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PubMed2005

Promoting the oral health of older adults through the chronic disease model: CDC's perspective on what we still need to know.

The Centers for Disease Control and Prevention (CDC) has adopted a multicomponent approach to health promotion: the Chronic Disease Model. Among its underlying public health principles are 1) recognition of the universal preference for primary prevention of disease, 2) awareness that prevention often takes place outside of clinical settings and is influenced by behaviors that can be affected by social circumstances and institutional policies, 3) the need to base program efforts on the best available science, 4) the special responsibility of public health for at-risk populations, and 5) the need for population-based approaches. Such approaches require public health agencies to build programs that engage broad networks of partners; monitor diseases, risk factors, and behaviors; implement proven prevention strategies; and evaluate programs rigorously. If CDC is to implement comprehensive programs to promote the oral health of elderly people, more information is needed. In this short report we comment on gaps in knowledge concerning the components of programs, measurement of oral diseases and risk factors, and the effectiveness of preventive interventions at the self-care, clinical, and community levels for dental caries and oral and pharyngeal cancers.

Aged↗
PubMed2005

Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America.

During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), CDC, and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Community-based organizations and CDC as partners in HIV education and prevention.

By 1982, community responses to the acquired immunodeficiency syndrome (AIDS) epidemic were evident in some cities in the United States. Community responses were planned, developed, and coordinated largely by service-oriented, community-based organizations. Indirect evidence suggests that such organizations' activities mainly were in the form of attempting to discourage behaviors associated with the transmission of human immunodeficiency virus. During 1984, Centers for Disease Control (CDC) assessed the educational activities of community-based organizations and public health agencies in several cities nationwide. Investigators found that in those cities where health education had become a secondary activity within a health department, prevention activities tended to be ineffective. They noted that the challenge of the epidemic lay in finding effective strategies for disseminating relevant information. They concluded that prevention efforts directed to groups at risk needed to be appropriate to the lifestyle, language, and environment of a particular risk group. CDC recognized these findings by adopting a policy of support of community-based organizations in its overall AIDS prevention strategy.

Centers for Disease Control and Prevention, U.S.↗
PubMed1991

Comparison of ribavirin and placebo in CDC group III human immunodeficiency virus infection. Spanish Ribavirin Trial Group.

To assess the efficacy and safety of ribavirin in patients with human immunodeficiency virus (HIV) infection a multicentre, placebo-controlled, prospectively randomised trial was conducted in CDC group III HIV-infected individuals between February, 1988, and October, 1989. Mean treatment time was 39 weeks (range 6-52); 152 individuals were enrolled, of whom 133 could be evaluated. The two treatment groups were similar at baseline and 66% of all subjects had intravenous drug abuse as the main risk factor for HIV infection. Ribavirin was given at a dose of 15 mg/kg daily by mouth (average daily dose 1000 mg). 9 of 67 patients in the placebo group (13.4%) progressed to CDC Groups IVA, C1, or D vs 6 of 66 (9%) in the ribavirin group. Progressions to group IVC2 were 7 (10.4%) and 9 (13.6%), respectively. These differences are not statistically significant. There were no clinically or statistically significant differences in CD4 cell counts, total lymphocytes, total white cells, or CD4/CD8 ratios between the two groups during treatment, and no clinically important side-effects were noted.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Epidemiology and public health at CDC.

Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control health problems. However, in public health, the terms "field epidemiology" and "applied epidemiology"--which emphasize use of results in public health settings--define the practice of epidemiology at CDC. Epidemiology has been characterized as the basic science of public health, and its practice at CDC has shaped the agency's development and will contribute to its future success.

Centers for Disease Control and Prevention, U.S.↗
PubMed1991

Treatment with quinidine gluconate of persons with severe Plasmodium falciparum infection: discontinuation of parenteral quinine from CDC Drug Service.

CDC has recently reviewed data on the reported incidence in the United States of Plasmodium falciparum malaria and has evaluated available information on the effective management of severe life-threatening infections. As a result of this review, CDC has concluded that the therapeutic drug of choice in the United States for persons with complicated P. falciparum infection is parenteral quinidine gluconate, and that stocking of parenteral quinine dihydrochloride for emergency distribution is no longer required to provide optimal management of P. falciparum infections.

Animals↗
PubMed1976

Alterations in lipid constituents during growth of Mycobacterium smegmatis CDC 46 and Mycobacterium phlei ATCC 354.

Phospholipids of Mycobacterium phlei ATCC 354 and Mycobacterium smegmatis CDC 46 consist of cardiolipin, phosphatidyl ethanolamine, tri-acylated dimannophosphoinositide, tetra-acylated dimannophosphoinositide and tetra-acylated pentamannosphosphoinositide. A comparative study of lipid patterns of M. phlei ATCC 354 and of M. smegmatis CDC 46 in relation to age of culture revealed higher total lipid level and increased activity of malate-vitamin K reductase, a phospholipid requiring enzyme, during the early logarithmic growth phase of the former. No appreciable change occurred in the latter. The high total lipid content coincides with an increase in phospholipid, brought about apparently by the increase in malate-vitamin K reductase. Changes in cardiolipin and phosphatidyl ethanolamine appeared to be unique to M. phlei ATCC 354. However, in both bacterial species, a decrease in glyceride and a progressive increase in tuberculostearic acid with a concomitant decrease in oleic acid, occurred with ageing.

Cardiolipins↗
PubMed1990

A comparison of the efficacy and safety of ceftizoxime with doxycycline versus conventional CDC therapies in the treatment of upper genital tract infection with or without a mass.

It is well known that sexually transmitted infections of the upper genital tract are widespread. A variety of regimens are used to treat these conditions, many of which have not been subjected to randomized, prospective clinical trials (including the 1985 Centers for Disease Control [CDC] Guidelines for the treatment of upper genital tract infections [UGTI]). This investigation was undertaken to compare the 1985 CDC treatment guidelines with different doses of ceftizoxime, a third-generation cephalosporin with an intermediate half-life, plus doxycycline in patients with UGTI. The patients were divided into subgroups, depending on the presence or absence of a pelvic mass. Sixty-seven women participated in the study. They were older than 14 years of age and required hospitalization for the treatment of UGTI. These women had lower abdominal pain and tenderness, cervical motion or adnexal tenderness, and one of the following: temperature greater than 100.4 degrees F orally, leukocytosis greater than 10,500/mm3, or presence of a suspected inflammatory pelvic mass on pelvic examination or by ultrasound. Informed consent was obtained from all patients in a manner approved by the Institutional Review Board. Pelvic examinations and ultrasound evaluations of the pelvic soft tissues were performed on all patients at the time of admission. Those who were found not to have a pelvic mass or who had a pelvic mass less than 4 cm in transverse diameter were randomly allocated to receive either ceftizoxime 2 gm intravenously every 12 hours with doxycycline 100 mg intravenously twice daily (Rx 1, n = 13) or cefoxitin 2 gm intravenously every six hours with doxycycline 100 mg intravenously twice daily (Rx 2, n = 14). Those patients found to have a pelvic mass (greater than 4 cm in transverse diameter) were randomly allocated to receive either ceftizoxime 2 gm intravenously every eight hours with doxycycline 100 mg intravenously twice daily (Rx 3, n = 19) or clindamycin 900 mg intravenously every eight hours with a 2-mg/kg loading dose of gentamicin followed by 1.5 mg/kg intravenously every eight hours, with adjustments as necessary (Rx 4, n = 21). All UGTI patients without a mass treated with either Rx 1 or Rx 2 responded adequately. However, UGTI patients with a mass treated with Rx 4 were more likely than those treated with Rx 3 to require a change in antibiotics or need extirpative surgery in order to obtain a satisfactory clinical response (Fisher's exact test = 0.046, two-sided).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[HIV infection in stage IV C-2 (CDC). Increase in the p24 antigen value before critical decrease in CD4+ lymphocytes].

The Center for Disease Control proposed a classification system of HIV-infection including a symptomatic stage IV C-2 with secondary infections like thrush, oral hairy leukoplakia and herpes zoster. Because the prognostic value of these symptoms for the development of AIDS has been proven and the CDC-classification does not include any immunological parameters we analyzed the numbers of CD4+-lymphocytes and the frequency of HIV-antigen in 65 HIV-infected individuals. When entering stage IV C-2, the incidence of HIV-antigenemia was as high as in full blown AIDS (53% and 60%, respectively). However, we observed no decrease of CD4+-lymphocytes as compared to earlier CDC-stages.--We conclude that in stage IV C-2 the increase of viral protein production proceeds independently from CD4+-status.

CD4 Antigens↗
PubMed1988

[Prognostic significance of the T4 lymphocyte count in patients infected with CDC Class II and III HIV].

From 1985 to 1987 101 patients infected with the human immunodeficiency virus (HIV) were seen at our outpatient clinic and prospectively analyzed in a cohort study. We evaluated the follow-up in 41 patients of CDC classes II and III with regard to the number of T-helper lymphocytes (T4) and clinical progression. The patients consisted of 24 i.v. drug addicts, 11 homosexuals and 6 persons with other or multiple risk factors for HIV infection. Patients with a T4 count of less than 400/mm3 at the first visit did not differ significantly with regard to development of AIDS from those with a count of greater than 400/mm3 after a mean follow-up of approximately 1 year. The course of the infection for the individual patient was extremely varied and not predictable by the T4 value. We conclude that the number of the T4-lymphocytes is of no help in assessment of prognosis in the individual patient of CDC classes II and III.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Antibody dependent cell mediated cytotoxicity (ADCC) and complement dependent cytotoxicity (CDC) in 229 sera from human renal allograft recipients.

Comparison between CDC and ADCC in a human allogeneic model using the same cytotoxicity marker, i.e. 51Cr release from labelled target cells, provided a better definition of the optimal technical conditions for revealing ADCC. Testing 229 sera from human renal allograft recipients after transplantation, we found that CDC is detected only during rejection (43% of cases) whereas ADCC can be found both in those recipients tolerating their grafts and in those undergoing rejection, more frequently in the former than in the latter (39% vs. 21%, p less than 0.05). These in vivo results and other in vitro experiments support the assumption that two distinct varieties of antibody can mediate the in vitro ADCC phenomenon, some directed against the A, B and C HLA loci and having a deleterious effect on the graft, and others capable of exerting a protective effect and which could be directed against D related HLA determinants.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1980

Continuous-flow enzymatic determination of total serum cholesterol and method standardization with CDC-calibrated pooled sera.

We compared Boehringer Mannheim's enzymatic kit for the continuous-flow (AutoAnalyzer II) determination of serum cholesterol with Technicon's N-24a extraction method. Results for patients' samples analyzed by the enzymatic method were higher than those by the comparison method. To evaluate accuracy in the cholesterol determinations, we enrolled the enzymatic method into the Center for Disease Control's (CDC) Lipid Standardization program. We calibrated the method by use of a pooled sera for which cholesterol content was assigned by CDC after analysis by their reference Abell-Kendall procedure. We discuss the difficulties with available calibration material and limitations in the application of some commercial control materials to the enzymatic cholesterol method. The continuous-flow variables, Michaelis-Menton constants, percent ester-hydrolase activity, and other factors affecting the performance of the enzyme-linked cholesterol method are evaluated. We believe pooled sera with an assigned value for cholesterol content is the best calibrator material.

Autoanalysis↗
PubMed1994

[Evaluation of tests recommended by the CDC for the determination of CD4+ T lymphocytes in patients infected by the human immunodeficiency virus].

The "Centers for Disease Control" (CDC) recently published the guidelines for the performance of CD4+ T-cell determinations in persons with Human Immunodeficiency Virus (HIV) infection. Especially, a monoclonal antibody panel for lymphocyte immunophenotyping has been recommended i.e CD45/CD14, isotypic controls, CD3/CD4, CD3/CD8, CD3/CD19, CD3/CD56+ and/or CD16+. The authors compared, in 50 HIV+ patients, this method with the conventional method used in their laboratory i.e CD4/CD8 associated with isotypic controls. The mean values of CD4+ and CD8+ cells obtained using dual color immunophenotyping CD3/CD4 and CD3/CD8 did not differed significantly as compared with the values obtained using dual color immunophenotyping CD4/CD8. Especially, concerning CD4+ cells, differences did not exceed 4% considering each patient and 1% considering the mean values. However, in some patients, the differences between the levels of CD8+ cells obtained using the two methods were greater than 10%. These differences were due to an important percentage of CD3-CD8+ cells corresponding to NK cells. In another hand, there was no significant difference between the levels of CD4 and CD8+ cells obtained with or without correction using the gating reagent CD45/CD14. In conclusion, monoclonal antibody pannel recommended by CDC for lymphocyte immunophenotyping in HIV patients do not seem necessary in all cases. Analysis for CD4 and CD8 positive cells could be accomplish by three color simultaneous method (CD3/CD4/CD8), by first gating on CD3 positive T lymphocytes in order to eliminate both monocyte and NK cell contamination.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Prevention of skin colonization and subsequent bacteremia with CDC-JK organisms in patients with cancer.

A 10-year experience with a program designed to reduce the incidence of bacteremias in the cancer patient, specifically those caused by Corynebacterium CDC-JK, is presented. Retrospective chart reviews identified patients at risk and generated the hypothesis that special attention to body hygiene may play a significant role. Implementation of a skin hygiene program resulted in a significant decrease in the incidence of CDC-JK bacteremias in Memorial Hospital patients.

Bacteremia↗
PubMedDate not supplied

Applications of data from the CDC Family of Surveys.

The CDC Family of Surveys is a national serologic surveillance system set up to characterize the extent of human immunodeficiency virus (HIV) infection in the United States. The now Centers for Disease Control and Prevention (CDC) and participating State and local health departments began the system in 1987. HIV seroprevalence data are collected by unlinked (anonymous) surveys of particular components of the population that include childbearing women; clients of sexually transmitted disease clinics; injecting drug users; tuberculosis patients; and several special populations, such as adolescents, prisoners, and homeless persons. The data obtained have been used extensively on both national and local levels to assist HIV-prevention programs. Data from the surveys have been used to identify specific demographic groups at risk for HIV infection so that health education programs may be planned and made available to them in clinical settings. Local serosurvey results have been used in planning and implementing prevention programs and in planning health services for HIV-positive persons. The completeness, or coverage, of HIV counseling and testing programs has been evaluated by comparing seroprevalences among clients tested voluntarily with those tested in the unlinked survey. Survey data are used in formulating recommendations and standards of care for health practitioners, in allocating resources, and in carrying out long-range planning for HIV prevention and treatment services for at-risk groups. Such data are essential to the decision-making process in forming public health policy and recommending practices involving the HIV epidemic.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Health communication takes on new dimensions at CDC.

Actions by the Centers for Disease Control and Prevention (CDC) to integrate health communication into overall prevention programs as a means of influencing individual behavior to reduce risks to health are described. These actions include a set of 5-year goals for the Agency; a proposal to establish an Office of Health Communication to provide leadership and support for accomplishing the goals; and establishment of a working group to create the proposed Office of Health Communication and to develop a framework for accomplishing the goals. Fundamental to the policy was development of a definition of health communication as the Agency would practice it. Steps taken to reach this definition are outlined as well as the 10 steps adopted as a framework for health communication. The article concludes with a statement describing communication as a part of CDC's overall mission. The hope is that the ultimate accomplishment will be increased awareness among Americans of the importance of good health and their ability to achieve it.

Centers for Disease Control and Prevention, U.S.↗
PubMed1996

CDC WONDER on the Web.

CDC WONDER, an information system developed at the Centers for Disease Control and Prevention (CDC), provides access to 26 text and numeric databases, and special facilities for surveillance, through an architecture developed for public health. We report extensions of the original architecture that allowed us to create a Web version (http:@wonder.cdc.gov).

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

[Dog bite infections associated with CDC group EF-4a. Report of 2 cases].

BACKGROUND: Group EF-4 bacteria make up part of the normal flora of the oral cavity of dogs and cats. Few reports have been published on the incidence of human infections by this group of bacteria and these are associated with animal bite or scratch. Two cases of infections by CDC group EF-4 by dog bite were diagnosed in 1996 by the Bacteriology Laboratory of the authors' hospital. These cases are herein described and the biochemical analysis and profile of sensitivity of this little known group of bacteria evaluated. METHODS: Two clinical cases of infection by CDC group EF-4a by dog bite are described. Identification of the bacteria was performed by conventional biochemical tests and quantitative antibiotic sensitivity to 12 antibiotics was carried out by the seried broth macrodilution method. RESULTS: The two strains isolated corresponded to biovar "a" of group EF-4 being sensitive to: ampicillin, ceftriaxone, aminoglycosides, chloramphenicol, rifamipicin, TMS and ciprofloxacin, intermediate sensitivity to erythromycin and were resistant to cefalotine, oxacillin and vancomycin. With respect to penicillin, one of the strains was sensitive and the other presented intermediate sensitivity. Neither of the strains produced beta lactamase. CONCLUSIONS: Although Pasteurella sp. is usually considered in dog bite wounds, the possible presence of group EF-4 should be taken into account since the sensitivity of both microorganisms against penicillin and cefalotin, which are effective against Pasteurella but less active against group EF-4 bacteria differ.

Adolescent↗