bluuebunny/crossref_metadata_2025_split huggingface dataset:
Children's exposure to polybrominated diphenyl ethers
Authors: ZUURBIER MONIEK , LEIJS MARIKE , SCHOETERS GREET , TUSSCHER GAVIN Ten , KOPPE JANNA G. 
Published: September 2006

Abstract Background: Polybrominated biphenyl ethers (PBDEs), a class of brominated flame retardants, are frequently used in consumer products. PBDEs levels in environmental and human samples have increased in recent decades. Children are exposed to PBDEs through diet, mainly through fish, meat and milk. Total dietary exposure of children in Europe was calculated to be 2–3 ng/kg b.w./day. For nursing infants the main source of PBDE exposure is breast milk; exposure levels are around 15 ng/kg b.w./day. PBDE exposure levels in North America are 10 to a 100 times higher. Because of their persistence and their similarity to polychlorinated biphenyls (PCBs), concern has been raised about the effects of PBDEs on human health. Exposure to penta‐ and octa‐BDE led to learning impairment and impaired motor behaviour in rodents. Exposure to penta‐, octa‐ and also deca‐BDE caused effects on thyroid homeostasis in animals. Conclusions: The EU has banned the production and use of penta‐ and octa‐BDE since 2004; however, exposure will continue during the coming decades. Based upon current toxicological evidence, human exposure to deca‐BDEs is not expected to lead to health effects, but data on exposure to deca‐BDE and data on toxicity of deca‐BDE are scarce. Therefore, monitoring studies and toxicity studies on deca‐BDEs and other BDEs should continue.
Policy and science in children's health and environment: Recommendations from the PINCHE project
Authors: VAN DEN HAZEL PETER , ZUURBIER MONIEK , BISTRUP MARIE LOUISE , BUSBY CHRIS , FUCIC ALEKSANDRA , KOPPE JANNA G. , LUNDQVIST CHRISTOFER , RONCHETTI ROBERTO , TUSSCHER GAVIN TEN 
Published: September 2006

Abstract Background: Policy recommendations result from the discussions and analysis of the present situation in environment and health. Such analysis was performed in PINCHE. This led to recommendations based on the scientific literature. In the field of children's environmental health the policy process will follow more or less fixed rules, but this process is still at an early level of development. The link between science and policy still faces many challenges. Scientific assessment of environmental risk must recognize and tackle the problems of data sets, variability of human and environmental systems, the range, spatial and temporal diffusion of potential health effects and many biases and confounding factors. Results: The PINCHE network recommends a general improvement of the supporting scientific fields in environment and health. Assessments from epidemiology or toxicology should play a key role in influencing science‐policy decisions in programmes that are intended to inform the public policy process. Scientific committees at a local level could play a role. The relation between health and environment needs to be better incorporated in training and education. There is a need for harmonization of data production and use. The priorities in PINCHE focus on the most important issues. A classification of low, medium or high priority for action was used to describe a range of different environmental stressors. Conclusions: PINCHE provided recommendations to reduce exposure for children. Exposure reduction is not always linked to improved health in the short term, but it will reduce the body burden of accumulating chemicals in children. A strategic choice is reduction of exposure of children to compounds by changing production techniques or by increasing the distance of child specific settings to sources. The contribution of all players in the production, distribution and use of scientific knowledge in the field of children's environmental health is necessary.
Role of Horizontal Transfer of the Transposon Tn1546in the Nosocomial Spread ofvanAVancomycin-Resistant Enterococci at a Tertiary Care Hospital in Korea
Authors: Yoo Soo Jin , Sung Heungsup , Cho Young-Uk , Kim Mi-Na , Pai Chik Hyun , Kim Yang Soo 
Published: September 2006

Objective:To investigate the epidemiologic characteristics of vancomycin-resistant enterococci (VRE) infection.Design.An epidemiologic description by means of chromosomal DNA fingerprinting and transposon typing.Setting.A 2,200-bed tertiary care hospital in Korea.Patients.First VRE isolates were obtained from patients hospitalized from April 1997 to December 2001.Interventions.Thevangenotypes of isolates were identified by means of multiplex polymerase chain reaction (PCR). The macro-restriction patterns of chromosomal DNA were determined by pulsed-field gel electrophoresis (PFGE). The transposon Tn1546was typed by means of 2 sets of long PCR restriction fragment-length polymorphism analysis, which wereClaI restriction of a 10.4-kb region fromorf1tovanZandDdeI restriction of a 4.4-kb region fromvanRtovanX.Results.VRE isolates were recovered from 215 patients. All werevanAgenotype. PFGE analysis of the 215 isolates showed 172 types, including 21 clusters composed of 64 isolates and 151 types of as many isolates. Each type was composed of 2-10 isolates; the isolates within each PFGE cluster were detected within a 10-month period and mostly shared a transposon type. Transposon typing classified 169 strains into 15 types and 158 strains belonged to 4 major transposon clusters. Each of these 4 transposon clusters was isolated from patients treated in 5-22 different wards during a 31-52 month period and consisted of 9-80 PFGE types. Each of the other 11 types were found in only one strain.Conclusions.Our findings suggest that the horizontal transfer of Tn1546has a major role in the nosocomial spread ofvanAVRE. Clonal spread of VRE seemed to contribute to short-term dissemination in limited areas.
Active Surveillance for Methicillin-Resistant Staphylococcus aureus(MRSA) Decreases the Incidence of MRSA Bacteremia
Authors: Shitrit Pnina , Gottesman Bat-Sheva , Katzir Michal , Kilman Avi , Ben-Nissan Yona , Chowers Michal 
Published: September 2006

Objectives.To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital.Design.Before-after trial.Setting.A 700-bed hospital.Patients.All patients admitted to the hospital who were at high risk for MRSA bacteremia.Intervention.Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004).Results.The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (P<.001). The mean number of MRSA bacteremia cases per month decreased from 3.6 cases before the intervention to 1.8 cases after the intervention (P< 0.001).Conclusions.Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.
Impact of Alcohol-Based, Waterless Hand Antiseptic on the Incidence of Infection and Colonization With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci
Authors: Lai Kwan Kew , Fontecchio Sally , Melvin Zita , Baker Stephen P. 
Published: September 2006

Objective:Colonized and infected inpatients are major reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and transient carriage of these pathogens on the hands of healthcare workers remains the most common mechanism of patient-to-patient transmission. We hypothesized that use of alcohol-based, waterless hand antiseptic would lower the incidence of colonization and/or infection with MRSA and VRE.Methods.On June 19, 2001, alcohol hand antiseptic was introduced at the University campus and not the nearby Memorial campus of the University of Massachusetts Medical School (Worcester, MA), allowing us to evaluate the impact of this antiseptic on the incidence of MRSA and VRE colonization and infection. From January 1 through December 31, 2001, the incidence of MRSA colonization or infection was compared between the 2 campuses before and after the hand antiseptic was introduced. Its effect on VRE colonization and infection was only studied in the medical intensive care unit at the University campus.Results.At the University campus, the incidence of MRSA colonization or infection decreased from 1.26 cases/1,000 patient-days before the intervention to 0.75 cases/1,000 patient-days after the intervention, for a 1.46-fold decrease (95% confidence interval, 1.04-2.58; P = .037). At the Memorial campus, the incidence of MRSA colonization or infection remained virtually unchanged, from 0.34 cases/1,000 patient-days to 0.49 cases/1,000 patient-days during the same period. However, a separate analysis of the University campus data that controlled for proximity to prevalent cases did not show a significant improvement in the rates of infection or colonization. The incidence of nosocomial VRE colonization or infection before and after the hand antiseptic decreased from 12.0 cases/1,000 patient-days to 3.0 cases/1,000 patient-days, a 2.25-fold decrease (P = .018). Compliance with rectal surveillance for detection of VRE was 86% before and 84% after implementation of the hand antiseptic intervention. The prevalences of VRE cases during these 2 periods were 25% and 29%, respectively (P = .017).Conclusions.Alcohol hand antiseptic appears to be effective in controlling the transmission of VRE. However, after controlling for proximity to prevalent cases (ie, for clustering), it does not appear to be more effective than standard methods for controlling MRSA. Further controlled studies are needed to evaluate its effectiveness.
Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit
Authors: Warren David K. , Guth Rebecca M. , Coopersmith Craig M. , Merz Liana R. , Zack Jeanne E. , Fraser Victoria J. 
Published: September 2006

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.Objective.To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.Design.Prospective cohort study.Setting.Surgical ICU at a teaching hospital.Patients.All patients admitted to the surgical ICU.Results.Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).Conclusions.Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.
Molecular Characterization of Methicillin-ResistantStaphylococcus aureusDisseminated in a Home Care System
Authors: Rozenbaum R. , Silva-Carvalho M. C. , Souza R. R. , Melo M. C. N. , Gobbi C. N. , Coelho L. R. , Ferreira R. L. , Ferreira-Carvalho B. T. , Schuenck A. L. , Neves F. M. C. S. , Silva L. R. P. O. F. , Figueiredo A. M. S. 
Published: September 2006

Objective.To study colonization with methicillin-resistantStaphylococcus aureusin a home care service during a 4-month period.Design.Prospective study.Setting.A home care service located in Rio de Janeiro, Brazil.Participants.Patients admitted to the home care service during this period, their household contacts, and health care workers (HCWs).Methods.Swab specimens from the anterior nares were collected from each patient in the 3 groups at admission. Screening was repeated every 7 days. MRSA was detected using a mecA probe, and the clonality of isolates was evaluated by molecular methods, primarily pulsed-field gel electrophoresis.Results.Of the 59 study patients, 9 (15.3%) had MRSA colonization detected; these cases of colonization were classified as imported. Only 1 (2.0%) of the 50 patients not colonized at admission became an MRSA carrier (this case of colonization was classified as autochthonous). Two (0.9%) of 224 household contacts and 16 (7.4%) of 217 HCWs had MRSA colonization. Cross-transmission from patient to HCW could be clearly demonstrated in 8 cases. The great majority of MRSA isolates belonged to the Brazilian epidemic clone.Conclusions.MRSA colonization was common in the home care service analyzed. The fact that the majority of MRSA isolates obtained were primarily of nosocomial origin (and belonged to the so-called Brazilian epidemic clone) substantiated our findings that all but 1 patient had already been colonized before admission to the home care service. Only cross-transmission from patients to healthcare workers could be verified. On the basis of these results, we believe that a control program built on admission screening of patients for detection of MRSA carriage could contribute to the overall quality of care.
Community-Associated Strains of Methicillin-ResistantStaphylococccus aureusas the Cause of Healthcare-Associated Infection
Authors: Gonzalez Blanca E. , Rueda Adriana M. , Shelburne Samuel A. , Musher Daniel M. , Hamill Richard J. , Hultén Kristina G. 
Published: September 2006

Objective:Methicillin-resistantStaphylococcus aureus(MRSA) isolates from patients with community-associated infection have been described as strains genetically distinct from the strains isolated from patients with healthcare-associated infection. This study examines the hypothesis that community-associated MRSA (CA-MRSA) strains now cause serious infections in hospitalized patients.Methods.Thirty-seven clinical MRSA isolates were randomly selected from blood isolates obtained from July 2003 through June 2004. Strains were tested for staphylococcal chromosomal cassettemec(SCCmec) type, pulsed-field gel electrophoresis (PFGE) type, and presence of Panton-Valentine leukocidin (PVL) genes. Medical records review and epidemiologic classification was performed by an investigator blinded to the results of the bacterial strain analysis. Episodes of bloodstream infection were independently classified as either community-associated or healthcare-associated infections, and bacterial isolates were independently classified as either CA-MRSA strains or healthcare-associated MRSA (HA-MRSA) strains, according to established definitions.Setting.A tertiary care Veterans Affairs Medical Center.Results.Twenty-four (65%) of 37 MRSA isolates were SCCmectype IV, a genetic type characteristic of CA-MRSA strains; 22 of these 24 isolates belonged to the CA-MRSA clone USA300 and carried PVL genes. Thirteen (35%) of the 37 strains were SCCmectype II, of which 12 were USA100-ST5 and 12 lacked PVL genes. Thirty patients (81%) had healthcare-associated infections; 18 (60%) of these 30 were infected with isolates carrying markers of CA-MRSA strains. Of 7 patients with CA-MRSA infections, 6 were infected with isolates belonging to the USA300 clone. Patients with healthcare-associated bloodstream infections were as likely to be infected with a CA-MRSA strain as patients with a community-associated infection (P= .38).Conclusions.MRSA strains with molecular characteristics of CA-MRSA strains have emerged as an important cause of serious health-care-associated infection in our hospital.
Emergence of Community-Associated Methicillin-ResistantStaphylococcus aureusInfection Among Patients With End-Stage Renal Disease
Authors: Johnson Leonard B. , Venugopal Anilrudh A. , Pawlak Joan , Saravolatz Louis D. 
Published: September 2006

Objective.To evaluate the frequency of infections due to community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) strains among our patients with end-stage renal disease.Design.Prospective observational clinical and laboratory study of patients in 2005. Molecular features of isolates recovered from these patients were compared with those of isolates recovered in 2000 from patients with end-stage renal disease.Setting.A 600-bed urban academic medical center.Patients.Thirty-two patients with end-stage renal disease and MRSA infection at the time of hospitalization from 2005 were evaluated. For comparison, laboratory analysis was performed for 17 MRSA isolates recovered from patients with end-stage renal disease in 2000.Results.The patients from 2005 were more likely than the patients from 2000 to have infection with strains that carried the staphylococcal cassette chromosome (SCC)mectype IV complex (50% vs 11.8%; relative risk, 4.25 [95% confidence interval, 1.17-25.98];P= .012) and the Panton-Valentine leukocidin toxin genes (25% vs 0%;P= .038). Eight patients from 2005 were infected with a strain that is identical to MRSA clone USA300 in terms of molecular type and presence of SCCmectype IV and Panton-Valentine leukocidin genes. Among the patients from 2005, those infected with SCCmectype IV strains (ie, CA-MRSA strains) and those infected with SCCmectype II strains (ie, healthcare-associated MRSA [HA-MRSA] strains) were similar with respect to demographic characteristics, risk factors, and outcomes.Conclusions.We documented an increased proportion of infections with CA-MRSA strains, including clone USA300, among our population of patients undergoing dialysis. Patients infected with CA-MRSA strains and HA-MRSA strains were similar with respect to presenting illness and outcomes.
Carriage of Multiple Subtypes of Methicillin-ResistantStaphylococcus aureusby Intensive Care Unit Patients
Authors: Lim Megan S. C. , Marshall Caroline L. , Spelman Denis 
Published: September 2006

Objective:To determine how consistently patients are colonized with methicillin-resistantStaphylococcus aureus(MRSA) at various sites and how many subtypes can be carried simultaneously by a single patient.Setting.A 28-bed Intensive care unit in a tertiary-care referral hospital.Methods.A total of 1,181 patients were screened by culture of swab specimens obtained from the nose, throat, groin, and axilla on admission to the intensive care unit (ICU), twice weekly during their ICU stay, and at discharge.Results.MRSA was isolated at least once from 224 patients. Of these isolates, 359 were selected from 32 patients to be subtyped using pulsed-field gel electrophoresis. The rate of compliance with collection of swab specimens was 79.9%. The combination of sites colonized varied frequently over time for many patients. Of patients who had swab specimens obtained twice in 1 day, 8.7% had discordant results from the 2 swab sets. No patient had a clinical isolate that was not of an identical subtype to an isolate from an anatomical site that was sampled for screening. Half the patients carried multiple subtypes during their stay, with up to 4 subtypes per patient.Conclusions.The findings of this study may indicate that these patients have been colonized with MRSA on more than one occasion, possibly because of multiple breaches in infection control procedure. In MRSA-colonized patients, anatomical sites were intermittently colonized and carriage of multiple subtypes was common. These findings indicate that MRSA carriage is not a fixed state but may vary over time.
Surveillance for Vancomycin-Resistant Enterococci: Type, Rates, Costs, and Implications
Authors: Shadel Brooke N. , Puzniak Laura A. , Gillespie Kathleen N. , Lawrence Steven J. , Kollef Marin , Mundy Linda M. 
Published: September 2006

Objective.To evaluate 2 active surveillance strategies for detection of enteric vancomycin-resistant enterococci (VRE) in an intensive care unit (ICU).Design.Thirty-month prospective observational study.Setting.ICU at a university-affiliated referral center.Patients.All patients with an ICU stay of 24 hours or more were eligible for the study.Intervention.Clinical active surveillance (CAS), involving culture of a rectal swab specimen for detection of VRE, was performed on admission, weekly while the patient was in the ICU, and at discharge. Laboratory-based active surveillance (LAS), involving culture of a stool specimen for detection of VRE, was performed on stool samples submitted forClostridium difficiletoxin detection.Results.Enteric colonization with VRE was detected in 309 (17%) of 1,872 patients. The CAS method initially detected 280 (91%) of the 309 patients colonized with VRE, compared with 25 patients (8%) detected by LAS; colonization in 4 patients (1%) was initially detected by analysis of other clinical specimens. Most patients with colonization (76%) would have gone undetected by LAS alone, whereas use of the CAS method exclusively would have missed only 3 patients (1%) who were colonized. CAS cost $1,913 per month, or $57,395 for the 30-month study period. Cost savings of CAS from preventing cases of VRE colonization and bacteremia were estimated to range from $56,258 to $303,334 per month.Conclusions.A patient-based CAS strategy for detection of enteric colonization with VRE was superior to LAS. In this high-risk setting, CAS appeared to be the most efficient and cost-effective surveillance method. The modest costs of CAS were offset by the averted costs associated with the prevention of VRE colonization and bacteremia.