Recurrent tuberculosis in the United States and Canada: relapse or reinfection?

Recurrence of active tuberculosis after treatment can be due to relapse of infection with the same strain or reinfection with a new strain of Mycobacterium tuberculosis. The proportion of recurrent tuberculosis cases caused by reinfection has varied widely in previous studies. We evaluated cases of recurrent tuberculosis in two prospective clinical trials: a randomized study of two regimens for the last 4 months of treatment (n = 1,075) and a study of a twice-weekly rifabutin-containing regimen for human immunodeficiency virus-infected tuberculosis (n = 169). Isolates at diagnosis and from positive cultures after treatment completion underwent genotyping using IS6110 (with secondary genotyping for isolates with less than six copies of IS6110). Of 85 patients having a positive culture after completing treatment, 6 (7.1%) were classified as false-positive cultures by a review committee blinded to treatment assignment. Of the remaining 75 cases with recurrent tuberculosis and genotyping data available, 72 (96%; 95% confidence interval, 88.8-99.2%) paired isolates had the same genotype; only 3 (4%; 95% confidence interval, 0.8-11.2%) had a different genotype and were categorized as reinfection. We conclude that recurrent tuberculosis in the United States and Canada, countries with low rates of tuberculosis, is rarely due to reinfection with a new strain of M. tuberculosis.     

Similarities and differences between Behet's disease and Crohn's disease

Behet's disease(BD) is a chronic inflammatory condition with multisystem involvement. Approximately 10%-15% of patients present with gastrointestinal involvement. Involved sites and the endoscopic view usually resemble Crohn's disease(CD). In addition to intestinal involvement, oral mucosa, the eyes, skin, and joints are commonly affected. No pathognomonic laboratory test is available for the diagnosis of either disease. Management approaches are also similar in various aspects. Differentiating BD from CD is highly challenging. In this article, the similarities and differences between BD and CD in terms of epidemiology, etiopathogenesis, clinical and imaging findings, and histopathological and therapeutic approaches are reviewed.     

Who Are the Uninsured Elderly in the United States?

Because of the Medicare program, a common assumption is made that virtually all older Americans have health insurance coverage. Data from the 2000 National Health Interview Survey were analyzed to estimate the number of people aged 65 and older without health insurance; their stated reasons for being uninsured; and the associations between lack of insurance and sociodemographic variables, health status, and access to and use of healthcare services. In 2000, there were approximately 350,000 older Americans with no health insurance. Those without insurance were more likely to be younger, Hispanic, nonwhite, unmarried (widowed, divorced, or never married), poor, and foreign-born. They were less likely to hold U.S. citizenship. Despite relatively high rates of chronic medical conditions, they were unlikely to receive outpatient or home healthcare services. The most common reason given for lack of insurance was its cost. This study reveals important gaps in the availability of health insurance for the elderly, gaps that are likely to affect an increasing number of older Americans in the coming decade.     

Chromoendoscopy and its alternatives for colonoscopy: useful in the United States?

American endoscopists have essentially ignored chromoendoscopy (dye spraying) in the colon and overwhelmingly perform white-light colonoscopy only. The published studies suggest that routine use of chromoendoscopy in Western populations will lead to identification of additional flat lesions. However, a number of these studies have design flaws. The authors' interpretation of the existing data is that pancolonic chromoendoscopy to detect flat and depressed lesions is not yet proven as a useful and therefore necessary adjunct to routine colonoscopic examination in non-inflammatory bowel disease patients in the United States. Chromoendoscopy, particularly combined with magnification, is very effective in delineating the pit pattern of polyps and in allowing real-time differentiation of adenomatous from non-adenomatous lesions. There might be a role for chromo endoscopy with high magnification in the delineation of unresected portions of lateral spreading tumors being removed by piecemeal polypectomy and in the evaluation of polypectomy scars during endoscopic follow-up. The authors suggest that US endoscopists begin to familiarize themselves with shape classification, and that they learn a method to determine histology in real time.     

What is the prevalence of resistant hypertension in the United States?

Purpose of review Resistant hypertension, defined as blood pressure uncontrolled on three, or controlled with at least four, antihypertensive agents (including a diuretic), is associated with higher risk of secondary hypertension, cardiovascular and renal events, and increased healthcare expenditures. Until recently, however, the prevalence of resistant hypertension in the United States (US) was based on clinical trial registries or pharmacy databases. Recent findings Recent analyses of National Health and Nutrition Examination Survey (NHANES) data, drawn from representative samples of the adult, noninstitutionalized, civilian population, have estimated the prevalence of resistant hypertension at 8.9 ± 0.6% of the US hypertensive population in 2003-2008. A time-sequence comparison of NHANES data from 1998 through 2008 suggests that, unlike hypertension, resistant hypertension is becoming more prevalent (e.g., 20.7% in 2005-2008), due to aging and increased obesity in the general population. Resistant hypertension was more frequent in people who were older, obese, male, African American or nonblack Hispanic. Summary In coming years, even if the prevalence of hypertension remains stable, resistant hypertension is likely to increase, especially as the proportion of treated hypertension increases. Because of increased use of healthcare resources, resistant hypertensive patients should be identified early, and greater efforts made to control their blood pressures.     

Comparison of the Asthma in America and Asthma Insight and Management surveys: did asthma burden and care improve in the United States between 1998 and 2009?

Significant changes in asthma treatment guidelines and therapies occurred between the period of time in which the Asthma in America (AIA) and Asthma Insight and Management (AIM) surveys were conducted: 1998 and 2009, respectively. This study compares asthma burden and management in 1998 and 2009. Both surveys were telephone based and conducted across the United States. The AIA survey included 2509 patients with asthma (aged <1 year to 89 years old), 512 physicians, and 1000 adults from the general population. The AIM survey included 2500 patients (aged ≥12 years), 309 physicians, and 1090 adults from the general population. Patient responses were weighted to match the entire population of U.S. patients with asthma. The impact of asthma burden and care on the general population and on asthma patients was slightly lower or unchanged in the AIM survey versus the AIA survey. Acute care use (hospitalizations, emergency department visits, or other urgent care visits) was common in AIA (36%) and AIM (34%) surveys. Most physicians were aware of guidelines in AIA (90%) and AIM (96%), but fewer "always" followed them (AIA, 36%; AIM, 28%). Spirometry was often used to aid in diagnosis by asthma care specialists (AIA, 73%; AIM, 76%) but infrequently by nonsubspecialists (AIA, 27%; AIM, 38%). Most physicians prescribed inhaled corticosteroids (ICSs) for mild (AIA, 70%; AIM, 83%) or moderate (AIA, 89%; AIM, 83%) persistent asthma. In the AIM survey, 38% of specialists prescribed ICSs combined with a long-acting β2-agonist for moderate asthma. The state of U.S. asthma care and clinical outcomes changed little from 1998 to 2009.     

Are educational differentials in adult mortality increasing in the United States?

Two recent studies have compared the size of educational mortality differentials among adults in the 1980s to estimates for 1960. Both studies have concluded that educational differentials have increased for males. One study finds a similar increase for females. We reconsider this question by introducing a data source that is better suited to estimating recent differentials than either of the two that have been employed. We also evaluate the quality of the 1960 baseline estimates and introduce broader measures of inequality. We conclude that educational inequalities have widened for males but contracted for working-age females. For both sexes, inequality trends are more adverse for persons aged 65+ than for persons aged 25-64. The role of national health insurance in shaping these trends is briefly considered.     

Sex differences in health and aging: a dialog between the brain and gonad?

Women live longer than men in virtually all circumstances. However, a more common pattern among animals is that one sex lives longer under some conditions, the other lives longer under other conditions. In laboratory mice, interventions that extend longevity are surprisingly often sex-specific in their effects. Understanding these conditional sex differences could provide mechanistic insight into how longevity could be modulated in humans. One way that longevity can be consistently enhanced is by inhibiting reproduction or eliminating the capacity to reproduce. Thus, there appears to be a mechanistic link between gonadal activity and longevity. There also appears to be a mechanistic link between some types of neuroendocrine signaling and longevity. Combining these two observations suggest that communication between the brain and gonad is a ripe avenue for further exploring longevity-assurance mechanisms. Also, because the timing and activity of specific brain–gonad endocrine differs between the sexes, neuroendocrine linkages between the brain and gonad, particularly among the less obvious hormones such as activin and inhibin, could provide additional insight into mechanisms of sex differences in aging.

     

Does lifelong training temper age-related decline in sport performance? Interpreting differences between cross-sectional and longitudinal data

In the face of remarkable aging trends in North American society, organized sport/physical activity is an important vehicle for promoting physical health, and a domain in which long-term participation might mitigate pessimistic trends for age decline. This investigation examined patterns of age-related decline in performance for 45 Masters runners who rigorously trained continuously for at least a decade. Longitudinal data for age and performance were collected for 200 m, 1500 m, and 10 km events retrospectively across participants' careers. Cross-sectional (CS) data representing normal patterns of aging were derived from online archives. Longitudinal data reflected within-participant training effects whereas CS data did not. Second-order regression analyses were performed separately for each data type and quadratic beta coefficients, indicative of accelerated age decline, were compared for CS and longitudinal samples on a within-event basis. Results showed evidence of accelerated decline with advancing age for both samples, although rates for longitudinal samples were moderated for the 200 m and 1500 m events. Findings for the long-distance event were anomalous. Results provide evidence for moderated age-decline in physical performance measures for individuals who sustain engagement in organized sport for lengthy periods. Discussion focuses on methodological considerations for advancing future research that contrasts CS and longitudinal samples, and the importance of encouraging sport involvement opportunities to aging individuals.     

Reading habits of infection control coordinators in the United States: peer-reviewed or non-peer-reviewed evidence?

BACKGROUND: Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized. METHODS: Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work. RESULTS: The survey response rate was 74%. Infection control coordinators spend a mean of 3.6 hours/week reading journals or periodicals. Resources identified as most useful included the Centers for Disease Control and Prevention (CDC) Web site (52%), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) text (11%), and the APIC e-mail list (8%). Proportion of subscribers was highest for the American Journal of Infection Control (84%) and Infection Control Today (72%). The top 3 journals ranked on a scale of 1 to 10 for quality of infection control articles were Infection Control & Hospital Epidemiology (8.0), the American Journal of Infection Control (7.5), and the New England Journal of Medicine (7.4). The American Journal of Infection Control (85%) and Infection Control & Hospital Epidemiology (72%) were the most frequently used peer-reviewed sources of information, whereas Morbidity and Mortality Weekly Report (85%) and Hospital Infection Control (63%) ranked at the top for non-peer-reviewed periodicals. CONCLUSION: Infection control coordinators devote limited time to reading and critically appraising published evidence and rely heavily on sources that provide rapid access to information or evidence summaries, suggesting a growing need for easy-to-read, reliable sources of information about evidence-based infection prevention and control practices.     

Changing pollen types/concentrations/distribution in the United States: Fact or fiction?

The buildup of greenhouse gases in the atmosphere has resulted in global climate change that is having a significant effect on many allergenic plants through increases in plant productivity and pollen allergenicity and shifts in plant phenology. Based on experimental studies, increased atmospheric levels of carbon dioxide have directly increased plant productivity. This has affected the total amount of pollen produced in some species. Research has also shown increased levels of birch allergen at warmer temperatures. Warmer temperatures have resulted in earlier flowering for many spring-flowering species in many countries, recorded through visual observations of flowering and by airborne pollen. Increases in the cumulative season totals of various pollen types also have been recorded; some of these increases may be explained by changes in plant distribution.     

Top priorities for alcohol regulators in the United States: protecting public health or the alcohol industry?

Aims This paper describes alcohol industry involvement in the 2010 annual conference proceedings of the National Conference of State Liquor Administrators (NCSLA) in the United States. Design The author attended the conference, observed conference attendees and panelists and identified key themes in the panel sessions. Setting The NCSLA Annual Meeting took place 20–24 June 2010 in New Orleans, Louisiana. Participants NCSLA meeting attendees and panelists were professionals from state alcohol control systems; federal government agencies; and companies representing the alcohol industry. Measurements The total number of conference attendees and participants were counted as well as the number of attendees and participants from regulator, industry and public health sectors. Findings More than two‐thirds (72.2%) of the 187 conference attendees were from alcohol producers, importers, wholesalers, retailers or their attorneys. Nearly two‐thirds (65.0%) of the 40 panelists were from the alcohol industry. The author of this paper was the only attendee, and the only panelist, representing public health policy. Conclusions The National Conference of State Liquor Administrators in the United States is dominated by the private, global companies that produce, import, distribute and sell alcohol, highlighting a lack of public health considerations within the Association's liquor control agenda.