Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 35 Records) |
Query Trace: Quintana K [original query] |
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Bartonella quintana Endocarditis: A Systematic Review of Individual Cases
Boodman C , Gupta N , Nelson CA , van Griensven J . Clin Infect Dis 2024 78 (3) 554-561 BACKGROUND: Bartonella quintana is a louse-borne bacterium that remains a neglected cause of endocarditis in low-resource settings. Our understanding of risk factors, clinical manifestations, and treatment of B. quintana endocarditis are biased by older studies from high-income countries. METHODS: We searched Pubmed Central, Medline, Scopus, Embase, EBSCO (CABI) Global Health, Web of Science and international trial registers for articles published before March 2023 with terms related to Bartonella quintana endocarditis. We included articles containing case-level information on B. quintana endocarditis and extracted data related to patient demographics, clinical features, diagnostic testing, treatment, and outcome. RESULTS: A total of 975 records were identified, of which 569 duplicates were removed prior to screening. In total, 84 articles were eligible for inclusion, describing a total of 167 cases. Infections were acquired in 40 different countries; 62 cases (37.1%) were acquired in low- and middle-income countries (LMICs). Disproportionately more female and pediatric patients were from LMICs. More patients presented with heart failure (n = 70/167 [41.9%]) than fever (n = 65/167 [38.9%]). Mean time from symptom onset to presentation was 5.1 months. Also, 25.7% of cases (n = 43/167) were associated with embolization, most commonly to the spleen and brain; 65.5% of antimicrobial regimens included doxycycline. The vast majority of cases underwent valve replacement surgery (n = 154/167, [98.0%]). Overall case fatality rate was 9.6% (n = 16/167). CONCLUSIONS: B. quintana endocarditis has a global distribution, and long delays between symptom onset and presentation frequently occur. Improved clinician education and diagnostic capacity are needed to screen at-risk populations and identify infection before endocarditis develops. |
Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States
Rich SN , Carpenter A , Dell B , Henderson R , Adams S , Bestul N , Grano C , Sprague B , Leopold J , Schiffman EK , Lomeli A , Zadeh H , Alarcón J , Halai UA , Nam YS , Seifu L , Slavinski S , Crum D , Mosites E , Salzer JS , Hinckley AF , McCormick DW , Marx GE . Zoonoses Public Health 2024 BACKGROUND AND AIMS: Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. METHODS AND RESULTS: Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. CONCLUSIONS: Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing. |
Molecular detection of Bartonella species in ticks from Peru.
Billeter SA , Cáceres AG , Gonzales-Hidalgo J , Luna-Caypo D , Kosoy MY . J Med Entomol 2011 48 (6) 1257-60 A total of 103 ticks, collected from canines, horses, donkeys, and snakes from Peru, were screened for the presence of Bartonella DNA by polymerase chain reaction analysis. Bartonella DNA was detected in two ticks using Bartonella 16S-23S intergenic spacer region primers and in an additional two ticks using Bartonella NADH dehydrogenase gamma subunit gene (nuoG) primers. Bartonella rochalimae Eremeeva et al., B. quintana Schmincke, and B. elizabethae Daly et al. DNA was detected in a Rhipicephalus sanguineus Latreille (Acari: Ixodidae) female tick removed from a dog and B. quintana DNA was present in a Dermacentor nitens Neumann (Acari: Ixodidae) pool of five larvae, one nymph, and one adult male tick collected from donkeys. This is the first study to report the detection of B. rochalimae, B. quintana, and B. elizabethae DNA in ticks from Peru. Further investigations must be performed to decipher the role ticks may play in the transmission of Bartonella species. |
Development of a quadruplex PCR amplicon next generation sequencing assay for detection and differentiation of Bartonella spp
Bai Y , Osikowicz LM , Hojgaard A , Eisen RJ . Front Microbiol 2023 14 1243471 The genus Bartonella includes a group of species that are associated with a wide range of mammalian species, including human. It is challenging to detect all Bartonella species using a single molecular target due to its high genetic diversity. To solve this issue, we developed a quadruplex PCR amplicon sequencing assay using next-generation sequencing (NGS) technology for the detection and differentiation of Bartonella species. Our objective was to obtain the specific sequences of a minimum of two of the four target genes as confirmation of the identity of a particular Bartonella species using the assay. Four pairs of primers targeting specific regions on gltA, groEL, rpoB, and ssrA were evaluated for their capability of differentiating Bartonella species individually and collectively by performing singular PCR amplicon sequencing and quadruplex PCR amplicon sequencing. Using the quadruplex PCR amplicon sequencing, 24 Bartonella reference species were tested, all of which were successfully differentiated by at least two targets. Bartonella species were accurately identified from the artificially mixed DNA templates developed to simulate coinfections. The limit of detection was determined to be 1 fg based on testing a series of 10-fold dilutions of DNA from the Bartonella species. Testing of high DNA concentrations of 19 non-Bartonella species showed high specificity with none of the non-Bartonella species misclassified as Bartonella. Finally, the assay was evaluated by testing DNA extracts from field-collected body lice (Pediculus humanus humanus) and Norway rats (Rattus norvegicus): Bartonella quintana was detected and confirmed by three targets in the lice and Bartonella tribocorum was detected and confirmed by two targets in the rats. These results demonstrated that Bartonella species could be accurately and rapidly detected and differentiated into different tissue types using the quadruplex sequencing assay. |
Notes from the field: Severe bartonella quintana infections among persons experiencing unsheltered homelessness - New York City, January 2020-December 2022
Rich SN , Beeson A , Seifu L , Mitchell K , Wroblewski D , Juretschko S , Keller M , Gnanaprakasam R , Agladze M , Kodama R , Kupferman T , Bhatnagar J , Martines RB , Reagan-Steiner S , Slavinski S , Kuehnert MJ , Bergeron-Parent C , Corvese G , Marx GE , Ackelsberg J . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1147-1148 Bartonella quintana infection is a vectorborne disease transmitted by the human body louse (1). In the United States, homelessness is the principal risk factor for B. quintana infection (2), likely attributable to limited access to hygiene facilities (1). This infection is not nationally notifiable in the United States, and its incidence is unknown. Acute B. quintana infection can cause fever, headache, and bone pain; severe manifestations include chronic bacteremia, bacillary angiomatosis, and infective endocarditis (3). Because the bacterium requires special conditions to grow in culture, standard blood cultures are usually negative (4). Diagnosis by serology is most common; however, cross-reactivity with other Bartonella species (e.g., B. henselae) can hamper interpretation. Molecular assays specific for B. quintana have been developed (5), but availability is limited to a few laboratories. Once diagnosed, infection can be cured by several weeks to months of antibiotic therapy. |
Development and validation of a real-time PCR test to detect Bartonella quintana in clinical samples
Choat J , Yockey B , Sheldon SW , Pappert R , Petersen J , Dietrich EA . Diagn Microbiol Infect Dis 2023 106 (4) 116000 This study reports on the validation of a real-time polymerase chain reaction test targeting the vomp region of Bartonella quintana. The assay displayed 100% sensitivity and specificity for the 52 bloods and 159 cultures tested. Molecular diagnosis of Bartonella quintana can aid clinical treatment during acute infection. |
Bartonella spp. infections identified by molecular methods, United States
McCormick DW , Rassoulian-Barrett SL , Hoogestraat DR , Salipante SJ , SenGupta D , Dietrich EA , Cookson BT , Marx GE , Lieberman JA . Emerg Infect Dis 2023 29 (3) 467-476 Molecular methods can enable rapid identification of Bartonella spp. infections, which are difficult to diagnose by using culture or serology. We analyzed clinical test results of PCR that targeted bacterial 16S rRNA hypervariable V1-V2 regions only or in parallel with PCR of Bartonella-specific ribC gene. We identified 430 clinical specimens infected with Bartonella spp. from 420 patients in the United States. Median patient age was 37 (range 1-79) years; 62% were male. We identified B. henselae in 77%, B. quintana in 13%, B. clarridgeiae in 1%, B. vinsonii in 1%, and B. washoensis in 1% of specimens. B. quintana was detected in 83% of cardiac specimens; B. henselae was detected in 34% of lymph node specimens. We detected novel or uncommon Bartonella spp. in 9 patients. Molecular diagnostic testing can identify Bartonella spp. infections, including uncommon and undescribed species, and might be particularly useful for patients who have culture-negative endocarditis or lymphadenitis. |
Public health and homelessness: A framework
Mosites E , Lobelo EE , Hughes L , Butler JC . J Infect Dis 2022 226 S372-s374 Over a half million Americans experience homelessness on any given night and more than 1.4 million experience it at some point over the course of a year [1, 2]. Between 2016 and 2020, the number of people experiencing homelessness increased. The homelessness epidemic is intertwined with other epidemics, both infectious and noninfectious. For example, among US veterans who were diagnosed with opioid use disorder in 2012, 35% were experiencing homelessness. Rates of cardiovascular disease in people experiencing homelessness exceed those of the general population [3], and prevalence of invasive cancers have been reported to be significantly higher, with poorer overall cancer survival [4]. Among people with human immunodeficiency virus (HIV), 8.5% experienced homelessness in the last year, and those who experienced homelessness were 48% less likely to sustain viral suppression [5]. Invasive group A Streptococcus, invasive meningococcal disease, and Bartonella quintana infection have all been identified with much higher frequency among people experiencing homelessness than the general population [6, 7]. |
Body Lice among People Experiencing Homelessness and Access to Hygiene Services during the COVID-19 Pandemic-Preventing Trench Fever in Denver, Colorado, 2020.
Marshall KE , Martinez HE , Woodall T , Guerrero A , Mechtenberg J , Herlihy R , House J . Am J Trop Med Hyg 2022 107 (2) 427-32 Eight people with human body louse-borne Bartonella quintana infections were detected among people experiencing homelessness (PEH) in Denver during January-September 2020, prompting a public health investigation and community outreach. Public health officials conducted in-person interviews with PEH to more fully quantify body lice prevalence, transmission risk factors, access to PEH resources, and how the COVID-19 pandemic has affected resource access. Recent body lice exposure was reported by 35% of 153 interview participants. In total, 75% of participants reported reduced access to PEH services, including essential hygiene activities to prevent body lice, during Colorado's COVID-19 stay-at-home orders. Future pandemic planning should consider hygiene resource allocation for PEH populations to prevent emerging and reemerging infections such as B. quintana. |
Characteristics and clinical outcomes of patients hospitalized with laboratory-confirmed COVID-19-Puerto Rico, March-August 2020.
Volkman HR , Pérez-Padilla J , Wong JM , Sánchez-González L , Acevedo-Molina L , Lugo-Menéndez M , Oliveras García CA , Adams LE , Frasqueri-Quintana VM , Rodriguez-Gonzalez R , González-Cosme JA , Calvo Díaz AE , Alvarado LI , Rivera-Amill V , Brown J , Wong KK , Bertrán-Pasarell J , Paz-Bailey G . PLoS One 2021 16 (12) e0260599 Hispanics are the majority ethnic population in Puerto Rico where we reviewed charts of 109 hospitalized COVID-19 patients to better understand demographic and clinical characteristics of COVID-19 and determine risk factors for poor outcomes. Eligible medical records of hospitalized patients with confirmed COVID-19 illnesses were reviewed at four participating hospitals in population centers across Puerto Rico and data were abstracted that described the clinical course, interventions, and outcomes. We found hospitalized patients had a median of 3 underlying conditions with obesity and diabetes as the most frequently reported conditions. Intensive care unit (ICU) admission occurred among 28% of patients and 18% of patients died during the hospitalization. Patients 65 or older or with immune deficiencies had a higher risk for death. Common symptoms included cough, dyspnea, and fatigue; less than half of patients in the study reported fever which was less frequent than reported elsewhere in the literature. It is important for interventions within Hispanic communities to protect high-risk groups. |
Bartonella Seroreactivity Among Persons Experiencing Homelessness During an Outbreak of Bartonella quintana in Denver, Colorado, 2020.
McCormick DW , Rowan SE , Pappert R , Yockey B , Dietrich EA , Petersen JM , Hinckley AF , Marx GE . Open Forum Infect Dis 2021 8 (6) ofab230 During a recent outbreak of Bartonella quintana disease in Denver, 15% of 241 persons experiencing homelessness who presented for severe acute respiratory syndrome coronavirus 2 testing were seroreactive for Bartonella. Improved recognition of B quintana disease and prevention of louse infestation are critical for this vulnerable population. |
Reactive astrocyte nomenclature, definitions, and future directions.
Escartin C , Galea E , Lakatos A , O'Callaghan JP , Petzold GC , Serrano-Pozo A , Steinhäuser C , Volterra A , Carmignoto G , Agarwal A , Allen NJ , Araque A , Barbeito L , Barzilai A , Bergles DE , Bonvento G , Butt AM , Chen WT , Cohen-Salmon M , Cunningham C , Deneen B , De Strooper B , Díaz-Castro B , Farina C , Freeman M , Gallo V , Goldman JE , Goldman SA , Götz M , Gutiérrez A , Haydon PG , Heiland DH , Hol EM , Holt MG , Iino M , Kastanenka KV , Kettenmann H , Khakh BS , Koizumi S , Lee CJ , Liddelow SA , MacVicar BA , Magistretti P , Messing A , Mishra A , Molofsky AV , Murai KK , Norris CM , Okada S , Oliet SHR , Oliveira JF , Panatier A , Parpura V , Pekna M , Pekny M , Pellerin L , Perea G , Pérez-Nievas BG , Pfrieger FW , Poskanzer KE , Quintana FJ , Ransohoff RM , Riquelme-Perez M , Robel S , Rose CR , Rothstein JD , Rouach N , Rowitch DH , Semyanov A , Sirko S , Sontheimer H , Swanson RA , Vitorica J , Wanner IB , Wood LB , Wu J , Zheng B , Zimmer ER , Zorec R , Sofroniew MV , Verkhratsky A . Nat Neurosci 2021 24 (3) 312-325 Reactive astrocytes are astrocytes undergoing morphological, molecular, and functional remodeling in response to injury, disease, or infection of the CNS. Although this remodeling was first described over a century ago, uncertainties and controversies remain regarding the contribution of reactive astrocytes to CNS diseases, repair, and aging. It is also unclear whether fixed categories of reactive astrocytes exist and, if so, how to identify them. We point out the shortcomings of binary divisions of reactive astrocytes into good-vs-bad, neurotoxic-vs-neuroprotective or A1-vs-A2. We advocate, instead, that research on reactive astrocytes include assessment of multiple molecular and functional parameters-preferably in vivo-plus multivariate statistics and determination of impact on pathological hallmarks in relevant models. These guidelines may spur the discovery of astrocyte-based biomarkers as well as astrocyte-targeting therapies that abrogate detrimental actions of reactive astrocytes, potentiate their neuro- and glioprotective actions, and restore or augment their homeostatic, modulatory, and defensive functions. |
Developing an experimental climate and health monitor and outlook
Jones HM , Quintana AV , Trtanj J , Balbus J , Schramm P , Saha S , Castranio T , Di Liberto TE . Bull Am Meteorol Soc 2020 101 (10) E1690-E1696 The U.S. Global Change Research Program (USGCRP) Climate and Health Monitor and Outlook (CHMO) workshop convened 23 experts in climate and health from government and academia to understand how existing climate and health prediction systems for specific diseases, vectors, and pathogens are producing and sharing information for health decision-making. | | The principal goal of the workshop was to understand how a national, integrated climate and health outlook, focused on vector-borne diseases, could be developed to support public health decision-makers in managing health risks. The CHMO workshop enabled the group to incorporate lessons and information from the many existing disease prediction systems across the nation to discuss how to create a consistent national view of potential health impacts from predicted future climatic conditions. This workshop summary synthesizes our discussion, captures a table of datasets and products that the CHMO can draw upon to characterize important aspects of climate-sensitive disease risk, and suggests a set of next steps to achieve progress in predicting these risks. |
The association between opioid discontinuation and heroin use: A nested case-control study
Binswanger IA , Glanz JM , Faul M , Shoup JA , Quintana LM , Lyden J , Xu S , Narwaney KJ . Drug Alcohol Depend 2020 217 108248 BACKGROUND: Opioid prescribing guidelines recommend reducing or discontinuing opioids for chronic pain if harms of opioid treatment outweigh benefits. As opioid discontinuation becomes more prevalent, it is important to understand whether opioid discontinuation is associated with heroin use. In this study, we sought to assess the association between opioid discontinuation and heroin use documented in the medical record. METHODS: A matched nested case-control study was conducted in an integrated health plan and delivery system in Colorado. Patients receiving opioid therapy in the study period (January 2006-June 2018) were included. Opioid discontinuation was defined as ≥45 days with no opioids dispensed after initiating opioid therapy. The heroin use onset date represented the index date. Case patients were matched to up to 20 randomly selected patients without heroin use (control patients) by age, sex, calendar time, and time between initiating opioid therapy and the index date. Conditional logistic regression models estimated matched odds ratios (mOR) for the association between an opioid discontinuation prior to the index date and heroin use. RESULTS: Among 22,962 patients prescribed opioid therapy, 125 patients (0.54%) used heroin after initiating opioid therapy, of which 74 met criteria for inclusion in the analysis. The odds of opioid discontinuation were approximately two times higher in case patients (n = 74) than control patients (n = 1045; mOR = 2.19; 95% CI 1.27-3.78). CONCLUSIONS: Among patients prescribed chronic opioid therapy, the observed increased risk for heroin use associated with opioid discontinuation should be balanced with potential benefits. |
Modeling the potential impact of administering vaccines against Clostridioides difficile infection to individuals in healthcare facilities.
Toth DJA , Keegan LT , Samore MH , Khader K , O'Hagan JJ , Yu H , Quintana A , Swerdlow DL . Vaccine 2020 38 (37) 5927-5932 BACKGROUND: A vaccine against Clostridioides difficile infection (CDI) is in development. While the vaccine has potential to both directly protect those vaccinated and mitigate transmission by reducing environmental contamination, the impact of the vaccine on C. difficile colonization remains unclear. Consequently, the transmission-reduction effect of the vaccine depends on the contribution of symptomatic CDI to overall transmission of C. difficile. METHODS: We designed a simulation model of CDI among patients in a network of 10 hospitals and nursing homes and calibrated the model using estimates of transmissibility from whole genome sequencing studies that estimated the fraction of CDI attributable to transmission from other CDI patients. We assumed the vaccine reduced the rate of progression to CDI among carriers by 25-95% after completion of a 3-dose vaccine course administered to randomly chosen patients at facility discharge. We simulated the administration of this vaccination campaign and tallied effects over 5 years. RESULTS: We estimated 30 times higher infectivity of CDI patients compared to other carriers. Simulations of the vaccination campaign produced an average reduction of 3-16 CDI cases per 1000 vaccinated patients, with 2-11 of those cases prevented among those vaccinated and 1-5 prevented among unvaccinated patients. CONCLUSIONS: Our findings demonstrate potential for a vaccine against CDI to reduce transmissions in healthcare facilities, even with no direct effect on carriage susceptibility. The vaccine's population impact will increase if received by individuals at risk for CDI onset in high-transmission settings. |
Evaluation of emergency department-based surveillance systems at 2 healthcare facilities after Hurricane Maria: Puerto Rico, 2017-2018
Adams LE , Vargas L , Frasqueri-Quintana VM , Torres-Figueroa X , Ryff K , Sanchez-Gonzalez L , Little E , Ciampaglio K , Reyes Claudio JM , Ponton-Cruz E , Santiago W , Paz-Bailey G , Alvarado LI . Disaster Med Public Health Prep 2019 17 1-9 OBJECTIVES: Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico. METHODS: We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period. RESULTS: The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category. CONCLUSIONS: The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings. |
Injury-related emergency department visits after hurricane Maria in a southern Puerto Rico hospital
Frasqueri-Quintana VM , Oliveras Garcia CA , Adams LE , Torres-Figueroa X , Iriarte RI , Ryff K , Sanchez-Gonzalez L , Perez Gomez V , Perez-Rodriguez NM , Alvarado LI , Paz-Bailey G . Disaster Med Public Health Prep 2019 14 (1) 1-8 OBJECTIVE: The aim of this study was to describe individuals seeking care for injury at a major emergency department (ED) in southern Puerto Rico in the months after Hurricane Maria on September 20, 2017. METHODS: After informed consent, we used a modified version of the Natural Disaster Morbidity Surveillance Form to determine why patients were visiting the ED during October 16, 2017-March 28, 2018. We analyzed visits where injury was reported as the primary reason for visit and whether it was hurricane-related. RESULTS: Among 5 116 patients, 573 (11%) reported injury as the primary reason for a visit. Of these, 10% were hurricane-related visits. The most common types of injuries were abrasions, lacerations, and cuts (43% of all injury visits and 50% of hurricane-related visits). The most common mechanisms of injury were falls, slips, trips (268, 47%), and being hit by/or against an object (88, 15%). Most injury visits occurred during the first 3 months after the hurricane. CONCLUSIONS: Surveillance after Hurricane Maria identified injury as the reason for a visit for about 1 in 10 patients visiting the ED, providing evidence on the patterns of injuries in the months following a hurricane. Public health and emergency providers can use this information to anticipate health care needs after a disaster. |
Factors of success for transitioning from a scientific role to a supervisory leadership role in a federal public health agency, 2016
Flores AL , Risley K , Zanoni J , Welter C , Hawkins D , Pinsker E , Quintana K . Public Health Rep 2019 134 (5) 466-471 Public health issues, such as emerging health threats, globalization of health, and a rapidly aging population, are challenging the public health system.1-4 These health demands require public health leaders who have the skills and competencies to address a changing landscape.5,6 These skills go beyond discipline-specific domains. To address public health challenges, leaders need skills that span areas that might not be taught in traditional schools and programs of public health,7 including “less definable skills in leadership, communication, problem solving, and systems thinking.”8 |
Randomised controlled trial of real-time feedback and brief coaching to reduce indoor smoking
Hovell MF , Bellettiere J , Liles S , Nguyen B , Berardi V , Johnson C , Matt GE , Malone J , Boman-Davis MC , Quintana PJE , Obayashi S , Chatfield D , Robinson R , Blumberg EJ , Ongkeko WM , Klepeis NE , Hughes SC . Tob Control 2019 29 (2) 183-190 BACKGROUND: Previous secondhand smoke (SHS) reduction interventions have provided only delayed feedback on reported smoking behaviour, such as coaching, or presenting results from child cotinine assays or air particle counters. DESIGN: This SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups. PARTICIPANTS: We enrolled 298 families with a resident tobacco smoker and a child under age 14. INTERVENTION: We installed air particle monitors in all homes. For the intervention homes, immediate light and sound feedback was contingent on elevated indoor particle levels, and up to four coaching sessions used prompts and praise contingent on smoking outdoors. Mean intervention duration was 64 days. MEASURES: The primary outcome was 'particle events' (PEs) which were patterns of air particle concentrations indicative of the occurrence of particle-generating behaviours such as smoking cigarettes or burning candles. Other measures included indoor air nicotine concentrations and participant reports of particle-generating behaviour. RESULTS: PEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes. CONCLUSIONS: Results suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources. TRIAL REGISTRATION NUMBER: NCT01634334; Post-results. |
Identifying preanalytic and postanalytic laboratory quality gaps using a data warehouse and structured multidisciplinary process
Raebel MA , Quintana LM , Schroeder EB , Shetterly SM , Pieper LE , Epner PL , Bechtel LK , Smith DH , Sterrett AT , Chorny JA , Lubin IM . Arch Pathol Lab Med 2018 143 (4) 518-524 CONTEXT.-: The laboratory total testing process includes preanalytic, analytic, and postanalytic phases, but most laboratory quality improvement efforts address the analytic phase. Expanding quality improvement to preanalytic and postanalytic phases via use of medical data warehouses, repositories that include clinical, utilization, and administrative data, can improve patient care by ensuring appropriate test utilization. Cross-department, multidisciplinary collaboration to address gaps and improve patient and system outcomes is beneficial. OBJECTIVE.-: To demonstrate medical data warehouse utility for characterizing laboratory-associated quality gaps amenable to preanalytic or postanalytic interventions. DESIGN.-: A multidisciplinary team identified quality gaps. Medical data warehouse data were queried to characterize gaps. Organizational leaders were interviewed about quality improvement priorities. A decision aid with elements including national guidelines, local and national importance, and measurable outcomes was completed for each gap. RESULTS.-: Gaps identified included (1) test ordering; (2) diagnosis, detection, and documentation, and (3) high-risk medication monitoring. After examination of medical data warehouse data including enrollment, diagnoses, laboratory, pharmacy, and procedures for baseline performance, high-risk medication monitoring was selected, specifically alanine aminotransferase, aspartate aminotransferase, complete blood count, and creatinine testing among patients receiving disease-modifying antirheumatic drugs. The test utilization gap was in monitoring timeliness (eg, >60% of patients had a monitoring gap exceeding the guideline recommended frequency). Other contributors to selecting this gap were organizational enthusiasm, regulatory labeling, and feasibility of a significant laboratory role in addressing the gap. CONCLUSIONS.-: A multidisciplinary process facilitated identification and selection of a laboratory medicine quality gap. Medical data warehouse data were instrumental in characterizing gaps. |
Developing a public health pipeline: Key components of a public health leadership program
Flores AL , Risley K , Quintana K . Prev Med Community Health 2018 2018 (2) Thirty percent of federal public health employees were retirement eligible in September 2017. Further, at the state public health level, as indicated in the recent Public Health Workforce Interests and Needs Survey (PH WINS), an estimated 25% of employees are planning to retire before 2020 with an additional 18% intending to leave their organizations within one year. Due to these workforce changes, there is an urgent need for public health organizations to examine how they are ensuring a talent pool from which leaders can emerge. As a large federal public health agency, the Centers for Disease Control and Prevention (CDC) faces the challenge of providing leadership development to staff. Factors were examined that agency leaders identified as key components of a leadership development program to transition scientific public health staff into supervisory leadership roles. While many factors contribute to leadership development, participants more often identified training, provision of opportunities, mentors, and identification of high potential employees as key components of a leadership develop program. With the need to develop organizational leaders to be ready when vacancies become available, findings from this study can inform the development and implementation of public health leadership development programs. |
Drivers of international variation in prevalence of disabling low back pain: Findings from the CUPID study
Coggon D , Ntani G , Palmer KT , Felli VE , Harari F , Quintana LA , Felknor SA , Rojas M , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu-Mkhize B , Kelsall HL , Harcombe H . Eur J Pain 2018 23 (1) 35-45 BACKGROUND: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally. METHODS: Baseline information about musculoskeletal pain and risk factors was elicited from 11,710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterised by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ("pain propensity index"). After a mean interval of 14 months, 9,055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression. RESULTS: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95%CI 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58). CONCLUSIONS: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine. This article is protected by copyright. All rights reserved. |
An updated review of ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management
Friedman MA , Fernandez M , Backer LC , Dickey RW , Bernstein J , Schrank K , Kibler S , Stephan W , Gribble MO , Bienfang P , Bowen RE , Degrasse S , Flores Quintana HA , Loeffler CR , Weisman R , Blythe D , Berdalet E , Ayyar R , Clarkson-Townsend D , Swajian K , Benner R , Brewer T , Fleming LE . Mar Drugs 2017 15 (3) Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties. |
Epidemiological differences between localised and non-localised low back pain
Coggon D , Ntani G , Walker-Bone K , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Sarquis LMM , Marziale MH , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Harris EC , Serra C , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Freimann T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VCW , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A , Salazar Vega EJ . Spine (Phila Pa 1976) 2016 42 (10) 740-747 STUDY DESIGN: Cross-sectional survey with longitudinal follow-up OBJECTIVES.: To test the hypothesis that pain which is localised to the low back differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analysed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability and potential risk factors, in 47 occupational groups (office workers, nurses and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localised LBP in the past month, and 3,820 (31.3%) non-localised LBP. Non-localised LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, non-localised LBP was differentially associated with risk factors, particularly female sex, older age and somatising tendency. There were also marked differences in the relative prevalence of localised and non-localised LBP by occupational group. CONCLUSIONS: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP which occurs in association with pain at other anatomical locations. LEVEL OF EVIDENCE: 2. |
Descriptive epidemiology of somatising tendency: Findings from the CUPID study
Vargas-Prada S , Coggon D , Ntani G , Walker-Bone K , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Sarquis LM , Marziale MH , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Harris EC , Serra C , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Freimann T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VC , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A , Vega EJ . PLoS One 2016 11 (4) e0153748 Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait. |
Classification of neck/shoulder pain in epidemiological research: A comparison of personal and occupational characteristics, disability and prognosis among 12,195 workers from 18 countries
Sarquis LM , Coggon D , Ntani G , Walker-Bone K , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Harris EC , Serra C , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Tiina , Freimann , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VC , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A , Salazar Vega EJ . Pain 2016 157 (5) 1028-1036 To inform case-definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9,150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The one-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs. 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs. 1.3) and poor mental health (PRR 1.3 vs. 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs. 61.7%). Our findings highlight important epidemiological distinctions between sub-categories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain which is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region. |
Bartonella spp. bacteremia in blood donors from Campinas, Brazil.
Pitassi LH , de Paiva Diniz PP , Scorpio DG , Drummond MR , Lania BG , Barjas-Castro ML , Gilioli R , Colombo S , Sowy S , Breitschwerdt EB , Nicholson WL , Velho PE . PLoS Negl Trop Dis 2015 9 (1) e0003467 Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death. This pathogen can survive for over a month in stored blood. However, its prevalence among blood donors is unknown, and screening of blood supplies for this pathogen is not routinely performed. We investigated Bartonella spp. prevalence in 500 blood donors from Campinas, Brazil, based on a cross-sectional design. Blood samples were inoculated into an enrichment liquid growth medium and sub-inoculated onto blood agar. Liquid culture samples and Gram-negative isolates were tested using a genus specific ITS PCR with amplicons sequenced for species identification. Bartonella henselae and Bartonella quintana antibodies were assayed by indirect immunofluorescence. B. henselae was isolated from six donors (1.2%). Sixteen donors (3.2%) were Bartonella-PCR positive after culture in liquid or on solid media, with 15 donors infected with B. henselae and one donor infected with Bartonella clarridgeiae. Antibodies against B. henselae or B. quintana were found in 16% and 32% of 500 blood donors, respectively. Serology was not associated with infection, with only three of 16 Bartonella-infected subjects seropositive for B. henselae or B. quintana. Bartonella DNA was present in the bloodstream of approximately one out of 30 donors from a major blood bank in South America. Negative serology does not rule out Bartonella spp. infection in healthy subjects. Using a combination of liquid and solid cultures, PCR, and DNA sequencing, this study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors. Our findings support further evaluation of Bartonella spp. transmission which can occur through blood transfusions. |
Risk factors for human lice and Bartonellosis among the homeless, San Francisco, California, USA
Bonilla DL , Cole-Porse C , Kjemtrup A , Osikowicz L , Kosoy M . Emerg Infect Dis 2014 20 (10) 1645-51 Homeless persons in San Francisco, California, USA, have been shown to have head and body lice infestations and Bartonella quintana infections. We surveyed a self-selected population of homeless persons in San Francisco to assess infestations of head and body lice, risks of having body lice, and presence of B. quintana in lice. A total of 203 persons who reported itching were surveyed during 2008-2010 and 2012: 60 (30%) had body lice, 10 (4.9%) had head lice, and 6 (3.0%) had both. B. quintana was detected in 10 (15.9%) of 63 body lice pools and in 6 (37.5%) of 16 head lice pools. Variables significantly associated (p<0.05) with having body lice in this homeless population included male sex, African-American ethnicity, and sleeping outdoors. Our study findings suggest that specific segments of the homeless population would benefit from information on preventing body lice infestations and louse-borne diseases. |
Patterns of multisite pain and associations with risk factors
Coggon D , Ntani G , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Masood Kadir M , Warnakulasuriya SSP , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Sarquis LM , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Salazar Vega EJ , Harris CE , Serra C , Martinez MJ , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Sirk T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe RA , Yoshimura N , Kelsall HL , Hoe VCW , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A . Pain 2013 154 (9) 1769-77 To explore definitions for multisite pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants vs 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites. |
Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture?
Coggon D , Ntani G , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Serra C , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Masood Kadir M , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Sarquis LM , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Salazar Vega EJ , Harris EC , Vargas-Prada S , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Sirk T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VC , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A . Pain 2013 154 (6) 856-63 To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed. |
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