Review of brucellosis cases from laboratory exposures in the United States in 2008 to 2011 and improved strategies for disease prevention

Five laboratory-acquired brucellosis (LAB) cases that occurred in the United States between 2008 and 2011 are presented. The Centers for Disease Control and Prevention (CDC) reviewed the recommendations published in 2008 and the published literature to identify strategies to further prevent LAB. The improved prevention strategies are described.

The isolation and identification of cis-diamminedichloroplatinum (ii)-DNA adducts by anion-exchange HPLC and inductively coupled plasma mass-spectrometry

The adducts produced by the reaction of cis-diamminedichloroplatinum(II) with DNA have previously been isolated and characterised. These adducts may be measured at the cellular level by immunochemical detection but the accuracy of this assay is dependent on the number of adducts per nucleotide. We have developed a novel assay for cisplatin-DNA adducts, utilising an established method in which platinated DNA is digested to form a mixture of nucleotides and adducts; these are then separated by anion exchange HPLC. The number of cisplatin-DNA adducts is determined by measurement of the platinum content of the HPLC fractions by inductively coupled plasma mass spectrometry. The assay has been validated by cochromatography of purified drug-DNA adducts whose identity has been confirmed by NMR. We describe an application of the assay, namely the measurement of in vitro removal of cisplatin-DNA adducts from calf thymus DNA by cell free extracts derived from tumour cell lines. Adduct removal is dependent on both the amount of extract protein and the duration of the reaction. Almost 70% of adducts are removed from 5mug of DNA (drug:nucleotide ratio 0.08) by 80mug of extract. Other potential applications of the assay are discussed.

Neighbourhood deprivation, health inequalities and service access by adults with intellectual disabilities: a cross-sectional study

BACKGROUND

Adults with intellectual disabilities (IDs) experience health inequalities and are more likely to live in deprived areas. The aim of this study was to determine whether the extent of deprivation of the area a person lives in affects their access to services, hence contributing to health inequalities.

METHOD

A cross-sectional study design was used. Interviews were conducted with all adults with IDs within a defined location (n = 1023), and their medical records were reviewed. The extent of area deprivation was defined by postcode, using Carstairs scores.

RESULTS

Area deprivation did not influence access to social supports, daytime primary health-care services or hospital admissions, but people in more deprived areas made less use of secondary outpatient health care [first contacts (P = 0.0007); follow-ups (P = 0.0002)], and more use of accident and emergency care (P = 0.02). Women in more deprived areas were more likely to have had a cervical smear; there was little association with other health promotion uptake. Area deprivation was not associated with access to paid employment, daytime occupation, nor respite care. These results were essentially unchanged after adjusting for type of accommodation and level of ability.

CONCLUSIONS

Deprivation may not contribute to health inequality in the population with IDs in the same way as in the general population. Focusing health promotion initiatives within areas of greatest deprivation would be predicted to introduce a further access inequality.

Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study

BACKGROUND

Injuries are among the leading causes of death and disability in the world and a major public health concern. Falls are a common cause. Young persons with intellectual disabilities (ID) have a higher rate and different pattern of injuries than the general population, but little is known regarding adults.

METHODS

The aim of this study was to determine the incidence and types of injuries experienced by a community-based cohort of adults with ID (n = 511) in a 12-month period. Face-to-face interviews were conducted with participants 2 years after they had first been recruited into a longitudinal study.

RESULTS

Incidence of at least one injury in a 12-month period was 20.5% (105), of which 12.1% (62) was because of falls. Incident injury was predicted by having epilepsy and not having autism. Incident fall injury was predicted by urinary incontinence, while Down syndrome reduced risk.

CONCLUSIONS

Adults with ID do experience a higher rate of injuries and falls when compared with the general population. The results of this study highlight this, and hence the need to work towards the development of interventions for injury and falls prevention in this population.

Surveillance of occupational skin disease using the Supplementary Data System

The utility of the Supplementary Data System (SDS) compiled by the Bureau of Labor Statistics (BLS) in conducting surveillance of occupational skin disease was evaluated by examining 14,703 workers' compensation cases reported to the SDS for the year 1981. Combined with state employment denominators obtained from the BLS Employment and Earnings Program, rates of illness (cases of dermatitis/10,000 employed) calculated for eight major industrial divisions varied significantly according to the criteria used for reporting cases. Despite quantitative variations in the rate of skin disease that depended on specific reporting criteria, the relative ranking of the major industrial divisions remained unchanged, with highest rates of skin disease consistently found in three major industry divisions: agriculture, manufacturing, and construction. This ranking of major industry divisions by rate of dermatitis corresponded extremely well with rankings generated from the 1981 Annual Survey (Spearman rank correlation = .98, p less than .01). At the two-digit level of the Standard Industrial Classification, the rankings based on the SDS had a 77% rank correlation with those from the Annual Survey. Two-digit SIC codes identified from the top 10 in both sets of rankings included crop and livestock production from the agricultural division and leather products, food products, rubber and plastic products from the manufacturing division.

Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.