinda Gates Foundation. |
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Murray Christopher J L , Vos Theo , Lozano Rafael , Naghavi Mohsen , Flaxman Abraham D , Michaud Catherine , Ezzati Majid , Shibuya Kenji , Salomon Joshua A , Abdalla Safa , Aboyans Victor , Abraham Jerry , Ackerman Ilana , Aggarwal Rakesh , Ahn Stephanie Y , Ali Mohammed K , Alvarado Miriam , Anderson H Ross , Anderson Laurie M , Andrews Kathryn G , Atkinson Charles , Baddour Larry M , Bahalim Adil N , Barker-Collo Suzanne , Barrero Lope H , Bartels David H , Basanez Maria-Gloria , Baxter Amanda , Bell Michelle L , Benjamin Emelia J , Bennett Derrick , Bernabe Eduardo , Bhalla Kavi , Bhandari Bishal , Bikbov Boris , Bin Abdulhak Aref , Birbeck Gretchen , Black James A , Blencowe Hannah , Blore Jed D , Blyth Fiona , Bolliger Ian , Bonaventure Audrey , Boufous Soufiane , Bourne Rupert , Boussinesq Michel , Braithwaite Tasanee , Brayne Carol , Bridgett Lisa , Brooker Simon , Brooks Peter , Brugha Traolach S , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Buckle Geoffrey , Budke Christine M , Burch Michael , Burney Peter , Burstein Roy , Calabria Bianca , Campbell Benjamin , Canter Charles E , Carabin Helene , Carapetis Jonathan , Carmona Loreto , Cella Claudia , Charlson Fiona , Chen Honglei , Cheng Andrew Tai-Ann , Chou David , Chugh Sumeet S , Coffeng Luc E , Colan Steven D , Colquhoun Samantha , Colson K Ellicott , Condon John , Connor Myles D , Cooper Leslie T , Corriere Matthew , Cortinovis Monica , de Vaccaro Karen Courville , Couser William , Cowie Benjamin C , Criqui Michael H , Cross Marita , Dabhadkar Kaustubh C , Dahiya Manu , Dahodwala Nabila , Damsere-Derry James , Danaei Goodarz , Davis Adrian , De Leo Diego , Degenhardt Louisa , Dellavalle Robert , Delossantos Allyne , Denenberg Julie , Derrett Sarah , Des Jarlais Don C , Dharmaratne Samath D , Dherani Mukesh , Diaz-Torne Cesar , Dolk Helen , Dorsey E Ray , Driscoll Tim , Duber Herbert , Ebel Beth , Edmond Karen , Elbaz Alexis , Ali Suad Eltahir , Erskine Holly , Erwin Patricia J , Espindola Patricia , Ewoigbokhan Stalin E , Farzadfar Farshad , Feigin Valery , Felson David T , Ferrari Alize , Ferri Cleusa P , Fevre Eric M , Finucane Mariel M , Flaxman Seth , Flood Louise , Foreman Kyle , Forouzanfar Mohammad H , Fowkes Francis Gerry R , Fransen Marlene , Freeman Michael K , Gabbe Belinda J , Gabriel Sherine E , Gakidou Emmanuela , Ganatra Hammad A , Garcia Bianca , Gaspari Flavio , Gillum Richard F , Gmel Gerhard , Gonzalez-Medina Diego , Gosselin Richard , Grainger Rebecca , Grant Bridget , Groeger Justina , Guillemin Francis , Gunnell David , Gupta Ramyani , Haagsma Juanita , Hagan Holly , Halasa Yara A , Hall Wayne , Haring Diana , Haro Josep Maria , Harrison James E , Havmoeller Rasmus , Hay Roderick J , Higashi Hideki , Hill Catherine , Hoen Bruno , Hoffman Howard , Hotez Peter J , Hoy Damian , Huang John J , Ibeanusi Sydney E , Jacobsen Kathryn H , James Spencer L , Jarvis Deborah , Jasrasaria Rashmi , Jayaraman Sudha , Johns Nicole , Jonas Jost B , Karthikeyan Ganesan , Kassebaum Nicholas , Kawakami Norito , Keren Andre , Khoo Jon-Paul , King Charles H , Knowlton Lisa Marie , Kobusingye Olive , Koranteng Adofo , Krishnamurthi Rita , Laden Francine , Lalloo Ratilal , Laslett Laura L , Lathlean Tim , Leasher Janet L , Lee Yong Yi , Leigh James , Levinson Daphna , Lim Stephen S , Limb Elizabeth , Lin John Kent , Lipnick Michael , Lipshultz Steven E , Liu Wei , Loane Maria , Ohno Summer Lockett , Lyons Ronan , Mabweijano Jacqueline , MacIntyre Michael F , Malekzadeh Reza , Mallinger Leslie , Manivannan Sivabalan , Marcenes Wagner , March Lyn , Margolis David J , Marks Guy B , Marks Robin , Matsumori Akira , Matzopoulos Richard , Mayosi Bongani M , McAnulty John H , McDermott Mary M , McGill Neil , McGrath John , Medina-Mora Maria Elena , Meltzer Michele , Mensah George A , Merriman Tony R , Meyer Ana-Claire , Miglioli Valeria , Miller Matthew , Miller Ted R , Mitchell Philip B , Mock Charles , Mocumbi Ana Olga , Moffitt Terrie E , Mokdad Ali A , Monasta Lorenzo , Montico Marcella , Moradi-Lakeh Maziar , Moran Andrew , Morawska Lidia , Mori Rintaro , Murdoch Michele E , Mwaniki Michael K , Naidoo Kovin , Nair M Nathan , Naldi Luigi , Narayan K M Venkat , Nelson Paul K , Nelson Robert G , Nevitt Michael C , Newton Charles R , Nolte Sandra , Norman Paul , Norman Rosana , O'Donnell Martin , O'Hanlon Simon , Olives Casey , Omer Saad B , Ortblad Katrina , Osborne Richard , Ozgediz Doruk , Page Andrew , Pahari Bishnu , Pandian Jeyaraj Durai , Rivero Andrea Panozo , Patten Scott B , Pearce Neil , Padilla Rogelio Perez , Perez-Ruiz Fernando , Perico Norberto , Pesudovs Konrad , Phillips David , Phillips Michael R , Pierce Kelsey , Pion Sebastien , Polanczyk Guilherme V , Polinder Suzanne , Pope C Arden 3rd , Popova Svetlana , Porrini Esteban , Pourmalek Farshad , Prince Martin , Pullan Rachel L , Ramaiah Kapa D , Ranganathan Dharani , Razavi Homie , Regan Mathilda , Rehm Jurgen T , Rein David B , Remuzzi Guiseppe , Richardson Kathryn , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , De Leon Felipe Rodriguez , Ronfani Luca , Room Robin , Rosenfeld Lisa C , Rushton Lesley , Sacco Ralph L , Saha Sukanta , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Schwebel David C , Scott James Graham , Segui-Gomez Maria , Shahraz Saeid , Shepard Donald S , Shin Hwashin , Shivakoti Rupak , Singh David , Singh Gitanjali M , Singh Jasvinder A , Singleton Jessica , Sleet David A , Sliwa Karen , Smith Emma , Smith Jennifer L , Stapelberg Nicolas J C , Steer Andrew , Steiner Timothy , Stolk Wilma A , Stovner Lars Jacob , Sudfeld Christopher , Syed Sana , Tamburlini Giorgio , Tavakkoli Mohammad , Taylor Hugh R , Taylor Jennifer A , Taylor William J , Thomas Bernadette , Thomson W Murray , Thurston George D , Tleyjeh Imad M , Tonelli Marcello , Towbin Jeffrey A , Truelsen Thomas , Tsilimbaris Miltiadis K , Ubeda Clotilde , Undurraga Eduardo A , van der Werf Marieke J , van Os Jim , Vavilala Monica S , Venketasubramanian N , Wang Mengru , Wang Wenzhi , Watt Kerrianne , Weatherall David J , Weinstock Martin A , Weintraub Robert , Weisskopf Marc G , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiebe Natasha , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Sean R M , Witt Emma , Wolfe Frederick , Woolf Anthony D , Wulf Sarah , Yeh Pon-Hsiu , Zaidi Anita K M , Zheng Zhi-Jie , Zonies David , Lopez Alan D , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2197-223 BACKGROUND: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. METHODS: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. FINDINGS: Global DALYs remained stable from 1990 (2.503 billion) to 2010 (2.490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. INTERPRETATION: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. FUNDING: Bill & Melinda Gates Foundation. |
Multilocus sequence typing of Enterocytozoon bieneusi: Lack of geographic segregation and existence of genetically isolated sub-populations.
Li W , Cama V , Akinbo FO , Ganguly S , Kiulia NM , Zhang X , Xiao L . Infect Genet Evol 2012 14 111-9 The population structure of Enterocytozoon bieneusi was examined by multilocus sequence typing (MLST) of 64 specimens from AIDS patients in Peru, Nigeria, and India and five specimens from captive baboons in Kenya using a combination of the ribosomal internal transcribed spacer (ITS) and four microsatellite and minisatellite markers. Parasites in different geographic locations (Peru, India, and Nigeria) all had strong and significant linkage disequilibrium (LD) and only limited recombination, indicative of a clonal population structure in E. bieneusi from each location. When isolates of various geographical areas were treated as a single population, phylogenetic analysis and substructural analysis using STRUCTURE found no evidence for the existence of geographically segregated sub-populations. Nevertheless, both analyses revealed the presence of two major genetically isolated groups of E. bieneusi: one (sub-population 1) contained all isolates of the anthroponotic ITS genotype A, whereas the other (sub-population 2) harbored isolates of multiple ITS genotypes with zoonotic potential. This was also supported by F(ST) analysis. The measurement of LD and recombination rates indicated that sub-population 2 had a clonal population structure, whereas sub-population 1 had an epidemic population structure. The data confirmed the existence of genetic sub-populations in E. bieneusi that may be transmitted differently in humans. |
An evaluation of the National Public Health Leadership Institute-1991-2006: part II. Strengthening public health leadership networks, systems, and infrastructure
Umble K , Baker EL , Diehl SJ , Haws S , Steffen D , Frederick S , Woltring C . J Public Health Manag Pract 2011 17 (3) 214-224 CONTEXT: The year-long National Public Health Leadership Institute's (PHLI) goals are to develop the capacity of individual leaders and networks of leaders so that both can lead improvements in public health systems, infrastructure, and population health. OBJECTIVE: To evaluate PHLI's impact on networks, systems, and infrastructure. PARTICIPANTS: Senior leaders from government, health care, associations, and other organizations who graduated from PHLI between 1992 and 2006. INTERVENTION: Retreats; readings, conference calls, and webinars; personal assessments, feedback, and coaching; and action learning projects. METHODS: A cross-sectional survey sent in 2007 to all leaders from the program's first 15 cohorts. Between 1992 and 2006, PHLI graduated 806 leaders. Of the 646 graduates located, 393 (61%) responded, for an overall response rate of 49% (393/806). Telephone interviews of 35 key informants were also conducted. RESULTS: Graduates fostered changes in systems, policies, organizations, and programs and frequently described these changes as resulting from their work as or with networks. Many graduates formed an informal national network of "thought leaders" and volunteered with professional associations to help in creating methods for improving systems and infrastructure. At the state level, graduates worked as informal networks and with associations to restructure services, reorganize agencies, catalyze new laws, and develop programs. Locally, graduates developed coalitions, fostered new laws, and improved programs, among other changes. CONCLUSION: The Centers for Disease Control and Prevention's multiyear sponsorship of a national program fostered national networks among "thought leaders" who helped to lead the development and diffusion of numerous innovations. Public health leadership development program sponsors should foster collaborative leadership by engaging leaders in systems thinking, team leadership, dialogue, conflict resolution, and negotiation, recommend using networks for sustained personal and system development, and link leaders to networks and associations. Networks provide the collective creativity and broad support needed to enact system and infrastructure changes. |
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