Last data update: Nov 11, 2024. (Total: 48109 publications since 2009)
Records 1-21 (of 21 Records) |
Query Trace: Mackey L[original query] |
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Evaluation of mpox exposures and outcomes in workplaces, 6 jurisdictions, June 1-August 31, 2022
de Perio MA , Horter L , Still W , Meh I , Persson N , Berns AL , Salinas A , Murphy K , Lafferty AG , Daltry D , Mackey S , Sockwell DC , Adams J , Rivas J , Somerville NJ , Valencia D . Public Health Rep 2024 333549241245655 OBJECTIVES: The risk for mpox virus (MPXV) transmission in most workplaces has not been thoroughly assessed in the context of the 2022 global mpox outbreak. Our objectives were to describe mpox case patients who worked while infectious and the subsequent workplace contact tracing efforts, risk assessments, and outcomes. METHODS: The Centers for Disease Control and Prevention requested information from health departments in the United States in September 2022 to identify people with confirmed or probable mpox who worked outside the home while infectious, either before or after diagnosis, from June 1 through August 31, 2022. We collected and summarized data on demographic, clinical, and workplace characteristics of case patients and workplace contact investigations. We stratified data by industry and occupation categories. RESULTS: In total, 102 case patients were reported by 6 jurisdictions. The most common industries were accommodation and food services (19.8%) and professional business, management, and technical services (17.0%). Contact investigations identified 178 total contacts; 54 cases (52.9%) had no contacts identified. Of 178 contacts, 54 (30.3%) were recommended to receive postexposure prophylaxis (PEP) and 18 (10.1%) received PEP. None of the contacts developed a rash or were tested for orthopox or mpox, and none were reported to have confirmed or probable mpox. CONCLUSION: Data from 6 jurisdictions suggest that the risk of MPXV transmission from workers to others in workplace settings in many industries is low. These findings might support future updates to exposure risk classifications and work activity recommendations for patients. These findings also demonstrate the importance of collecting and analyzing occupation and industry data in case reports to better understand risks in workplaces. |
Measuring the burden of infodemics: Summary of the methods and results of the Fifth WHO Infodemic Management Conference
Wilhelm E , Ballalai I , Belanger ME , Benjamin P , Bertrand-Ferrandis C , Bezbaruah S , Briand S , Brooks I , Bruns R , Bucci LM , Calleja N , Chiou H , Devaria A , Dini L , D'Souza H , Dunn AG , Eichstaedt JC , Evers Smaa , Gobat N , Gissler M , Gonzales IC , Gruzd A , Hess S , Ishizumi A , John O , Joshi A , Kaluza B , Khamis N , Kosinska M , Kulkarni S , Lingri D , Ludolph R , Mackey T , Mandić-Rajčević S , Menczer F , Mudaliar V , Murthy S , Nazakat S , Nguyen T , Nilsen J , Pallari E , Pasternak Taschner N , Petelos E , Prinstein MJ , Roozenbeek J , Schneider A , Srinivasan V , Stevanović A , Strahwald B , Syed Abdul S , Varaidzo Machiri S , van der Linden S , Voegeli C , Wardle C , Wegwarth O , White BK , Willie E , Yau B , Purnat TD . JMIR Infodemiology 2023 3 e44207 BACKGROUND: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. OBJECTIVE: In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. METHODS: An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. RESULTS: The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. CONCLUSIONS: Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers. |
Incorporating COVID-19 into acute febrile illness surveillance systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020-2021
Shih DC , Silver R , Henao OL , Alemu A , Audi A , Bigogo G , Colston JM , Edu-Quansah EP , Erickson TA , Gashu A , Gbelee GB Jr , Gunter SM , Kosek MN , Logan GG , Mackey JM , Maliga A , Manzanero R , Morazan G , Morey F , Munoz FM , Murray KO , Nelson TV , Olortegui MP , Yori PP , Ronca SE , Schiaffino F , Tayachew A , Tedasse M , Wossen M , Allen DR , Angra P , Balish A , Farron M , Guerra M , Herman-Roloff A , Hicks VJ , Hunsperger E , Kazazian L , Mikoleit M , Munyua P , Munywoki PK , Namwase AS , Onyango CO , Park M , Peruski LF , Sugerman DE , Gutierrez EZ , Cohen AL . Emerg Infect Dis 2022 28 (13) S34-s41 Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats. |
Epidemiologic and clinical features of children and adolescents aged <18 years with monkeypox - United States, May 17-September 24, 2022
Hennessee I , Shelus V , McArdle CE , Wolf M , Schatzman S , Carpenter A , Minhaj FS , Petras JK , Cash-Goldwasser S , Maloney M , Sosa L , Jones SA , Mangla AT , Harold RE , Beverley J , Saunders KE , Adams JN , Stanek DR , Feldpausch A , Pavlick J , Cahill M , O'Dell V , Kim M , Alarcón J , Finn LE , Goss M , Duwell M , Crum DA , Williams TW , Hansen K , Heddy M , Mallory K , McDermott D , Cuadera MKQ , Adler E , Lee EH , Shinall A , Thomas C , Ricketts EK , Koonce T , Rynk DB , Cogswell K , McLafferty M , Perella D , Stockdale C , Dell B , Roskosky M , White SL , Davis KR , Milleron RS , Mackey S , Barringer LA , Bruce H , Barrett D , D'Angeli M , Kocharian A , Klos R , Dawson P , Ellington SR , Mayer O , Godfred-Cato S , Labuda SM , McCormick DW , McCollum AM , Rao AK , Salzer JS , Kimball A , Gold JAW . MMWR Morb Mortal Wkly Rep 2022 71 (44) 1407-1411 Data on monkeypox in children and adolescents aged <18 years are limited (1,2). During May 17-September 24, 2022, a total of 25,038 monkeypox cases were reported in the United States,(dagger) primarily among adult gay, bisexual, and other men who have sex with men (3). During this period, CDC and U.S. jurisdictional health departments identified Monkeypox virus (MPXV) infections in 83 persons aged <18 years, accounting for 0.3% of reported cases. Among 28 children aged 0-12 years with monkeypox, 64% were boys, and most had direct skin-to-skin contact with an adult with monkeypox who was caring for the child in a household setting. Among 55 adolescents aged 13-17 years, most were male (89%), and male-to-male sexual contact was the most common presumed exposure route (66%). Most children and adolescents with monkeypox were non-Hispanic Black or African American (Black) (47%) or Hispanic or Latino (Hispanic) (35%). Most (89%) were not hospitalized, none received intensive care unit (ICU)-level care, and none died. Monkeypox in children and adolescents remains rare in the United States. Ensuring equitable access to monkeypox vaccination, testing, and treatment is a critical public health priority. Vaccination for adolescents with risk factors and provision of prevention information for persons with monkeypox caring for children might prevent additional infections. |
Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020.
Ly AN , Manzanero R , Maliga A , Gunter SM , Ronca SE , Zielinski-Gutierrez E , Morey F , Bautista K , Espinosa-Bode A , López B , Cadena L , Fuentes RC , Erickson TA , Munoz FM , Mackey J , Morazán G , Murray KO . Viruses 2022 14 (4) The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission. |
A review of potential national chronic pain surveillance systems in the United States
Duca LM , Helmick CG , Barbour KE , Nahin RL , Von Korff M , Murphy LB , Theis K , Guglielmo D , Dahlhamer J , Porter L , Falasinnu T , Mackey S . J Pain 2022 23 (9) 1492-1509 Pain has been established as a major public health problem in the United States (U.S.) with 50 million adults experiencing chronic pain and 20 million afflicted with high-impact chronic pain (i.e., chronic pain that interferes with life or work activities). High financial and social costs are associated with chronic pain. Over the past two decades, pain management has been complicated by the marked increase in opioids prescribed to treat chronic non-cancer pain and by the concurrent opioid crisis. Monitoring the prevalence of chronic pain and pain management is especially important because pain management is changing in uncertain ways. We review potential U.S. chronic pain surveillance systems, present potential difficulties of chronic pain surveillance, and explore how to address chronic pain surveillance in the current opioid era. We consider case definitions, severity, anatomic site, and varieties of chronic pain management strategies in reviewing and evaluating national surveys for chronic pain surveillance. Based on the criteria evaluated, the National Health Interview Survey offers the best single source for pain surveillance as the pain-related questions administered are brief, valid, and cover a broad scope of pain-related phenomenon. Perspective: This review article describes data sources that can be leveraged to conduct national chronic pain surveillance in the United States, explores case defining or pain-related questions administered, and evaluates them against eight surveillance attributes. |
Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May-July 2020.
Sami S , Akinbami LJ , Petersen LR , Crawley A , Lukacs SL , Weiss D , Henseler RA , Vuong N , Mackey L , Patel A , Grohskopf LA , Morgenthau BM , Daskalakis D , Pathela P . Emerg Infect Dis 2021 27 (3) 796-804 We conducted a serologic survey in public service agencies in New York City, New York, USA, during May-July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2-specific antibodies. Seroprevalence for police and firefighters was similar to overall seroprevalence; seroprevalence was highest in correctional staff (39.2%) and emergency medical technicians (38.3%) and lowest in laboratory technicians (10.1%) and medicolegal death investigators (10.8%). Adjusted analyses demonstrated association between seropositivity and exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 3.52 [95% CI 3.19-3.87]), non-Hispanic Black race or ethnicity (aOR 1.50 [95% CI 1.33-1.68]), and severe obesity (aOR 1.31 [95% CI 1.05-1.65]). Consistent glove use (aOR 1.19 [95% CI 1.06-1.33]) increased likelihood of seropositivity; use of other personal protective equipment had no association. Infection control measures, including vaccination, should be prioritized for frontline workers. |
Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July-August 2020.
Akinbami LJ , Chan PA , Vuong N , Sami S , Lewis D , Sheridan PE , Lukacs SL , Mackey L , Grohskopf LA , Patel A , Petersen LR . Emerg Infect Dis 2021 27 (3) 823-834 Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation. |
COVID-19 symptoms and SARS-CoV-2 antibody positivity in a large survey of first responders and healthcare personnel, May-July 2020.
Akinbami LJ , Petersen LR , Sami S , Vuong N , Lukacs SL , Mackey L , Atas J , LaFleur BJ . Clin Infect Dis 2021 73 (3) e822-e825 A SARS-CoV-2 serosurvey among first responder/healthcare personnel showed that loss of taste/smell was most predictive of seropositivity; percent seropositivity increased with number of COVID-19 symptoms. However, 22.9% with nine symptoms were seronegative, and 8.3% with no symptoms were seropositive. These findings demonstrate limitations of symptom-based surveillance and importance of testing. |
SARS-CoV-2 Seroprevalence among Healthcare, First Response, and Public Safety Personnel, Detroit Metropolitan Area, Michigan, USA, May-June 2020.
Akinbami LJ , Vuong N , Petersen LR , Sami S , Patel A , Lukacs SL , Mackey L , Grohskopf LA , Shehu A , Atas J . Emerg Infect Dis 2020 26 (12) 2863-2871 To estimate seroprevalence of severe acute respiratory syndrome 2 (SARS-CoV-2) among healthcare, first response, and public safety personnel, antibody testing was conducted in emergency medical service agencies and 27 hospitals in the Detroit, Michigan, USA, metropolitan area during May-June 2020. Of 16,403 participants, 6.9% had SARS-CoV-2 antibodies. In adjusted analyses, seropositivity was associated with exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 6.18, 95% CI 4.81-7.93) and working within 15 km of Detroit (aOR 5.60, 95% CI 3.98-7.89). Nurse assistants (aOR 1.88, 95% CI 1.24-2.83) and nurses (aOR 1.52, 95% CI 1.18-1.95) had higher likelihood of seropositivity than physicians. Working in a hospital emergency department increased the likelihood of seropositivity (aOR 1.16, 95% CI 1.002-1.35). Consistently using N95 respirators (aOR 0.83, 95% CI 0.72-0.95) and surgical facemasks (aOR 0.86, 95% CI 0.75-0.98) decreased the likelihood of seropositivity. |
Lack of antibodies to SARS-CoV-2 in a large cohort of previously infected persons.
Petersen LR , Sami S , Vuong N , Pathela P , Weiss D , Morgenthau BM , Henseler RA , Daskalakis DC , Atas J , Patel A , Lukacs S , Mackey L , Grohskopf LA , Thornburg N , Akinbami LJ . Clin Infect Dis 2020 73 (9) e3066-e3073 BACKGROUND: Reports suggest that some persons previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lack detectable IgG antibodies. We aimed to determine the proportion IgG seronegative and predictors for seronegativity among persons previously infected with SARS-CoV-2. METHODS: We analyzed serologic data collected from health care workers and first responders in New York City and the Detroit metropolitan area with history of a positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test result and who were tested for IgG antibodies to SARS-CoV-2 spike protein at least 2 weeks after symptom onset. RESULTS: Of 2,547 persons with previous confirmed SARS-CoV-2 infection, 160 (6.3%) were seronegative. Of 2,112 previously symptomatic persons, the proportion seronegative slightly increased from 14 to 90 days post symptom onset (p=0.06). The proportion seronegative ranged from 0% among 79 persons previously hospitalized to 11.0% among 308 persons with asymptomatic infections. In a multivariable model, persons taking immunosuppressive medications were more likely to be seronegative (31.9%, 95% confidence interval [CI] 10.7%-64.7%), while participants of non-Hispanic Black race/ethnicity (versus non-Hispanic White) (2.7%, 95% CI 1.5%-4.8%), with severe obesity (versus under/normal weight) (3.9%, 95% CI 1.7%-8.6%), or with more symptoms were less likely to be seronegative. CONCLUSIONS: In our population with previous RT-PCR confirmed infection, approximately one in 16 persons lacked IgG antibodies. Absence of antibodies varied independently by illness severity, race/ethnicity, obesity, and immunosuppressive drug therapy. The proportion seronegative remained relatively stable among persons tested up to 90 days post symptom onset. |
Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association
Benjamin EJ , Virani SS , Callaway CW , Chamberlain AM , Chang AR , Cheng S , Chiuve SE , Cushman M , Delling FN , Deo R , de Ferranti SD , Ferguson JF , Fornage M , Gillespie C , Isasi CR , Jiménez MC , Jordan LC , Judd SE , Lackland D , Lichtman JH , Lisabeth L , Liu S , Longenecker CT , Lutsey PL , Mackey JS , Matchar DB , Matsushita K , Mussolino ME , Nasir K , O'Flaherty M , Palaniappan LP , Pandey A , Pandey DK , Reeves MJ , Ritchey MD , Rodriguez CJ , Roth GA , Rosamond WD , Sampson UKA , Satou GM , Shah SH , Spartano NL , Tirschwell DL , Tsao CW , Voeks JH , Willey JZ , Wilkins JT , Wu JH , Alger HM , Wong SS , Muntner P . Circulation 2018 137 (12) e67-e492 Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors listed in the AHA’s My Life Check - Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) and stroke produce immense health and economic burdens in the United States and globally. The Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease [CHD], heart failure [HF], valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2007, the annual versions of the Statistical Update have been cited >20 000 times in the literature. From January to July 2017 alone, the 2017 Statistical Update was accessed >106 500 times. |
Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016
Dahlhamer J , Lucas J , Zelaya C , Nahin R , Mackey S , DeBar L , Kerns R , Von Korff M , Porter L , Helmick C . MMWR Morb Mortal Wkly Rep 2018 67 (36) 1001-1006 Chronic pain, one of the most common reasons adults seek medical care (1), has been linked to restrictions in mobility and daily activities (2,3), dependence on opioids (4), anxiety and depression (2), and poor perceived health or reduced quality of life (2,3). Population-based estimates of chronic pain among U.S. adults range from 11% to 40% (5), with considerable population subgroup variation. As a result, the 2016 National Pain Strategy called for more precise prevalence estimates of chronic pain and high-impact chronic pain (i.e., chronic pain that frequently limits life or work activities) to reliably establish the prevalence of chronic pain and aid in the development and implementation of population-wide pain interventions (5). National estimates of high-impact chronic pain can help differentiate persons with limitations in major life domains, including work, social, recreational, and self-care activities from those who maintain normal life activities despite chronic pain, providing a better understanding of the population in need of pain services. To estimate the prevalence of chronic pain and high-impact chronic pain in the United States, CDC analyzed 2016 National Health Interview Survey (NHIS) data. An estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalences of both chronic pain and high-impact chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents. These findings could be used to target pain management interventions. |
Urinary cadmium concentration and the risk of ischemic stroke
Chen C , Xun P , Tsinovoi C , McClure LA , Brockman J , MacDonald L , Cushman M , Cai J , Kamendulis L , Mackey J , He K . Neurology 2018 91 (4) e382-e391 OBJECTIVES: To examine the association between urinary cadmium levels and the incidence of ischemic stroke and to explore possible effect modifications. METHODS: A case-cohort study was designed nested in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including 680 adjudicated incident cases of ischemic stroke and 2,540 participants in a randomly selected subcohort. Urinary creatinine-corrected cadmium concentration was measured at baseline. Multivariable-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated with the Barlow weighting method for the Cox proportional hazards regression model. RESULTS: The median urinary cadmium concentration was 0.42 (interquartile range 0.27-0.68) mug/g creatinine. After adjustment for potential confounders, urinary cadmium was associated with increased incidence of ischemic stroke (quintile 5 vs quintile 1: HR 1.50, 95% CI 1.01-2.22, p for trend = 0.02). The observed association was more pronounced among participants in the lowest serum zinc tertile (tertile 3 vs tertile 1: HR 1.82, 95% CI 1.06-3.11, p for trend = 0.004, p for interaction = 0.05) but was attenuated and became nonsignificant among never smokers (tertile 3 vs tertile 1: never smokers: HR 1.27, 95% CI 0.80-2.03, p for trend = 0.29; ever smokers: HR 1.60, 95% CI 1.06-2.43, p for trend = 0.07, p for interaction = 0.51). CONCLUSIONS: Findings from this study suggest that cadmium exposure may be an independent risk factor for ischemic stroke in the US general population. Never smoking and maintaining a high serum zinc level may ameliorate the potential adverse effects of cadmium exposure. |
Serum mercury concentration and the risk of ischemic stroke: The REasons for Geographic and Racial Differences in Stroke Trace Element Study
Chen C , Xun P , McClure LA , Brockman J , MacDonald L , Cushman M , Cai J , Kamendulis L , Mackey J , He K . Environ Int 2018 117 125-131 BACKGROUND: Although biologically plausible, epidemiological evidence linking exposure to methylmercury with increased risk of ischemic stroke is limited. The effects of methylmercury may be modified by selenium, which is an anti-oxidant that often co-exists with mercury in fish. OBJECTIVES: To examine the association between serum mercury levels with the incidence of ischemic stroke and to explore the possible effect modifications by serum selenium levels and demographic and geographic factors. METHODS: A case-cohort study was designed nested in the REasons for Geographic and Racial Differences in Stroke cohort, including 662 adjudicated incident cases of ischemic stroke and 2494 participants in a randomly selected sub-cohort. Serum mercury was measured using samples collected at recruitment. Multivariable-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated using the Barlow-weighting method for the Cox proportional hazards regression model. RESULTS: No statistically significant association was observed between serum mercury concentration and the incidence of ischemic stroke (the highest vs. lowest quintile of mercury levels: HR=0.82; 95% CI=0.55-1.22; P for linear trend=0.42). Sex (P for interaction=0.06), but not serum selenium levels, modified the association; a more evident trend toward lower incidence of ischemic stroke with higher mercury levels was observed among women. CONCLUSION: This study does not support an association between mercury and the incidence of ischemic stroke within a population with low-to-moderate level of exposure. Further studies are needed to explore the possibility of mercury-induced ischemic stroke toxicity in other populations at higher exposure levels. |
Solution to Detect, Classify, and Report Illicit Online Marketing and Sales of Controlled Substances via Twitter: Using Machine Learning and Web Forensics to Combat Digital Opioid Access.
Mackey T , Kalyanam J , Klugman J , Kuzmenko E , Gupta R . J Med Internet Res 2018 20 (4) e10029 BACKGROUND: On December 6-7, 2017, the U.S. Department of Health and Human Services hosted its first Code-a-Thon event aimed at leveraging technology and data-driven solutions to help combat the opioid epidemic. Authors, comprised of an interdisciplinary team from academia, the private sector, and the U.S. Centers for Disease Control and Prevention, participated in the Code-a-Thon as part of the "Prevention" track. OBJECTIVE: To develop and deploy a methodology using machine learning to accurately detect the marketing and sale of opioids by illicit online sellers via Twitter as part of participation at the HHS Opioid Code-a-Thon event. METHODS: Tweets were collected from the Twitter public API stream filtered for common prescription opioid keywords in conjunction with participation in the Code-a-Thon from November 15 - December 5, 2017. An unsupervised machine learning-based approach was developed and used during the Code-a-Thon competition (24 hours) to obtain a summary of the content of the Tweets to isolate those clusters associated with illegal online marketing and sale using a Biterm Topic Model (BTM). After isolating relevant tweets, hyperlinks associated with these tweets were reviewed to assess characteristics of illegal online sellers. RESULTS: We collected and analyzed 213K tweets over the course of the Code-a-Thon containing keywords codeine, percocet, vicodin, oxycontin, oxycodone, fentanyl and hydrocodone. Using BTM, 692 (0.3%) tweets were identified as being associated with illegal online marketing and sale of prescription opioids. After removing duplicates and dead links, we identified 34 unique "live" tweets with 15 (44.1%) directing consumers to illicit online pharmacies, 11 (32.4%) linked to individual drug sellers, and 7 (20.6%) used by marketing affiliates. In addition to offering the "no prescription" sale of opioids, many of these vendors also sold other controlled substances and illicit drugs. CONCLUSIONS: Results of this study confirm prior studies that have identified social media platforms, including Twitter, as a potential conduit for supply and sale of illicit opioids. To translate these results into action, authors also developed a prototype wireframe for the purposes of detecting, classifying, and reporting illicit online pharmacy tweets selling controlled substances illegally to the U.S. Food and Drug Administration and U.S. Drug Enforcement Agency. Further development of solutions based on these methods has the potential to proactively alert regulators and law enforcement agencies of illegal opioid sales, while also making the online environment safer for the public. CLINICALTRIAL: not applicable. |
Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association
Benjamin EJ , Blaha MJ , Chiuve SE , Cushman M , Das SR , Deo R , de Ferranti SD , Floyd J , Fornage M , Gillespie C , Isasi CR , Jiménez MC , Jordan LC , Judd SE , Lackland D , Lichtman JH , Lisabeth L , Liu S , Longenecker CT , Mackey RH , Matsushita K , Mozaffarian D , Mussolino ME , Nasir K , Neumar RW , Palaniappan L , Pandey DK , Thiagarajan RR , Reeves MJ , Ritchey M , Rodriguez CJ , Roth GA , Rosamond WD , Sasson C , Towfighi A , Tsao CW , Turner MB , Virani SS , Voeks JH , Willey JZ , Wilkins JT , Wu JH , Alger HM , Wong SS , Muntner P . Circulation 2017 135 (10) e146-e603 Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the factors in the AHA’s Life’s Simple 7 (Figure1), which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. Cardiovascular disease (CVD) and stroke produce immense health and economic burdens in the United States and globally. The Update also presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure (HF), valvular disease, venous disease, and peripheral arterial disease) and the associated outcomes (including quality of care, procedures, and economic costs). Since 2006, the annual versions of the Statistical Update have been cited >20 000 times in the literature. In 2015 alone, the various Statistical Updates were cited ≈4000 times. |
The incidence of traumatic intracranial hemorrhage in head-injured older adults transported by EMS with and without anticoagulant or antiplatelet use
Nishijima DK , Gaona SD , Waechter T , Maloney R , Blitz A , Elms AR , Farrales RD , Montoya J , Bair T , Howard C , Gilbert M , Trajano R , Hatchel K , Faul M , Bell JM , Coronado V , Vinson DR , Ballard DW , Tancredi DJ , Garzon H , Mackey KE , Shahlaie K , Holmes JF . J Neurotrauma 2017 35 (5) 750-759 Field triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based on studies suggesting a high incidence of traumatic intracranial hemorrhage (tICH). We compared the incidence of tICH in older adults transported by EMS with and without anticoagulation or antiplatelet use and evaluated the accuracies of different sets of field triage criteria to identify tICH. This was a prospective, observational study at 5 EMS agencies and 11 hospitals. Older adults (≥55 years) with head trauma and transported by EMS from Aug 2015 to Sept 2016 were eligible. EMS providers completed standardized data forms and patients were followed through ED or hospital discharge. We enrolled 1,304 patients; 1147 (88%) received a cranial CT scan and were eligible for analysis. 434 (33%) patients had anticoagulant or antiplatelet use and 112 (10%) had tICH. The incidence of tICH in patients with (11%, 95%CI 8-14%) and without (9%, 95%CI 7-11%) anticoagulant or antiplatelet use was similar. Anticoagulant or antiplatelet use was not predictive of tICH on adjusted analysis. Steps 1-3 criteria alone were not sensitive in identifying tICH (27%) while the addition of anticoagulant or antiplatelet criterion improved sensitivity (63%). Other derived sets of triage criteria were highly sensitive (>98%) but poorly specific (<11%). The incidence of tICH was similar between patients with and without anticoagulant or antiplatelet use. Use of anticoagulant or antiplatelet medications was not a risk factor for tICH. We were unable to identify a set of triage criteria that was accurate for trauma center need. |
United States National Pain Strategy for Population Research: Concepts, definitions and pilot data
Von Korff M , Scher AI , Helmick C , Carter-Pokras O , Dodick D , Goulet J , Hamill-Ruth R , LeResche L , Porter L , Tait R , Terman G , Veasley C , Mackey S . J Pain 2016 17 (10) 1068-1080 National Pain Strategy (NPS) population research objectives include: estimating chronic pain prevalence; studying pain treatment with electronic health care data; and, developing metrics to assess progress in reducing chronic pain impact. In this paper, the NPS Population Research Workgroup reviews concepts relevant to achieving these aims. High impact chronic pain was defined as persistent pain with substantial restriction of life activities lasting six months or more. In pilot work, we tested a brief assessment of high impact chronic pain, and employed electronic health records data to describe pain-related health care. A mail survey of adult health plan enrollees (N=770) found that 14% had high impact chronic pain. Relative to persons with lower impact chronic pain, those with high impact chronic pain were more often frequent users of health care for pain, reported lower quality of life, greater pain-related interference with activities, and more often reported pain at multiple anatomic locations. Analyses of health care data (N=289,464) found that pain patients had higher health care costs compared to others and that pain services were typically delivered in primary care. These results support the feasibility of developing data on chronic pain through national health interview surveys and large electronic health care databases. PERSPECTIVE: Pilot analyses supported the feasibility of brief chronic pain assessments suitable for national health surveys and use of electronic health care databases to develop data regarding trends in the delivery of pain treatments, costs, and effectiveness. These methods are relevant to achieving the aims of the U.S. National Pain Strategy. |
Heart disease and stroke statistics--2014 update: a report from the American Heart Association
Go AS , Mozaffarian D , Roger VL , Benjamin EJ , Berry JD , Blaha MJ , Dai S , Ford ES , Fox CS , Franco S , Fullerton HJ , Gillespie C , Hailpern SM , Heit JA , Howard VJ , Huffman MD , Judd SE , Kissela BM , Kittner SJ , Lackland DT , Lichtman JH , Lisabeth LD , Mackey RH , Magid DJ , Marcus GM , Marelli A , Matchar DB , McGuire DK , Mohler ER 3rd , Moy CS , Mussolino ME , Neumar RW , Nichol G , Pandey DK , Paynter NP , Reeves MJ , Sorlie PD , Stein J , Towfighi A , Turan TN , Virani SS , Wong ND , Woo D , Turner MB . Circulation 2014 129 (3) e28-e292 Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease–related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. | | For this year’s edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year’s edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA’s 2020 Impact Goals. Below are a few highlights from this year’s Update. |
A cysteine protease inhibitor rescues mice from a lethal cryptosporidium parvum infection
Ndao M , Nath-Chowdhury M , Sajid M , Marcus V , Mashiyama ST , Sakanari J , Chow E , Mackey Z , Land KM , Jacobson MP , Kalyanaraman C , McKerrow JH , Arrowood MJ , Caffrey CR . Antimicrob Agents Chemother 2013 57 (12) 6063-73 Cryptosporidiosis, caused by the protozoan parasite Cryptosporidium parvum, can stunt infant growth and can be lethal in immunocompromised individuals. The most widely used drugs for treating cryptosporidiosis are nitazoxanide and paromomycin, although both exhibit limited efficacy. To investigate an alternative approach to therapy, we demonstrate that the clan CA cysteine protease inhibitor N-methyl piperazine-Phe-homoPhe-vinylsulfone phenyl (K11777) inhibits C. parvum growth in mammalian cell lines in a concentration-dependent manner. Further, using the C57BL/6 gamma interferon receptor knockout (IFN-gammaR-KO) mouse model, which is highly susceptible to C. parvum, oral or intraperitoneal treatment with K11777 for 10 days rescued mice from otherwise lethal infections. Histologic examination of untreated mice showed intestinal inflammation, villous blunting, and abundant intracellular parasite stages. In contrast, K11777-treated mice (210 mg/kg of body weight/day) showed only minimal inflammation and no epithelial changes. Three putative protease targets (termed cryptopains 1 to 3, or CpaCATL-1, -2, and -3) were identified in the C. parvum genome, but only two are transcribed in infected mammals. A homology model predicted that K11777 would bind to cryptopain 1. Recombinant enzymatically active cryptopain 1 was successfully targeted by K11777 in a competition assay with a labeled active-site-directed probe. K11777 exhibited no toxicity in vitro and in vivo, and surviving animals remained free of parasites 3 weeks after treatment. The discovery that a cysteine protease inhibitor provides potent anticryptosporidial activity in an animal model of infection encourages the investigation and development of this biocide class as a new, and urgently needed, chemotherapy for cryptosporidiosis. |
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