Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-30 (of 30 Records) |
Query Trace: Sacks J [original query] |
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Asthma-associated emergency department visits during the Canadian wildfire smoke episodes - United States, April- August 2023
McArdle CE , Dowling TC , Carey K , DeVies J , Johns D , Gates AL , Stein Z , van Santen KL , Radhakrishnan L , Kite-Powell A , Soetebier K , Sacks JD , Sircar K , Hartnett KP , Mirabelli MC . MMWR Morb Mortal Wkly Rep 2023 72 (34) 926-932 During April 30-August 4, 2023, smoke originating from wildfires in Canada affected most of the contiguous United States. CDC used National Syndromic Surveillance Program data to assess numbers and percentages of asthma-associated emergency department (ED) visits on days with wildfire smoke, compared with days without wildfire smoke. Wildfire smoke days were defined as days when concentrations of particulate matter (particles generally ≤2.5 μm in aerodynamic diameter) (PM(2.5)) triggered an Air Quality Index ≥101, corresponding to the air quality categorization, "Unhealthy for Sensitive Groups." Changes in asthma-associated ED visits were assessed across U.S. Department of Health and Human Services regions and by age. Overall, asthma-associated ED visits were 17% higher than expected during the 19 days with wildfire smoke that occurred during the study period; larger increases were observed in regions that experienced higher numbers of continuous wildfire smoke days and among persons aged 5-17 and 18-64 years. These results can help guide emergency response planning and public health communication strategies, especially in U.S. regions where wildfire smoke exposure was previously uncommon. |
At the intersection: Protecting public health from smoke while addressing the U.S. Wildfire Crisis
Sacks JD , Holder AL , Rappold AG , Vaidyanathan A . Am J Respir Crit Care Med 2023 208 (7) 755-757 Climate change, historical practices of fire suppression, and an increase in the growth of the wildland-urban interface are driving forces behind the increased occurrence of large, catastrophic fires in the U.S. (1, 2). While fire itself can lead to extensive damage and detrimental ecological effects, the smoke emitted has substantial adverse impacts on public health. Wildfire smoke consists of a complex mixture, including fine particles (PM2.5; particles with aerodynamic diameter generally ≤ 2.5 μm), which has been shown to impact large geographic domains and contribute to thousands of estimated deaths and illnesses annually (2, 3). As a result, public health agencies at the local, state, and national levels have developed strategies to reduce exposure to smoke and to address wide-ranging health concerns associated with such exposures. These strategies help prepare and educate individuals and communities before, during, and after smoke episodes; and are instituted by well-documented programs (e.g., smoke-ready programs, the Interagency Wildland Fire Air Quality Response Program (IWFAQRP) (https://www.wildlandfiresmoke.net/) with the overarching goal of raising awareness on a suite of public health approaches and preventative measures (4). |
Human-aided dispersal facilitates parasitism escape in the most invasive mosquito species (preprint)
Girard M , Martin E , Vallon L , Van VT , Da Silva Carvalho C , Sacks J , Bontemps Z , Balteneck J , Colin F , Duval P , Malassigne S , Swanson J , Hennessee I , Jiang S , Vizcaino L , Romer Y , Dada N , Huynh Kim KL , Thi Thuy TH , Bellet C , Lambert G , Raharimalala FN , Jupatanakul N , Goubert C , Boulesteix M , Mavingui P , Desouhant E , Luis P , Cazabet R , Hay AE , Moro CV , Minard G . bioRxiv 2023 20 Human-aided invasion of alien species across the world sometimes leads to economic, health or environmental burdens. During invasion process, species encounter new environments and partially escape some ecological constrains they faced in their native range, while they face new ones. The Asian tiger mosquito Aedes albopictus is one of the most iconic invasive species that was introduced in every inhabited continent over a short period of time due to international trade. It has also been shown to be infected by a prevalent and yet disregarded gregarine entomoparasite Ascogregarina taiwanensis. In this study, we aimed at deciphering the global dynamics of As. taiwanensis infection in natural Ae. albopictus populations and we further explored factors shaping its distribution. We showed that Ae. albopictus populations are highly colonized by several As. taiwanesis genotypes but recently introduced ones are escaping the parasite. We further performed experiments to explain such pattern. First, we hypothesized that founder effects (i.e. population establishment by a small number of individuals) may influence the parasite dynamics. This was confirmed since experimental increase in mosquitoes' density improves the parasite horizontal transmission to larvae. Furthermore, Ae. albopictus larvae do not exhibit density dependent prophylaxis to control the parasite meaning that infection is not mitigated when larval density increases. Secondly, we hypothesized that unparasitized mosquitoes were more prompt to found new populations through active flight dispersal. This was, however, unlikely since parasitized mosquitoes tend to be more active than their unparasitized relatives. Finally, we hypothesized that mosquito passive dispersal (i.e. often mediated by human-aided transportation of dried eggs) affects the parasite infectiveness. Our results support this hypothesis since parasite infection decreases over time when dry eggs are stored. This study highlights the importance of global trade on parasitism escape in one of the most invasive vector species on earth. Copyright The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
An early warning system for emerging SARS-CoV-2 variants.
Subissi L , von Gottberg A , Thukral L , Worp N , Oude Munnink BB , Rathore S , Abu-Raddad LJ , Aguilera X , Alm E , Archer BN , Attar Cohen H , Barakat A , Barclay WS , Bhiman JN , Caly L , Chand M , Chen M , Cullinane A , de Oliveira T , Drosten C , Druce J , Effler P , El Masry I , Faye A , Gaseitsiwe S , Ghedin E , Grant R , Haagmans BL , Herring BL , Iyer SS , Kassamali Z , Kakkar M , Kondor RJ , Leite JA , Leo YS , Leung GM , Marklewitz M , Moyo S , Mendez-Rico J , Melhem NM , Munster V , Nahapetyan K , Oh DY , Pavlin BI , Peacock TP , Peiris M , Peng Z , Poon LLM , Rambaut A , Sacks J , Shen Y , Siqueira MM , Tessema SK , Volz EM , Thiel V , van der Werf S , Briand S , Perkins MD , Van Kerkhove MD , Koopmans MPG , Agrawal A . Nat Med 2022 28 (6) 1110-1115 Global sequencing and surveillance capacity for SARS-CoV-2 must be strengthened and combined with multidisciplinary studies of infectivity, virulence and immune escape, in order to track the unpredictable evolution of the ongoing COVID-19 pandemic. | | In June 2020, the World Health Organization (WHO) SARS-CoV-2 evolution working group was established to track SARS-CoV-2 variants and their specific genetic changes and to monitor viral characteristics and their impact on medical and non-medical countermeasures, including vaccines against COVID-19. In November 2021, this working group transitioned to a formal WHO Technical Advisory Group on Virus Evolution (TAG-VE), with the aim of developing and implementing a global risk-monitoring framework for SARS-CoV-2 variants, based on a multidisciplinary approach that includes in silico, virological, clinical and epidemiological data. |
When to update COVID-19 vaccine composition.
Grant R , Sacks JA , Abraham P , Chunsuttiwat S , Cohen C , Figueroa JP , Fleming T , Fine P , Goldblatt D , Hasegawa H , MacIntrye CR , Memish ZA , Miller E , Nishioka S , Sall AA , Sow S , Tomori O , Wang Y , Van Kerkhove MD , Wambo MA , Cohen HA , Mesfin S , Otieno JR , Subissi L , Briand S , Wentworth DE , Subbarao K . Nat Med 2023 29 (4) 776-780 Vaccines against different SARS-CoV-2 variants have been approved, but continued surveillance is needed to determine when the antigen composition of vaccines should be updated, together with clinical studies to assess vaccine efficacy. | | Entering the fourth year of the COVID-19 pandemic, index virus-based1 vaccines across several different platforms continue to provide high levels of protection against severe disease caused by all variants of SARS-CoV-2, including Omicron2. However, there has been continuous and substantial evolution of SARS-CoV-2 since the virus emerged, posing challenges to the ongoing public health response, including ensuring that vaccines continue to provide protection. In September 2021, the World Health Organization (WHO) established the Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC)3 to assess the public health implications of emerging SARS-CoV-2 variants of concern (VOC) on the performance of COVID-19 vaccines and to issue timely recommendations on proposed modifications to vaccine antigen composition. The TAG-CO-VAC has evaluated evidence to inform its advice on COVID-19 vaccine composition so far, but there remain challenges and evidence gaps that the scientific community needs to address to enable future, timely decisions on modifications to COVID-19 vaccine antigen composition. |
Improving estimates of alcohol-attributable deaths in the United States: Impact of adjusting for the underreporting of alcohol consumption
Esser MB , Sherk A , Subbaraman MS , Martinez P , Karriker-Jaffe KJ , Sacks JJ , Naimi TS . J Stud Alcohol Drugs 2022 83 (1) 134-144 OBJECTIVE: Self-reported alcohol consumption in U.S. public health surveys covers only 30%-60% of per capita alcohol sales, based on tax and shipment data. To estimate alcohol-attributable harms using alcohol-attributable fractions, accurate measures of total population consumption and the distribution of this drinking are needed. This study compared methodological approaches of adjusting self-reported survey data on alcohol consumption to better reflect sales and assessed the impact of these adjustments on the distribution of average daily consumption (ADC) levels and the number of alcohol-attributable deaths. METHOD: Prevalence estimates of ADC levels (i.e., low, medium, and high) among U.S. adults who responded to the 2011-2015 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,198,089) were estimated using six methods. BRFSS ADC estimates were adjusted using the National Alcohol Survey, per capita alcohol sales data (from the Alcohol Epidemiologic Data System), or both. Prevalence estimates for the six methods were used to estimate average annual alcohol-attributable deaths, using a population-attributable fraction approach. RESULTS: Self-reported ADC in the BRFSS accounted for 31.3% coverage of per capita alcohol sales without adjustments, 36.1% using indexed-BRFSS data, and 44.3% with National Alcohol Survey adjustments. Per capita sales adjustments decreased low ADC prevalence estimates and increased medium and high ADC prevalence estimates. Estimated alcohol-attributable deaths ranged from approximately 91,200 per year (BRFSS unadjusted; Method 1) to 125,200 per year (100% of per capita sales adjustment; Method 6). CONCLUSIONS: Adjusting ADC to reflect total U.S. alcohol consumption (e.g., adjusting to 73% of per capita sales) has implications for assessing the impact of excessive drinking on health outcomes, including alcohol-attributable death estimates. |
Prevalence of aflatoxins in dietary staples in the border county of Busia, Western Kenya
Awuor AO , Thuita FM , Okoth SD . Afr J Food Agric Nutr Dev 2020 20 (7) 17045-17062 Aflatoxins, secondary metabolites of some Aspergillus fungi, are of public health importance. They are major contaminants of cereals and tubers. Data on prevalence of aflatoxin contamination of sorghum, millet and cassava in Busia County are limited. The extent of aflatoxin contamination in dietary staples in Busia County were assessed and potential sources associated with the contamination evaluated. A tool designed to collect sociodemographic profile, food sources and storage locations and vessels and food consumption habits of respondents was loaded onto an Open Data Kit and used in 3 subcounties. Quantitative data were analyzed using SAS version 15 software. Maize, millet, sorghum, cassava and groundnut samples were collected from 469 households. Competitive Enzyme-linked Immunosorbent Assay method was used to determine total aflatoxin levels in food samples. Sixty-eight percent of the maize samples were sourced from the market. Approximately 75% of maize samples were stored in polypropylene sacks. Samples of all five foods had detectable levels of aflatoxin. Overall, maize had the highest level of contamination (mean 100 ppb; SD 252.9; range 1-1584 ppb) with about a third of maize samples above the East African Community regulatory limits (10 ppb). The levels of aflatoxin ranged from 0.3 to 740 ppb in sorghum, 0.5 to 15 ppb in cassava, from 0.5 to 12 ppb in millet and from 0.1 to 2.8 ppb in groundnuts. The odds of contamination above 10 ppb for market-sourced maize was 1.2 times higher than homegrown maize (OR 1.185, CI 0.554, 2.534). Sorghum stored in buckets had a 12.81 likelihood of having higher than allowable limits of aflatoxin (OR 12.82, CI 2.566, 63.992) than when stored in polypropylene sacks. Aflatoxin is prevalent in the dietary staples consumed in households within Busia County. Residents are at risk of chronic exposure to aflatoxin. Enhanced market surveillance within the county is recommended. |
Distribution of drinks consumed by U.S. adults by average daily alcohol consumption: A comparison of 2 nationwide surveys
Esser MB , Sacks JJ , Sherk A , Karriker-Jaffe KJ , Greenfield TK , Pierannunzi C , Brewer RD . Am J Prev Med 2020 59 (5) 669-677 INTRODUCTION: Estimates of alcohol consumption in the Behavioral Risk Factor Surveillance System are generally lower than those in other surveys of U.S. adults. This study compares the estimates of adults' drinking patterns and the distribution of drinks consumed by average daily alcohol consumption from 2 nationwide telephone surveys. METHODS: The 2014-2015 National Alcohol Survey (n=7,067) and the 2015 Behavioral Risk Factor Surveillance System (n=408,069) were used to assess alcohol consumption among adults (≥18 years), analyzed in 2019. The weighted prevalence of binge-level drinking and the distribution of drinks consumed by average daily alcohol consumption (low, medium, high) were assessed for the previous 12 months using the National Alcohol Survey and the previous 30 days using the Behavioral Risk Factor Surveillance System, stratified by respondents' characteristics. RESULTS: The prevalence of binge-level drinking in a day was 26.1% for the National Alcohol Survey; the binge drinking prevalence was 17.4% for the Behavioral Risk Factor Surveillance System. The prevalence of high average daily alcohol consumption among current drinkers was 8.2% for the National Alcohol Survey, accounting for 51.0% of total drinks consumed, and 3.3% for the Behavioral Risk Factor Surveillance System, accounting for 27.7% of total drinks consumed. CONCLUSIONS: National Alcohol Survey yearly prevalence estimates of binge-level drinking in a day and high average daily consumption were consistently greater than Behavioral Risk Factor Surveillance System monthly binge drinking and high average daily consumption prevalence estimates. When planning and evaluating prevention strategies, the impact of different survey designs and methods on estimates of excessive drinking and related harms is important to consider. |
Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data
Barr DA , Lewis JM , Feasey N , Schutz C , Kerkhoff AD , Jacob ST , Andrews B , Kelly P , Lakhi S , Muchemwa L , Bacha HA , Hadad DJ , Bedell R , van Lettow M , Zachariah R , Crump JA , Alland D , Corbett EL , Gopinath K , Singh S , Griesel R , Maartens G , Mendelson M , Ward AM , Parry CM , Talbot EA , Munseri P , Dorman SE , Martinson N , Shah M , Cain K , Heilig CM , Varma JK , Gottberg AV , Sacks L , Wilson D , Squire SB , Lalloo DG , Davies G , Meintjes G . Lancet Infect Dis 2020 20 (6) 742-752 BACKGROUND: The clinical and epidemiological significance of HIV-associated Mycobacterium tuberculosis bloodstream infection (BSI) is incompletely understood. We hypothesised that M tuberculosis BSI prevalence has been underestimated, that it independently predicts death, and that sputum Xpert MTB/RIF has suboptimal diagnostic yield for M tuberculosis BSI. METHODS: We did a systematic review and individual patient data (IPD) meta-analysis of studies performing routine mycobacterial blood culture in a prospectively defined patient population of people with HIV aged 13 years or older. Studies were identified through searching PubMed and Scopus up to Nov 10, 2018, without language or date restrictions and through manual review of reference lists. Risk of bias in the included studies was assessed with an adapted QUADAS-2 framework. IPD were requested for all identified studies and subject to harmonised inclusion criteria: age 13 years or older, HIV positivity, available CD4 cell count, a valid mycobacterial blood culture result (excluding patients with missing data from lost or contaminated blood cultures), and meeting WHO definitions for suspected tuberculosis (presence of screening symptom). Predicted probabilities of M tuberculosis BSI from mixed-effects modelling were used to estimate prevalence. Estimates of diagnostic yield of sputum testing with Xpert (or culture if Xpert was unavailable) and of urine lipoarabinomannan (LAM) testing for M tuberculosis BSI were obtained by two-level random-effect meta-analysis. Estimates of mortality associated with M tuberculosis BSI were obtained by mixed-effect Cox proportional-hazard modelling and of effect of treatment delay on mortality by propensity-score analysis. This study is registered with PROSPERO, number 42016050022. FINDINGS: We identified 23 datasets for inclusion (20 published and three unpublished at time of search) and obtained IPD from 20, representing 96.2% of eligible IPD. Risk of bias for the included studies was assessed to be generally low except for on the patient selection domain, which was moderate in most studies. 5751 patients met harmonised IPD-level inclusion criteria. Technical factors such as number of blood cultures done, timing of blood cultures relative to blood sampling, and patient factors such as inpatient setting and CD4 cell count, explained significant heterogeneity between primary studies. The predicted probability of M tuberculosis BSI in hospital inpatients with HIV-associated tuberculosis, WHO danger signs, and a CD4 count of 76 cells per muL (the median for the cohort) was 45% (95% CI 38-52). The diagnostic yield of sputum in patients with M tuberculosis BSI was 77% (95% CI 63-87), increasing to 89% (80-94) when combined with urine LAM testing. Presence of M tuberculosis BSI compared with its absence in patients with HIV-associated tuberculosis increased risk of death before 30 days (adjusted hazard ratio 2.48, 95% CI 2.05-3.08) but not after 30 days (1.25, 0.84-2.49). In a propensity-score matched cohort of participants with HIV-associated tuberculosis (n=630), mortality increased in patients with M tuberculosis BSI who had a delay in anti-tuberculosis treatment of longer than 4 days compared with those who had no delay (odds ratio 3.15, 95% CI 1.16-8.84). INTERPRETATION: In critically ill adults with HIV-tuberculosis, M tuberculosis BSI is a frequent manifestation of tuberculosis and predicts mortality within 30 days. Improved diagnostic yield in patients with M tuberculosis BSI could be achieved through combined use of sputum Xpert and urine LAM. Anti-tuberculosis treatment delay might increase the risk of mortality in these patients. FUNDING: This study was supported by Wellcome fellowships 109105Z/15/A and 105165/Z/14/A. |
The YSI 2300 Analyzer Replacement Meeting Report
Han J , Heinemann L , Ginsberg BH , Alva S , Appel M , Bess S , Chen KY , Freckmann G , Harris DR , Hartwig M , Hinzmann R , Kerr D , Krouwer J , Morrow L , Nichols J , Pfutzner A , Pleus S , Rice M , Sacks DB , Schlueter K , Vesper HW , Klonoff DC . J Diabetes Sci Technol 2020 14 (3) 679-686 This is a summary report of the most important aspects discussed during the YSI 2300 Analyzer Replacement Meeting. The aim is to provide the interested reader with an overview of the complex topic and propose solutions for the current issue. This solution should not only be adequate for the United States or Europe markets but also for all other countries. The meeting addendum presents three outcomes of the meeting. |
Where have all the patients gone Profile of US adults who report doctor-diagnosed arthritis but are not being treated
Theis KA , Brady TJ , Sacks JJ . J Clin Rheumatol 2019 25 (8) 341-347 BACKGROUND: Patients only benefit from clinical management of arthritis if they are under the care of a physician or other health professional. OBJECTIVES: We profiled adults who reported doctor-diagnosed arthritis who are not currently being treated for it to understand better who they are. METHODS: Individuals with no current treatment (NCT) were identified by "no" to "Are you currently being treated by a doctor or other health professional for arthritis or joint symptoms?" Demographics, current symptoms, physical functioning, arthritis limitations and interference in life activities, and level of agreement with treatment and attitude statements were assessed in this cross-sectional, descriptive study of noninstitutionalized US adults aged 45 years or older with self-reported, doctor-diagnosed arthritis (n = 1793). RESULTS: More than half of the study population, 52%, reported NCT (n = 920). Of those with NCT, 27% reported fair/poor health, 40% reported being limited by their arthritis, 51% had daily arthritis pain, 59% reported 2 or more symptomatic joints, and 19% reported the lowest third of physical functioning. Despite NCT, 83% with NCT agreed or strongly agreed with the importance of seeing a doctor for diagnosis and treatment. CONCLUSIONS: Greater than half of those aged 45 years or older with arthritis were not currently being treated for it, substantial proportions of whom experienced severe symptoms and poor physical function and may benefit from clinical management and guidance, complemented by community-delivered public health interventions (self-management education, physical activity). Further research to understand the reasons for NCT may identify promising intervention points to address missed treatment opportunities and improve quality of life and functioning. |
Supporting self-management education for arthritis: Evidence from the Arthritis Conditions and Health Effects Survey on the influential role of health care providers
Murphy LB , Theis KA , Brady TJ , Sacks JJ . Chronic Illn 2019 17 (3) 1742395319869431 OBJECTIVE: Self-management education programs are recommended for many chronic conditions. We studied which adults with arthritis received a health care provider's recommendation to take a self-management education class and who attended. METHODS: We analyzed data from a 2005--2006 national telephone survey of US adults with arthritis >/=45 years (n = 1793). We used multivariable-adjusted prevalence ratios (PR) from logistic regression models to estimate associations with: (1) receiving a health care provider recommendation to take a self-management education class; and (2) attending a self-management education class. RESULTS: Among all adults with arthritis: 9.9% received a health care provider recommendation to take an self-management education class; 9.7% attended a self-management education class. Of those receiving a recommendation, 52.0% attended a self-management education class. The strongest association with self-management education class attendance was an health care provider recommendation to take one (PR = 8.9; 95% CI = 6.6-12.1). CONCLUSIONS: For adults with arthritis, a health care provider recommendation to take a self-management education class was strongly associated with self-management education class attendance. Approximately 50% of adults with arthritis have >/=1 other chronic conditions; by recommending self-management education program attendance, health care providers may activate patients' self-management behaviors. If generalizable to other chronic conditions, this health care provider recommendation could be a key influencer in improving outcomes for a range of chronic conditions and patients' quality of life. |
Performance of cepheid GeneXpert HIV-1 viral load plasma assay to accurately detect treatment failure: a clinical meta-analysis
Sacks JA , Fong Y , Gonzalez MP , Andreotti M , Baliga S , Garrett N , Jordan J , Karita E , Kulkarni S , Mor O , Mosha F , Ndlovu Z , Plantier JC , Saravanan S , Scott L , Peter T , Doherty M , Alexander H , Vojnov L . AIDS 2019 33 (12) 1881-1889 BACKGROUND: Coverage of viral load testing remains low with only half of the patients in need having adequate access. Alternative technologies to high throughput centralized machines can be used to support viral load scale-up; however, clinical performance data are lacking. We conducted a meta-analysis comparing the Cepheid Xpert HIV-1 viral load plasma assay to traditional laboratory-based technologies. METHODS: Cepheid Xpert HIV-1 and comparator laboratory technology plasma viral load results were provided from 13 of the 19 eligible studies, which accounted for a total of 3790 paired data points. We used random effects models to determine the accuracy and misclassification at various treatment failure thresholds (detectable, 200, 400, 500, 600, 800 and 1000 copies/ml). RESULTS: Thirty percent of viral load test results were undetectable, while 45% were between detectable and 10 000 copies/ml and the remaining 25% were above 10 000 copies/ml. The median Xpert viral load was 119 copies/ml and the median comparator viral load was 157 copies/ml, while the log10 bias was 0.04 (0.02-0.07). The sensitivity and specificity to detect treatment failure were above 95% at all treatment failure thresholds, except for detectable, at which the sensitivity was 93.33% (95% confidence interval: 88.2-96.3) and specificity was 80.56% (95% CI: 64.6-90.4). CONCLUSION: The Cepheid Xpert HIV-1 viral load plasma assay results were highly comparable to laboratory-based technologies with limited bias and high sensitivity and specificity to detect treatment failure. Alternative specimen types and technologies that enable decentralized testing services can be considered to expand access to viral load. |
Measuring Alcohol Outlet Density: An Overview of Strategies for Public Health Practitioners
Sacks JJ , Brewer RD , Mesnick J , Holt JB , Zhang X , Kanny D , Elder R , Gruenewald PJ . J Public Health Manag Pract 2019 26 (5) 481-488 CONTEXT: Excessive alcohol use is responsible for 88 000 deaths in the United States annually and cost the United States $249 billion in 2010. There is strong scientific evidence that regulating alcohol outlet density is an effective intervention for reducing excessive alcohol consumption and related harms, but there is no standard method for measuring this exposure. PROGRAM: We overview the strategies available for measuring outlet density, discuss their advantages and disadvantages, and provide examples of how they can be applied in practice. IMPLEMENTATION: The 3 main approaches for measuring density are container-based (eg, number of outlets in a county), distance-based (eg, average distance between a college and outlets), and spatial access-based (eg, weighted distance between town center and outlets). EVALUATION: While container-based measures are the simplest to calculate and most intuitive, distance-based or spatial access-based measures are unconstrained by geopolitical boundaries and allow for assessment of clustering (an amplifier of certain alcohol-related harms). Spatial access-based measures can also be adjusted for population size/demographics but are the most resource-intensive to produce. DISCUSSION: Alcohol outlet density varies widely across and between locations and over time, which is why it is important to measure it. Routine public health surveillance of alcohol outlet density is important to identify problem areas and detect emerging ones. Distance- or spatial access-based measures of alcohol outlet density are more resource-intensive than container-based measures but provide a much more accurate assessment of exposure to alcohol outlets and can be used to assess clustering, which is particularly important when assessing the relationship between density and alcohol-related harms, such as violent crime. |
Measuring Alcohol Outlet Density: An Overview of Strategies for Public Health Practitioners
Sacks JJ , Brewer RD , Mesnick J , Holt JB , Zhang X , Kanny D , Elder R , Gruenewald PJ . J Public Health Manag Pract 2019 26 (5) 481-488 CONTEXT: Excessive alcohol use is responsible for 88 000 deaths in the United States annually and cost the United States $249 billion in 2010. There is strong scientific evidence that regulating alcohol outlet density is an effective intervention for reducing excessive alcohol consumption and related harms, but there is no standard method for measuring this exposure. PROGRAM: We overview the strategies available for measuring outlet density, discuss their advantages and disadvantages, and provide examples of how they can be applied in practice. IMPLEMENTATION: The 3 main approaches for measuring density are container-based (eg, number of outlets in a county), distance-based (eg, average distance between a college and outlets), and spatial access-based (eg, weighted distance between town center and outlets). EVALUATION: While container-based measures are the simplest to calculate and most intuitive, distance-based or spatial access-based measures are unconstrained by geopolitical boundaries and allow for assessment of clustering (an amplifier of certain alcohol-related harms). Spatial access-based measures can also be adjusted for population size/demographics but are the most resource-intensive to produce. DISCUSSION: Alcohol outlet density varies widely across and between locations and over time, which is why it is important to measure it. Routine public health surveillance of alcohol outlet density is important to identify problem areas and detect emerging ones. Distance- or spatial access-based measures of alcohol outlet density are more resource-intensive than container-based measures but provide a much more accurate assessment of exposure to alcohol outlets and can be used to assess clustering, which is particularly important when assessing the relationship between density and alcohol-related harms, such as violent crime. |
Evaluation of five rapid diagnostic tests for detection of antibodies to hepatitis C virus (HCV): A step towards scale-up of HCV screening efforts in India
Mane A , Sacks J , Sharma S , Singh H , Tejada-Strop A , Kamili S , Kacholia K , Gautam R , Thakar M , Gupta RS , Gangakhedkar R . PLoS One 2019 14 (1) e0210556 OBJECTIVES: Hepatitis C virus (HCV) infection is a major contributor to morbidity and mortality worldwide. Early detection and curative treatment of HCV can reduce the risk of liver-related mortality and serve to prevent transmission of new infections. India is estimated to have about six million HCV infected individuals, most of whom are unaware of their infection status. Rapid diagnostic test kits (RDTs) could help identify HCV infected persons more expeditiously and thus availability of high performing, quality-assured RDTs is essential to scale-up HCV screening efforts. The present study was thus undertaken to evaluate the performance characteristics of five anti-HCV RDTs. METHODS: Five anti-HCV RDTs (Alere Truline, Flaviscreen, Advanced Quality, SD Bioline and OraQuick) were evaluated using two panels of known anti-HCV positive and negative samples; one characterized from Indian patient samples (n = 360) and other obtained from the US Centers for Disease Control and Prevention (CDC), Atlanta (n = 100). Sensitivity, specificity, inter-observer agreement, test validity and operational characteristics of RDTs were assessed. RESULTS: The combined sensitivities across both panels for Alere Truline, Flaviscreen, Advanced Quality, SD Bioline and OraQuick RDTs were 99.4% (95%CI-96.6%-99.9%), 86.2% (95%CI-79.8%-91.1%), 96.2% (95%CI-91.9%-98.6%), 99.4% (95%CI-96.6%-99.9%) and 99.4% (95%CI-96.6%-99.9%) respectively. The overall specificities across both panels for all RDTs were 99.7%. The inter-observer agreement was 100% for Alere Truline, SD Bioline and OraQuick, while it was 99.5% and 98.6% with Advanced Quality and Flavicheck respectively. Discordant results were significantly associated with human immunodeficiency virus (HIV) positivity for both Advanced Quality and Flavicheck (p<0.001). CONCLUSION: The present evaluation demonstrated that Alere Truline, SD Bioline and OraQuick RDTs had sensitivity and specificity in accordance with the acceptance criteria of the Drug Controller General, India, the national regulatory authority, had excellent inter-observer agreement and superior operational characteristics. Our findings suggest that certain HCV RDTs perform well and can be a useful tool in screening of HCV infections expeditiously. |
Arthritis prevalence: which case definition for surveillance
Murphy LB , Sacks JJ , Helmick CG , Brady TJ , Boring MA , Moss S , Barbour KE , Guglielmo D , Hootman JM , Theis KA . Arthritis Rheumatol 2018 71 (1) 172-175 In the article titled "Updated Estimates Suggest a Much Higher Prevalence of Arthritis in United States Adults than Previous Ones", Jafarzadeh and Felson present an alternative estimate of arthritis prevalence. (1) Specifically, using a new case definition for arthritis and applying Bayesian methods to correct for misclassification, Jafarzadeh and Felson analyzed National Health Interview Survey (NHIS) data and estimated that in 2015, 91.2 million US adults had arthritis. In contrast, CDC had estimated from the 2013-2015 NHIS that 54.4 million US adults had doctor-diagnosed arthritis. (2) In this letter, we make two observations about their methods and discuss implications for public health surveillance of arthritis. This article is protected by copyright. All rights reserved. |
Operationalizing surveillance of chronic disease self-management and self-management support
Brady TJ , Sacks JJ , Terrillion AJ , Colligan EM . Prev Chronic Dis 2018 15 E39 Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS-related research. |
Evaluation of a maternal health program in Uganda and Zambia finds mixed results on quality of care and satisfaction
Kruk ME , Vail D , Austin-Evelyn K , Atuyambe L , Greeson D , Grepin KA , Kibira SP , Macwan'gi M , Masvawure TB , Rabkin M , Sacks E , Simbaya J , Galea S . Health Aff (Millwood) 2016 35 (3) 510-9 Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients' receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers' knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers' clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers' knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program. |
2010 national and state costs of excessive alcohol consumption
Sacks JJ , Gonzales KR , Bouchery EE , Tomedi LE , Brewer RD . Am J Prev Med 2015 49 (5) e73-9 INTRODUCTION: Excessive alcohol use cost the U.S. $223.5 billion in 2006. Given economic shifts in the U.S. since 2006, more-current estimates are needed to help inform the planning of prevention strategies. METHODS: From March 2012 to March 2014, the 26 cost components used to assess the cost of excessive drinking in 2006 were projected to 2010 based on incidence (e.g., change in number of alcohol-attributable deaths) and price (e.g., inflation rate in cost of medical care). The total cost, cost to government, and costs for binge drinking, underage drinking, and drinking while pregnant were estimated for the U.S. for 2010 and allocated to states. RESULTS: Excessive drinking cost the U.S. $249.0 billion in 2010, or about $2.05 per drink. Government paid for $100.7 billion (40.4%) of these costs. Binge drinking accounted for $191.1 billion (76.7%) of costs; underage drinking $24.3 billion (9.7%) of costs; and drinking while pregnant $5.5 billion (2.2%) of costs. The median cost per state was $3.5 billion. Binge drinking was responsible for >70% of these costs in all states, and >40% of the binge drinking-related costs were paid by government. CONCLUSIONS: Excessive drinking cost the nation almost $250 billion in 2010. Two of every $5 of the total cost was paid by government, and three quarters of the costs were due to binge drinking. Several evidence-based strategies can help reduce excessive drinking and related costs, including increasing alcohol excise taxes, limiting alcohol outlet density, and commercial host liability. |
Development of the Diabetes Technology Society Blood Glucose Monitor System Surveillance protocol
Klonoff DC , Lias C , Beck S , Parkes JL , Kovatchev B , Vigersky RA , Arreaza-Rubin G , Burk RD , Kowalski A , Little R , Nichols J , Petersen M , Rawlings K , Sacks DB , Sampson E , Scott S , Seley JJ , Slingerland R , Vesper HW . J Diabetes Sci Technol 2015 10 (3) 697-707 BACKGROUND: Inaccurate blood glucose monitoring systems (BGMSs) can lead to adverse health effects. The Diabetes Technology Society (DTS) Surveillance Program for cleared BGMSs is intended to protect people with diabetes from inaccurate, unreliable BGMS products that are currently on the market in the United States. The Surveillance Program will provide an independent assessment of the analytical performance of cleared BGMSs. METHODS: The DTS BGMS Surveillance Program Steering Committee included experts in glucose monitoring, surveillance testing, and regulatory science. Over one year, the committee engaged in meetings and teleconferences aiming to describe how to conduct BGMS surveillance studies in a scientifically sound manner that is in compliance with good clinical practice and all relevant regulations. RESULTS: A clinical surveillance protocol was created that contains performance targets and analytical accuracy-testing studies with marketed BGMS products conducted by qualified clinical and laboratory sites. This protocol entitled "Protocol for the Diabetes Technology Society Blood Glucose Monitor System Surveillance Program" is attached as supplementary material. CONCLUSION: This program is needed because currently once a BGMS product has been cleared for use by the FDA, no systematic postmarket Surveillance Program exists that can monitor analytical performance and detect potential problems. This protocol will allow identification of inaccurate and unreliable BGMSs currently available on the US market. The DTS Surveillance Program will provide BGMS manufacturers a benchmark to understand the postmarket analytical performance of their products. Furthermore, patients, health care professionals, payers, and regulatory agencies will be able to use the results of the study to make informed decisions to, respectively, select, prescribe, finance, and regulate BGMSs on the market. |
Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey
Cisternas MG , Murphy L , Sacks JJ , Solomon DH , Pasta DJ , Helmick CG . Arthritis Care Res (Hoboken) 2015 68 (5) 574-80 OBJECTIVE: Provide a contemporary estimate of osteoarthritis (OA) by comparing accuracy and prevalence of alternative definitions of OA. METHODS: The Medical Expenditure Panel Survey (MEPS) household component (HC) records respondent-reported medical conditions as open-ended responses; professional coders translate these responses into ICD-9-CM codes for the medical conditions files. Using these codes and other data from the MEPS-HC medical conditions files, we constructed three case definitions of OA and assessed them against medical provider diagnoses of ICD-9-CM 715 [osteoarthrosis and allied disorders] in a MEPS subsample. The three definitions were: 1) strict = ICD-9-CM 715; 2) expanded = ICD-9-CM 715, 716 [other and unspecified arthropathies], OR 719 [other and unspecified disorders of joint]); and 3) probable = strict OR expanded + respondent-reported prior diagnosis of OA or other arthritis excluding rheumatoid arthritis (RA). RESULTS: Sensitivity and specificity of the three definitions were: strict - 34.6% and 97.5%; expanded - 73.8% and 90.5%; and probable - 62.9% and 93.5%. CONCLUSION: The strict definition for OA (ICD-9-CM 715) excludes many individuals with OA. The probable definition of OA has the optimal combination of sensitivity and specificity relative to the two other MEPS-based definitions and yields a national annual estimate of 30.8 million adults with OA (13.4% of US adult population) for 2008 - 2011. |
Psoriasis and psoriatic arthritis: a public health agenda
Helmick CG , Sacks JJ , Gelfand JM , Bebo B Jr , Lee-Han H , Baird T , Bartlett C . Am J Prev Med 2013 44 (4) 424-6 Robust clinical, biomedical, and public health efforts currently address chronic conditions such as heart disease, diabetes, and cancer. However, similar efforts are less common for nonfatal conditions such as psoriasis, which is estimated to affect between 1% and 3% of the adult population,1,2 and psoriatic arthritis, an inflammatory arthritis found in up to one third of adults with psoriasis.3 Both diseases present a substantial public health burden in terms of healthcare costs ($650 million in 1997)1; employment and ability to work4; and quality of life.5,6 | In 2008, the National Psoriasis Foundation (NPF) approached the CDC to explore how a public health perspective could be incorporated into existing clinical and biomedical perspectives. In 2010, the U.S. Congress included funding for the CDC | … to support the collection of epidemiological and longitudinal data on individuals with psoriasis and psoriatic arthritis, including children and adolescents, to better understand the co-morbidities associated with psoriasis, examine the relationship of psoriasis to other public health concerns, and gain insight into the long-term impact and treatment of these two conditions.7 | In other words, the funding was to begin developing and addressing a public health agenda for psoriasis and psoriatic arthritis. |
Anxiety is more common than depression among US adults with arthritis
Murphy LB , Sacks JJ , Brady TJ , Hootman JM , Chapman DP . Arthritis Care Res (Hoboken) 2012 64 (7) 968-76 BACKGROUND: There has been limited characterization of the burden of anxiety and depression, especially the former, among US adults with arthritis in the general population. The study objective was to estimate the prevalence and correlates of anxiety and depression among US adults with doctor-diagnosed arthritis. METHODS: The study sample comprised US adults aged ≥ 45 years with doctor-diagnosed arthritis (n=1,793) from Arthritis Condition and Health Effects Survey (a cross-sectional, population based, random digit dialed telephone interview survey). Anxiety and depression were measured using separate and validated subscales of the Arthritis Impact Measurement Scales. Prevalence was estimated for the sample overall and stratified by subgroups. Associations between correlates and each condition were estimated with prevalence ratios and 95% confidence intervals using logistic regression models. RESULTS: Anxiety was more common than depression (31% and 18% respectively); overall, a third of respondents reported at least one of the two conditions. Most (84%) of those with depression also had anxiety. Multivariable logistic regression modeling failed to identify a distinct profile of characteristics of those with anxiety or/and depression. Only half of respondents with anxiety and/or depression had sought help for their mental health condition in the past year. CONCLUSIONS: Despite the clinical focus on depression among people with arthritis, anxiety was almost twice as common as depression. Given their high prevalence, profound impact on quality of life, and range of effective treatments available, we encourage health care providers to screen all people with arthritis for both anxiety and depression. (c) 2012 by the American College of Rheumatology. |
Economic costs of excessive alcohol consumption in the U.S., 2006
Bouchery EE , Harwood HJ , Sacks JJ , Simon CJ , Brewer RD . Am J Prev Med 2011 41 (5) 516-24 BACKGROUND: Excessive alcohol consumption causes premature death (average of 79,000 deaths annually); increased disease and injury; property damage from fire and motor vehicle crashes; alcohol-related crime; and lost productivity. However, its economic cost has not been assessed for the U.S. since 1998. PURPOSE: To update prior national estimates of the economic costs of excessive drinking. METHODS: This study (conducted 2009-2010) followed U.S. Public Health Service Guidelines to assess the economic cost of excessive alcohol consumption in 2006. Costs for health care, productivity losses, and other effects (e.g., property damage) in 2006 were obtained from national databases. Alcohol-attributable fractions were obtained from multiple sources and used to assess the proportion of costs that could be attributed to excessive alcohol consumption. RESULTS: The estimated economic cost of excessive drinking was $223.5 billion in 2006 (72.2% from lost productivity, 11.0% from healthcare costs, 9.4% from criminal justice costs, and 7.5% from other effects) or approximately $1.90 per alcoholic drink. Binge drinking resulted in costs of $170.7 billion (76.4% of the total); underage drinking $27.0 billion; and drinking during pregnancy $5.2 billion. The cost of alcohol-attributable crime was $73.3 billion. The cost to government was $94.2 billion (42.1% of the total cost), which corresponds to about $0.80 per alcoholic drink consumed in 2006 (categories are not mutually exclusive and may overlap). CONCLUSIONS: On a per capita basis, the economic impact of excessive alcohol consumption in the U.S. is approximately $746 per person, most of which is attributable to binge drinking. Evidence-based strategies for reducing excessive drinking should be widely implemented. |
Advancing the development of diagnostic tests and biomarkers for tuberculosis
Yasinskaya Y , Plikaytis B , Sizemore C , Sacks L . Int J Tuberc Lung Dis 2011 15 (7) 985-7 High costs and limited returns on investment have hampered progress in developing new diagnostic tests and treatments for tuberculosis (TB). We need new biomarkers to develop assays that can rapidly, efficiently and reliably detect Mycobacterium tuberculosis infection and disease, identify drug resistance and expedite drug and vaccine development. This can only be accomplished through cross-disciplinary collaborations to facilitate access to human specimens. The Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health, the industry and academia experts came together in a June 2010 workshop to examine the field of TB diagnostic test development and biomarker discovery, identify areas of most urgent need and formulate strategies to address those needs. |
Should people who have joint symptoms, but no diagnosis of arthritis from a doctor, be included in surveillance efforts?
Bolen J , Helmick CG , Sacks JJ , Gizlice Z , Potter C . Arthritis Care Res (Hoboken) 2010 63 (1) 150-4 OBJECTIVE: In 2005, 27% of adults reported doctor-diagnosed arthritis (DrDx), and 14% reported chronic joint symptoms but no DrDx (i.e., possible arthritis [PA]). We evaluate the value of including persons classified as PA in surveillance of arthritis. METHODS: In 2005, Kansas, Oklahoma, North Carolina, and Utah added extra questions to their Behavioral Risk Factor Surveillance System (BRFSS) telephone survey targeted to a subsample of those classified as PA. RESULTS: Persons classified as PA (n = 2,884) were younger, more often male, and had less activity limitation than persons with DrDx. Of those classified as PA, half had seen a doctor for their symptoms, 12.5% reported arthritis; 61.9% gave other causes. Of the half who had not seen a doctor, most reported mild symptoms (64.8%). CONCLUSION: Only 6.3% of those classified as PA had what we considered arthritis. Most who did not see a doctor reported mild symptoms and, thus, would be unlikely to be amenable to medical and public health interventions for arthritis. Although including PA would slightly improve the sensitivity of detecting arthritis in the population, it would increase false positives that would interfere with targeting state intervention efforts and burden estimates. The ability to add back questions in BRFSS allows reintroduction of PA should national surveillance suggest it is warranted or studies document an increased rate at which PA turns into arthritis. Currently PA does not need to be included in state arthritis surveillance efforts, and limited question space on surveys is better spent on other arthritis issues. |
Arthritis restricts volunteer participation: prevalence and correlates of volunteer status among adults with arthritis
Theis KA , Murphy L , Hootman JM , Helmick CG , Sacks JJ . Arthritis Care Res (Hoboken) 2010 62 (7) 907-16 OBJECTIVE: To estimate, among adults ages > or = 45 years with arthritis, the prevalence and correlates of 1) volunteering, 2) arthritis-attributable restrictions among volunteers, and 3) arthritis as the main barrier to volunteering (AMBV) among non-volunteers. METHODS: Data were from the 2005-2006 Arthritis Conditions Health Effects Survey, a cross-sectional random-digit-dialed national telephone survey of noninstitutionalized US adults ages > or = 45 years with self-reported, doctor-diagnosed arthritis. Respondents (n = 1,793; weighted population 37.7 million) were asked if they currently volunteer (work outside the home without pay). Volunteers were asked if arthritis affects their amount or type of volunteering (arthritis-attributable volunteer limitation [AAVL]). Non-volunteers were asked if arthritis is the main reason they do not volunteer (AMBV). Univariable and multivariable-adjusted logistic regression analyses were performed to estimate associations between potential correlates and each outcome. RESULTS: One-third of the respondents reported volunteering. Among volunteers, 41% (4.9 million) reported AAVL. Among non-volunteers, 27% (6.8 million) reported AMBV. Fair/poor self-rated health was significantly associated with less volunteering (multivariable-adjusted odds ratio [OR] 0.5, 95% confidence interval [95% CI] 0.4-0.8) and greater AAVL (multivariable-adjusted OR 2.1, 95% CI 1.1-4.0) and AMBV (multivariable-adjusted OR 1.8, 95% CI 1.2-2.7). Poor physical function was the most strongly associated correlate of both AAVL and AMBV (multivariable-adjusted ORs 8.0 and 4.3, respectively). CONCLUSION: Volunteering is an important role with individual and societal benefits, but almost 12 million adults with arthritis are limited or do not participate in volunteering due to arthritis. Individuals with restrictions in volunteering reported a substantial burden of poor physical function and may benefit from effective, underused interventions designed to improve physical function, delay disability, and enhance arthritis self-management. |
A national public health agenda for osteoarthritis 2010
Lubar D , White PH , Callahan LF , Chang RW , Helmick CG , Lappin DR , Melnick A , Moskowitz RW , Odom E , Sacks J , Toal SB , Waterman MB . Semin Arthritis Rheum 2010 39 (5) 323-6 Arthritis is the most common cause of disability, and osteoarthritis is our nation's most common form of arthritis. This serious, painful and potentially life-altering joint disease places severe limits on daily activity and quality of life for over 27 million Americans. Affecting mainly hands, knees and hips, osteoarthritis (OA) often causes weakness and disability, interferes with work productivity, results in joint replacement and generates inordinate socioeconomic costs. In view of the fact that the U.S. population is aging and obesity is on the rise, the prevalence, health impact and economic consequences of OA are expected to increase dramatically. | Now is the time for bold and innovative action to reduce the burden of this growing public health issue. The National Public Health Agenda for Osteoarthritis sets the stage for a collaborative and focused initiative to achieve three overall goals over the next three to five years: | • | Ensure the availability of evidence-based intervention strategies—such as self management education, physical activity, injury prevention, and weight management and healthy nutrition—to all Americans with OA | • | Establish supportive policies, communication initiatives and strategic alliances for OA prevention and management | • | Initiate needed research to better understand the burden of OA, its risk factors and effective strategies for intervention. | | Leadership from the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation (AF) initiated a collaboration to address ways to reduce the public health burden of osteoarthritis. This collaboration led to the creation of The National Public Health Agenda for Osteoarthritis. This document is an executive summary of the report; the complete report can be found on our journal's website (http://semarthritisrheumatism.com), the AF's website (http://www.arthritis.org/osteoarthritis-agenda.php), and the CDC's website (www.cdc.gov/arthritis/docs/OAagenda.pdf). |
The effect of ambient air pollution on sperm quality
Hansen C , Luben TJ , Sacks JD , Olshan A , Jeffay S , Strader L , Perreault SD . Environ Health Perspect 2010 118 (2) 203-9 Background: Research has suggested an association with ambient air pollution and sperm quality. Objectives: We investigated the effect of exposure to ozone (O3) and particulate matter < 2.5 microm in aerodynamic diameter (PM2.5) on sperm quality. Methods: We reexamined a previous cohort study of water disinfection by-products to evaluate sperm quality in 228 presumed fertile men with different air pollution profiles. Outcomes included sperm concentration, total sperm per ejaculate (count), and morphology, as well as DNA integrity and chromatin maturity. Exposures to O3 and PM2.5 were evaluated for the 90-day period before sampling. We used multivariable linear regression, which included different levels of adjustment (i.e., without and with season and temperature) to assess the relationship between exposure to air pollutants during key periods of sperm development and adverse sperm outcomes. Results: Sperm concentration and count were not associated with exposure to PM2.5, but there was evidence of an association (but not statistically significant) with O3 concentration and decreased sperm concentration and count. Additionally, a significant increase in the percentage of sperm cells with cytoplasmic drop [beta = 2.64; 95% confidence interval (CI), 0.215.06] and abnormal head (beta = 0.47; 95% CI, 0.030.92) was associated with PM2.5 concentration in the base model. However, these associations, along with all other sperm outcomes, were not significantly associated with either pollutant after controlling for season and temperature. Overall, although we found both protective and adverse effects, there was generally no consistent pattern of increased abnormal sperm quality with elevated exposure to O3 or PM2.5. Conclusions: Exposures to O3 or PM2.5 at levels below the current National Ambient Air Quality Standards were not associated with statistically significant decrements in sperm outcomes in this cohort of fertile men. However, some results suggested effects on sperm concentration, count, and morphology. Editor's Summary: Adverse effects of air pollution on sperm quality have been reported, but few studies have evaluated ambient exposures consistent with U.S. regulatory guidelines. Hansen et al. (p. 203) studied levels of ozone (O3) and PM2.5 (particulate matter < 2.5 microm in aerodynamic diameter) in association with semen outcomes among 228 presumed-fertile men residing in three southeastern U.S. counties. Exposures were classified based on measurements averaged across fixed monitoring stations in each county during the 90 days before sample collection. Outcomes included sperm concentration, count (per ejaculate) and morphology, and proxy measures of DNA integrity (sperm chromatin structure assay) and chromatin maturity (CMA assay). Associations with exposures during key time windows of sperm development were estimated using multivariable linear regression. The authors report crude inverse associations for O3 and sperm concentration and count, and positive associations for PM2.5 and the proportion of sperm cells with cytoplasmic drop and abnormal heads; however, associations did not persist after adjustment for season and temperature. Overall, O3 and PM2.5 exposures in the study population were not clearly associated with adverse outcomes, but the authors conclude that better characterized exposure estimates are needed to clarify relations between air pollutants and sperm quality. |
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