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MMWR – Morbidity and Mortality Weekly Report


1. HIV Infection and HIV-Associated Behaviors Among Injecting Drug Users — 20 Cities, United States, 2009

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A new report shows that despite declines in new HIV infections among injection drug users (IDUs), risk behaviors and unawareness of infection remain high in this population. This first large scale study of HIV seroprevalence among IDU in a decade finds 9 percent  of IDU were HIV infected, nearly half of whom (45 percent ) were unaware of their infection. The findings are part of the 2009 data from the National HIV Behavioral Surveillance System in which 10,073 IDUs in 20 metropolitan areas were surveyed regarding risk behaviors, HIV testing, and use of prevention services in the preceding 12 months and also tested for HIV. Surveys revealed high prevalence of injection-related and sexual risk behaviors among IDUs. More than one-third of respondents reported sharing syringes (34 percent) or other injection equipment (58 percent). In addition, most participants reported having had unprotected vaginal sex (69 percent) and almost half had multiple partners (46 percent). The report also revealed that fewer IDUs had been tested for HIV in the prior 12 months, when compared to a previous NHBS survey in 2006 (49 percent vs. 66 percent). Study authors note the importance of public health strategies like testing and access to new sterile syringes to reduce risk for infection.

2. Exposure to Nitrogen Dioxide in an Indoor Ice Arena — New Hampshire, 2011

In addition to carbon monoxide (CO), nitrogen dioxide gas (NO2) is an important, though less frequently recognized, threat to safe air in ice arenas.  In January 2011, an unusual cluster of acute respiratory symptoms in a group of ice hockey players in New Hampshire (NH) prompted an investigation by the NH Department of Health and Human Services. The symptoms – cough, hemoptysis, and chest pain or tightness – were consistent with exposure to nitrogen dioxide gas (NO2), a combustion by-product. The investigation implicated a local ice arena which had hosted hockey practices and used propane-powered ice resurfacers while arena ventilation systems were not functioning. Of the 43 persons exposed, 31 developed symptoms consistent with NO2 intoxication. Repair of the ventilation system prevented further cases. To avoid similar episodes, routine maintenance of equipment and ventilation systems, as well as installation of air monitoring equipment and alarms in ice arenas, is essential. Ice arena operators as well as ice hockey players and coaches should be familiar with the characteristics of NO2 as well as the signs and symptoms of NO2 toxicity.

3. Chronic Obstructive Pulmonary Disease and Associated Health-Care Resource Use — North Carolina, 2007 and 2009

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Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and disability in the United States, but can be treated. COPD, which includes emphysema and chronic bronchitis, is a condition characterized by the obstruction of airflow that makes it difficult to breathe. COPD and related conditions are the third leading cause of death in the United States. In recent surveys, 5.7 percent of North Carolina adults reported having COPD. Among adults with COPD, approximately 40 percent went to a physician and more than 10 percent visited an emergency department or were admitted to a hospital for COPD-related symptoms in the previous 12 months. Most individuals with COPD felt that their quality of life was impacted by shortness of breath, but less than half reported daily use of COPD medications. One in five adults with COPD did not have the diagnosis confirmed by a breathing test.


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