Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Lozier MJ [original query] |
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Factors associated with hand hygiene adherence among healthcare workers in guatemala during the COVID-19 pandemic
Fahsen N , Garzaro P , Lozier MJ , Pratt CQ , Craig C , McDavid K , Vega Ocasio D , Cordon-Rosales C , Call DR , Ramay BM . J Hosp Infect 2024 BACKGROUND: Healthcare-associated infections are prevalent in low- and middle-income countries and may be reduced through proper hand hygiene (HH) adherence during patient care. AIM: We produced and distributed alcohol-based hand rub (ABHR) to 19 public primary and secondary-level public healthcare facilities in Quetzaltenango, Guatemala, and carried out HH observations to assess healthcare workers' (HCWs) HH adherence, and to identify factors associated with this practice. HH adherence was defined as washing hands with soap and water or using ABHR. METHODS: Observations were conducted before (2021, baseline) and after (2022, follow-up) ABHR distribution to evaluate the evolution of HH practices over time. Bivariate comparisons and mixed-effects logistic regression models were used to explore associations between HH adherence and the following independent variables: healthcare facility level, type of contact performed, timing of HH performance, occupational category of HCW and materials present (e.g. water, soap, ABHR) FINDINGS: We observed 243 and 300 patient interactions among 67 and 82 HCWs at each time point respectively. HH adherence was low for both observation periods (40% at baseline and 35% at follow-up). HCWs were more likely to adhere to HH during invasive contacts, after patient contact, and if HCW was a physician. CONCLUSION: HH adherence varied by scenario, which underscores the importance of addressing multiple determinants of behaviour change to improve adherence. This requires interventions implemented with a multimodal approach that includes both increasing access to HH materials and infrastructure, as well as HH education and training, monitoring and feedback, reminders, and promoting a HH safety culture. |
Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study
Craig CE , Schnorr CD , Then Paulino CJ , Payano EC , Guzmán PM , Ripkey C , de St Aubin M , Dumas D , Roberts KW , Duke W , Skewes-Ramm R , Lozier MJ , Nilles EJ . Infect Preven Prac 2024 6 (2) Background: Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence. Aim: This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions. Methods: We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach. Results: A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation). Discussion: By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact. © 2024 |
Assessing hand hygiene knowledge, attitudes, and behaviors among Guatemalan primary school students in the context of the COVID-19 pandemic
Pieters MM , Fahsen N , Quezada R , Pratt C , Craig C , McDavid K , Vega Ocasio D , Hug C , Cordón-Rosales C , Lozier MJ . BMC Public Health 2023 23 (1) 2252 BACKGROUND: Hand hygiene (HH) is an important practice that prevents transmission of infectious diseases, such as COVID-19. However, in resource-limited areas, where water and soap are not always available, it can be difficult to practice HH correctly and at appropriate moments. The purpose of this study was to assess HH knowledge and behaviors among students from six elementary schools in Quetzaltenango, Guatemala to identify gaps that could later inform interventions to improve HH. METHODS: We conducted knowledge, attitude, and practices (KAP) surveys among primary school students during the COVID-19 pandemic in July 2022. We also observed students' HH practices at three different moments during the day, making note of the use of the HH station and materials, duration of handwashing, presence of a HH assistant, and the students' sex. We also used the Quantitative Personal Hygiene Assessment Tool (qPHAT), to measure hand dirtiness before eating, after restroom use, and upon arriving to school. RESULTS: We surveyed 109 students across six schools. Mean scores were 4 out of 5 for knowledge, 8 out of 8 for attitudes, and 6 out of 7 for HH practices. Most students identified "before eating" as a critical moment for HH (68.8%), fewer identified "after restroom use" (31.2%), and no students mentioned HH being necessary "after coughing or sneezing". We observed 326 HH opportunities of which 51.2% performed correct HH (used water and soap for at least 20 s or used alcohol-based hand rub, where materials were available). We collected 82 qPHAT hand swabs. A Kruskal Wallis test revealed a significant difference in hand dirtiness between entering the school and after restroom use (p = 0.017), but no significant difference before eating and after entering the school (p = 0.6988). CONCLUSIONS: The results from the KAP survey show high scores, however correct identification of key moments for HH was relatively uncommon, especially after restroom use and after coughing or sneezing. Additionally, half of HH opportunities observed had correct HH practices and on average, hands were dirtiest when arriving at school. These findings will inform interventions to improve HH practices and behaviors, which will be evaluated with follow-up data collection. |
Establishment of district-led production of WHO-recommended Alcohol-Based Hand Rub (ABHR) during the COVID-19 pandemic: a model for improving access to ABHR during health emergencies
Tusabe F , Lamorde M , Medley A , Kesande M , Lozier MJ , Yapswale S , Ociti F , Isabirye H , Nuwamanya E , Nanyondo J , Boore A , Vosburgh W , Kasule JN , Pratt C , Berendes D . J Water Sanit Hyg Develop 2023 13 (10) 847-856 In response to the COVID-19 pandemic, we established and sustained local production of Alcohol-Based Hand Rub (ABHR) at a district scale for healthcare facilities and community, public locations in four districts in Uganda. District officials provided space and staff for production units. The project renovated space for production, trained staff on ABHR production, and transported ABHR to key locations. The production officer conducted internal ABHR quality assessments while trained district health inspectors conducted external quality assessments prior to distribution. Information, education, and communication materials accompanied ABHR distribution. Onsite ABHR consumption was moni-tored by site staff using stock cards. On average, it took 11 days (range: 8–14) and 5,760 USD (range: 4,400–7,710) to setup a production unit. From March to December 2021, 21,600 L of quality-controlled ABHR were produced for 111 healthcare facilities and community locations at an average cost of 4.30 USD/L (range: 3.50–5.76). All ABHR passed both internal and external quality control (average ethanol concentration of 80%, range: 78–81%). This case study demonstrated that establishing centralized, local production of quality-controlled, affordable ABHR at a district-wide scale is feasible and strengthens the ability of healthcare workers and community locations to access and use ABHR during infectious disease outbreaks in low-resource countries. © 2023 The Authors. |
Assessment of water, sanitation, and hygiene conditions in public elementary schools in Quetzaltenango, Guatemala, in the Context of the COVID-19 Pandemic
Pieters MM , Fahsen N , Craig C , Quezada R , Pratt CQ , Gomez A , Brown TW , Kossik A , McDavid K , Vega Ocasio D , Lozier MJ , Cordón-Rosales C . Int J Environ Res Public Health 2023 20 (20) Water, sanitation, and hygiene (WASH) services in schools are essential to reduce infectious disease transmission, including that of COVID-19. This study aimed to establish a baseline of WASH services in six public elementary schools in Guatemala, with a focus on hand hygiene. We used the WHO/UNICEF Joint Monitoring Programme (JMP) report indicators to assess the WASH infrastructure at each school. We collected water samples from easily accessible water points (pilas, or bathroom sinks) at each school to test for the presence of total coliforms and E. coli. In-depth interviews were carried out with teachers to understand hand hygiene practices and systems at school. Results indicate that all schools had water available at the time of the survey. All water samples at four schools tested positive for total coliforms and at one school, positive for E. coli. All schools had sanitation facilities, but services were limited. Only 43% of handwashing stations at schools had soap available. No school had disability-inclusive WASH services. Financial constraints and a lack of appropriate WASH infrastructure were the main barriers reported by teachers to meet hand hygiene needs at school. Appropriate access to WASH infrastructure and supplies could increase hand hygiene practices and improve learning conditions for students. |
Identification of risk factors and mosquito vectors associated with dengue virus infection in American Samoa, 2017
Sharp TM , Tufa AJ , Cotter CJ , Lozier MJ , Santiago GA , Johnson SS , Mataia'a M , Waterman SH , Muñoz-Jordán JL , Paz-Bailey G , Hemme RR , Schmaedick MA , Anesi S . PLOS Glob Public Health 2023 3 (7) e0001604 INTRODUCTION: The first outbreak of dengue in American Samoa was reported in 1911. Sporadic outbreaks have been reported since, as were outbreaks of other pathogens transmitted by Aedes species mosquitoes including Ross River, chikungunya, and Zika viruses. During an outbreak of dengue virus-type 2 (DENV-2) in 2016-2018, we conducted household-based cluster investigations to identify population-specific risk factors associated with infection and performed entomologic surveillance to determine the relative abundance of Ae. aegypti and Ae. polynesiensis. METHODS AND FINDINGS: We contacted dengue patients who had tested positive for DENV infection and offered them as well as their household members participation in household-based cluster investigations. For those that accepted participation, we also offered participation to residents of households within a 50-meter radius of each case-patient's home. Questionnaires were administered and serum specimens collected for testing by RT-PCR and anti-DENV IgM ELISA. Adult female mosquitoes were aspirated from inside and outside participating households and tested by RT-PCR. We analyzed characteristics associated with DENV infection in bivariate analyses. A total of 226 participants was enrolled from 91 households in 20 clusters. Median age of participants was 34 years (range: <1-94), and 56.2% were female. In total, 7 (3.2%) participants had evidence of DENV infection by IgM ELISA (n = 5) or RT-PCR (n = 2). Factors significantly associated with DENV infection were reporting a febrile illness in the past three months (prevalence ratio: 7.5 [95% confidence interval: 1.9-29.8]) and having a household septic tank (Fisher's Exact Test, p = 0.004). Of 93 Ae. aegypti and 90 Ae. polynesiensis females collected, 90% of Ae. aegypti were collected inside homes whereas 83% of Ae. polynesiensis were collected outside homes. DENV nucleic acid was not detected in any mosquito pools. Sequencing of the DENV-2 from patient specimens identified the Cosmopolitan genotype of DENV-2 and was most closely related to virus detected in the Solomon Islands during 2016. CONCLUSIONS: This investigation demonstrated that dengue is a continuing risk in American Samoa. Increased frequency of infection among residents with a septic tank suggests a need to investigate whether septic tanks serve as larval habitats for mosquito vectors of DENV in American Samoa. Future efforts should also evaluate the role of Ae. polynesiensis in DENV transmission in the wild. |
Improving access to who formulations of alcohol-based hand rub in healthcare facilities: A district-wide approach
Tusabe F , Nanyondo J , Lozier MJ , Kesande M , Tumuhairwe O , Watsisi M , Twinomugisha F , Medley A , Mutoro J , Lamorde M , Berendes D . Am J Trop Med Hyg 2023 109 (1) 191-200 Alcohol-based hand rub (ABHR) is an effective hand hygiene measure to mitigate and prevent infectious disease transmission in healthcare facilities (HCFs); however, availability and affordability in low- and middle-income countries are limited. We sought to establish centralized local production of ABHR using a district-wide approach to increase provider access at all public HCFs in Kabarole and Kasese Districts in Western Uganda. Partner organizations worked with district governments to adapt and implement the WHO protocol for local ABHR production at the district scale. These groups identified and upgraded sites for ABHR production and storage to ensure recommended security, ventilation, and air conditioning. District governments selected technicians for training on ABHR production. Raw materials were sourced within Uganda. Alcohol-based hand rub underwent internal quality control by the production officer and external quality control (EQC) by a trained district health inspector before distribution to HCFs. We assessed ABHR production and demand from March 2019 to December 2020. All ABHR batches (N = 316) met protocol standards (alcohol concentration: 75.0-85.0%) with a mean of 79.9% (range: 78.5-80.5%). Internal quality control measurements (mean alcohol concentration: 80.0%, range: 79.5-81.0%) matched EQC measurements (mean: 79.8%, range: 78.0-80.0%). Production units supplied ABHR to 127 HCFs in Kasese District (100%) and 31 HCFs in Kabarole District (56%); 94% of HCFs were small (dispensary or next higher level). This district-wide production met quality standards and supplied ABHR to many HCFs where facility-level production would be unfeasible. Low- and middle-income countries may consider district models to expand ABHR production and supply to smaller HCFs. |
Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico
Sharp TM , Quandelacy TM , Adams LE , Aponte JT , Lozier MJ , Ryff K , Flores M , Rivera A , Santiago GA , Muñoz-Jordán JL , Alvarado LI , Rivera-Amill V , Garcia-Negrón M , Waterman SH , Paz-Bailey G , Johansson MA , Rivera-Garcia B . PLoS Negl Trop Dis 2020 14 (9) e0008532 BACKGROUND: After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. METHODS AND FINDINGS: Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015-December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20-29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]: -0.22 [95% confidence interval -0.29, -0.14]), eastern longitude (log HR: -1.04 [-1.17, -0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR: -0.30 [-0.32, -0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature (log HR: -0.04 [-0.05, -0.03]). Higher incidence of ZIKV disease was associated with lower mean precipitation, but not socioeconomic factors. CONCLUSIONS: During the ZIKV epidemic in Puerto Rico, 1% of residents were reported to public health authorities and had laboratory evidence of ZIKV disease. Transmission was first detected in urban areas of eastern Puerto Rico, where transmission also peaked earlier. These trends suggest that ZIKV was first introduced to Puerto Rico in the east before disseminating throughout the island. |
Update: Interim guidance for health care professionals evaluating and caring for patients with suspected e-cigarette, or vaping, product use-associated lung injury and for reducing the risk for rehospitalization and death following hospital discharge - United States, December 2019
Evans ME , Twentyman E , Click ES , Goodman AB , Weissman DN , Kiernan E , Hocevar SA , Mikosz CA , Danielson M , Anderson KN , Ellington S , Lozier MJ , Pollack LA , Rose DA , Krishnasamy V , Jones CM , Briss P , King BA , Wiltz JL . MMWR Morb Mortal Wkly Rep 2020 68 (5152) 1189-1194 What is already known on this topic? In a recent examination of rehospitalization and death among previously hospitalized patients with e-cigarette or vaping, product use–associated lung injury (EVALI), at least one quarter of rehospitalizations and deaths occurred within 2 days of discharge; comorbidities were common among patients who were rehospitalized or who died after discharge. What is added by this report? Updated guidance recommends posthospitalization outpatient follow-up, optimally within 48 hours of discharge, and emphasizes the importance of preparation for hospital discharge and postdischarge care coordination to reduce risk of rehospitalization and death among hospitalized EVALI patients. What are the implications for public health practice? Incorporating this updated guidance into the management of hospitalized EVALI patients might reduce EVALI-associated morbidity and mortality. © 2020 Department of Health and Human Services. All rights reserved. |
Update: Demographic, product, and substance-use characteristics of hospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injuries - United States, December 2019
Lozier MJ , Wallace B , Anderson K , Ellington S , Jones CM , Rose D , Baldwin G , King BA , Briss P , Mikosz CA . MMWR Morb Mortal Wkly Rep 2019 68 (49) 1142-1148 What is already known about this topic? Patients with e-cigarette, or vaping, product use–associated lung injury (EVALI) in Illinois and Wisconsin reported using a variety of tetrahydrocannabinol (THC)-containing products in the 3 months preceding illness; a product labeled “Dank Vapes” was most commonly reported. What is added by this report? Nationally, Dank Vapes were the most commonly reported THC-containing product by hospitalized EVALI patients, but a wide variety of products were reported, with regional differences. Data suggest the outbreak might have peaked in mid-September. What are the implications for public health practice? These data further support the association of EVALI with THC-containing products; it is unlikely that one brand is responsible for the outbreak. CDC recommends that persons not use e-cigarette, or vaping, products that contain THC. © 2019 Department of Health and Human Services. All rights reserved. |
Characterizing environmental asthma triggers and healthcare use patterns in Puerto Rico
Lewis LM , Mirabelli MC , Beavers SF , Kennedy CM , Shriber J , Stearns D , Morales Gonzalez JJ , Santiago MS , Felix IM , Ruiz-Serrano K , Dirlikov E , Lozier MJ , Sircar K , Flanders WD , Rivera-Garcia B , Irizarry-Ramos J , Bolanos-Rosero B . J Asthma 2019 57 (8) 1-12 Objective: Asthma carries a high burden of disease for residents of Puerto Rico. We conducted this study to better understand asthma-related healthcare use and to examine potential asthma triggers. Methods: We characterized asthma-related healthcare use in 2013 by demographics, region, and date using outpatient, hospital, and emergency department (ED) insurance claims with a primary diagnostic ICD-9-CM code of 493.XX. We examined environmental asthma triggers, including outdoor allergens (i.e., mold and pollen), particulate pollution, and influenza-like illness. Analyses included descriptive statistics and Poisson time-series regression. Results: During 2013, there were 550,655 medical asthma claims reported to the Puerto Rico Healthcare Utilization database, representing 148 asthma claims/1,000 persons; 71% of asthma claims were outpatient visits, 19% were hospitalizations, and 10% were ED visits. Females (63%), children aged </=9 years (77% among children), and adults aged >/=45 years (80% among adults) had the majority of asthma claims. Among health regions, Caguas had the highest asthma claim-rate at 142/1,000 persons (overall health region claim-rate = 108). Environmental exposures varied across the year and demonstrated seasonal patterns. Metro health region regression models showed positive associations between increases in mold and particulate matter <10 microns in diameter (PM10) and outpatient asthma claims. Conclusions: This study provides information about patterns of asthma-related healthcare use across Puerto Rico. Increases in mold and PM10 were associated with increases in asthma claims. Targeting educational interventions on exposure awareness and reduction techniques, especially to persons with higher asthma-related healthcare use, can support asthma control activities in public health and clinical settings. |
Reassessing serosurvey-based estimates of the symptomatic proportion of Zika virus infections
Mitchell PK , Mier-Y-Teran-Romero L , Biggerstaff BJ , Delorey MJ , Aubry M , Cao-Lormeau VM , Lozier MJ , Cauchemez S , Johansson MA . Am J Epidemiol 2019 188 (1) 206-213 Since the 2007 Zika epidemic in the Micronesian state of Yap, it has been apparent that not all people infected with Zika virus (ZIKV) experience symptoms. However, the proportion of infections that result in symptoms remains unclear. Existing estimates have varied in their interpretation of symptoms due to other causes and the case definition used, and they have assumed perfect test sensitivity and specificity. Using a Bayesian model and data from ZIKV serosurveys in Yap (2007), French Polynesia (2013-2014), and Puerto Rico (2016), we found that assuming perfect sensitivity and specificity generally led to lower estimates of the symptomatic proportion. Incorporating reasonable assumptions for assay sensitivity and specificity, we estimated that 27% (95% credible interval (CrI): 15, 37) (Yap), 44% (95% CrI: 26, 66) (French Polynesia), and 50% (95% CrI: 34, 92) (Puerto Rico) of infections were symptomatic, with variation due to differences in study populations, study designs, and case definitions. The proportion of ZIKV infections causing symptoms is critical for surveillance system design and impact assessment. Here, we accounted for key uncertainties in existing seroprevalence data and found that estimates for the symptomatic proportion ranged from 27% to 50%, suggesting that while the majority of infections are asymptomatic or mildly symptomatic, symptomatic infections might be more common than previously estimated. |
Prolonged detection of Zika virus nucleic acid among symptomatic pregnant women: a cohort study
Lozier MJ , Rosenberg ES , Doyle K , Adams L , Klein L , Munoz-Jordan J , Alvarado LI , Sharp TM , Paz-Bailey G . Clin Infect Dis 2018 67 (4) 624-627 A prospective cohort of women with RT-PCR confirmed Zika virus infection aged 18-39 years in Puerto Rico found that pregnant women have about a three-fold longer estimated median detection of Zika virus RNA in serum, which can increase definitive diagnosis of infection and facilitate timely and appropriate clinical management. |
Assessing health outcomes, quality of life, and healthcare use among school-age children with asthma
Lozier MJ , Zahran HS , Bailey CM . J Asthma 2018 56 (1) 1-8 OBJECTIVE: Asthma affects six million children in the United States. Most people can control their asthma symptoms with effective care, management, and appropriate medical treatment. Information on the relationship between asthma control and quality of life indicators and health care use among school-age children is limited. METHODS: Using the 2006-2010 combined Behavior Risk Factor Surveillance System Asthma Call-back Survey child data, we examined asthma control and asthma attack status among school-age (aged 5-17 years) children with asthma from 35 states and the District of Columbia. Multivariable logistic regression models were used to assess if having uncontrolled asthma and having >/=1 asthma attacks affect quality of life (activity limitation and missed school days) and healthcare use (emergency department [ED] visits and hospitalizations). RESULTS: About one-third (36.5%) of the 8,484 respondents with current asthma had uncontrolled asthma and 56.8% reported >/=1 asthma attack in the past year. Having uncontrolled asthma and having >/=1 asthma attack were significantly associated with activity limitation (aPR = 1.43 and 1.74, respectively), missed school (1.45 and 1.68), ED visits (2.05 and 4.78), and hospitalizations (2.38 and 3.64). Long-term control (LTC) medication use was higher among respondents with uncontrolled asthma (61.3%) than respondents with well-controlled asthma (33.5%). CONCLUSIONS: Having uncontrolled asthma is associated with reduced quality of life and increased health care use. However, only 61.3% of respondents with uncontrolled asthma use LTC medications. Increasing use of LTC medications among children with uncontrolled asthma could help improve quality of life and reduce health care use. |
Differences in prevalence of symptomatic Zika virus infection by age and sex - Puerto Rico, 2016
Lozier MJ , Burke RM , Lopez J , Acevedo V , Amador M , Read JS , Jara A , Waterman SH , Barrera R , Munoz-Jordan J , Garcia-Rivera B , Sharp TM . J Infect Dis 2017 217 (11) 1678-1689 Background: During the Zika virus (ZIKV) outbreak in Puerto Rico in 2016, non-pregnant women aged 20-39 years were disproportionately identified with ZIKV disease. We used household-based cluster investigations to determine if this disparity was associated with age- or sex-dependent differences in the rate of ZIKV infection or reporting symptoms. Methods: Participation was offered to residents of households within a 100-meter radius of the residences of a convenience sample of 19 laboratory-confirmed ZIKV disease cases. Participants answered a questionnaire and provided specimens for diagnostic testing by RT-PCR and ELISA. Results: Among 367 study participants, 114 (31.1%) were laboratory-positive for ZIKV infection, of which 30% reported a recent illness (defined as self-reported rash or arthralgia) attributable to ZIKV infection. Age and sex were not associated with ZIKV infection. Female sex (adjusted prevalence ratio [aPR]=2.28; 95% confidence interval [CI]=1.40, 3.67), age <40 years (aPR=2.39; 95% CI=1.55, 3.70), and asthma (aPR=1.63; 95% CI=1.12, 2.37) were independently associated with symptomatic infection. Conclusions: Although neither female sex nor age were associated with increased prevalence of ZIKV infection, both were associated with symptomatic infection. Further investigation to identify a potential mechanism of age- and sex-dependent differences in reporting symptomatic ZIKV infection is warranted. |
Use of temperature sensors to determine exclusivity of improved stove use and associated household air pollution reductions in Kenya
Lozier MJ , Sircar K , Christensen B , Pillarisetti A , Pennise D , Bruce N , Stanistreet D , Naeher L , Pilishvili T , Farrar JL , Sage M , Nyagol R , Muoki J , Wofchuck T , Yip F . Environ Sci Technol 2016 50 (8) 4564-71 Household air pollution (HAP) contributes to 3.5-4 million annual deaths globally. Recent interventions using improved cookstoves (ICS) to reduce HAP have incorporated temperature sensors as stove use monitors (SUMs) to assess stove use. We deployed SUMs in an effectiveness study of 6 ICSs in 45 Kenyan rural homes. Stove were installed sequentially for 2 weeks and kitchen air monitoring was conducted for 48 h during each 2-week period. We placed SUMs on the ICSs and traditional cookstoves (TCS), and the continuous temperature data were analyzed using an algorithm to examine the number of cooking events, days of exclusive use of ICS, and how stove use patterns affect HAP. Stacking, defined as using both a TCS and an ICS in the same day, occurred on 40% of the study days, and exclusive use of the ICS occurred on 25% of study days. When researchers were not present, ICS use declined, which can have implications for long-term stove adoption in these communities. Continued use of TCSs was also associated with higher HAP levels. SUMs are a valuable tool for characterizing stove use and provide additional information to interpret HAP levels measured during ICS intervention studies. |
Acetyl fentanyl, a novel fentanyl analog, causes 14 overdose deaths in Rhode Island, March-May 2013
Lozier MJ , Boyd M , Stanley C , Ogilvie L , King E , Martin C , Lewis L . J Med Toxicol 2015 11 (2) 208-17 From 2000 to 2011, the rate of death from unintentional drug poisoning in the USA more than doubled from 4.1 per 100,000 to 10.6 per 100,000, respectively [1]. Further, from 1999 to 2011, drug overdose deaths involving opioids quadrupled from 4030 to 16,917 [1]. Nationally, since 2009, more people have died each year from drug poisoning than from motor vehicle crashes [1]. In fact, overdose is the leading cause of adult unintentional injury death in Rhode Island, which is one of 30 states where overdose mortality exceeded motor vehicle collision mortality in 2010 [2]. | The major driver of the increase in drug overdose deaths is pharmaceutical opioids. In 2010, 60 % of the unintentional drug poisoning deaths in the USA were caused by pharmaceuticals, and 75 % of the fatal pharmaceutical overdoses were caused by opioids [3]. Nationally, heroin use doubled from 2003 to 2012, and from 2002 to 2011, drug poisoning deaths involving heroin more than doubled from 2089 to 4397, respectively [4, 5]. In Rhode Island, overdose deaths caused by illicit drugs increased so much during 2011–2013 that it overtook fatal pharmaceutical overdoses, which remained steady during the same time period [6]. | Fentanyl (N-(1-(2-phenethyl)-4-piperidinyl-N-phenyl-propanamide) is a synthetic opioid first synthesized by Janssen Pharmaceuticals in the 1960s and used medicinally since 1968. It is estimated to be between 80 and 100 times more potent than morphine [7, 8] and has over 200 chemical derivatives, some of which have been used recreationally or implicated in heroin adulteration in the past. The first fentanyl derivatives synthesized in the early 1970s showed similar pharmacokinetics but significantly different potencies. By the early 1980s, clandestinely produced synthetic fentanyl and fentanyl derivatives were becoming available on the black market [7, 9]. The speed of onset and potency of these drugs made them attractive to opioid users but also made them more dangerous. Fentanyl derivatives can be a few to hundreds of times more potent than heroin, and if users unknowingly obtain and administer packages sold as heroin but containing a more potent fentanyl derivative, this can lead to inadvertent overdose and death [10]. |
Determinants of atrazine contamination in the homes of commercial pesticide applicators across time
Lozier MJ , Curwin B , Nishioka MG , Sanderson W . J Occup Environ Hyg 2012 9 (5) 289-97 Twenty-nine commercial pesticide applicator households in eastern Iowa were enrolled to investigate in-home contamination of atrazine, the most commonly used corn herbicide in the Unites States. From each home, four vacuum dust samples were collected during atrazine application season (Visit 1) and again 6 months later during winter months (Visit 2). Samples were taken from the following locations: primary entryway for pesticide applicator, living room, master bedroom, and kitchen. The applicator completed an atrazine handling log and household questionnaire with spouse. Of the 230 dust samples, only 2 were below the level of detection, 2 ng of atrazine per gram (ng/g) of fine dust (dust particle size 5-150 mcm). Dust levels were standardized to chemical loading. During application season the entryway (2.68 ng/cm(2)) and kitchen (0.47 ng/cm(2)) had the highest geometric mean atrazine chemical loading. The entryway chemical loading during Visit 2 was the second highest aggregate (0.55 ng/cm(2)). Aggregate concentrations were significantly higher at Visit 1 compared with Visit 2 when paired by location (p≤0.02). Analysis showed that job (application, mixing/loading, or both) was not associated with in-home atrazine contamination. Linear regression showed a strong positive association between atrazine handling (number of acres applied with atrazine, number of days atrazine handled, and pounds of atrazine handled) and aggregate dust chemical loading from both visits (p = 0.06, 0.03, and 0.10, respectively). Frequency of vacuuming was inversely associated with Visit 2 concentrations (p = 0.10) and showed a weaker association with Visit 1 (p = 0.30). Removing shoes outside the home was associated with lower atrazine chemical loading (p = 0.03), and applicators changing work clothes in the master bedroom had significantly increased atrazine chemical loading in master bedrooms (p = 0.01). Changes in hygiene practices for commercial pesticide applicators could significantly reduce atrazine and, likely, other pesticide contaminations in the home. |
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