The Potential for State Attorneys General to Promote the Public’s Health: Theory, Evidence, and Practice

The Attorneys General of the 50 states have considerable legal authority to protect the public’s health, yet their role in the development of health policy is often under-appreciated or misunderstood. This article analyzes state Attorneys’ General current powers and provides a logic model that illustrates how the use of these powers can lead to the protection and promotion of the public’s health. The article then provides four brief case studies to demonstrate how state Attorneys General have used their varied powers to influence policy-making and benefit the public’s health. In addition, this article offers a roadmap for research that could be conducted to better understand the association between state Attorneys’ General actions and the protection of the public’s health. The article concludes with a series of recommendations intended to enhance state Attorneys’ General ability to protect the public’s health, along with suggestions for future research in this area

The Potential for State Attorneys General to Promote the Public’s Health: Theory, Evidence, and Practice

The Attorneys General of the 50 states have considerable legal authority to protect the public’s health, yet their role in the development of health policy is often under-appreciated or misunderstood. This article analyzes state Attorneys’ General current powers and provides a logic model that illustrates how the use of these powers can lead to the protection and promotion of the public’s health. The article then provides four brief case studies to demonstrate how state Attorneys General have used their varied powers to influence policy-making and benefit the public’s health. In addition, this article offers a roadmap for research that could be conducted to better understand the association between state Attorneys’ General actions and the protection of the public’s health. The article concludes with a series of recommendations intended to enhance state Attorneys’ General ability to protect the public’s health, along with suggestions for future research in this area

Die Phylogenie des klonalen Komplexes 398 von Staphylococcus aureus und dessen Interaktionen mit verschiedenen Wirten

Staphylococcus aureus is not only a frequent nasal coloniser of all mammals and birds, but also is a common cause of a wide range of infections in both hospitals and the community. In humans, S. aureus is associated with a wide spectrum of diseases from skin infections to life-threatening endocarditis. Infections caused by methicillin-resistant S. aureus (MRSA) are of particular concern due to limited treatment opportunities. Since the early 2000s, a particular MRSA clonal complex (CC398) was widely disseminated as a coloniser and pathogen in economically important live-stock and companion animals worldwide. Since then, CC398 is of increasing concern to pose a risk to public health. In this study, we investigated the population structure of CC398 through mutation discovery at 97 genetic housekeeping loci, which are distributed along the S. aureus chromosome within 195 CC398 isolates, collected from 11 different host species and various countries. Furthermore, we investigated the phenotypic characters of a certain sub-clone within CC398 by studying its ability to adhere to fibronectin and to invade neutrophils from various host species. To gain a better insight into the genetic determinants of this CC398 sub-clone, we have applied whole genome sequencing approach on eight representative CC398 isolates. This study provided a novel insight into the phylogeny of CC398 concerning the spread of a specific MRSA-CC398 sub-clone within equine settings, which causes infections in horses and nasal colonisation of humans that are in close contact with these horses. Of note, it remained extremely rare among S. aureus isolates from hu-man infections. Furthermore, this MRSA-CC398 sub-clone can initiate colonisation in both human and horse efficiently; however, it was not generally protected from the host immune system response. Lastly, the comparative genomic analysis of CC398 revealed a novel pathogenicity island and two prophages that were harboured by certain CC398 isolates.Staphylococcus aureus ist nicht nur ein häufiger Besiedler des Vestibulum nasi aller Säugetiere, sondern auch Verursacher vielfältiger Infektionen in Krankenhäusern und der nicht hospitalisierten Bevölkerung. Beim Menschen reicht das weite Infektionsspektrum von Infektionen der Haut bis hin zur lebensbedrohlichen Endokarditis. Besonders besorgniserregend sind, auf Grund der begrenzten Möglichkeiten der antibiotischen Therapie, Infektionen mit Methicillin-resistenten S. aureus (MRSA). Seit 2004 wurden MRSA des klonalen Komplexes CC398 weltweit als Besiedler und Infektionserreger bei Nutz- und Haustieren nachgewiesen. Seit dieser Zeit wächst die Besorgnis um damit verbundene gesundheitliche Risiken für den Menschen. In der vorliegenden Arbeit wurde die Populationsstruktur des klonalen Komplexes CC398 durch Analyse von Mutationen in 97 chromosomal lokalisierten Haushaltsgenen bei 195 Isolaten untersucht. Diese stammen von 11 verschiedenen Wirtsspezies aus mehreren Ländern. Des Weiteren wurden bei ausgewählten Isolaten einer bestimmten Subpopulation die Fähigkeit an Fibronectin zu binden und die Phagozytoserate durch Granulozyten von verschiedenen Wirtsspezies untersucht. Um tiefere Einblicke in die genetische Ausstattung dieser Subpopulation zu erhalten, wurden Ganzgenomsequenzierungen für repräsentative Isolate durchgeführt. Die vorliegende Arbeit erweitert unsere Kenntnisse zur Populationsstruktur des klonalen Komplexes CC398. Insbesondere zeigte sich, dass es eine speziell in Pferde-Kliniken verbreitete Subpopulation gibt, die als Besiedler und Infektionserreger bei Pferden und auch als nasaler Besiedler bei Menschen mit engem Kontakt zu diesen Tieren auftritt. Bisher wurden Isolate dieser Subpopulation nur sehr selten als Infektionserreger beim Menschen nachgewiesen. Offenbar kann diese Subpopulation Menschen und Pferde effizient besiedeln, ist aber nicht gegen die Wirtsimmunität geschützt. Die vergleichende Genomanalyse zeigte das Auftreten einer neuen Pathogenitätsinsel, sowie zweier bisher noch nicht beschriebener Prophagen bei Isolaten dieser Subpopulation

The Potential for State Attorneys General to Promote the Public’s Health: Theory, Evidence, and Practice

The Attorneys General of the 50 states have considerable legal authority to protect the public’s health, yet their role in the development of health policy is often under-appreciated or misunderstood. This article analyzes state Attorneys’ General current powers and provides a logic model that illustrates how the use of these powers can lead to the protection and promotion of the public’s health. The article then provides four brief case studies to demonstrate how state Attorneys General have used their varied powers to influence policy-making and benefit the public’s health. In addition, this article offers a roadmap for research that could be conducted to better understand the association between state Attorneys’ General actions and the protection of the public’s health. The article concludes with a series of recommendations intended to enhance state Attorneys’ General ability to protect the public’s health, along with suggestions for future research in this area