Recommendations to improve preconception health and health care -- United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care

"This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives" - p. 1Introduction -- -- Preconception Health and Care -- Healthy People 2000/2010 Objectives for Improving Preconception Health and Guidelines for Preconception Care -- Preconception Risks Associated with Adverse Pregnancy Outcomes -- Preconception Prevention and Intervention -- -- Context and Frame Work for Recommendations -- How the Recommendations were Developed -- Recommendations to Improve Preconception Health -- Recommendations -- Conclusion References -- Appendix: External Partner Organizationsprepared by Kay Johnson, Samuel F. Posner, Janis Biermann , Jose\ucc? F. Cordero, Hani K. Atrash, Christopher S. Parker, Sheree Boulet, Michele G. Curtis."April 21, 2006."Cover title."The material in this report originated in the National Center on Birth Defects and Developmental Disabilities, Jose\ucc? F. Cordero, MD, Director; and the Office of Program Development, Hani K. Atrash, MD, Associate Director; and the National Center for Chronic Disease Prevention and Health Promotion, Janet Collins, PhD, Director, and the Division of Reproductive Health, John Lehnherr, Director. " - p. 1Also available via the World Wide Web.Includes bibliographical references (p. 16-21)

CDC's vision for public health surveillance in the 21st century

"This MMWR supplement summarizes the deliberations of CDC/ATSDR scientists and managers who met in September 2009 in Atlanta as part of the 2009 Consultation on CDC/ ATSDR's Vision for Public Health Surveillance in the 21st Century. The meeting was convened to reflect on domestic and global public health surveillance practice and to recommend a strategic framework to advance public health surveillance to meet continuing and new challenges. The first report is an adaptation of the keynote address for the meeting, which summarized the history of public health surveillance, the need to reassess its usefulness, the rationale for topics selected for discussion, and the charge to participants. Subsequent reports summarize the discussions of workgroups that addressed specific topics in surveillance science and practices. Each CDC Center/Institute/Office (CIO) identified five public health surveillance scientists or senior scientists to participate in the meeting. Other participants included the planning committee members and invited workgroup leads, including representatives from the CDC's Surveillance Science Advisory Group (SurvSAG) - a CDC/ATSDR employee organization dedicated to advancing surveillance practice. Although representatives from organizations representing state and local health departments were invited as observers and reviewed drafts of the papers in this MMWR supplement, the meeting was intended to generate ideas from within CDC/ ATSDR and to stimulate further discussion with partners. Participation in the meeting was constrained in part because it occurred during the midst of the fall 2009 upswing in cases of H1N1 pandemic influenza, and several persons from both CDC/ATSDR and health departments were unable to attend because of their involvement in the response to the pandemic. Altogether, approximately 100 surveillance specialists from across CDC/ATSDR participated in the one and a half day meeting. Participants were divided into six workgroups that were charged to describe challenges and opportunities for each of the topic areas identified above and to propose a vision for addressing those challenges and opportunities." -p. 1Introduction / James W. Buehler -- Public health surveillance in the United States: evolution and challenges / Stephen B. Thacker, Judith R. Qualters, Lisa M. Lee -- Lexicon, definitions, and conceptual framework for public health surveillance / H. Irene Hall, Adolfo Correa, Paula W. Yoon, Christopher R. Braden -- Global health surveillance / Michael St. Louis -- The role of public health informatics in enhancing public health surveillance / Thomas G. Savel, Seth Foldy -- Public health surveillance workforce of the future / Patricia A. Drehobl, Sandra W. Roush, Beth H. Stover, Denise Koo -- Public health surveillance data: legal, policy, ethical, regulatory, and practical issues / Amy B. Bernstein, Marie Haring Sweeney -- Analytical challenges for emerging public health surveillance / Henry Rolka, David W. Walker, Roseanne English, Myron J. Katzoff, Gail Scogin, Elizabeth Neuhaus -- Workgroup participants in the 2009 consultation on CDC's vision for public health surveillance in the 21st century"July 27, 2012."Also available via the World Wide Web as an Acrobat .pdf file (872.86 KB, 44 p.).Includes bibliographical references

Clostridium perfringensepsilon toxin H149A mutant as a platform for receptor binding studies

Clostridium perfringens epsilon toxin (Etx) is a pore-forming toxin responsible for a severe and rapidly fatal enterotoxemia of ruminants. The toxin is classified as a category B bioterrorism agent by the U.S. Government Centres for Disease Control and Prevention (CDC), making work with recombinant toxin difficult. To reduce the hazard posed by work with recombinant Etx, we have used a variant of Etx that contains a H149A mutation (Etx-H149A), previously reported to have reduced, but not abolished, toxicity. The three-dimensional structure of H149A prototoxin shows that the H149A mutation in domain III does not affect organisation of the putative receptor binding loops in domain I of the toxin. Surface exposed tyrosine residues in domain I of Etx-H149A (Y16, Y20, Y29, Y30, Y36 and Y196) were mutated to alanine and mutants Y30A and Y196A showed significantly reduced binding to MDCK.2 cells relative to Etx-H149A that correlated with their reduced cytotoxic activity. Thus, our study confirms the role of surface exposed tyrosine residues in domain I of Etx in binding to MDCK cells and the suitability of Etx-H149A for further receptor binding studies. In contrast, binding of all of the tyrosine mutants to ACHN cells was similar to that of Etx-H149A, suggesting that Etx can recognise different cell surface receptors. In support of this, the crystal structure of Etx-H149A identified a glycan (β-octyl-glucoside) binding site in domain III of Etx-H149A, which may be a second receptor binding site. These findings have important implications for developing strategies designed to neutralise toxin activity

Programmatic Impact of QuantiFERON-TB Gold In-Tube Implementation on Latent Tuberculosis Diagnosis and Treatment in a Public Health Clinic

Background: QuantiFERON-TB Gold In-Tube (QFT-GIT) is considered an alternative to the tuberculin skin test (TST) for the diagnosis of tuberculosis (TB) infection, but the programmatic impact of QFT-GIT implementation is largely unknown. In March, 2010, the Baltimore City Health Department (BCHD) introduced routine QFT-GIT testing for individuals referred to the TB program for suspected latent TB infection (LTBI). Design: Retrospective study comparing LTBI diagnosis and treatment during the 13 months before and after QFT-GIT implementation at the BCHD TB clinic. Results: 607 and 750 individuals were referred by community-providers for suspected LTBI in the pre- and post-QFT-GIT periods, respectively. Most individuals in the pre- and post-QFT-GIT periods were referred on the basis of a positive TST (597/607 [98%] vs. 690/750 [92%], respectively) and were foreign-born (363/607[59%] vs. 507/750[68%], respectively). BCHD performed QFT-GIT testing for 375/543 (69%) eligible individuals in the post-QFT-GIT period, of which 185 (49%) were positive, 178 (47%) were negative, 1 (0.25%) was indeterminate, and 11 (3%) did not yield results. Concordance of QFT-GIT with TST was low (183/352[52%]). Foreign-born individuals had higher proportions of QFT-GIT positivity (57%) than US-born individuals (36%; AOR 3.3 [95%CI 1.7–6.2]). Significantly fewer individuals received a final diagnosis of LTBI in the post-QFT-GIT period (397/567 [70%]) compared to the pre-QFT-GIT period (445/452 [98%], p,0.001). In the post-QFT-GIT period, onl

Bridging the gap between adult and paediatric outcomes in HIV-1 vertically infected children: a single-centre comparison with adult data

Prognosis of HIV-1 infection dramatically improved during the last decade. Meanwhile, treatment-induced virological success has always been different in adult and children patients

Predicting and explaining transtheoretical model stage transitions in relation to condom-carrying behaviour

Objectives: The stages of change component of the transtheoretical model has been applied to safe sex behaviours in cross-sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross-sectional analyses would demonstrate good discrimination between the stages of change, (b) prospective analyses would allow for the identification of predictors of stage transitions, and (c) implementation intentions would explain progression from the preparation stage. Design: This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2-months follow up. Methods: 525 adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow up (n = 393) measuring: demographic variables, stage of change, theory of planned behaviour constructs, anticipated regret and moral norm in relation to condom carrying behaviour. The experimental condition completed a self-generated implementation intention to carry condoms at the end of the baseline questionnaire. Results: Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross-sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage. Conclusions: Transitions between most stages were reliably predicted thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilised and expanded to encompass a broader range of sexual health behaviours.</p

Molecular epidemiology of a hepatitis C virus epidemic in a haemodialysis unit: outbreak investigation and infection outcome

<p>Abstract</p> <p>Background</p> <p>HCV is a leading cause of liver chronic diseases all over the world. In developed countries the highest prevalence of infection is reported among intravenous drug users and haemodialysis (HD) patients. The present report is to identify the pathway of HCV transmission during an outbreak of HCV infection in a privately run haemodialysis (HD) unit in Italy in 2005.</p> <p>Methods</p> <p>Dynamics of the outbreak and infection clinical outcomes were defined through an ambi-directional cohort study. Molecular epidemiology techniques were used to define the relationships between the viral variants infecting the patients and confirm the outbreak. Risk analysis and auditing procedures were carried out to define the transmission pathway(s).</p> <p>Results</p> <p>Of the 50 patients treated in the HD unit 5 were already anti-HCV positive and 13 became positive during the study period (AR = 28.9%). Phylogenic analysis identified that, all the molecularly characterized incident cases (10 out of 13), were infected with the same viral variant of one of the prevalent cases. The multivariate analysis and the auditing procedure disclosed a single event of multi-dose vials heparin contamination as the cause of transmission of the infection in 11 out of the 13 incident cases; 2 additional incident cases occurred possibly as a result of inappropriate risk management.</p> <p>Discussion</p> <p>More than 30% of all HCV infections in developed countries results from poor application of standard precautions during percutaneous procedures. Comprehensive strategy which included: educational programmes, periodical auditing on standard precaution, use of single-dose vials whenever possible, prospective surveillance for blood-borne infections (including a system of prompt notification) and risk assessment/management dedicated staff are the cornerstone to contain and prevent outbreaks in HD</p> <p>Conclusions</p> <p>The outbreak described should serve as a reminder to HD providers that patients undergoing dialysis are at risk for HCV infection and that HCV may be easily transmitted whenever standard precautions are not strictly applied.</p