Cisplatin contamination observed on the outside of drug vials

Exposure to cytotoxic drugs is of great concern today. Special regulations for handling these drugs during preparation and administration have been implemented in most countries. Concern has also been raised as to whether exposure to these drugs can occur due to contaminated drug vials. In this investigation, wipe samples were taken from drug vials used for platinum-containing drugs, e.g. cisplatin and related drugs. The vials were randomly picked from unbroken packages from different manufacturers. The results showed that drug vials may already be contaminated on the outside when delivered from the manufacturer.     

Global aspects of emerging and potential zoonoses: a WHO perspective.

Many new human pathogens that have emerged or reemerged worldwide originated from animals or from products of animal origin. Many animal species as well as categories of agents have been involved in the emergence of diseases. Wild (e.g., bats, rodents) as well as draught animals (e.g., horses) and food animals (e.g., poultry, cattle) were implicated in the epidemiologic cycles of these diseases. Many of the agents responsible for new infections and diseases in humans were viruses (e.g., hantaviruses, lyssaviruses, and morbilliviruses), but bacteria, especially enteritic bacteria (e.g., Salmonellae and Escherichia coli) and parasites (e.g., Cryptosporidium) of animal origin, were also involved in major food and waterborne outbreaks. The public health relevance of some of these agents (e.g., new lyssaviruses and morbilliviruses) is not yet fully assessed. In addition the zoonotic nature of some other human diseases, such as Ebola and the new variant form of Creutzfeldt-Jakob disease, is suspected but not yet demonstrated. Finally, the possible future use of xenografts may lead, if precautions are not taken, to the emergence of new diseases called xenozoonoses.     

Convenience Stores Surrounding Urban Schools: An Assessment of Healthy Food Availability,Advertising, and Product Placement

Adolescent obesity is a national public health problem, particularly among urban populations. Recent evidence has linked neighborhood food environments to health and nutrition status, with easier access to convenience stores being associated with increased risk for obesity. Little is known about the availability of healthy purchasing options within small, urban food stores, or the extent to which these factors are relevant to youth. The objective of this research was to characterize various features of the food environment within small convenience stores located nearby urban junior high and high schools. In-store audits were conducted in 63 stores located within 800 m of 36 urban Minnesota public secondary schools. Results indicated that a limited number of healthier beverages (i.e., water and 100% fruit juice) and snack options (i.e., nuts and pretzels) were available at most stores (≥85%). However, a wide range of healthy snack options were typically not available, with many specific items stocked in less than half of stores (e.g., low-fat yogurt in 27% of stores and low-fat granola bars in 43%). Overall, 51% of stores had fresh fruit and 49% had fresh vegetables. Few stores carried a range of healthier snack alternatives in single-serving packages. All stores had less healthful impulse purchase items available (e.g., candy) while only 46% carried healthier impulse items (e.g., fruit). Most stores (97%) had food/beverage advertising. Overall, convenience stores located in close proximity to secondary schools represent an important and understudied component of the youth food environment.     

SEQMINER: An R‐Package to Facilitate the Functional Interpretation of Sequence‐Based Associations

Next‐generation sequencing has enabled the study of a comprehensive catalogue of genetic variants for their impact on various complex diseases. Numerous consortia studies of complex traits have publically released their summary association statistics, which have become an invaluable resource for learning the underlying biology, understanding the genetic architecture, and guiding clinical translations. There is great interest in the field in developing novel statistical methods for analyzing and interpreting results from these genotype‐phenotype association studies. One popular platform for method development and data analysis is R. In order to enable these analyses in R, it is necessary to develop packages that can efficiently query files of summary association statistics, explore the linkage disequilibrium structure between variants, and integrate various bioinformatics databases. The complexity and scale of sequence datasets and databases pose significant computational challenges for method developers. To address these challenges and facilitate method development, we developed the R package SEQMINER for annotating and querying files of sequence variants (e.g., VCF/BCF files) and summary association statistics (e.g., METAL/RAREMETAL files), and for integrating bioinformatics databases. SEQMINER provides an infrastructure where novel methods can be distributed and applied to analyzing sequence datasets in practice. We illustrate the performance of SEQMINER using datasets from the 1000 Genomes Project. We show that SEQMINER is highly efficient and easy to use. It will greatly accelerate the process of applying statistical innovations to analyze and interpret sequence‐based associations. The R package, its source code and documentations are available from http://cran.r‐project.org/web/packages/seqminer and http://seqminer.genomic.codes/ .     

Advice Given to Parents on Welcoming a Second Child: A Critical Review*

A review of popular press books and articles for parents published between 1975 and 2000 was conducted to delineate the areas in which the advice given to parents about the transition to a second child is consistent with or diverges from the results of relevant research. Although popular advice reflects available research in certain areas (e.g., encouraging sibling caregiving), research to substantiate other directives (e.g., sibling preparation classes) is lacking. Key research findings about how to promote harmonious sibling relationships often are not represented in popular writings. These results highlight the need for researchers and popular press writers to acknowledge their complementary roles in disseminating information.     

Sicherheitsbewertung von Materialien im Kontakt mit Lebensmitteln

For materials and articles intended to come in contact with food – particularly for substances from plastics (e.g., monomers, additives) – there are comprehensive European regulations based on toxicological evaluations. Other food contact materials, e.g., paper and rubber, are covered by resolutions established by the European Council without additional evaluations, while in Germany substances from these materials are toxicologically evaluated by the Federal Institute for Risk Assessment (BfR) and are included in the “BfR recommendations”. Some further areas of food contact materials are not regulated by European or by national regulations (e.g., substances from printing inks). Recently, new European regulations for recycled plastics intended for food contact and for active and intelligent materials and articles have been released. Future challenges are the risk assessment of contaminants and reaction products from the production of food contact substances, which may migrate into the food in only tiny amounts, and of complex mixtures of substances, e.g., of hormone-like substances (endocrine disruptors).     

Newborn health: Everybody's business

Despite advances in issue-attention and in evidence of what works to save newborn lives (e.g., kangaroo mother care, antenatal corticosteroids, immediate and exclusive breastfeeding), we are still falling short on impact. To advance the unfinished newborn survival agenda, newborns must become an integral priority in developing countries where the burden of neonatal mortality is highest. Interventions must be adapted to local contexts and cultures and integrated into packages along the continuum of care delivered through the primary health-care systems that countries have at their disposal.     

The relative impact of health education for low- and high-risk patients with hypertension

An experimental study was carried out to test and analyze the effects of an educational program on a group of hypertensive patients, comparing those with known higher risks of stroke and heart attack, e.g., secondary organ damage, with a group whose risks were relatively lower. Specific interventions have been shown to be differentially effective on specific patient behaviors (e.g., compliance with therapy) and on blood pressure control for both higher- and lower-risk patients in most of the experimental groups. Such findings emphasize the importance of tailored educational approaches, not only for a hypertensive population, but, more importantly, for patients who are known to have more difficulty achieving their blood pressure control and who are at higher risk of morbidity and mortality, i.e., patients who have secondary organ damage, have been previously hospitalized for hypertension, or are black males under 50 years of age.     

An Examination of the Community Participation Interests of Young Adults with Serious Mental Illnesses

Participation in various aspects of community life (e.g., education, employment) plays a critical role in fostering young adult development and health. To support behavioral health services in addressing a broader array of meaningful community participation areas, the current study examined the participation interests of young adults with serious mental illnesses via a literature review and focus groups interviews. Literature review results revealed a range of community participation areas of interest to these individuals, including employment, education, religion and spirituality, social networking (e.g., using social media), volunteering activities, socializing, and civic and artistic participation (e.g., attending a political event, playing music). Focus group participants named many of these same areas, but also mentioned unique areas of participation that have not been the focus of previous research (i.e., playing games, sports, exploration of other communities (e.g., traveling), hanging out, and nature-based participation). Implications for future research and behavioral health practice are discussed.

     

Tutored-Untutored Dramatic Play: Similarities and Differences

Untutored dramatic play is the children's free undirected play, where they adopt roles real or imaginary, using symbols: to represent real beings (e.g., mothers) objects (e.g., telephones) that are not presented; or to represent imaginary beings (e.g., witches) and objects (e.g., magic hat). Tutored dramatic play or creative drama is the dramatic play which is directed by a flexible teacher, who helps children to develop their imagination, or to encourage their creativity through various and appropriate dramatic exercises. Untutored and tutored dramatic play have differences in many ways; a) in the spontaneity that children have in playing, b) in the inconsistency of playing, c) in the amount of props that children use in play, d) in the using improvised or not dialogue, e) in the need of having an audience, and f) in the guiding of the story by different individuals (children or teacher). However, activities have some important similarities: that both involve interaction, transformation and imagination, and serve the child's artistic, emotional and intellectual needs.     

Vaccination of healthcare personnel: Spotlight on groups with underlying conditions

Healthcare personnel (HCP) are at increased risk of acquiring vaccine-preventable diseases (VPDs). Vaccination protects HCP and their patients from nosocomial transmission of VPDs. HCP who have underlying diseases (e.g., immunocompromised, HIV-infected, or those with chronic diseases) and HCP in particular phases of life (e.g., pregnant, elderly) require special consideration in regards the provision of vaccines. On the one hand, live virus vaccines may be contraindicated (e.g., pregnant HCP, immunocompromised HCP), while on the other hand, vaccines not routinely recommended (e.g., pneumococcal) may be indicated (e.g., elderly or immunocompromised HCP). It is not known how many HCP with underlying conditions require special consideration in the healthcare setting. This is an important issue, because the risk for serious morbidity, complications and mortality for HCP with underlying conditions will only increase. The prevention of nosocomial infections requires comprehensive occupational safety programs. The healthcare system must engage HCP and occupational physicians to ensure sufficient vaccination rates as part of an effective nosocomial infection prevention and HCP safety strategy.     

Surface contamination of cyclophosphamide packaging and surface contamination with antineoplastic drugs in a hospital pharmacy in Sweden

Workplaces, e.g. hospital pharmacies and hospital departments, where antineoplastic drugs are handled might be contaminated with these drugs, and pharmacy personnel and health care workers may be exposed. In this study potential sources for exposure of antineoplastic drugs were investigated. Unbroken drug vials and tablet blister packages, both containing cyclophosphamide (CP) and their outer packaging were wipe sampled. Analysis was performed by liquid chromatography combined with tandem mass spectrometry (LC-MS/MS). The result showed that almost every part of the primary packaging was contaminated with CP and ifosfamide (IF). However, the amounts of CP and IF were low, and most likely not harmful for the personnel handling these packaging in association with drug preparation. The contamination must originate from the pharmaceutical manufacturer. Different surfaces in the preparation unit of a Swedish hospital pharmacy were also investigated at two different occasions by wipe sampling. In the preparation unit CP and IF were found as contaminants on the majority of the investigated surfaces. After the first measurement the hospital pharmacy improved its routines. Lower amounts of CP and IF were detected at the second measurement. A low degree of contamination with CP and IF was also detected on the floor outside the preparation unit and this indicated a small distribution of antineoplastic drugs to the surroundings.     

Rickettsia felis in Fleas, Southern Ethiopia, 2010

TO THE EDITOR: Fleas (order Siphonaptera) are obligate hematophagous insects. They are laterally flattened, holometabolous, and wingless ectoparasites. More than 2,500 species of flea, belonging to 16 families and 238 genera, have been described. A minority of these genera live in close association with humans (synanthropic), including fleas of these species: Pulex irritans, Ctenocephalides felis, Ctenocephalides canis, Xenopsylla cheopis, Nosopsyllus fasciatus, Echidnophaga gallinacea, and Tunga penetrans (1). Many fleas are capable of transmitting the following pathogens to their hosts: bacteria (e.g., Rickettsia typhi, R. felis, Yersinia pestis, and many Bartonella spp.); viruses (e.g., myxoma virus); protozoa (e.g., Trypanosoma spp.); or helminths (e.g., Hymenolepis spp.) (2). Ctenocephalides spp. fleas are of special interest as main reservoirs and vectors of R. felis, because this agent causes an emerging disease, fleaborne rickettsiosis. The distribution and prevalence of this disease have not been well studied. Symptoms of this disease range from mild to moderate and include fever, cutaneous rash, and sometimes an inoculation eschar (3,4). R. felis can also infect at least 10 other species of arthropods, including P. irritans fleas, trombiculid and mesostygmata mites, hard and soft ticks, and booklice (5,6).     

Educational content and health literacy issues in direct-to-consumer advertising of pharmaceuticals

Direct-to-consumer (DTC) pharmaceutical advertisements have been analyzed in many ways, but richer conceptualizations of health literacy have been largely absent from this research. With approximately half of U.S. adults struggling to understand health information, it is important to consider consumers' health literacy when analyzing DTC advertisements. This project, framed by the health belief model, analyzed 82 advertisements. Advertisements provided some kinds of educational content (e.g., drugs' medical benefits) but typically failed to offer other useful information (e.g., other strategies for dealing with conditions). Issues likely to be barriers to low health literate consumers, such as nonstandard text formatting, are common.     

Outbreak of mesotherapy-associated skin reactions--District of Columbia area, January-February 2005

Mesotherapy is a treatment involving local subcutaneous injections of minute quantities of various substances (e.g., vitamins or plant extracts) for cosmetic purposes (e.g., fat and wrinkle reduction or body contouring) or relief of musculoskeletal pain. In February 2005, the Virginia Department of Health and CDC were notified of a cluster of skin reactions unresponsive to antimicrobial therapy among patients who had been administered mesotherapy by an unlicensed practitioner in the District of Columbia (DC) area. This report 1) summarizes the subsequent investigation by CDC and state and local health departments in Virginia, Maryland, and DC, which identified prolonged skin reactions in 14 patients, and 2) provides recommendations for practices related to mesotherapy. Patients should accept medical therapy only from licensed practitioners and should not permit injection of substances that have not been approved by the Food and Drug Administration (FDA). Licensed practitioners should follow safe-injection practices when practicing mesotherapy and patients should observe that safe-injection practices are followed.     

Empathic Versus Directive Preparation of Children for Needles

A review of the literature on preparation of children for medical procedures revealed that (1) preparation is widely recommended but there is little empirical evidence documenting its effectiveness (2) the relative efficiency of different preparations generally has not been determined and (3) preparation for procedures that are routine for medical personnel but painful and stressful for children (e g fingers sticks) has not received much attention The present study compared the reactions of a group of children that received empathic, supportive preparation for needles (including statements such as "It is going to hurt a little" and 'I don't mind if you cry') with a group that was told to be big brave and not cry The group that was instructed not to cry actually cried more and had more other negative reactions than did the empathically prepared group Thus style of preparation even for routine medical procedures can affect children's behavior and medical personnel might benefit from instruction in effective preparation techniques.     

Where there is smoke, there is stress: low-income women identify support needs and preferences for smoking reduction

Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income women's support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).     

Drug use,drug prohibition and minority communities

Drug problems, including alcohol and tobacco abuse, present major public health concerns for the American people. Drug abuse and its related difficulties have been associated with both increased morbidity and premature mortality. In the United States, ethnic minorities have experienced the overall negative impact of drug abuse much more severely than the general population. The impact of drug prohibition in the United States has not been to eliminate or minimize the use of illicit drugs. Indeed, in recent times, the use of some illegal substances (e.g., cocaine) has increased among certain segments of our population; while the use of licit substances (e.g., alcohol) has decreased among specific groups. Unfortunately, drug prohibition and related policies have contributed to the differential impact of the negative consequences of drug abuse on ethnic and racial minorities. The passage and enforcement of repressive drug laws, to curb what is essentially a public health problem, has not been demonstrated to be a productive mechanism for the amelioration of drug related problems within our minority communities.     

Tutorial in biostatistics: competing risks and multi-state models

Standard survival data measure the time span from some time origin until the occurrence of one type of event. If several types of events occur, a model describing progression to each of these competing risks is needed. Multi-state models generalize competing risks models by also describing transitions to intermediate events. Methods to analyze such models have been developed over the last two decades. Fortunately, most of the analyzes can be performed within the standard statistical packages, but may require some extra effort with respect to data preparation and programming. This tutorial aims to review statistical methods for the analysis of competing risks and multi-state models. Although some conceptual issues are covered, the emphasis is on practical issues like data preparation, estimation of the effect of covariates, and estimation of cumulative incidence functions and state and transition probabilities. Examples of analysis with standard software are shown.