Issue 9, March 7, 2017


CDC Science Clips: Volume 9, Issue 9, March 7, 2017

Each Tuesday, to enhance awareness of emerging scientific knowledge, selected science clips will be posted here for the public health community. The focus is applied public health research and prevention science that has the capacity to improve health now.

This week, Science Clips is pleased to collaborate with CDC Vital Signs by featuring scientific articles from the March Vital Signs (www.cdc.gov/vitalsigns). The articles marked with an asterisk are general review articles which may be of particular interest to clinicians and public health professionals seeking background information in this area.

  1. CDC Vital Signs
    • Chronic Diseases and Conditions – Arthritis RSS Word feed
      1. *Effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases: a meta-analysisExternal
        Kelley GA, Kelley KS, Hootman JM, Jones DL.
        Arthritis Care Res (Hoboken). 2011 Jan;63(1):79-93.
        OBJECTIVE: To use the meta-analytic approach to determine the effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases (AORD). METHODS: Data sources consisted of 6 electronic databases, cross-referencing from retrieved studies and expert review. Study selection included 1) randomized controlled trials; 2) >/= 1 exercise intervention group; 3) community-deliverable exercise interventions >/= 4 weeks in duration; 4) control group; 5) adults ages >/= 18 years with rheumatoid arthritis, osteoarthritis, fibromyalgia, lupus, gout, or ankylosing spondylitis; 6) published and unpublished studies; 7) studies published in any language between January 1, 1980, and January 1, 2008; and 8) data available for pain and/or physical function. Data abstraction included dual coding by 2 of the authors. Standardized effect sizes (g) and random-effects models were used to pool pain and physical function outcomes. Data were analyzed according to per-protocol and intent-to-treat (ITT) results. The minimally clinically important difference (MCID) and number needed to treat (NNT) were also calculated. RESULTS: Thirty-three studies representing 3,180 men and women (1,857 exercise, 1,323 control) with rheumatoid arthritis, osteoarthritis, and fibromyalgia were included. Statistically significant and clinically important improvements were observed for pain (per-protocol g = -0.37 [95% confidence interval (95% CI) -0.53, -0.21], MCID -18%; ITT g = -0.20 [95% CI -0.33, -0.07], MCID -9%, NNT 9) and physical function (per-protocol g = 0.37 [95% CI 0.21, 0.52], MCID 15%; ITT g = 0.34 [95% CI 0.25, 0.43], MCID 10%, NNT 5). CONCLUSION: Community-deliverable exercise improves pain and physical function in adults with the types of AORD included in the analysis. Dose-response as well as studies in those with other types of AORD is needed.

      2. *A meta-analysis of health status, health behaviors, and healthcare utilization outcomes of the Chronic Disease Self-Management ProgramExternal
        Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, House M, Chervin D.
        Prev Chronic Dis. 2013 ;10:120112.
        INTRODUCTION: The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program’s effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. METHODS: We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. RESULTS: Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months CONCLUSION: Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.

      3. Prevalence of severe joint pain among adults with doctor-diagnosed arthritis – United States, 2002-2014External
        Barbour KE, Boring M, Helmick CG, Murphy LB, Qin J.
        MMWR Morb Mortal Wkly Rep. 2016 Oct 07;65(39):1052-1056.
        In the United States, arthritis is a leading cause of disability (1,2); arthritis affected an estimated 52.5 million (22.7%) adults in 2010-2012 and has been projected to affect 78.4 million adults by 2040 (3). Severe joint pain (SJP) can limit function and seriously compromise quality of life (4,5). To determine the prevalence of SJP among adults with doctor-diagnosed arthritis, and the trend in SJP from 2002 to 2014, CDC analyzed data from the National Health Interview Survey. In 2014, approximately one fourth of adults with arthritis had SJP (27.2%). Within selected groups, the age-standardized prevalence of SJP was higher among women (29.2%), non-Hispanic blacks (42.3%), Hispanics (35.8%), and persons with a disability (45.6%), and those who were unable to work (51.9%); prevalence also was higher among those who had fair or poor health (49.1%), obesity (31.7%), heart disease (34.1%), diabetes (40.9%), or serious psychological distress (56.3%). From 2002 to 2014, the age-standardized prevalence of SJP among adults with arthritis did not change (p = 0.14); however, the number of adults with SJP was significantly higher in 2014 (14.6 million) than in 2002 (10.5 million). A strategy to improve pain management (e.g., the 2016 National Pain Strategy*) has been developed, and more widespread dissemination of evidence-based interventions that reduce joint pain in adults with arthritis might reduce the prevalence of SJP.

      4. Falls and fall injuries among adults with arthritis–United States, 2012External
        Barbour KE, Stevens JA, Helmick CG, Luo YH, Murphy LB, Hootman JM, Theis K, Anderson LA, Baker NA, Sugerman DE.
        MMWR Morb Mortal Wkly Rep. 2014 May 02;63(17):379-83.
        Falls are the leading cause of injury-related morbidity and mortality among older adults, with more than one in three older adults falling each year, resulting in direct medical costs of nearly $30 billion. Some of the major consequences of falls among older adults are hip fractures, brain injuries, decline in functional abilities, and reductions in social and physical activities. Although the burden of falls among older adults is well-documented, research suggests that falls and fall injuries are also common among middle-aged adults. One risk factor for falling is poor neuromuscular function (i.e., gait speed and balance), which is common among persons with arthritis. In the United States, the prevalence of arthritis is highest among middle-aged adults (aged 45-64 years) (30.2%) and older adults (aged >/=65 years) (49.7%), and these populations account for 52% of U.S. adults. Moreover, arthritis is the most common cause of disability. To examine the prevalence of falls among middle-aged and older adults with arthritis in different states/territories, CDC analyzed data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) to assess the state-specific prevalence of having fallen and having experienced a fall injury in the past 12 months among adults aged >/=45 years with and without doctor-diagnosed arthritis. This report summarizes the results of that analysis, which found that for all 50 states and the District of Columbia (DC), the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. The prevalence of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fall prevention programs in clinical and community practice.

      5. Report to Congress: The Centers for Medicare & Medicaid Services evaluation of community-based wellness and prevention programs under section 4202 (b) of the Affordable Care Act
        Centers for Medicare and Medicaid Services .Cdc-pdfExternal

        Washington: Government Printing Office. 2013 ;Baltimore, MD: Centers for Medicare & Medicaid Services.
        [No abstract]
      6. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016External
        Dowell D, Haegerich TM, Chou R.
        MMWR Recomm Rep. 2016 Mar 18;65(1):1-49.
        This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (https://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.

      7. The burden of musculoskeletal diseases in the United States: prevalence, societal and economic bosts (BMUS)External
        Helmick C, Watkins-Castillo S.
        3rd ed. Rosemont, IL: The United States Bone and Joint Initiative. 2014 .
        [No abstract]
      8. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040External
        Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA.
        Arthritis Rheumatol. 2016 Jul;68(7):1582-7.
        OBJECTIVE: To update the projected prevalence of arthritis and arthritis-attributable activity limitations among US adults, using a newer baseline for estimates. METHODS: Baseline prevalence data were obtained from the 2010-2012 National Health Interview Survey. Arthritis was defined as an answer of “yes” to the question “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?” Arthritis-attributable activity limitation was defined as an answer of “yes” to the question “Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?” The baseline prevalence of arthritis and arthritis-attributable activity limitation was stratified according to age and sex and was statistically weighted to account for the complex survey design. The projected prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation was calculated by multiplying the age- and sex-stratified population estimates projected for 2015-2040 (in 5-year intervals; provided by the US Census Bureau) by the baseline estimates. Age- and sex-specific prevalences were summed to provide the total prevalence estimates for each year. RESULTS: In 2010-2012, 52.5 million adults in the US (22.7% of all adults) had doctor-diagnosed arthritis, and 22.7 million (9.8%) had arthritis-attributable activity limitation. By 2040, the number of US adults with doctor-diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of all adults), and the number of adults with arthritis-attributable activity limitation will increase 52% to 34.6 million (11.4% of all adults). CONCLUSION: Updated projections suggest that arthritis and arthritis-attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs.

      9. Validation of a surveillance case definition for arthritisExternal
        Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA.
        J Rheumatol. 2005 Feb;32(2):340-7.
        OBJECTIVE: To assess whether self-reports of chronic joint symptoms or doctor-diagnosed arthritis can validly identify persons with clinically verifiable arthritis. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS), a telephone health survey, defines a case of arthritis as a self-report of chronic joint symptoms (CJS) and/or doctor-diagnosed arthritis (DDx). A sample of health plan enrollees aged 45-64 years and >/= 65 years with upcoming annual physical examinations were surveyed by telephone using the 2002 BRFSS CJS and DDx questions. Based on responses (CJS+, DDx-; CJS-, DDx+; CJS+, DDx+; CJS-, DDx-), respondents were recruited to undergo a standardized clinical history and physical examination for arthritis (the gold standard for clinical validation). Weighted sensitivities and specificities of the case definition were calculated to adjust for sampling. RESULTS: Of 2180 persons completing the telephone questionnaire, 389 were examined; of these, 258 met the case definition and 131 did not. For those examined and aged 45 to 64 years (n = 179), 96 persons had arthritis confirmed, of whom 76 met the case definition. Among those examined and aged >/= 65 (n = 210), 150 had arthritis confirmed, of whom 124 met the case definition. Among those without clinical arthritis, 45 of 83 of those aged 45 to 64 years and 40 of 60 of those aged >/= 65 did not meet the case definition. For those aged 45 to 64 years, the weighted sensitivity of the case definition in this sample was 77.4% and the weighted specificity was 58.8%; for those aged >/= 65, the sensitivity was 83.6% and specificity 70.6%. CJS+ had higher sensitivity and lower specificity than DDx+ in the younger age group; CJS+ and DDx+ behaved more comparably in the older age group. CONCLUSION: The case definition based on self-reported CJS and/or DDx appeared to be sensitive in identifying arthritis, but specificity was lower than desirable for those under age 65 years. Better methods of ascertaining arthritis by self-report are needed. Until then, a change in the surveillance case definition for arthritis appears warranted.

      10. Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010External
        Ward BW, Schiller JS.
        Prev Chronic Dis. 2013 Apr 25;10:E65.
        Preventing and ameliorating chronic conditions has long been a priority in the United States; however, the increasing recognition that people often have multiple chronic conditions (MCC) has added a layer of complexity with which to contend. The objective of this study was to present the prevalence of MCC and the most common MCC dyads/triads by selected demographic characteristics. We used respondent-reported data from the 2010 National Health Interview Survey (NHIS) to study the US adult civilian noninstitutionalized population aged 18 years or older (n = 27,157). We categorized adults as having 0 to 1, 2 to 3, or 4 or more of the following chronic conditions: hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, chronic obstructive pulmonary disease, or current asthma. We then generated descriptive estimates and tested for significant differences. Twenty-six percent of adults have MCC; the prevalence of MCC has increased from 21.8% in 2001 to 26.0% in 2010. The prevalence of MCC significantly increased with age, was significantly higher among women than men and among non-Hispanic white and non-Hispanic black adults than Hispanic adults. The most common dyad identified was arthritis and hypertension, and the combination of arthritis, hypertension, and diabetes was the most common triad. The findings of this study contribute information to the field of MCC research. The NHIS can be used to identify population subgroups most likely to have MCC and potentially lead to clinical guidelines for people with more common MCC combinations.

  2. CDC Authored Publications
    The names of CDC authors are indicated in bold text.
    Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.
    • Chronic Diseases and Conditions RSS Word feed
      1. Food insecurity, CKD, and subsequent ESRD in US adultsExternal
        Banerjee T, Crews DC, Wesson DE, Dharmarajan S, Saran R, Rios Burrows N, Saydah S, Powe NR.
        Am J Kidney Dis. 2017 Feb 15.
        BACKGROUND: Poor access to food among low-income adults has been recognized as a risk factor for chronic kidney disease (CKD), but there are no data for the impact of food insecurity on progression to end-stage renal disease (ESRD). We hypothesized that food insecurity would be independently associated with risk for ESRD among persons with and without earlier stages of CKD. STUDY DESIGN: Longitudinal cohort study. SETTING & PARTICIPANTS: 2,320 adults (aged >/= 20 years) with CKD and 10,448 adults with no CKD enrolled in NHANES III (1988-1994) with household income </= 400% of the federal poverty level linked to the Medicare ESRD Registry for a median follow-up of 12 years. PREDICTOR: Food insecurity, defined as an affirmative response to the food-insecurity screening question. OUTCOME: Development of ESRD. MEASUREMENTS: Demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. Dietary acid load was estimated from 24-hour dietary recall. We used a Fine-Gray competing-risk model to estimate the relative hazard (RH) for ESRD associated with food insecurity after adjusting for covariates. RESULTS: 4.5% of adults with CKD were food insecure. Food-insecure individuals were more likely to be younger and have diabetes (29.9%), hypertension (73.9%), or albuminuria (90.4%) as compared with their counterparts (P<0.05). Median dietary acid load in the food-secure versus food-insecure group was 51.2 mEq/d versus 55.6 mEq/d, respectively (P=0.05). Food-insecure adults were more likely to develop ESRD (RH, 1.38; 95% CI, 1.08-3.10) compared with food-secure adults after adjustment for demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. In the non-CKD group, 5.7% were food insecure. We did not find a significant association between food insecurity and ESRD (RH, 0.77; 95% CI, 0.40-1.49). LIMITATIONS: Use of single 24-hour diet recall; lack of laboratory follow-up data and measure of changes in food insecurity over time; follow-up of cohort ended 10 years ago. CONCLUSIONS: Among adults with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.

      2. Epilepsy by the numbers: Epilepsy deaths by age, race/ethnicity, and gender in the United States significantly increased from 2005 to 2014External
        Greenlund SF, Croft JB, Kobau R.
        Epilepsy Behav. 2017 Feb 17;69:28-30.
        To inform public health efforts to prevent epilepsy-related deaths, we used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER; Wonder.cdc.gov) to examine any-listed epilepsy deaths for the period 2005-2014 by age groups (</=24, 25-44, 45-64, 65-84, >/=85years), sex, and race/ethnicity (non-Hispanic White, non-Hispanic African American, Hispanic, Asian/Pacific Islander, or American Indian/Alaska Native). Epilepsy deaths were defined by the International Classification of Diseases, Tenth Revision (ICD-10) codes G40.0-G40.9. The total number of deaths per year with epilepsy as any listed cause ranged from 1760 in 2005 to 2962 in 2014. Epilepsy was listed as the underlying cause of death for about 54% of all deaths with any mention of epilepsy in 2005 and for 43% of such deaths in 2014. Age-adjusted epilepsy mortality rates (as any-listed cause of death) per 100,000 significantly increased from 0.58 in 2005 to 0.85 in 2014 (47% increase). In 2014, deaths among the non-Hispanic Black population (1.42 deaths per 100,000) were higher than among non-Hispanic White (0.86 deaths per 100,000) and Hispanic populations (0.70 deaths per 100,000). Males had a higher mortality rate than females (1.01 per 100,000 versus 0.74 per 100,000 in 2014), and those aged 85years or older had the highest mortality among age groups. Results highlight the need for heightened action to prevent and monitor epilepsy-associated mortality.

      3. Prostate cancer screening decision-making in three states: 2013 Behavioral Risk Factor Surveillance System analysisExternal
        Li J, Hall IJ, Zhao G.
        Cancer Causes Control. 2017 Feb 16.
        INTRODUCTION: Given the discordant prostate cancer screening recommendations in the United States, shared decision-making (SDM) has become increasingly important. The objectives of this study were to determine who made the final decision to obtain prostate-specific antigen (PSA)-based screening and identify factors associated with the screening decision made by both patients and their health care providers. METHODS: Using the 2013 Behavioral Risk Factor Surveillance System data from Delaware, Hawaii, and Massachusetts, we calculated weighted percentages of SDM. Associations between the SDM and sociodemographic, lifestyle, access to care, and PSA testing-related factors were assessed using multivariate logistic regression. RESULTS: There were 2,248 men aged 40 years or older who ever had a PSA-based screening in these three states. Only 36% of them made their prostate cancer screening decision jointly with their health care provider. Multivariate analyses showed that men who were married/living together or had a college degree and above were more likely to report having SDM than men who were never married or had less than high school education (P = 0.02 and 0.002). Moreover, men whose most recent PSA test occurred within the past year were more likely to report SDM than men who had the test done more than 2 years ago (P = 0.02). CONCLUSIONS: The majority of screening decisions were made by the patient or health care provider alone in these three states, not jointly, as recommended. Our study points to the need to promote SDM among patients and their health care providers before PSA testing.

      4. Leptospira seropositivity as a risk factor for Mesoamerican NephropathyExternal
        Riefkohl A, Ramirez-Rubio O, Laws RL, McClean MD, Weiner DE, Kaufman JS, Galloway RL, Shadomy SV, Guerra M, Amador JJ, Sanchez JM, Lopez-Pilarte D, Parikh CR, Leibler JH, Brooks DR.
        Int J Occup Environ Health. 2017 Feb 17:1-10.
        BACKGROUND: Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. OBJECTIVES: Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. METHODS: In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti-leptospiral antibodies, serum creatinine, and urinary injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and N-acetyl-D-glucosaminidase (NAG). RESULTS: Leptospira seroprevalence differed among job categories and was highest among sugarcane cutters (59%). Seropositive sugarcane workers had higher NGAL concentrations (relative mean: 1.28; 95% CI: 0.94-1.75) compared to those who were seronegative, with similar findings among field and non-field workers. CONCLUSIONS: Leptospira seroprevalence varied by job category. There was some indication that seropositivity was associated with elevated biomarker levels, but results were inconsistent. Additional studies may help establish whether Leptospira infection plays any role in MeN among Central American workers.

      5. The Managing Epilepsy Well Network: Advancing epilepsy self-managementExternal
        Sajatovic M, Jobst BC, Shegog R, Bamps YA, Begley CE, Fraser RT, Johnson EK, Pandey DK, Quarells RC, Scal P, Spruill TM, Thompson NJ, Kobau R.
        Am J Prev Med. 2017 Mar;52(3s3):S241-s245.
        Epilepsy, a complex spectrum of disorders, affects about 2.9 million people in the U.S. Similar to other chronic disorders, people with epilepsy face challenges related to management of the disorder, its treatment, co-occurring depression, disability, social disadvantages, and stigma. Two national conferences on public health and epilepsy (1997, 2003) and a 2012 IOM report on the public health dimensions of epilepsy highlighted important knowledge gaps and emphasized the need for evidence-based, scalable epilepsy self-management programs. The Centers for Disease Control and Prevention translated recommendations on self-management research and dissemination into an applied research program through the Prevention Research Centers Managing Epilepsy Well (MEW) Network. MEW Network objectives are to advance epilepsy self-management research by developing effective interventions that can be broadly disseminated for use in people’s homes, healthcare providers’ offices, or in community settings. The aim of this report is to provide an update on the MEW Network research pipeline, which spans efficacy, effectiveness, and dissemination. Many of the interventions use e-health strategies to eliminate barriers to care (e.g., lack of transportation, functional limitations, and stigma). Strengths of this mature research network are the culture of collaboration, community-based partnerships, e-health methods, and its portfolio of prevention activities, which range from efficacy studies engaging hard-to-reach groups, to initiatives focused on provider training and knowledge translation. The MEW Network works with organizations across the country to expand its capacity, help leverage funding and other resources, and enhance the development, dissemination, and sustainability of MEW Network programs and tools. Guided by national initiatives targeting chronic disease or epilepsy burden since 2007, the MEW Network has been responsible for more than 43 scientific journal articles, two study reports, seven book chapters, and 62 presentations and posters. To date, two programs have been adopted and disseminated by the national Epilepsy Foundation, state Epilepsy Foundation affiliates, and other stakeholders. Recent expansion of the MEW Network membership will help to extend future reach and public health impact.

      6. Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50External
        Wheeler SB, Kuo TM, Meyer AM, Martens CE, Hassmiller Lich KM, Tangka FK, Richardson LC, Hall IJ, Smith JL, Mayorga ME, Brown P, Crutchfield TM, Pignone MP.
        Prev Med Rep. 2017 Jun;6:9-16.
        Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10-15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important.

    • Communicable Diseases RSS Word feed
      1. Acute respiratory infections among returning Hajj pilgrims-Jordan, 2014External
        Al-Abdallat MM, Rha B, Alqasrawi S, Payne DC, Iblan I, Binder AM, Haddadin A, Nsour MA, Alsanouri T, Mofleh J, Whitaker B, Lindstrom SL, Tong S, Ali SS, Dahl RM, Berman L, Zhang J, Erdman DD, Gerber SI.
        J Clin Virol. 2017 Feb 08;89:34-37.
        BACKGROUND: The emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) has prompted enhanced surveillance for respiratory infections among pilgrims returning from the Hajj, one of the largest annual mass gatherings in the world. OBJECTIVES: To describe the epidemiology and etiologies of respiratory illnesses among pilgrims returning to Jordan after the 2014 Hajj. STUDY DESIGN: Surveillance for respiratory illness among pilgrims returning to Jordan after the 2014 Hajj was conducted at sentinel health care facilities using epidemiologic surveys and molecular diagnostic testing of upper respiratory specimens for multiple respiratory pathogens, including MERS-CoV. RESULTS: Among the 125 subjects, 58% tested positive for at least one virus; 47% tested positive for rhino/enterovirus. No cases of MERS-CoV were detected. CONCLUSIONS: The majority of pilgrims returning to Jordan from the 2014 Hajj with respiratory illness were determined to have a viral etiology, but none were due to MERS-CoV. A greater understanding of the epidemiology of acute respiratory infections among returning travelers to other countries after Hajj should help optimize surveillance systems and inform public health response practices.

      2. Effects of antiretroviral therapy on the survival of human immunodeficiency virus-positive adult patients in Andhra Pradesh, India: A retrospective cohort study, 2007-2013External
        Bajpai R, Chaturvedi H, Jayaseelan L, Harvey P, Seguy N, Chavan L, Raj P, Pandey A.
        J Prev Med Public Health. 2016 Nov;49(6):394-405.
        OBJECTIVES: The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. METHODS: The present study used data from 139 679 HIV patients aged >/=15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. RESULTS: The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for <100 cells/mm3 vs. >350 cells/mm3), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for <45 kg vs. >60 kg) were strongly associated with the survival of HIV patients. CONCLUSIONS: The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.

      3. Prevalence of internalized HIV-related stigma among HIV-infected adults in care, United States, 2011-2013External
        Baugher AR, Beer L, Fagan JL, Mattson CL, Freedman M, Skarbinski J, Shouse RL.
        AIDS Behav. 2017 Feb 14.
        HIV-infected U.S. adults have reported internalized HIV-related stigma; however, the national prevalence of stigma is unknown. We sought to determine HIV-related stigma prevalence among adults in care, describe which socio-demographic groups bear the greatest stigma burden, and assess the association between stigma and sustained HIV viral suppression. The Medical Monitoring Project measures characteristics of U.S. HIV-infected adults receiving care using a national probability sample. We used weighted data collected from June 2011 to May 2014 and assessed self-reported internalized stigma based on agreement with six statements. Overall, 79.1% endorsed >/=1 HIV-related stigma statements (n = 13,841). The average stigma score was 2.4 (out of a possible high score of six). White males had the lowest stigma scores while Hispanic/Latina females and transgender persons who were multiracial or other race had the highest. Although stigma was associated with viral suppression, it was no longer associated after adjusting for age. Stigma was common among HIV-infected adults in care. Results suggest individual and community stigma interventions may be needed, particularly among those who are <50 years old or Hispanic/Latino. Stigma was not independently associated with viral suppression; however, this sample was limited to adults in care. Examining HIV-infected persons not in care may elucidate stigma’s association with viral suppression.

      4. Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programsExternal
        Cranmer LM, Langat A, Ronen K, McGrath CJ, LaCourse S, Pintye J, Odeny B, Singa B, Katana A, Nganga L, Kinuthia J, John-Stewart G.
        Int J Tuberc Lung Dis. 2017 Mar 01;21(3):256-262.
        BACKGROUND: Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. METHODS: As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined. RESULTS: Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P = 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P = 0.02) and non-specific TB symptoms, including cough (P = 0.003), fever (P = 0.05), and difficulty breathing (P = 0.01). TB exposure was reported by 11% of the women, and 15% of the TB-exposed women received isoniazid preventive therapy. CONCLUSIONS: Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.

      5. Levels of intracellular phosphorylated tenofovir and emtricitabine correlate with natural substrate concentrations in peripheral blood mononuclear cells of persons prescribed daily oral TruvadaTM for HIV pre-exposure prophylaxisExternal
        Haaland RE, Holder A, Pau CP, Swaims-Kohlmeier A, Dawson C, Smith DK, Segolodi TM, Thigpen MC, Paxton LA, Parsons TL, Hendrix CW, Hart CE.
        J Acquir Immune Defic Syndr. 2017 Feb 14.
        [No abstract]
      6. Risk factors for death during a resurgence of influenza-A (H1N1) pdm09 in Punjab State in 2013External
        Kumar T, Bhatia D, Maha Lakshmi PV, Laserson KF, Narain JP, Kumar R.
        Indian J Public Health. 2017 Jan-Mar;61(1):9-13.
        BACKGROUND: In 2013, high mortality from influenza-A (H1N1) pdm09 (pH1N1) was observed in Punjab, India. OBJECTIVES: To describe cases and deaths of 2013 pH1N1 positives, to evaluate the high case fatality ratio and risk factors for pH1N1-associated mortality among the hospitalized cases in Punjab for 2013. METHODS: A case-control study was conducted and compared those who died from confirmed pH1N1 with those who survived in the hospital between January 1, 2013, and April 30, 2013. Sociodemographic and clinical details were extracted from hospital records and from telephone interviews with controls and next of kin of cases using pretested questionnaires. Logistic regression analysis was performed. RESULTS: A total of 182 laboratory-confirmed pH1N1 cases (99 males and 83 females) were hospitalized in 30 hospitals in Punjab; 42 (23%) patients died. Those who died were significantly more likely to be younger than 50 years of age (adjusted odds ratio [AOR] =10.6, 95% confidence interval [CI] =1.8-21.1), be obese (AOR = 16.7, 95% CI = 1.6-170.7), and have visited more than two health-care facilities before laboratory confirmation (AOR = 25.8, 95% CI = 5.4-121.6). CONCLUSIONS: The health-care community should have a high index of suspicion for influenza, and general community should be sensitized about risk factors and to seek medical advice early in the illness.

      7. Correlates of bacterial ulcers and acute HSV-2 infection among men with genital ulcer disease in South Africa: Age, recent sexual behaviors, and HIVExternal
        Leichliter JS, Lewis DA, Paz-Bailey G.
        S Afr J Infect Dis. 2016 ;31(2):61-65.
        Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcer) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) vs. recurrent HSV-2 ulcers (sero-positive), separately. Compared to men with recurrent HSV-2 ulcers, men with bacterial ulcers had larger ulcers but were less likely to be HIV-positive whereas men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; the difference was not statistically significant.

      8. Hepatitis C virus and HIV co-infection among pregnant women in RwandaExternal
        Mutagoma M, Balisanga H, Sebuhoro D, Mbituyumuremyi A, Remera E, Malamba SS, Riedel DJ, Nsanzimana S.
        BMC Infect Dis. 2017 Feb 22;17(1):167.
        BACKGROUND: Hepatitis C virus (HCV) infection is a pandemic causing disease; more than 185 million people are infected worldwide. An HCV antibody (Ab) prevalence of 6.0% was estimated in Central African countries. The study aimed at providing HCV prevalence estimates among pregnant women in Rwanda. METHODS: HCV surveillance through antibody screening test among pregnant women attending antenatal clinics was performed in 30 HIV sentinel surveillance sites in Rwanda. RESULTS: Among 12,903 pregnant women tested at antenatal clinics, 335 (2.6% [95% Confidence Interval 2.32-2.87]) tested positive for HCV Ab. The prevalence of HCV Ab in women aged 25-49 years was 2.8% compared to 2.4% in women aged 15-24 years (aOR = 1.3; [1.05-1.59]); This proportion was 2.7% [2.37-2.94] in pregnant women in engaged in non-salaried employment compared to 1.2% [0.24-2.14] in those engaged in salaried employment (aOR = 3.2; [1.60-6.58]). The proportion of HCV Ab-positive co-infected with HIV was estimated at 3.9% (13 cases). Women in urban residence were more likely to be associated with HCV-infection (OR = 1.3; 95%CI [1.0-1.6]) compared to those living in rural setting. CONCLUSION: HCV is a public health problem in pregnant women in Rwanda. Few pregnant women were co-infected with HCV and HIV. Living in urban setting was more likely to associate pregnant women with HCV infection.

      9. The 17th International Congress on Infectious Diseases Workshop on Developing Infection Prevention and Control Resources for Low to Middle Income CountriesExternal
        Sastry S, Masroor N, Bearman G, Hajjeh R, Holmes A, Memish Z, Lassmann B, Pittet D, Macnab F, Kamau R, Wesangula E, Pokharel P, Brown P, Daily F, Amer F, Torres J, O’Ryan M, Gunturu R, Bulabula A, Mehtar S.
        Int J Infect Dis. 2017 Feb 16.
        Hospital acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks including MERS (Middle East Respiratory Syndrome) coronavirus and Ebola have highlighted the importance of infection control. Further, HAIs especially with multi-drug resistant gram negative rods (MDRO-GNRs) have become a top global priority. Though adequate approaches and guidelines have been in existence for many years and have sometimes proven effective in some countries, the implementation of such approaches in low and middle income countries (LMICs) is often restricted due to limited resources and underdeveloped infrastructure. While evidence based infection control principles and practices are universal, studies are needed to evaluate simplified approaches that can be better adapted to LMIC needs, in order to practically guide IPC practices. A group of experts from around the world attended a workshop held at the 17th International Congress on Infectious Diseases conference in Hyderabad, India, to discuss the existing IPC practices in LMICs, and how these can be best improved within the local context.

      10. Perspectives on West Africa Ebola virus disease outbreak, 2013-2016External
        Spengler JR, Ervin ED, Towner JS, Rollin PE, Nichol ST.
        Emerg Infect Dis. 2016 Jun;22(6):956-63.
        The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013-2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community’s insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research.

      11. As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with menExternal
        Stenger MR, Baral S, Stahlman S, Wohlfeiler D, Barton JE, Peterman T.
        Sex Health. 2016 Sep 02.
        The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.

      12. Evaluation of a field test for antibodies against Chlamydia trachomatis during trachoma surveillance in NepalExternal
        Sun MJ, Zambrano AI, Dize L, Munoz B, Gwyn S, Mishra S, Martin DL, Sharma S, West SK.
        Diagn Microbiol Infect Dis. 2017 Jan 17.
        PURPOSE: Testing for antibodies to Chlamydia trachomatis has potential as a surveillance tool. Our evaluation compares lateral flow assays (LFAs) during surveillance surveys in Nepal with Multiplex bead array (MBA). Fifty children were randomly sampled from each of 15 random clusters in two districts of Nepal. Finger prick blood samples were collected from 1509 children and tested onsite for anti-Pgp3 antibodies by LFA. The LFA was read at 30min as negative, positive, or invalid. Tests results were also rated as difficult to read (“equivocal”). Blood was processed at Johns Hopkins University using the MBA. RESULTS: The LFA had agreement of 40.0% for MBA-positive samples and 99.3% for MBA-negative samples. Inter-reader reliability was kappa=0.65 (95% CI=0.56-0.74). If the equivocal results (7%) could be decreased, reliability could be improved. CONCLUSIONS: Further optimization and testing of the LFA test are needed to improve agreement with MBA and the interpretation of the results.

      13. Efficacy of the Young Women’s CoOp: An HIV risk-reduction intervention for substance-using African-American female adolescents in the south
        Wechsberg WM, Browne FA, Zule WA, Novak SP, Doherty IA, Kline TL, Carry MG, Raiford JL, Herbst JH.
        J Child Adolesc Subst Abuse. 2017 :1-14.
        HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a risk-reduction intervention, the Young Women’s CoOp (YWC), relative to a nutrition control. In efficacy analyses adjusting for baseline condom use, at three-month follow-up participants in the YWC were significantly less likely to report sex without a condom at last sex relative to control. There were mixed findings for within-group differences over follow-up, underscoring the challenges for intervening with substance-using female youths.

      14. Highlights from the 2016 HIV Diagnostics Conference: The new landscape of HIV testing in laboratories, public health programs and clinical practiceExternal
        Wesolowski LG, Parker MM, Delaney KP, Owen SM.
        J Clin Virol. 2017 Feb 07.
        The 2016 HIV Diagnostics Conference, held in Atlanta, Georgia, was attended by public health officials, laboratorians, HIV testing program managers, surveillance coordinators and industry representatives. The conference addressed test performance data, the implementation of new testing algorithms, quality assurance, and the application of new tests in a variety of settings. With regard to the recommended Centers for Disease Control and Prevention/Association of Public Health Laboratories HIV laboratory testing algorithm, the conference featured performance data, implementation challenges such as a lack of test options for the second and third steps, as well as data needs for new tests that may be used as part of the algorithm. There are delays when nucleic acid testing is needed with the algorithm. Novel tests such as point of care nucleic acid tests are needed on the U.S. market to readily identify acute infection. Multiplex tests are being developed which allow for the simultaneous detection of multiple pathogens. CDC staff highlighted new guidance for testing in non-clinical settings. Innovative approaches to linking testing and care in some settings have led to identification of early infections, improved receipt of test results and expedited initiation of therapy. Work continues to optimize testing so that infections are accurately identified as early as possible and time to treatment is minimized to improve health outcomes and prevent transmission.

    • Disaster Control and Emergency Services RSS Word feed
      1. Establishing a hospital response network among children’s hospitalsExternal
        Bartenfeld MT, Griese SE, Krug SE, Andreadis J, Peacock G.
        Health Secur. 2017 Jan/Feb;15(1):118-122.
        A timely and effective response to public health threats requires a broad-reaching infrastructure. Children’s hospitals are focused on evaluating and managing some of the most vulnerable patients and thus have unique preparedness and response planning needs. A virtual forum was established specifically for children’s hospitals during the 2014-15 Ebola outbreak, and it demonstrated the importance and utility of connecting these specialty hospitals to discuss their shared concerns. Developing a successful children’s hospital response network could build the national infrastructure for addressing children’s needs in preparedness and response and for enhancing preparedness and response to high-consequence pathogens. Using the Laboratory Response Network and tiered-hospital network as models, a network of children’s hospitals could work together, and with government and nongovernment partners, to establish and refine best practices for treating children with pathogens of public health concern. This network could more evenly distribute hospital readiness and tertiary pediatric patient care capabilities for highly infectious diseases across the country, thus reducing the need to transport pediatric patients across the country and increasing the national capacity to care for children infected with high-consequence pathogens.

      2. CDC’s evolving approach to emergency responseExternal
        Redd SC, Frieden TR.
        Health Secur. 2017 Jan/Feb;15(1):41-52.
        The Centers for Disease Control and Prevention (CDC) transformed its approach to preparing for and responding to public health emergencies following the anthrax attacks of 2001. The Office of Public Health Preparedness and Response, an organizational home for emergency response at CDC, was established, and 4 programs were created or greatly expanded after the anthrax attacks: (1) an emergency management program, including an Emergency Operations Center; (2) increased support of state and local health department efforts to prepare for emergencies; (3) a greatly enlarged Strategic National Stockpile of medicines, vaccines, and medical equipment; and (4) a regulatory program to assure that work done on the most dangerous pathogens and toxins is done as safely and securely as possible. Following these changes, CDC led responses to 3 major public health emergencies: the 2009-10 H1N1 influenza pandemic, the 2014-16 Ebola epidemic in West Africa, and the ongoing Zika epidemic. This article reviews the programs of CDC’s Office of Public Health Preparedness, the major responses, and how these responses have resulted in changes in CDC’s approach to responding to public health emergencies.

      3. Evaluating the impact of pharmacies on pandemic influenza vaccine administrationExternal
        Schwerzmann J, Graitcer SB, Jester B, Krahl D, Jernigan D, Bridges CB, Miller J.
        Disaster Med Public Health Prep. 2017 Feb 21:1-7.
        OBJECTIVES: The objective of this study was to quantify the potential retail pharmacy vaccine administration capacity and its possible impact on pandemic influenza vaccine uptake. METHODS: We developed a discrete event simulation model by use of ExtendSim software (Imagine That Inc, San Jose, CA) to forecast the potential effect of retail pharmacy vaccine administration on total weekly vaccine administration and the time needed to reach 80% vaccination coverage with a single dose of vaccine per person. RESULTS: Results showed that weekly national vaccine administration capacity increased to 25 million doses per week when retail pharmacist vaccination capacity was included in the model. In addition, the time to achieve 80% vaccination coverage nationally was reduced by 7 weeks, assuming high public demand for vaccination. The results for individual states varied considerably, but in 48 states the inclusion of pharmacies improved time to 80% coverage. CONCLUSIONS: Pharmacists can increase the numbers of pandemic influenza vaccine doses administered and reduce the time to achieve 80% single-dose coverage. These results support efforts to ensure pharmacist vaccinators are integrated into pandemic vaccine response planning. (Disaster Med Public Health Preparedness. 2017;page 1 of 7).

      4. A community checklist for health sector resilience informed by Hurricane SandyExternal
        Toner ES, McGinty M, Schoch-Spana M, Rose DA, Watson M, Echols E, Carbone EG.
        Health Secur. 2017 Jan/Feb;15(1):53-69.
        This is a checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to use to strengthen the resilience of their community’s health sector to disasters. It is informed by the experience of Hurricane Sandy in New York and New Jersey and analyzed in the context of findings from other recent natural disasters in the United States. The health sector is defined very broadly, including-in addition to hospitals, emergency medical services (EMS), and public health agencies-healthcare providers, outpatient clinics, long-term care facilities, home health providers, behavioral health providers, and correctional health services. It also includes community-based organizations that support these entities and represent patients. We define health sector resilience very broadly, including all factors that preserve public health and healthcare delivery under extreme stress and contribute to the rapid restoration of normal or improved health sector functioning after a disaster. We present the key findings organized into 8 themes. We then describe a conceptual map of health sector resilience that ties these themes together. Lastly, we provide a series of recommended actions for improving health sector resilience at the local level. The recommended actions emphasize those items that individuals who experienced Hurricane Sandy deemed to be most important. The recommendations are presented as a checklist that can be used by a variety of interested parties who have some role to play in disaster preparedness, response, and recovery in their own communities. Following a general checklist are supplemental checklists that apply to specific parts of the larger health sector.

    • Disease Reservoirs and Vectors RSS Word feed
      1. Risk factors for Anopheles mosquitoes in rural and urban areas of Blantyre District, southern Malawi
        Mzilahowa T, Luka-Banda M, Uzalili V, Mathanga DP, Campbell CH, Mukaka M, Gimnig JE.
        Malawi Medical Journal. 2016 ;28(4):151-158.
        Background Although urban malaria transmission is low and seasonal, it remains a major public health problem. This study aimed at demonstrating the presence of Anopheles mosquitoes and their potential to transmit malaria in urban settings. Methods Two cross-sectional surveys were carried out in Blantyre District, Malawi, during the dry and wet seasons of 2008 and 2010, respectively. A map of Blantyre was divided into a grid of 400 cells, of which 60 cells were randomly selected. Five households located within 100 m from the centre of each selected cell were enrolled, a standard questionnaire was administered, and indoor resting mosquitoes were sampled. Results In 2008 and 2010, a total of 960 and 1045 mosquitoes were collected, respectively. Anophelesfunestus comprised 9.9% (n = 95) and 10.3% (n = 108) during the two surveys, respectively. Anophelesgambiae sensu lato (s.l.) was rarely detected during the second survey (n = 6; 0.6%). Molecular identification was performed on samples collected during the first survey, and An. funestus sensu stricto (s.s.) was the only sibling species detected. All the Anopheles mosquitoes were collected from households located in rural areas of Blantyre and none from urban areas. In univariate analysis, the presence of open eaves was associated with increased Anopheles prevalence, both during the dry (incidence rate ratio, IRR = 4.3; 95% CI 2.4-7.6) and wet (IRR = 2.47; 95% CI 1.7-3.59) seasons. Chances of detecting Anopheles spp. decreased with increasing altitude (IRR = 0.996; 95% CI 0.995-0.997) and during the dry season, but increased during the wet season (IRR = 1.0017; 95% CI 1.0012-1.0023). These factors remained significant following a multiple Poisson regression analysis. No association was found between insecticide-treated bednet ownership and the number of Anopheles mosquitoes detected. Conclusions The presence of An. funestus s.s and An. gambiae s.l. in the periphery of Blantyre city was an indication that malaria transmission was potentially taking place in these areas.

      2. Isolation and characterization of a unique strain of Rickettsia parkeri associated with the hard tick Dermacentor parumapertus Neumann in the western United StatesExternal
        Paddock CD, Allerdice ME, Karpathy SE, Nicholson WL, Levin ML, Smith TC, Becker T, Delph RJ, Knight RN, Ritter JM, Sanders JH, Goddard J.
        Appl Environ Microbiol. 2017 Feb 17.
        In 1953, investigators at the Rocky Mountain Laboratories in Hamilton, Montana, described the isolation of a spotted fever group Rickettsia (SFGR) species from Dermacentor parumapertus collected from black-tailed jackrabbits (Lepus californicus) in northern Nevada. Several decades later, investigators characterized this SFGR by using mouse serotyping methods and determined that it represented a distinct rickettsial serotype, related closely to Rickettsia parkeri; nonetheless, the parumapertus agent was not further characterized or studied. No extant isolates of the parumapertus agent remain in any rickettsial culture collection around the world which precludes contemporary phylogenetic placement of this enigmatic SFGR. To rediscover the parumapertus agent, adult-stage D. parumapertus ticks were collected from black-tailed jackrabbits shot or encountered as road-kills in Arizona, Utah, or Texas during 2011-2016. A total of 339 ticks were collected and evaluated for infection with Rickettsia species. From 112 D. parumapertus collected in south Texas, 16 (14.3%) contained partial ompA sequences with closest identity (99.6%) to Rickettsia sp. Atlantic rainforest, a recently identified pathogenic SFGR that causes a mild rickettsiosis in several states of Brazil. A pure isolate, designated strain Black Gap, was cultivated in Vero E6 cells and sequence analysis of the rrs, gltA, sca0, sca5 and sca4 genes also revealed closest genetic identity to Rickettsia sp. Atlantic rainforest. Phylogenetic analysis of the five concatenated rickettsial genes place Rickettsia sp. Black Gap and Rickettsia sp. Atlantic rainforest with R. parkeri in a distinct and well-supported clade.Importance. We suggest that Rickettsia sp. Black Gap and Rickettsia sp. Atlantic rainforest represent nearly identical strains of R. parkeri, and that Rickettsia sp. Black Gap, or a very similar strain of R. parkeri, represents the parumapertus agent. Close genetic relatedness among these taxa, as well as the response of guinea pigs infected with Black Gap strain, suggest that R. parkeri Black Gap could cause disease in humans. The identification of this organism could also account, at least in part, for remarkable differences in severity ascribed to RMSF among various regions of the American West during the early 20th century. We suggest that wide variation in case-fatality rates attributed to RMSF could have occurred by the inadvertent inclusion of cases of milder disease caused by R. parkeri Black Gap.

      3. Prevalence and antimicrobial resistance in Salmonella enterica isolated from broiler chickens, pigs and meat products in Thailand-Cambodia border provincesExternal
        Trongjit S, Angkititrakul S, Tuttle RE, Poungseree J, Padungtod P, Chuanchuen R.
        Microbiol Immunol. 2017 Jan;61(1):23-33.
        This study aimed to examine the prevalence and antimicrobial resistance (AMR) of Salmonella isolates from broiler chickens, pigs and their associated meat products in the Thailand-Cambodia border provinces. A total of 941 samples were collected from pigs and broiler chickens at slaughter houses and from carcasses at local fresh markets in Sa Kaeo, Thailand (n = 554) and Banteay Meanchey, Cambodia (n = 387) in 2014 and 2015. From these samples, 345 Salmonella isolates were collected from Sa Keao (n = 145; 23%) and Banteay Meanchey (n = 200; 47%) and assayed for antimicrobial susceptibility, class 1 integrons and extended-spectrum beta-lactamase (ESBL) genes. Serovars Typhimurium (29%) and Rissen (29%) were the most common serotypes found in Thai and Cambodian isolates, respectively. Multidrug resistance was detected in 34% and 52% of isolates from Sa Keao and Banteay Meanchey, respectively. The majority of the Thai isolates were resistant to ampicillin (72.4%), whereas most Cambodian isolates were resistant to sulfamethoxazole (71%). Eleven isolates from Sa Keao and 44 from Banteay Meanchey carried class 1 integrons comprising resistance gene cassettes. The most common gene cassette array was dfrA12-aadA2 (61.1%). Six isolates were ESBL producers. The beta-lactamase genes found included blaTEM-1 , blaCTX-M-55 and blaCMY-2 . Some of these class 1 integrons and ESBL genes were located on conjugative plasmid. In conclusion, multidrug-resistant Salmonella are common in pigs, chickens and their products in the Thailand-Cambodia border provinces. Our findings indicate that class 1 integrons play a role in spread of AMR in the strains in this study.

    • Drug Safety RSS Word feed
      1. Summary of the Workshop on the Safe Handling of Hazardous Drugs cohosted by the National Institute for Occupational Safety and Health and the American Society of Clinical OncologyExternal
        Connor TH, Celano P, Frame JN, Zon RT.
        J Oncol Pract. 2017 Feb 21:Jop2016017384.
        [No abstract]
    • Environmental Health RSS Word feed
      1. Blood cadmium by race/Hispanic origin: The role of smokingExternal
        Aoki Y, Yee J, Mortensen ME.
        Environ Res. 2017 Feb 20;155:193-198.
        BACKGROUND: There have been increasing concerns over health effects of low level exposure to cadmium, especially those on bones and kidneys. OBJECTIVE: To explore how age-adjusted geometric means of blood cadmium in adults varied by race/Hispanic origin, sex, and smoking status among U.S. adults and the extent to which the difference in blood cadmium by race/Hispanic origin and sex may be explained by intensity of smoking, a known major source of cadmium exposure. METHODS: Our sample included 7,368 adults from National Health and Nutrition Examination Survey (NHANES) 2011-2014. With direct age adjustment, geometric means of blood cadmium and number of cigarettes smoked per day were estimated for subgroups defined by race/Hispanic origin, smoking status, and sex using interval regression, which allows mean estimation in the presence of left- and right-censoring. RESULTS: Among never and former smoking men and women, blood cadmium tended to be higher for non-Hispanic Asian adults than adults of other race/Hispanic origin. Among current smokers, who generally had higher blood cadmium than never and former smokers, non-Hispanic white, black, and Asian adults had similarly elevated blood cadmium compared to Hispanic adults. A separate analysis revealed that non-Hispanic white adults tended to have the highest smoking intensity regardless of sex, than adults of the other race/Hispanic origin groups. CONCLUSIONS: The observed pattern provided evidence for smoking as a major source of cadmium exposure, yet factors other than smoking also appeared to contribute to higher blood cadmium of non-Hispanic Asian adults.

      2. Assessing adaptation strategies for extreme heat: A public health evaluation of cooling centers in Maricopa County, Arizona
        Berisha V, Hondula D, Roach M, White JR, McKinney B, Bentz D, Mohamed A, Uebelherr J, Goodin K.
        Weather Clim Soc. 2017 ;9(1):71-80.
        Preventing heat-associated morbidity and mortality is a public health priority in Maricopa County, Arizona (United States). The objective of this project was to evaluate Maricopa County cooling centers and gain insight into their capacity to provide relief for the public during extreme heat events. During the summer of 2014, 53 cooling centers were evaluated to assess facility and visitor characteristics. Maricopa County staff collected data by directly observing daily operations and by surveying managers and visitors. The cooling centers in Maricopa County were often housed within community, senior, or religious centers, which offered various services for at least 1500 individuals daily. Many visitors were unemployed and/or homeless. Many learned about a cooling center by word of mouth or by having seen the cooling center’s location. The cooling centers provide a valuable service and reach some of the region’s most vulnerable populations. This project is among the first to systematically evaluate cooling centers from a public health perspective and provides helpful insight to community leaders who are implementing or improving their own network of cooling centers.

      3. Private well groundwater quality in West Virginia, USA – 2010External
        Law RK, Murphy MW, Choudhary E.
        Sci Total Environ. 2017 Feb 16.
        The Centers for Disease Control and Prevention (CDC), in collaboration with the West Virginia Bureau of Public Health (BPH), initiated an investigation to characterize private well water quality in West Virginia. The objective was to better characterize private well water across various aquifer geologies by testing household drinking water samples and comparing them to EPA’s National Primary Drinking Water Standards. The BPH selected ten counties representing three regions to capture geologically diverse areas that represent varying aquifer geology. We collected well-water samples from participating households and analyzed all water samples for 20 constituents currently monitored in public drinking-water systems. We calculated geometric means for each constituent and compared metal concentrations to EPA maximum and secondary contaminant levels by the geologic age of the rock surrounding the aquifer where the sample was obtained. All participating households (n=139) provided a water sample. We detected arsenic at levels higher than the EPA maximum contaminant level in 10 (7.2%) samples. We detected elevated radon-222 in 48 (34.5%) samples. Geologic age of the region was indicative of whether arsenic and radon-222 were present at levels that exceeded current EPA drinking water standards. We found arsenic and radon concentrations were higher in Permian aquifers compared to those of other geologic ages. Homeowners with private wells in areas with Permian aged aquifers could benefit from targeted public health messaging about potentially harmful constituent concentrations in the well water. This may help ensure proper testing and maintenance of private wells and reduce exposure to these constituents.

      4. Integrating health and transportation in Nashville, Tennessee, USA: From policy to projects
        Meehan LA, Whitfield GP.
        J Transp Health. 2017 .
        The Nashville Area Metropolitan Planning Organization (MPO) is among the first MPOs in the United States to recognize the interplay of transportation and public health, particularly regarding physical activity, air pollution, and traffic crashes. The Nashville MPO has taken a multifaceted approach to simultaneously improve the transportation system, quality of life, and health status of the region’s population. The purpose of this paper is to describe the multiple programs and projects that the MPO has undertaken to this end, so that other cities might learn from Nashville’s example.The MPO’s strategy comprised six processes. First, the MPO conducted the Regional Bicycle and Pedestrian Study in 2009 and 2014 that established priority issues to be addressed by bicycle and pedestrian projects in Regional Transportation Plans. Second, the MPO responded to public opinion by adopting new transportation policies in the 2035 and 2040 Regional Transportation Plans, including increasing bicycle and pedestrian options and expanding public transit. Third, the MPO created scoring criteria for proposed roadway projects that prioritized health impacts. Fourth, the MPO reserved funding for projects selected under the new criteria and established a new funding program, the Active Transportation Program. Fifth, the MPO conducted the Middle Tennessee Transportation and Health Study, one of the first regional studies in the nation linking transportation and health. Finally, the MPO implemented the Integrated Transport and Health Impact Model which predicts and monetizes population-level health impacts of shifting the population towards active transportation modes.Recent inventories of bicycle and pedestrian infrastructure suggest these interrelated processes are increasing opportunities for walking, bicycling, and public transit use in the region. Further, each of these projects has contributed to a growing appreciation in the region of the links between transportation and health, and continued evaluation efforts can determine if transportation behaviors and health outcomes are changing.

    • Epidemiology and Surveillance RSS Word feed
      1. Surveillance for health care access and health services use, adults aged 18-64 years – Behavioral Risk Factor Surveillance System, United States, 2014External
        Okoro CA, Zhao G, Fox JB, Eke PI, Greenlund KJ, Town M.
        MMWR Surveill Summ. 2017 Feb 24;66(7):1-42.
        PROBLEM/CONDITION: As a result of the 2010 Patient Protection and Affordable Care Act, millions of U.S. adults attained health insurance coverage. However, millions of adults remain uninsured or underinsured. Compared with adults without barriers to health care, adults who lack health insurance coverage, have coverage gaps, or skip or delay care because of limited personal finances might face increased risk for poor physical and mental health and premature mortality. PERIOD COVERED: 2014. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged >/=18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18-64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module. RESULTS: In 2014, health insurance coverage and other health care access measures varied substantially by state, state Medicaid expansion status, expanded geographic region (i.e., states categorized geographically into nine regions), and FPL category. The following proportions refer to the range of estimated prevalence for health insurance and other health care access measures by examined geographical unit (unless otherwise specified), as reported by respondents. Among adults with health insurance coverage, the range was 70.8%-94.5% for states, 78.8%-94.5% for Medicaid expansion states, 70.8%-89.1% for nonexpansion states, 73.3%-91.0% for expanded geographic regions, and 64.2%-95.8% for FPL categories. Among adults who had a usual source of health care, the range was 57.2%-86.6% for states, 57.2%-86.6% for Medicaid expansion states, 61.8%-83.9% for nonexpansion states, 64.4%-83.6% for expanded geographic regions, and 61.0%-81.6% for FPL categories. Among adults who received a routine checkup, the range was 52.1%-75.5% for states, 56.0%-75.5% for Medicaid expansion states, 52.1%-71.1% for nonexpansion states, 56.8%-70.2% for expanded geographic regions, and 59.9%-69.2% for FPL categories. Among adults who had unmet health care need because of cost, the range was 8.0%-23.1% for states, 8.0%-21.9% for Medicaid expansion states, 11.9%-23.1% for nonexpansion states, 11.6%-20.3% for expanded geographic regions, and 5.3%-32.9% for FPL categories. Estimated prevalence of cancer screenings, influenza vaccination, and having ever been tested for human immunodeficiency virus also varied by state, state Medicaid expansion status, expanded geographic region, and FPL category. The prevalence of insurance coverage varied by approximately 25 percentage points among racial/ethnic groups (range: 63.9% among Hispanics to 88.4% among non-Hispanic Asians) and by approximately 32 percentage points by FPL category (range: 64.2% among adults with household income <100% of FPL to 95.8% among adults with household income >400% of FPL). The prevalence of unmet health care need because of cost varied by nearly 14 percentage points among racial/ethnic groups (range: 11.3% among non-Hispanic Asians to 25.0% among Hispanics), by approximately 17 percentage points among adults with and without disabilities (30.8% versus 13.7%), and by approximately 28 percentage points by FPL category (range: 5.3% among adults with household income >400% of FPL to 32.9% among adults with household income <100% of FPL). Among the 43 states that included questions from the optional module, a majority of adults reported private health insurance coverage (63.4%), followed by public health plan coverage (19.4%) and no primary source of insurance (17.1%). Financial barriers to health care (unmet health care need because of cost, unmet prescribed medication need because of cost, and medical bills being paid off over time [medical debt]) were typically lower among adults in Medicaid expansion states than those in nonexpansion states regardless of source of insurance. Approximately 75.6% of adults reported being continuously insured during the preceding 12 months, 12.9% reported a gap in coverage, and 11.5% reported being uninsured during the preceding 12 months. The largest proportion of adults reported >/=3 visits to a health care professional during the preceding 12 months (47.3%), followed by 1-2 visits (37.1%), and no health care visits (15.6%). Adults in expansion and nonexpansion states reported similar levels of satisfaction with received health care by primary source of health insurance coverage and by continuity of health insurance coverage during the preceding 12 months. INTERPRETATION: This report presents for the first time estimates of population-based health care access and use of CPS among adults aged 18-64 years. The findings in this report indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS by state, state Medicaid expansion status, expanded geographic region, and FPL category. In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. These disparities might be due to larger differences to begin with, decreased disparities in Medicaid expansion states versus nonexpansion states, or increased disparities in nonexpansion states. PUBLIC HEALTH ACTION: BRFSS data from 2014 can be used as a baseline by which to assess and monitor changes that might occur after 2014 resulting from programs and policies designed to increase access to health care, reduce health disparities, and improve the health of the adult population. Post-2014 changes in health care access, such as source of health insurance coverage, attainment and continuity of coverage, financial barriers, preventive care services, and health outcomes, can be monitored using these baseline estimates.

      2. Near real-time surveillance of U.S. norovirus outbreaks by the Norovirus Sentinel Testing and Tracking Network – United States, August 2009-July 2015External
        Shah MP, Wikswo ME, Barclay L, Kambhampati A, Shioda K, Parashar UD, Vinje J, Hall AJ.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 24;66(7):185-189.
        Norovirus is the leading cause of endemic and epidemic acute gastroenteritis in the United States. New variant strains of norovirus GII.4 emerge every 2-4 years and are often associated with increased disease and health care visits. Since 2009, CDC has obtained epidemiologic data on norovirus outbreaks from state health departments through the National Outbreak Reporting System (NORS) and laboratory data through CaliciNet. NORS is a web-based platform for reporting waterborne, foodborne, and enteric disease outbreaks of all etiologies, including norovirus, to CDC. CaliciNet, a nationwide electronic surveillance system of local and state public health and regulatory agency laboratories, collects genetic sequences of norovirus strains associated with gastroenteritis outbreaks. Because these two independent reporting systems contain complementary data, integration of NORS and CaliciNet records could provide valuable public health information about norovirus outbreaks. However, reporting lags and inconsistent identification codes in NORS and CaliciNet records have been an obstacle to developing an integrated surveillance system.

    • Genetics and Genomics RSS Word feed
      1. Genome sequence of a genotype 2 hepatitis E virus World Health Organization reference strainExternal
        Kaiser M, Kamili S, Hayden T, Blumel J, Baylis SA.
        Genome Announc. 2017 Feb 16;5(7).
        We report here the sequence of a genotype 2a reference strain of hepatitis E virus (HEV), developed on behalf of the World Health Organization. The HEV reference strain is intended for use in assays based on nucleic acid amplification for the validation of HEV RNA detection.

      2. Genetic assessment of African swine fever isolates involved in outbreaks in the Democratic Republic of Congo between 2005 and 2012 reveals co-circulation of p72 genotypes I, IX and XIV, including 19 variantsExternal
        Mulumba-Mfumu LK, Achenbach JE, Mauldin MR, Dixon LK, Tshilenge CG, Thiry E, Moreno N, Blanco E, Saegerman C, Lamien CE, Diallo A.
        Viruses. 2017 Feb 18;9(2).
        African swine fever (ASF) is a devastating disease of domestic pigs. It is a socioeconomically important disease, initially described from Kenya, but subsequently reported in most Sub-Saharan countries. ASF spread to Europe, South America and the Caribbean through multiple introductions which were initially eradicated-except for Sardinia-followed by reintroduction into Europe in 2007. In this study of ASF within the Democratic Republic of the Congo, 62 domestic pig samples, collected between 2005-2012, were examined for viral DNA and sequencing at multiple loci: C-terminus of the B646L gene (p72 protein), central hypervariable region (CVR) of the B602L gene, and the E183L gene (p54 protein). Phylogenetic analyses identified three circulating genotypes: I (64.5% of samples), IX (32.3%), and XIV (3.2%). This is the first evidence of genotypes IX and XIV within this country. Examination of the CVR revealed high levels of intra-genotypic variation, with 19 identified variants.

      3. Evolutionary relationships of macaca fascicularis fascicularis (Raffles 1821) (primates: Cercopithecidae) from Singapore revealed by Bayesian analysis of mitochondrial DNA sequences
        Schillaci MA, Klegarth AR, Switzer WM, Shattuck MR, Lee BP, Hollocher H.
        Raffles Bull Zool. 2017 ;65:3-19.
        Long-tailed macaques (Macaca fascicularis) have a wide geographic distribution across mainland and insular Southeast Asia. The evolutionary history of long-tailed macaques has been examined extensively through comparison of phenotypic variation and by phylogenetic analyses of molecular genetic data. Nonetheless, the complex evolutionary history of M. fascicularis throughout Southeast Asia is not fully understood. For the present study, we performed a Bayesian phylogenetic analysis of M. fascicularis mitochondrial 12S/tRNA-val/16S sequences to examine the evolutionary relationships of the long-tailed macaques from Singapore. More generally, we hoped to gain a better understanding of the evolutionary history of long-tailed macaques throughout Southeast Asia. We used previously archived sequences in GenBank and new sequences from Singapore (n=34) and Bali, Indonesia (n=2) in a Bayesian phylogenetic framework to co-infer evolutionary histories and divergence dates. Our results revealed two large clades, one composed of haplotypes primarily from Sundaic islands populations, and the second primarily from continental populations. These two larger clades comprise four primary regional clades. All three haplotypes from Singapore form a well-supported subclade within a larger peninsular clade. A medianjoining network of haplotypes mirrored the results from the phylogenetic analyses. We found divergence dates that were largely consistent with previous studies using complete mitochondrial genomes. Based on an assessment of phylogenetic relationships, the pattern of estimated divergence dates, and the available fossil record, we suggest that the evolutionary history of M. fascicularis likely included multiple dispersal events.

    • Health Economics RSS Word feed
      1. Cost-effectiveness analysis of four simulated colorectal cancer screening interventions, North CarolinaExternal
        Hassmiller Lich K, Cornejo DA, Mayorga ME, Pignone M, Tangka FK, Richardson LC, Kuo TM, Meyer AM, Hall IJ, Smith JL, Durham TA, Chall SA, Crutchfield TM, Wheeler SB.
        Prev Chronic Dis. 2017 Feb 23;14:E18.
        INTRODUCTION: Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions to improve their population’s health. The objective of this study was to demonstrate use of a simulation model that incorporates synthetic census data and claims-based statistical models to project screening behavior in North Carolina. METHODS: We used individual-based modeling to simulate and compare intervention costs and results under 4 evidence-based and stakeholder-informed intervention scenarios for a 10-year intervention window, from January 1, 2014, through December 31, 2023. We compared the proportion of people living in North Carolina who were aged 50 to 75 years at some point during the window (that is, age-eligible for screening) who were up to date with CRC screening recommendations across intervention scenarios, both overall and among groups with documented disparities in receipt of screening. RESULTS: We estimated that the costs of the 4 intervention scenarios considered would range from $1.6 million to $3.75 million. Our model showed that mailed reminders for Medicaid enrollees, mass media campaigns targeting African Americans, and colonoscopy vouchers for the uninsured reduced disparities in receipt of screening by 2023, but produced only small increases in overall screening rates (0.2-0.5 percentage-point increases in the percentage of age-eligible adults who were up to date with CRC screening recommendations). Increased screenings ranged from 41,709 additional life-years up to date with screening for the voucher intervention to 145,821 for the mass media intervention. Reminders mailed to Medicaid enrollees and the mass media campaign for African Americans were the most cost-effective interventions, with costs per additional life-year up to date with screening of $25 or less. The intervention expanding the number of endoscopy facilities cost more than the other 3 interventions and was less effective in increasing CRC screening. CONCLUSION: Cost-effective CRC screening interventions targeting observed disparities are available, but substantial investment (more than $3.75 million) and additional approaches beyond those considered here are required to realize greater increases population-wide.

      2. Cost-effectiveness of the 2014 U.S. Preventive Services Task Force (USPSTF) Recommendations for Intensive Behavioral Counseling Interventions for Adults With Cardiovascular Risk FactorsExternal
        Lin J, Zhuo X, Bardenheier B, Rolka DB, Gregg WE, Hong Y, Wang G, Albright A, Zhang P.
        Diabetes Care. 2017 Feb 17.
        OBJECTIVE: In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended behavioral counseling interventions for overweight or obese adults with the following known cardiovascular disease risk factors: impaired fasting glucose (IFG), hypertension, dyslipidemia, or metabolic syndrome. We assessed the long-term cost-effectiveness (CE) of implementing the recommended interventions in the U.S. RESEARCH DESIGN AND METHODS: We used a disease progression model to simulate the 25-year CE of the USPSTF recommendation for eligible U.S. adults and subgroups defined by a combination of the risk factors. The baseline population was estimated using 2005-2012 National Health and Nutrition Examination Surveys. The cost and effectiveness of the intervention were obtained from systematic reviews. Incremental CE ratios (ICERs), measured in cost/quality-adjusted life year (QALY), were used to assess the CE of the intervention compared with no intervention. Future QALYs and costs (reported in 2014 U.S. dollars) were discounted at 3%. RESULTS: We estimated that approximately 98 million U.S. adults (44%) would be eligible for the recommended intervention. Compared with no intervention, the ICER of the intervention would be $13,900/QALY. CE varied widely among subgroups, ranging from a cost saving of $302 per capita for those who were obese with IFG, hypertension, and dyslipidemia to a cost of $103,200/QALY in overweight people without these conditions. CONCLUSIONS: The recommended intervention is cost effective based on the conventional CE threshold. Considerable variation in CE across the recommended subpopulations suggests that prioritization based on risk level would yield larger total health gains per dollar spent.

      3. Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United StatesExternal
        Zheng Z, Han X, Guy GP, Davidoff AJ, Li C, Banegas MP, Ekwueme DU, Yabroff KR, Jemal A.
        Cancer. 2017 Feb 20.
        BACKGROUND: There is limited evidence from nationally representative samples about changes in prescription drug use for financial reasons among cancer survivors in the United States. METHODS: The 2011 to 2014 National Health Interview Survey was used to identify adults who reported ever having been told they had cancer (cancer survivors; n = 8931) and individuals without a cancer history (n = 126,287). Measures of changes in prescription drug use for financial reasons included: 1) skipping medication doses, 2) taking less medicine, 3) delaying filling a prescription, 4) asking a doctor for lower cost medication, 5) buying prescription drugs from another country, and 6) using alternative therapies. Multivariable logistic regression analyses were controlled for demographic characteristics, number of comorbid conditions, interactions between cancer history and number of comorbid conditions, and health insurance coverage. Main analyses were stratified by age (nonelderly, ages 18-64 years; elderly, ages >/=65 years) and time since diagnosis (recently diagnosed, <2 years; previously diagnosed, >/=2 years). RESULTS: Among nonelderly individuals, both recently diagnosed (31.6%) and previously diagnosed (27.9%) cancer survivors were more likely to report any change in prescription drug use for financial reasons than those without a cancer history (21.4%), with the excess percentage changes for individual measures ranging from 3.5% to 9.9% among previously diagnosed survivors and from 2.6% to 2.7% among recently diagnosed survivors (P < .01). Elderly cancer survivors and those without a cancer history had comparable rates of changes in prescription drug use for financial reasons. CONCLUSIONS: Nonelderly cancer survivors are particularly vulnerable to changes in prescription drug use for financial reasons, suggesting that targeted efforts are needed. Cancer 2017.

      4. Trends of lack of health insurance among US adults aged 18-64 years: findings from the Behavioral Risk Factor Surveillance System, 1993-2014
        Zhao G, Okoro CA, Dhingra SS, Xu F, Zack M.
        Public Health. 2017 ;146:108-117.
        Objective To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18-64 years) in 50 states and the District of Columbia (DC). Study design Cross-sectional surveys. Methods We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18-64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993-2010 and 2011-2014 due to methodologic changes in the BRFSS. Results From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0-24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2-10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state. Conclusions The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18-64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population.

    • Informatics RSS Word feed
      1. Cross-disciplinary consultancy to enhance predictions of asthma exacerbation risk in BostonExternal
        Reid M, Gunn J, Shah S, Donovan M, Eggo R, Babin S, Stajner I, Rogers E, Ensor KB, Raun L, Levy JI, Painter I, Phipatanakul W, Yip F, Nath A, Streichert LC, Tong C, Burkom H.
        Online J Public Health Inform. 2016 ;8(3):e199.
        This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission. Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement.

      2. Zimbabwe’s Human Resources for health Information System (ZHRIS) – an assessment in the context of establishing a global standard
        Waters KP, Zuber A, Simbini T, Bangani Z, Krishnamurthy RS.
        Int J Med Inform. 2017 01 Apr;100:121-128.
        Introduction There have been numerous global calls to action to utilize human resources information systems (HRIS) to improve the availability and quality of data for strengthening the regulation and deployment of health workers. However, with no normative guidance in existence, the development of HRIS has been inconsistent and lacking in standardization, hindering the availability and use of data for health workforce planning and decision making (Riley et al., 2012). CDC and WHO partnered with the Ministry of Health in several countries to conduct HRIS functional requirements analyses and establish a Minimum Data Set (MDS) of elements essential for a global standard HRIS. As a next step, CDC advanced a study to examine the alignment of one of the HRIS it supports (in Zimbabwe) against this MDS. Method For this study, we created a new data collection and analysis tool to assess the extent to which Zimbabwe’s CDC-supported HRIS was aligned with the WHO MDS. We performed systematic “gap analyses” in order to make prioritized recommendations for addressing the gaps, with the aim of improving the availability and quality of data on Zimbabwe’s health workforce. Results The majority of the data elements outlined in the WHO MDS were present in the ZHRIS databases, though they were found to be missing various applicable elements. The lack of certain elements could impede functions such as health worker credential verification or equitable in-service training allocation. While the HRIS MDS treats all elements equally, our assessment revealed that not all the elements have equal significance when it comes to data utilization. Further, some of the HRIS MDS elements exceeded the current needs of regulatory bodies and the Ministry of Health and Child Care (MOHCC) in Zimbabwe. The preliminary findings of this study helped inspire the development of a more recent HRH Registry MDS subset, which is a shorter list of priority data elements recommended as a global standard for HRIS. Conclusion The field-tested assessment methodology presented here, with suggested improvements to the tool, can be used to identify absent or unaligned elements in either an HRH Registry or a full HRIS. Addressing the prioritized gaps will increase the availability of critical data in the ZHRIS and can empower the MOHCC and councils to conduct more strategic analyses, improving health workforce planning and ultimately public health outcomes in the country.

    • Injury and Violence RSS Word feed
      1. Linkage of traffic crash and hospitalization records with limited identifiers for enhanced public health surveillanceExternal
        Conderino S, Fung L, Sedlar S, Norton JM.
        Accid Anal Prev. 2017 Feb 19;101:117-123.
        BACKGROUND: Motor vehicle traffic (MVT) crashes kill or seriously injure approximately 4250 people in New York City (NYC) each year. Traditionally, NYC surveillance practices use hospitalization and crash data separately to monitor trends in MVT-related injuries, but key information linking crash circumstances to health outcomes is lost when analyzing these data sources in isolation. Our objective was to match crash reports to hospitalization records to create a traffic injury surveillance dataset that can be used to describe crash circumstances and related injury outcomes. The linkage of the two systems presents a unique challenge since the system tracking crashes and the system tracking hospitalizations and emergency department (ED) visits lack key identifying data such as names and dates of birth. METHODS: NYC Department of Transportation provided electronic records based on reports of motor vehicle crashes submitted to the New York State Department of Motor Vehicles for all crashes occurring in NYC from 2009 to 2013. New York Statewide Planning and Research Cooperative System (SPARCS) ED and hospitalization administrative data from NYC hospitals were used to identify unintentional MVT-related injuries using external cause of injury codes. Since the two systems do not share unique individual identifiers, probabilistic record linkage was conducted using LinkSolv9.0. Sensitivity/specificity calculations and chi-square analyses of linkage rates were conducted to assess linkage results. RESULTS: From 2009-2013, there were 1,054,344 individuals involved in MVT crashes in NYC and 280,340 ED visits and hospitalizations from MVT-related injuries. There were 145,003 linked pairs, giving a linkage rate of 52% of the total MVT-related hospital records. This linkage had a sensitivity of 74% and a specificity of 93%. Linkage rates were comparable by age, sex, crash role, collision type, hospital county, injury location, hospital type, and hospital status, indicating no apparent biases in the match by these variables. CONCLUSIONS: Performing a probabilistic linkage between MVT crash reports and hospitalization records is possible with a limited set of identifying variables. These linked data will inform traffic safety policies by providing new information on how crash circumstances translate to health outcomes.

    • Laboratory Sciences RSS Word feed
      1. Serum-borne bioactivity caused by pulmonary multiwalled carbon nanotubes induces neuroinflammation via blood-brain barrier impairmentExternal
        Aragon MJ, Topper L, Tyler CR, Sanchez B, Zychowski K, Young T, Herbert G, Hall P, Erdely A, Eye T, Bishop L, Saunders SA, Muldoon PP, Ottens AK, Campen MJ.
        Proc Natl Acad Sci U S A. 2017 Feb 21.
        Pulmonary exposure to multiwalled carbon nanotubes (MWCNTs) causes indirect systemic inflammation through unknown pathways. MWCNTs translocate only minimally from the lungs into the systemic circulation, suggesting that extrapulmonary toxicity may be caused indirectly by lung-derived factors entering the circulation. To assess a role for MWCNT-induced circulating factors in driving neuroinflammatory outcomes, mice were acutely exposed to MWCNTs (10 or 40 microg/mouse) via oropharyngeal aspiration. At 4 h after MWCNT exposure, broad disruption of the blood-brain barrier (BBB) was observed across the capillary bed with the small molecule fluorescein, concomitant with reactive astrocytosis. However, pronounced BBB permeation was noted, with frank albumin leakage around larger vessels (>10 microm), overlain by a dose-dependent astroglial scar-like formation and recruitment of phagocytic microglia. As affirmed by elevated inflammatory marker transcription, MWCNT-induced BBB disruption and neuroinflammation were abrogated by pretreatment with the rho kinase inhibitor fasudil. Serum from MWCNT-exposed mice induced expression of adhesion molecules in primary murine cerebrovascular endothelial cells and, in a wound-healing in vitro assay, impaired cell motility and cytokinesis. Serum thrombospondin-1 level was significantly increased after MWCNT exposure, and mice lacking the endogenous receptor CD36 were protected from the neuroinflammatory and BBB permeability effects of MWCNTs. In conclusion, acute pulmonary exposure to MWCNTs causes neuroinflammatory responses that are dependent on the disruption of BBB integrity.

      2. Chemical characterization of mainstream smoke from SPECTRUM variable nicotine research cigarettesExternal
        Ding YS, Richter P, Hearn B, Zhang L, Bravo R, Yan X, Perez JJ, Chan M, Hughes J, Chen P, Chen W, Wong J, Holmberg S, Smith S, Larango M, Valentin-Blasini L, Watson CH.
        Tob Regul Sci. 2017 Dec 01;3(1):81-94.
        OBJECTIVE: Our objective was to characterize mainstream smoke constituent deliveries from SPECTRUM variable nicotine research cigarettes under 2 machine smoking regimens. SPECTRUM cigarettes are manufactured by the 22nd Century company for the National Institute on Drug Abuse, National Institutes of Health to contain varying (including reduced) levels of nicotine. METHODS: Mainstream smoke constituent deliveries of “tar,” nicotine, carbon monoxide, tobacco-specific nitrosamines (N’-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)), benzo[a]pyrene, aromatic amines, and carbonyls were analyzed in 23 varieties of SPECTRUM cigarettes using ISO 17025 accredited methods. RESULTS: Data are presented as means and standard deviations of 5 replicates for all analytes. CONCLUSIONS: Under the ISO smoking regimen, mean levels of many smoke emissions for SPECTRUM varieties were comparable to the 3R4F research cigarette. Calculated SPECTRUM elasticity ranged from 1.6 to 4.0. Accordingly, under intense machine smoking conditions differences in emissions of SPECTRUM cigarettes were apparent. In addition, NNN increased with smoke nicotine while the same rate of change was not seen for NNK. It is important to monitor levels of chemicals of public health concern and regulatory interest as technologies emerge to reduce levels of nicotine or other targeted chemicals in tobacco products.

      3. AOAC SMPR 2016.010: Standard Method Performance Requirements (SMPRs) for DNA-based methods of detecting Burkholderia pseudomallei in field-deployable, Department of Defense aerosol collection devices
        Gee J, Arce J, Beck LC, Blank TR, Blyn L, Cahall R, Clark AJ, et al .
        J AOAC Int. 2017 ;100(1):261-265.
        [No abstract]
      4. High-confidence qualitative identification of organophosphorus nerve agent adducts to human butyrylcholinesteraseExternal
        Mathews TP, Carter MD, Johnson D, Isenberg SL, Graham LA, Thomas JD, Johnson RC.
        Anal Chem. 2017 Feb 07;89(3):1955-1964.
        In this study, a data-dependent, high-resolution tandem mass spectrometry (ddHRMS/MS) method capable of detecting all organophosphorus nerve agent (OPNA) adducts to human butyrylcholinesterase (BChE) was developed. After an exposure event, immunoprecipitation from blood with a BChE-specific antibody and digestion with pepsin produces a nine amino acid peptide containing the OPNA adduct. Signature product ions of this peptic BChE nonapeptide (FGES*AGAAS) offer a route to broadly screen for OPNA exposure. Taking this approach on an HRMS instrument identifies biomarkers, including unknowns, with high mass accuracy. Using a set of pooled human sera exposed to OPNAs as quality control (QC) materials, the developed method successfully identified precursor ions with <1 ppm and tied them to signature product ions with <5 ppm deviation from their chemical formulas. This high mass accuracy data from precursor and product ions, collected over 23 independent immunoprecipitation preparations, established method operating limits. QC data and experiments with 14 synthetic reference peptides indicated that reliable qualitative identification of biomarkers was possible for analytes >15 ng/mL. The developed method was applied to a convenience set of 96 unexposed serum samples and a blinded set of 80 samples treated with OPNAs. OPNA biomarkers were not observed in convenience set samples and no false positive or negative identifications were observed in blinded samples. All biomarkers in the blinded serum set >15 ng/mL were correctly identified. For the first time, this study reports a ddHRMS/MS method capable of complementing existing quantitative methodologies and suitable for identifying exposure to unknown organophosphorus agents.

      5. The combined effects of 3,4-methylenedioxymethamphetamine (MDMA) and selected substituted methcathinones on measures of neurotoxicityExternal
        Miner NB, O’Callaghan JP, Phillips TJ, Janowsky A.
        Neurotoxicol Teratol. 2017 Feb 14.
        The rise in popularity of substituted methcathinones (aka “bath salts”) has increased the focus on their neurotoxic effects. Two commonly abused methcathinones, 3,4-methylenedioxymethcathinone (methylone, MDMC) and 3,4-methylenedioxypyrovalerone (MDPV), are often concomitantly ingested with the illicit drug 3,4-methylenedioxymethamphetamine (MDMA). To examine potential neurotoxic effects of these drug combinations, C57BL/6J mice were administered 4 i.p. injection of the drugs, at 2h intervals, either singularly: MDMA 15 or 30mg/kg, methylone 20mg/kg, MDPV 1mg/kg; or in combination: methylone/MDMA 20/15mg/kg, MDPV/MDMA 1/15mg/kg. Drug effects on thermoregulation were characterized and striatal tissue analyzed after 2 or 7days for dopamine (DA) and tyrosine hydroxylase (TH) levels, as well as glial fibrillary acidic protein (GFAP) expression. Two days following drug administration, DA and TH were decreased only in the MDMA 30mg/kg group, whereas GFAP expression was dose-dependently increased by MDMA alone. While the combination of the methcathinones with the lower MDMA dose did not affect DA or TH levels, both blocked the MDMA-induced increase in GFAP expression. Seven days following drug administration, there were no significant differences in DA, TH, or GFAP for any treatment group, indicating that changes in DA, TH, and GFAP were transient. Five of the six drug groups exhibited acute hypothermia followed by gradually increasing temperatures. Animals treated with MDPV did not exhibit these biphasic temperature changes, and resembled the saline group. These results indicate that specific effects of both methylone and MDPV on DA depletion or astrocyte activation in the striatum are not additive with effects of MDMA, but block astrogliosis caused by MDMA alone. Additionally, MDPV modulates thermoregulation through a different mechanism than methylone or MDMA.

      6. High-throughput next-generation sequencing of poliovirusesExternal
        Montmayeur AM, Ng TF, Schmidt A, Zhao K, Magana L, Iber J, Castro CJ, Chen Q, Henderson E, Ramos E, Shaw J, Tatusov RL, Dybdahl-Sissoko N, Endegue-Zanga MC, Adeniji JA, Oberste MS, Burns CC.
        J Clin Microbiol. 2017 Feb;55(2):606-615.
        The poliovirus (PV) is currently targeted for worldwide eradication and containment. Sanger-based sequencing of the viral protein 1 (VP1) capsid region is currently the standard method for PV surveillance. However, the whole-genome sequence is sometimes needed for higher resolution global surveillance. In this study, we optimized whole-genome sequencing protocols for poliovirus isolates and FTA cards using next-generation sequencing (NGS), aiming for high sequence coverage, efficiency, and throughput. We found that DNase treatment of poliovirus RNA followed by random reverse transcription (RT), amplification, and the use of the Nextera XT DNA library preparation kit produced significantly better results than other preparations. The average viral reads per total reads, a measurement of efficiency, was as high as 84.2% +/- 15.6%. PV genomes covering >99 to 100% of the reference length were obtained and validated with Sanger sequencing. A total of 52 PV genomes were generated, multiplexing as many as 64 samples in a single Illumina MiSeq run. This high-throughput, sequence-independent NGS approach facilitated the detection of a diverse range of PVs, especially for those in vaccine-derived polioviruses (VDPV), circulating VDPV, or immunodeficiency-related VDPV. In contrast to results from previous studies on other viruses, our results showed that filtration and nuclease treatment did not discernibly increase the sequencing efficiency of PV isolates. However, DNase treatment after nucleic acid extraction to remove host DNA significantly improved the sequencing results. This NGS method has been successfully implemented to generate PV genomes for molecular epidemiology of the most recent PV isolates. Additionally, the ability to obtain full PV genomes from FTA cards will aid in facilitating global poliovirus surveillance.

      7. Comparison between the triglycerides standardization of routine methods used in Japan and the chromotropic acid reference measurement procedure used by the CDC Lipid Standardization ProgrammeExternal
        Nakamura M, Iso H, Kitamura A, Imano H, Noda H, Kiyama M, Sato S, Yamagishi K, Nishimura K, Nakai M, Vesper HW, Teramoto T, Miyamoto Y.
        Ann Clin Biochem. 2016 Nov;53(6):632-639.
        Background The US Centers for Disease Control and Prevention ensured adequate performance of the routine triglycerides methods used in Japan by a chromotropic acid reference measurement procedure used by the Centers for Disease Control and Prevention lipid standardization programme as a reference point. We examined standardized data to clarify the performance of routine triglycerides methods. Methods The two routine triglycerides methods were the fluorometric method of Kessler and Lederer and the enzymatic method. The methods were standardized using 495 Centers for Disease Control and Prevention reference pools with 98 different concentrations ranging between 0.37 and 5.15 mmol/L in 141 survey runs. The triglycerides criteria for laboratories which perform triglycerides analyses are used: accuracy, as bias </=5% from the Centers for Disease Control and Prevention reference value and precision, as measured by CV, </=5%. Results The correlation of the bias of both methods to the Centers for Disease Control and Prevention reference method was: y (%bias) = 0.516 x (Centers for Disease Control and Prevention reference value) -1.292 ( n = 495, R2 = 0.018). Triglycerides bias at medical decision points of 1.13, 1.69 and 2.26 mmol/L was -0.71%, -0.42% and -0.13%, respectively. For the combined precision, the equation y (CV) = -0.398 x (triglycerides value) + 1.797 ( n = 495, R2 = 0.081) was used. Precision was 1.35%, 1.12% and 0.90%, respectively. It was shown that triglycerides measurements at Osaka were stable for 36 years. Conclusions The epidemiologic laboratory in Japan met acceptable accuracy goals for 88.7% of all samples, and met acceptable precision goals for 97.8% of all samples measured through the Centers for Disease Control and Prevention lipid standardization programme and demonstrated stable results for an extended period of time.

      8. AOAC SMPR 2016.012: Standard Method Performance Requirements (SMPRs) for detection and identification of Variola virus
        Olson V, Arce J, Beck LC, Blyn L, Cahall R, Clark AJ, Damer K, Ibrahim MS, Jackson PJ, Kiss K, Meyer H, Naraghi-Arani P, Pettit D, Schaefer F, Scheckelhoff M, Sozhamannan S, Vitalis E, Coates SG.
        J AOAC Int. 2017 ;100(1):270-275.
        [No abstract]
      9. Immunogenicity and cross protection in mice afforded by pandemic H1N1 live attenuated influenza vaccine containing wild-type nucleoproteinExternal
        Rekstin A, Isakova-Sivak I, Petukhova G, Korenkov D, Losev I, Smolonogina T, Tretiak T, Donina S, Shcherbik S, Bousse T, Rudenko L.
        Biomed Res Int. 2017 ;2017:9359276.
        Since conserved viral proteins of influenza virus, such as nucleoprotein (NP) and matrix 1 protein, are the main targets for virus-specific CD8+ cytotoxic T-lymphocytes (CTLs), we hypothesized that introduction of the NP gene of wild-type virus into the genome of vaccine reassortants could lead to better immunogenicity and afford better protection. This paper describes in vitro and in vivo preclinical studies of two new reassortants of pandemic H1N1 live attenuated influenza vaccine (LAIV) candidates. One had the hemagglutinin (HA) and neuraminidase (NA) genes from A/South Africa/3626/2013 H1N1 wild-type virus on the A/Leningrad/134/17/57 master donor virus backbone (6 : 2 formulation) while the second had the HA, NA, and NP genes of the wild-type virus on the same backbone (5 : 3 formulation). Although both LAIVs induced similar antibody immune responses, the 5 : 3 LAIV provoked greater production of virus-specific CTLs than the 6 : 2 variant. Furthermore, the 5 : 3 LAIV-induced CTLs had higher in vivo cytotoxic activity, compared to 6 : 2 LAIV. Finally, the 5 : 3 LAIV candidate afforded greater protection against infection and severe illness than the 6 : 2 LAIV. Inclusion in LAIV of the NP gene from wild-type influenza virus is a new approach to inducing cross-reactive cell-mediated immune responses and cross protection against pandemic influenza.

      10. AOAC SMPR 2016.009: Standard Method Performance Requirements (SMPRs) for DNA-based methods of detecting Brucella suis in field-deployable, Department of Defense aerosol collection devices
        Roberto F, Arce J, Beck LC, Blank TR, Cahall R, Damer K, Ficht T, Foster J, Kiss K, Nikolich M, Olsen S, Ozanich R, Rozak D, Schaefer F, Sozhamannan S, Tiller R, Coates SG.
        J AOAC Int. 2017 ;100(1):255-260.
        [No abstract]
      11. Engineering botulinum neurotoxin C1 as a molecular vehicle for intra-neuronal drug deliveryExternal
        Vazquez-Cintron EJ, Beske PH, Tenezaca L, Tran BQ, Oyler JM, Glotfelty EJ, Angeles CA, Syngkon A, Mukherjee J, Kalb SR, Band PA, McNutt PM, Shoemaker CB, Ichtchenko K.
        Sci Rep. 2017 Feb 21;7:42923.
        Botulinum neurotoxin (BoNT) binds to and internalizes its light chain into presynaptic compartments with exquisite specificity. While the native toxin is extremely lethal, bioengineering of BoNT has the potential to eliminate toxicity without disrupting neuron-specific targeting, thereby creating a molecular vehicle capable of delivering therapeutic cargo into the neuronal cytosol. Building upon previous work, we have developed an atoxic derivative (ad) of BoNT/C1 through rationally designed amino acid substitutions in the metalloprotease domain of wild type (wt) BoNT/C1. To test if BoNT/C1 ad retains neuron-specific targeting without concomitant toxic host responses, we evaluated the localization, activity, and toxicity of BoNT/C1 ad in vitro and in vivo. In neuronal cultures, BoNT/C1 ad light chain is rapidly internalized into presynaptic compartments, but does not cleave SNARE proteins nor impair spontaneous neurotransmitter release. In mice, systemic administration resulted in the specific co-localization of BoNT/C1 ad with diaphragmatic motor nerve terminals. The mouse LD50 of BoNT/C1 ad is 5 mg/kg, with transient neurological symptoms emerging at sub-lethal doses. Given the low toxicity and highly specific neuron-targeting properties of BoNT/C1 ad, these data suggest that BoNT/C1 ad can be useful as a molecular vehicle for drug delivery to the neuronal cytoplasm.

      12. Safe recombinant outer membrane vesicles that display M2e elicit heterologous influenza protectionExternal
        Watkins HC, Rappazzo CG, Higgins JS, Sun X, Brock N, Chau A, Misra A, Cannizzo JP, King MR, Maines TR, Leifer CA, Whittaker GR, DeLisa MP, Putnam D.
        Mol Ther. 2017 Feb 16.
        Recombinant, Escherichia coli-derived outer membrane vesicles (rOMVs), which display heterologous protein subunits, have potential as a vaccine adjuvant platform. One drawback to rOMVs is their lipopolysaccharide (LPS) content, limiting their translatability to the clinic due to potential adverse effects. Here, we explore a unique rOMV construct with structurally remodeled lipids containing only the lipid IVa portion of LPS, which does not stimulate human TLR4. The rOMVs are derived from a genetically engineered B strain of E. coli, ClearColi, which produces lipid IVa, and which was further engineered in our laboratory to hypervesiculate and make rOMVs. We report that rOMVs derived from this lipid IVa strain have substantially attenuated pyrogenicity yet retain high levels of immunogenicity, promote dendritic cell maturation, and generate a balanced Th1/Th2 humoral response. Additionally, an influenza A virus matrix 2 protein-based antigen displayed on these rOMVs resulted in 100% survival against a lethal challenge with two influenza A virus strains (H1N1 and H3N2) in mice with different genetic backgrounds (BALB/c, C57BL/6, and DBA/2J). Additionally, a two-log reduction of lung viral titer was achieved in a ferret model of influenza infection with human pandemic H1N1. The rOMVs reported herein represent a potentially safe and simple subunit vaccine delivery platform.

    • Maternal and Child Health RSS Word feed
      1. Trends in anthropometric measures among US children 6 to 23 months, 1976-2014External
        Akinbami LJ, Kit BK, Carroll MD, Fakhouri TH, Ogden CL.
        Pediatrics. 2017 Feb 17.
        BACKGROUND AND OBJECTIVES: The surveillance of children’s growth reflects a population’s nutritional status and risk for adverse outcomes. This study aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months. METHODS: We analyzed NHANES data from 1976-1980, 1988-1994, 1999-2002, 2003-2006, 2007-2010, and 2011-2014. We estimated z scores < -2 (low) and >/=+2 (high) in comparison with World Health Organization growth standards for each indicator. Weight gain (relative to sex-age-specific medians) from birth until survey participation was estimated. Trends were assessed by low birth weight status and race/Hispanic origin. Race/Hispanic origin trends were assessed from 1988-1994 to 2011-2014. RESULTS: In 2011-2014, the prevalence of low and high length-for-age was 3.3% (SE, 0.8) and 3.7% (SE, 0.8); weight-for-age was 0.6% (SE, 0.3) and 7.0% (SE, 1.1); and weight-for-length was 1.0% (SE, 0.4) and 7.7% (SE, 1.2). The only significant trend was a decrease in high length-for-age (5.5% in 1976-1980 vs 3.7% in 2011-2014; P = .04). Relative weight gain between birth and survey participation did not differ over time, although trends differed by race/Hispanic origin. Non-Hispanic black children gained more weight between birth and survey participation in 2011-2014 versus 1988-1994, versus no change among other groups. CONCLUSIONS: Between 1976-1980 and 2011-2014, there were no significant trends in low or high weight-for-age and weight-for-length among 6- to 23-month-old children whereas the percent with high length-for-age decreased. A significant trend in relative weight gain between birth and survey participation was observed among non-Hispanic black children.

      2. The Sudden Death in the Young Case Registry: Collaborating to understand and reduce mortalityExternal
        Burns KM, Bienemann L, Camperlengo L, Cottengim C, Covington TM, Dykstra H, Faulkner M, Kobau R, Erck Lambert AB, MacLeod H, Parks SE, Rosenberg E, Russell MW, Shapiro-Mendoza CK, Shaw E, Tian N, Whittemore V, Kaltman JR.
        Pediatrics. 2017 Feb 22.
        Knowledge gaps persist about the incidence of and risk factors for sudden death in the young (SDY). The SDY Case Registry is a collaborative effort between the National Institutes of Health, the Centers for Disease Control and Prevention, and the Michigan Public Health Institute. Its goals are to: (1) describe the incidence of SDY in the United States by using population-based surveillance; (2) compile data from SDY cases to create a resource of information and DNA samples for research; (3) encourage standardized approaches to investigation, autopsy, and categorization of SDY cases; (4) develop partnerships between local, state, and federal stakeholders toward a common goal of understanding and preventing SDY; and (5) support families who have lost loved ones to SDY by providing resources on bereavement and medical evaluation of surviving family members. Built on existing Child Death Review programs and as an expansion of the Sudden Unexpected Infant Death Case Registry, the SDY Case Registry achieves its goals by identifying SDY cases, providing guidance to medical examiners/coroners in conducting comprehensive autopsies, evaluating cases through child death review and an advanced review by clinical specialists, and classifying cases according to a standardized algorithm. The SDY Case Registry also includes a process to obtain informed consent from next-of-kin to save DNA for research, banking, and, in some cases, diagnostic genetic testing. The SDY Case Registry will provide valuable incidence data and will enhance understanding of the characteristics of SDY cases to inform the development of targeted prevention efforts.

      3. Hearing loss in children with asymptomatic congenital cytomegalovirus infectionExternal
        Lanzieri TM, Chung W, Flores M, Blum P, Caviness AC, Bialek SR, Grosse SD, Miller JA, Demmler-Harrison G.
        Pediatrics. 2017 Feb 16.
        OBJECTIVES: To assess the prevalence, characteristics, and risk of sensorineural hearing loss (SNHL) in children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected children. METHODS: We included 92 case-patients and 51 controls assessed by using auditory brainstem response and behavioral audiometry. We used Kaplan-Meier survival analysis to estimate the prevalence of SNHL, defined as >/=25 dB hearing level at any frequency and Cox proportional hazards regression analyses to compare SNHL risk between groups. RESULTS: At age 18 years, SNHL prevalence was 25% (95% confidence interval [CI]: 17%-36%) among case-patients and 8% (95% CI: 3%-22%) in controls (hazard ratio [HR]: 4.0; 95% CI: 1.2-14.5; P = .02). Among children without SNHL by age 5 years, the risk of delayed-onset SNHL was not significantly greater for case-patients than for controls (HR: 1.6; 95% CI: 0.4-6.1; P = .5). Among case-patients, the risk of delayed-onset SNHL was significantly greater among those with unilateral congenital/early-onset hearing loss than those without (HR: 6.9; 95% CI: 2.5-19.1; P < .01). The prevalence of severe to profound bilateral SNHL among case-patients was 2% (95% CI: 1%-9%). CONCLUSIONS: Delayed-onset and progression of SNHL among children with asymptomatic congenital cytomegalovirus infection continued to occur throughout adolescence. However, the risk of developing SNHL after age 5 years among case-patients was not different than in uninfected children. Overall, 2% of case-patients developed SNHL that was severe enough for them to be candidates for cochlear implantation.

    • Nutritional Sciences RSS Word feed
      1. Store-directed price promotions and communications strategies improve healthier food supply and demand: impact results from a randomized controlled, Baltimore City store-intervention trialExternal
        Budd N, Jeffries JK, Jones-Smith J, Kharmats A, McDermott AY, Gittelsohn J.
        Public Health Nutr. 2017 Feb 22:1-11.
        OBJECTIVE: Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. DESIGN: Factorial design randomized controlled trial. SETTING: Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. SUBJECTS: Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10-30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. RESULTS: All interventions showed significantly increased stock of promoted foods v. CONTROL: There was a significant treatment effect for daily unit sales of healthy snacks (beta=6.4, 95 % CI 0.9, 11.9) and prices of healthy staple foods (beta=-0.49, 95 % CI -0.90, -0.03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors. CONCLUSIONS: All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.

    • Occupational Safety and Health – Mining RSS Word feed
      1. Development of a roof bolter canopy air curtain for respirable dust control
        Reed WR, Joy GJ, Kendall B, Bailey A, Zheng Y.
        Mining Engineering. 2017 ;69(1):33-39.
        Testing of the roof bolter canopy air curtain (CAC) designed by the U.S. National Institute for Occupational Safety and Health (NIOSH) has gone through many iterations, demonstrating successful dust control performance under controlled laboratory conditions. J.H. Fletcher & Co., an original equipment manufacturer of mining equipment, further developed the concept by incorporating it into the design of its roof bolting machines. In the present work, laboratory testing was conducted, showing dust control efficiencies ranging from 17.2 to 24.5 percent. Subsequent computational fluid dynamics (CFD) analysis revealed limitations in the design, and a potential improvement was analyzed and recommended. As a result, a new CAC design is being developed, incorporating the results of the testing and CFD analysis.

    • Parasitic Diseases RSS Word feed
      1. Assessment of lymphatic filariasis prior to re-starting mass drug administration campaigns in coastal KenyaExternal
        Njenga SM, Kanyi HM, Mutungi FM, Okoyo C, Matendechero HS, Pullan RL, Halliday KE, Brooker SJ, Wamae CN, Onsongo JK, Won KY.
        Parasit Vectors. 2017 Feb 22;10(1):99.
        BACKGROUND: Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and is one of a diverse group of diseases referred to as neglected tropical diseases (NTDs) which mainly occur among the poorest populations. In line with global recommendations to eliminate LF, Kenya launched its LF elimination programme in 2002 with the aim to implement annual mass drug administration (MDA) in order to interrupt LF transmission. However, the programme faced financial and administrative challenges over the years such that sustained annual MDA was not possible. Recently, there has been renewed interest to eliminate LF and the Kenyan Ministry of Health, through support from World Health Organization (WHO), restarted annual MDA in 2015. The objective of this study was to evaluate the current status of LF infection in the endemic coastal region of Kenya before MDA campaigns were restarted. RESULTS: Ten sentinel sites in Kwale, Kilifi, Tana River, Lamu, and Taita-Taveta counties in coastal Kenya were selected for participation in a cross-sectional survey of LF infection prevalence. At least 300 individuals in each sentinel village were sampled through random house-to-house visits. During the day, the point-of-care immunochromatographic test (ICT) was used to detect the presence of Wuchereria bancrofti circulating filarial antigen in finger prick blood samples collected from residents of the selected sentinel villages. Those individuals who tested positive with the ICT test were requested to provide a night-time blood sample for microfilariae (MF) examination. The overall prevalence of filarial antigenaemia was 1.3% (95% CI: 0.9-1.8%). Ndau Island in Lamu County had the highest prevalence (6.3%; 95% CI: 4.1-9.7%), whereas sites in Kilifi and Kwale counties had prevalences < 1.7%. Mean microfilarial density was also higher in Ndau Island (234 MF/ml) compared to sentinel sites in Kwale and Kilifi counties (< 25 MF/ml). No LF infection was detected in Tana River and Taita-Taveta counties. Overall, more than 88% of the study participants reported to have used a bed net the previous night. CONCLUSIONS: Prevalence of LF infection is generally very low in coastal Kenya, but there remain areas that require further rounds of MDA if the disease is to be eliminated as a public health problem in line with the ongoing global elimination efforts. However, areas where there was no evidence of LF transmission should be considered for WHO-recommended transmission assessment surveys in view of stopping MDA.

    • Physical Activity RSS Word feed
      1. The impact of the Physical Activity Policy Research NetworkExternal
        Manteiga AM, Eyler AA, Valko C, Brownson RC, Evenson KR, Schmid T.
        Am J Prev Med. 2017 Mar;52(3s3):S224-s227.
        INTRODUCTION: Lack of physical activity is one of the greatest challenges of the 21st century. The Physical Activity Policy Research Network (PAPRN) is a thematic network established in 2004 to identify determinants, implementation, and outcomes of policies that are effective in increasing physical activity. The purpose of this study is to describe the products of PAPRN and make recommendations for future research and best practices. METHODS: A mixed methods approach was used to obtain both quantitative and qualitative data on the network. First, in 2014, PAPRN’s dissemination products from 2004 to 2014 were extracted and reviewed, including 57 publications and 56 presentations. Next, semi-structured qualitative interviews were conducted with 25 key network participants from 17 locations around the U.S. The transcripts were transcribed and coded. RESULTS: The results of the interviews indicated that the research network addressed several components of its mission, including the identification of physical activity policies, determinants of these policies, and the process of policy implementation. However, research focusing on physical activity policy outcomes was limited. Best practices included collaboration between researchers and practitioners and involvement of practitioners in research design, data collection, and dissemination of results. CONCLUSIONS: PAPRN is an example of a productive research network and has contributed to both the process and content of physical activity policy research over the past decade. Future research should emphasize physical activity policy outcomes. Additionally, increased partnerships with practitioners for collaborative, cross-sectoral physical activity policy research should be developed.

    • Public Health Leadership and Management RSS Word feed
      1. The Prevention Research Centers directors: Reflections covering two decades of leadershipExternal
        Harris JR, Riley PL, Kreuter M, Simoes EJ.
        Am J Prev Med. 2017 Mar;52(3s3):S211-s213.
        [No abstract]
      2. The Guest editors’ introduction to the special issue: Prevention Research Centers Program’s 30th anniversary celebrationExternal
        Massoudi MS, Ammerman AS, Brownson RC, Harris JR.
        Am J Prev Med. 2017 Mar;52(3s3):S207-s208.
        [No abstract]
      3. Prevention Research Centers: Perspective for the futureExternal
        Massoudi MS, Marcelin RA, Young BR, Bish CL, Henry D, Hurley S, Greenlund KJ, Giles WH.
        Am J Prev Med. 2017 Mar;52(3s3):S218-s223.
        [No abstract]
      4. Incorporating One Health into medical educationExternal
        Rabinowitz PM, Natterson-Horowitz BJ, Kahn LH, Kock R, Pappaioanou M.
        BMC Med Educ. 2017 Feb 23;17(1):45.
        One Health is an emerging concept that stresses the linkages between human, animal, and environmental health, as well as the need for interdisciplinary communication and collaboration to address health issues including emerging zoonotic diseases, climate change impacts, and the human-animal bond. It promotes complex problem solving using a systems framework that considers interactions between humans, animals, and their shared environment. While many medical educators may not yet be familiar with the concept, the One Health approach has been endorsed by a number of major medical and public health organizations and is beginning to be implemented in a number of medical schools. In the research setting, One Health opens up new avenues to understand, detect, and prevent emerging infectious diseases, and also to conduct translational studies across species. In the clinical setting, One Health provides practical ways to incorporate environmental and animal contact considerations into patient care. This paper reviews clinical and research aspects of the One Health approach through an illustrative case updating the biopsychosocial model and proposes a basic set of One Health competencies for training and education of human health care providers.

    • Reproductive Health RSS Word feed
      1. Removing barriers to contraception through use of criteria to assess pregnancy riskExternal
        Tepper NK, Curtis KM, Jatlaoui TC, Whiteman MK.
        Contraception. 2017 Feb 15.
        [No abstract]
    • Social and Behavioral Sciences RSS Word feed
      1. Being committed: Conceptualizations of romantic relationship commitment among low-income African American adolescents
        Barton AW, Hurt TR, Futris TG, Sheats KF, McElroy SE, Landor AM.
        J Black Psychol. 2017 ;43(2):111-134.
        Few studies have examined adolescents’ understanding of romantic relationship commitment, particularly among African American youth. Using three waves of semistructured interviews, the present descriptive study addresses this topic by exploring the ways in which 20 African American adolescents (age range 13-19 years) from low-income backgrounds conceptualize and describe commitment in romantic relationships. Qualitative analyses revealed three main themes related to defining commitment, indicating that which commitment provides, and describing the nature of commitment in different relationship contexts. Findings inform psychological research and practice relating to commitment and romantic relationships among African American adolescents.

    • Veterinary Medicine RSS Word feed
      1. Expanding veterinary biosurveillance in Washington, DC: The creation and utilization of an electronic-based online veterinary surveillance system
        Hennenfent A, DelVento V, Davies-Cole J, Johnson-Clarke F.
        Prev Vet Med. 2017 ;138:70-78.
        Objectives To enhance the early detection of emerging infectious diseases and bioterrorism events using companion animal-based surveillance. Methods Washington, DC, small animal veterinary facilities (n=17) were surveyed to determine interest in conducting infectious disease surveillance. Using these results, an electronic-based online reporting system was developed and launched in August 2015 to monitor rates of canine influenza, canine leptospirosis, antibiotic resistant infections, canine parvovirus, and syndromic disease trends. Results Nine of the 10 facilities that responded expressed interest conducting surveillance. In September 2015, 17 canine parvovirus cases were reported. In response, a campaign encouraging regular veterinary preventative care was launched and featured on local media platforms. Additionally, during the system’s first year of operation it detected 5 canine leptospirosis cases and 2 antibiotic resistant infections. No canine influenza cases were reported and syndromic surveillance compliance varied, peaking during National Special Security Events. Conclusions Small animal veterinarians and the general public are interested in companion animal disease surveillance. The system described can serve as a model for establishing similar systems to monitor disease trends of public health importance in pet populations and enhance biosurveillance capabilities.

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DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article’s inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article’s methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS. 

Page last reviewed: January 31, 2019