BACKGROUND & AIMS: :Although an estimated 6.5 million United States (US) children aged 6-17 practiced a martial art in 2004, there have been no nationally representative studies comparing pediatric injuries among the three most popular disciplines, karate, taekwondo, and judo. Describe pediatric martial arts injuries presenting to a representative sample of US Emergency Departments (EDs) from 1990 to 2003. We reviewed all martial arts injuries captured by the US Consumer Product Safety Commission's (CPSC), National Electronic Injury Surveillance System (NEISS). An estimated 128,400 children

BACKGROUND & AIMS: :Statistics on treatment rates for patients with end stage renal disease (ESRD) show that the number of ESRD patients per million population in the United Kingdom has increased slowly in recent years. The British Transplantation Society issued questionnaires in 1983 and 1984 to determine the number of patients transplanted, the number of suitable patients, and the facilities needed to enable all suitable patients to receive treatment. While there is a high transplant rate, the percentage of ESRD patients on dialysis is low, and there is a "socially unacceptable deficit" with respect to treatment of diabetics and the elderly.

背景与目标： : 有关终末期肾病 (ESRD) 患者治疗率的统计数据表明，英国每百万人口中ESRD患者的数量近年来增长缓慢。英国移植学会1983年和1984发放了问卷，以确定移植的患者人数、合适的患者人数以及使所有合适的患者都能接受治疗所需的设施。尽管移植率很高，但接受透析的ESRD患者的百分比却很低，并且在糖尿病患者和老年人的治疗方面存在 “社会上不可接受的缺陷”。

BACKGROUND & AIMS: BACKGROUND:In 2009, 6.7% of the estimated 1.1 million persons living with human immunodeficiency virus (HIV) infection in the United States were youths (defined in this report as persons aged 13-24 years); more than half of youths with HIV (59.5%) were unaware of their infection. METHODS:CDC used National HIV Surveillance System data to estimate, among youths, prevalence rates of diagnosed HIV infection in 2009 and the number of new infections (incidence) in 2010. To assess the prevalence of risk factors and HIV testing among youths, CDC used the 2009 and 2011 Youth Risk Behavior Surveillance System for 9th-12th grade students and the 2010 National Health Interview Survey (NHIS) for persons 18-24 years. RESULTS:Prevalence of diagnosed HIV was 69.5 per 100,000 youths at the end of 2009. Youths accounted for 12,200 (25.7%) new HIV infections in 2010. Of these, 7,000 (57.4%) were among blacks/African Americans, 2,390 (19.6%) among Hispanics/Latinos, and 2,380 (19.5%) among whites; 8,800 (72.1%) were attributed to male-to-male sexual contact. The percentage of youths tested for HIV overall was 12.9% among high school students and 34.5% among those aged 18-24 years; it was lower among males than females, and lower among whites and Hispanics/Latinos than blacks/African Americans. CONCLUSIONS:A disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM). The percentage of youths tested for HIV, however, was low, particularly among males. Implications for Public Health: More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVES:To determine the total number of active sleep laboratories in the United States and the number of polysomnograms conducted on a yearly basis in these laboratories. METHODS:All members of the AASM and all AASM accredited sleep laboratory directors received a questionnaire addressing their laboratory and its volume. In three states, multiple telephone calls to AASM members were used to correctly identify the absolute number of labs and their PSG volume in those states. Extrapolating from the number of labs studies identified per questionnaire relative to the correct number (per calls) in those states and, then applying this ratio to the entire US, the total number of labs and studies was determined. RESULTS:Our data suggests that there are, in the year 2001, 1,292 sleep laboratories conducting 1,165,135 polysomnograms per year. This comes to 427 PSG's/year per 100,000 population in the United States. CONCLUSIONS:These data suggest that there are a relatively large number of sleep laboratories in the US conducting a substantial number of PSG's. However, there was considerable variability in this volume between states that did not relate to known markers of healthcare utilization. These numbers have likely increased since 2001.

背景与目标：

BACKGROUND & AIMS: :Chronic hepatitis C virus (HCV) infection causes substantial morbidity and mortality in the United States. Testing and treatment of asymptomatic persons might avert progression to more advanced disease. In 1998, CDC published guidelines for HCV testing based on risk factors for infection; however, recent studies indicate that at least one half of all persons living with HCV infection in the United States are unaware of their infection status. To increase testing rates, in 2012 CDC recommended one-time testing of all persons born during 1945-1965. To better understand where and why persons with chronic HCV infection sought their initial testing, 2006-2010 data were analyzed from a survey conducted as part of the ongoing Chronic Hepatitis Cohort Study. Of 4,689 patients with HCV infection who responded to the survey, 60.4% reported that their initial HCV test occurred in a physician's office. CDC's risk-based indications (e.g., injection drug use and hemodialysis) were cited by 1,045 (22.3%) of the patients as reasons for testing, whereas clinical indications (e.g., abnormal liver function tests or liver-related symptoms such as jaundice) were cited by 2,121 (45.2%), suggesting that many HCV infections were identified only after the patient had become symptomatic. Promoting U. S. Preventive Services Task Force and CDC recommendations for testing and identifying strategies that help physicians implement HCV testing in their offices might help facilitate timely identification of HCV infection and reduce morbidity and mortality.

背景与目标： : 在美国，慢性丙型肝炎病毒 (HCV) 感染会导致大量的发病率和死亡率。无症状者的检测和治疗可能会避免进展到更晚期的疾病。1998年，疾病预防控制中心发布了基于感染危险因素的HCV检测指南; 然而，最近的研究表明，在美国，至少有一半的HCV感染者不知道他们的感染状况。为了提高检测率，2012年疾病预防控制中心建议对1945-1965年期间出生的所有人进行一次性检测。为了更好地了解慢性HCV感染者在哪里以及为什么要进行初步测试，从正在进行的慢性肝炎队列研究的一部分进行的一项调查中分析了2006-2010的数据。在对调查做出回应的4,689例HCV感染患者中，60.4% 例报告说他们最初的HCV测试在医生办公室进行。1,045 (22.3%) 的患者引用CDC的基于风险的适应症 (例如，注射药物使用和血液透析) 作为测试的原因，而临床适应症 (例如，2,121 (45.2%) 引用了肝功能检查异常或肝脏相关症状 (例如黄疸)，这表明仅在患者出现症状后才发现许多HCV感染。促进美国预防服务工作组和疾病预防控制中心的检测和识别策略的建议，帮助医生在其办公室实施HCV检测，可能有助于及时识别HCV感染，降低发病率和死亡率。

BACKGROUND & AIMS: :Discussions of drug policy tend not to consider whether the stated goals of policies are an accurate statement of what they are meant to do and also may not consider the fact that what benefits some people may harm others. We explore these issues and present an agenda for research in this area that, while not eliminating these difficulties, both illuminates them and can help guide actors toward more effective action.

背景与目标： : 关于毒品政策的讨论往往不会考虑政策的既定目标是否是对其意图的准确陈述，也可能不会考虑这样一个事实，即某些人的利益可能会损害其他人。我们探讨了这些问题，并提出了该领域的研究议程，尽管没有消除这些困难，但两者都阐明了这些困难，并可以帮助指导行为者采取更有效的行动。

BACKGROUND & AIMS: :Previous studies conducted in Western cultures have shown that negative emotions predict higher levels of pro-inflammatory biomarkers, specifically interleukin-6 (IL-6). This link between negative emotions and IL-6 may be specific to Western cultures where negative emotions are perceived to be problematic and thus may not extend to Eastern cultures where negative emotions are seen as acceptable and normal. Using samples of 1044 American and 382 Japanese middle-aged and older adults, we investigated whether the relationship between negative emotions and IL-6 varies by cultural context. Negative emotions predicted higher IL-6 among American adults, whereas no association was evident among Japanese adults. Furthermore, the interaction between culture and negative emotions remained even after controlling for demographic variables, psychological factors (positive emotions, neuroticism, extraversion), health behaviors (smoking status, alcohol consumption), and health status (chronic conditions, BMI). These findings highlight the role of cultural context in shaping how negative emotions affect inflammatory physiology and underscore the importance of cultural ideas and practices relevant to negative emotions for understanding of the interplay between psychology, physiology, and health.

背景与目标： : 先前在西方文化中进行的研究表明，负面情绪预示着更高水平的促炎生物标志物，特别是interleukin-6 (IL-6)。负面情绪和IL-6之间的这种联系可能是特定于西方文化的，在西方文化中，负面情绪被认为是有问题的，因此可能不会扩展到负面情绪被视为可接受和正常的东方文化。我们使用1044名美国和382名日本中年和老年人的样本，调查了负面情绪与IL-6之间的关系是否因文化背景而异。负面情绪预示着美国成年人的IL-6会更高，而日本成年人则没有明显的关联。此外，即使控制了人口统计学变量，心理因素 (积极情绪，神经质，外向性)，健康行为 (吸烟状况，饮酒) 和健康状况 (慢性病，BMI)，文化与负面情绪之间的相互作用仍然存在。这些发现强调了文化背景在塑造负面情绪如何影响炎症生理方面的作用，并强调了与负面情绪相关的文化思想和实践对于理解心理，生理学和健康的相互作用的重要性。

BACKGROUND & AIMS: :Pregnant women and their newborns are at elevated risk for influenza-associated hospitalization and death. The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester. To estimate influenza vaccination coverage among pregnant women for the 2011-12 influenza season, CDC analyzed data from an Internet panel survey conducted April 3-17, 2012, among women pregnant at any time during the 4-month period October 2011-January 2012. Among 1,660 survey respondents, 47.0% reported they had received influenza vaccination; 9.9% were vaccinated before pregnancy, 36.5% during pregnancy, and <1.0% after pregnancy. Overall, 43.7% of women reported receipt of both a health-care provider recommendation and offer of influenza vaccination; these women had higher vaccination coverage (73.6%) than women who received only a recommendation but no offer of vaccination (47.9%) and women who received neither a recommendation nor an offer (11.1%). Continued efforts are needed to encourage providers of medical care to routinely recommend and offer influenza vaccination to women who are pregnant or who might become pregnant.

背景与目标： : 孕妇及其新生儿患流感相关住院和死亡的风险较高。预防接种实践咨询委员会 (ACIP) 和美国妇产科学院 (ACOG) 建议所有在流感季节怀孕或将要怀孕的妇女接种流感疫苗，无论孕期如何。为了估计2011-12流感季节孕妇的流感疫苗接种覆盖率，疾病预防控制中心分析了2012年4月3至17日进行的互联网小组调查的数据，该调查在2011年10月2012年1月的4个月内的任何时间对孕妇进行了调查。在1,660调查受访者中，47.0% 报告他们接受了流感疫苗接种; 9.9% 在怀孕前接种了疫苗，36.5% 在怀孕期间接种了疫苗，并且在怀孕后 <1.0%。总体而言，43.7% 的妇女报告收到了卫生保健提供者的建议和流感疫苗接种的提议; 这些妇女的疫苗接种覆盖率 (73.6%) 高于只收到建议但没有提供疫苗接种的妇女 (47.9%) 和既没有收到建议也没有收到建议的妇女 (11.1%)。需要继续努力鼓励医疗服务提供者定期向怀孕或可能怀孕的妇女推荐和提供流感疫苗。

BACKGROUND & AIMS: OBJECTIVE:To describe the long term impact of football on the health related quality of life (HRQL) of former professional footballers in the United Kingdom. METHOD:A cross sectional survey gathered data from 284 former professional players. Respondents reported medical treatments, osteoarthritis (OA) diagnosis, other morbidity, disability status, and work related disability since their football career. The EuroQol (EQ-5D) and global health rating scales were selected to assess HRQL. RESULTS:Medical treatment for football related injuries was a common feature, as was OA, with the knee being the most commonly affected joint. Respondents with OA reported poorer HRQL compared with those without OA. As with medical treatments and problems on each of the five EQ-5D dimensions (pain, mobility, usual activities, anxiety/depression, self care), frequency of disability and work related disability were higher among respondents with OA than those without. CONCLUSION:This exploratory study suggests that playing professional football can impact on the health of United Kingdom footballers in later life. The development of OA was associated with poorer outcomes on all aspects of HRQL.

背景与目标：

BACKGROUND & AIMS: :The antimicrobial susceptibility of 718 isolates of Salmonella from humans and of 688 isolates from animals was examined. Of the 46 different serotypes among the isolates from humans, Salmonella typhimurium accounted for 34%. Thirty percent of isolates were resistant to one or more antibiotic(s). Resistance to streptomycin was most common; resistance to tetracycline was next most common. Over 50% of isolates of S. typhimurium and Salmonella newport were resistant to four antibiotics. Resistance to tetracycline, kanamycin, and ampicillin has increased steadily during the past decade. Most strains possessed R-factors, and resistance to ampicillin, streptomycin, sulfisoxazole, tetracycline, chloramphenicol, and kanamycin (but not that to cephalothin) was transferable. Among the salmonellae commonly isolated from humans, only Salmonella enteritidis showed limited resistance to antibiotics (5.8%). Antibiotic resistance of isolates of S. typhimurium, Salmonella saint-paul, and Salmonella heidelberg from animals was similar to the resistance of isolates from humans. Resistance to kanamycin increased markedly over the level noted in previous studies. R-factor prevalence was high. Antibiograms of the isolates from animals and humans were similar, although some patterns were seen only in isolates from one source. Ampicillin resistance was more common in human isolates, and resistance to tetracycline, sulfonamide, and streptomycin was more common in animal isolates. Salmonellae of serotypes other than S. typhimurium that came from humans were less resistant to all antibiotics than were isolates from animals.

背景与目标： : 检查了来自人类的718株沙门氏菌和来自动物的688株的抗菌敏感性。在来自人类的分离株中，46种不同的血清型中，鼠伤寒沙门氏菌占34%。30% 的分离株对一种或多种抗生素耐药。对链霉素的耐药性最常见; 对四环素的耐药性次之。超过50% 的鼠伤寒沙门氏菌和纽波特沙门氏菌分离株对四种抗生素耐药。在过去的十年中，对四环素，卡那霉素和氨苄青霉素的耐药性稳步上升。大多数菌株具有R因子，并且对氨苄西林，链霉素，磺胺恶唑，四环素，氯霉素和卡那霉素的抗性 (但对头孢菌素不具有抗性) 是可转移的。在通常从人类分离的沙门氏菌中，只有肠炎沙门氏菌对抗生素表现出有限的耐药性 (5.8%)。动物鼠伤寒沙门氏菌，圣保罗沙门氏菌和海德堡沙门氏菌分离株的抗生素耐药性与人类分离株的耐药性相似。对卡那霉素的耐药性明显高于先前研究中指出的水平。R因子患病率很高。尽管仅在一种来源的分离物中看到某些模式，但来自动物和人类的分离物的抗菌素图相似。氨苄西林耐药性在人类分离株中更为常见，而对四环素，磺酰胺和链霉素的耐药性在动物分离株中更为常见。来自人类的除鼠伤寒沙门氏菌以外的血清型沙门氏菌对所有抗生素的抵抗力均低于来自动物的分离株。

BACKGROUND & AIMS: :On an average day in the United States, more than 100 Americans die by suicide; half of these suicides involve the use of firearms. In this ecological study, we used linear regression techniques and recently available state-level measures of suicide attempt rates to assess whether, and if so, to what extent, the well-established relationship between household firearm ownership rates and suicide mortality persists after accounting for rates of underlying suicidal behavior. After controlling for state-level suicide attempt rates (2008-2009), higher rates of firearm ownership (assessed in 2004) were strongly associated with higher rates of overall suicide and firearm suicide, but not with nonfirearm suicide (2008-2009). Furthermore, suicide attempt rates were not significantly related to gun ownership levels. These findings suggest that firearm ownership rates, independent of underlying rates of suicidal behavior, largely determine variations in suicide mortality across the 50 states. Our results support the hypothesis that firearms in the home impose suicide risk above and beyond the baseline risk and help explain why, year after year, several thousand more Americans die by suicide in states with higher than average household firearm ownership compared with states with lower than average firearm ownership.

背景与目标： : 在美国，平均每天有100多名美国人死于自杀; 这些自杀中有一半涉及使用枪支。在这项生态学研究中，我们使用线性回归技术和最近可用的州一级自杀未遂率测量方法来评估家庭枪支拥有率与自杀死亡率之间的良好关系，以及在何种程度上，在考虑了潜在自杀行为的发生率后仍然存在。在控制了州一级的自杀企图率 (2008-2009) 之后，较高的枪支拥有率 (评估2004年) 与较高的总体自杀和枪支自杀率密切相关，但与非枪支自杀无关 (2008-2009)。此外，自杀企图率与枪支拥有率没有显着关系。这些发现表明，枪支拥有率与自杀行为的基本发生率无关，在很大程度上决定了50个州自杀死亡率的变化。我们的结果支持这样的假设，即家庭枪支带来的自杀风险高于和超过基线风险，并有助于解释为什么年复一年，与家庭枪支拥有量低于平均水平的州相比，数千名美国人死于自杀。

BACKGROUND & AIMS: :Five carbapenem-resistant Acinetobacter baumannii isolates, collected from the United Arab Emirates in 2006, were investigated to identify the mechanism(s) responsible for carbapenem resistance. Genotyping was performed by pulsed-field gel electrophoresis, and the location of the bla(OXA-23) gene was determined by using the endonuclease I CeuI technique and mating-out assays. The four isolates in which the bla(OXA-23) gene was located on the chromosome within a Tn2006 composite transposon were clonally related. The single non-clonally related isolate harboured the bla(OXA-23) gene on a 70-kb transferable plasmid. This study reports on the dissemination of OXA-23-producing A. baumannii isolates in the Middle East.

背景与目标： : 研究了从阿拉伯联合酋长国2006年收集的五种耐碳青霉烯类鲍曼不动杆菌分离株，以确定引起碳青霉烯类耐药的机制。通过脉冲场凝胶电泳进行基因分型，并通过使用内切核酸酶I ceeu技术和交配试验确定bla(OXA-23) 基因的位置。其中bla(OXA-23) 基因位于Tn2006复合转座子内染色体上的四个分离株是克隆相关的。单个非克隆相关分离物将bla(OXA-23) 基因携带在70kb可转移质粒上。本研究报告了OXA-23-producing鲍曼不动杆菌分离株在中东的传播情况。

BACKGROUND & AIMS: BACKGROUND:Using smokeless tobacco and smoking are behaviors that increase the risk of developing oral cancer, soft-tissue lesions, caries, periodontal disease and other oral conditions. The author conducted a study to examine use of smokeless tobacco and smoking by adolescents. METHODS:The study was a cross-sectional analysis of participants with complete data regarding smoking, smokeless tobacco use and other variables of interest from the 2011 national Youth Risk Behavior Surveillance System survey (n = 9,655). The author performed descriptive analysis and multivariable logistic regression analyses. RESULTS:The unadjusted odds ratio for smokeless tobacco use and smoking was 9.68 (95 percent confidence interval [CI], 7.72-12.13; P < .0001), and the adjusted odds ratio was 3.92 (95 percent CI, 2.89-5.31; P < .0001). Adolescents who used smokeless tobacco were more likely to be male, to smoke and to have engaged in binge drinking. CONCLUSION:Adolescents who were using smokeless tobacco were more likely to be engaging in concomitant smoking and to be participating in other risk-taking behaviors. Practical Implications. Dentists are involved in helping patients with tobacco-use cessation. The association of smoking with using smokeless tobacco needs to be considered in the design of tobacco-use cessation programs for adolescents.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To inform strategic decisions on respiratory syncytial virus (RSV) vaccine development and identify critical endpoints likely to drive the vaccine's medical and economic impact. DESIGN:A decision-analysis model populated using healthcare utilization data and costs from the literature; vaccine efficacy and duration based on assumptions. SETTING:Vaccination in the physician office setting in the USA. PARTICIPANTS:A hypothetical cohort of newborn infants. INTERVENTION:Vaccination of children at low and high risk of respiratory sequelae with a theoretical RSV vaccine vs palivizumab prophylaxis for children at high risk. OUTCOME MEASURES:Medical and economic value of RSV vaccination, including cost per quality adjusted life-year (QALY) gained. RESULTS:Using base-case assumptions (efficacy 50% at birth; half-life 12 months), RSV vaccination would prevent 23,069 hospitalizations and 66 deaths per vaccinated birth cohort in the USA. Excluding vaccination costs, direct medical costs for RSV would reduce by $236 million, and income and productivity losses by $134 million. Assuming a vaccine cost per course similar to Rotarix® in the USA ($232 including administration fees), the cost per QALY gained would be $93,401 (95% CI: $65,815-$126,060) from the healthcare system perspective and $65,115 (95% CI: $41,003-$93,679) from the societal perspective. The net cost (healthcare system perspective) per life-year saved would be $216,120 (95% CI: $161,184-$263,981); the cost per hospitalization averted would be $19,172 (95% CI: $14,679-$22,093). Aside from efficacy, the vaccine's impact is sensitive to the start of protective immunity and the duration of protection. CONCLUSIONS:Development of an RSV vaccine would substantially reduce inpatient hospitalizations and outpatient visits. It would also have an impact on infant mortality. To demonstrate the full medical and economic value of the vaccine, appropriate endpoints or endpoint surrogates for hospitalization, mortality, and total case reductions should be collected during vaccine development.

背景与目标：

BACKGROUND & AIMS: IMPORTANCE:The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. OBJECTIVE:We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. DESIGN, SETTING, AND PARTICIPANTS:We conducted an ecological study for 75 designated market areas from 2005 to 2009 in the United States using linked data regarding televised DTCA volume, non-DTCA marketing and promotion, retail, mail order and long-term care prescription drug sales, prescription drug and ambulatory care health care utilization, and contextual factors such as health care density and socioeconomic status. Main outcomes and measures were volume of sales, number of dispensed prescriptions, and high cholesterol-related outpatient visits. Analyses were conducted in 2016. RESULTS:The intensity of rosuvastatin and atorvastatin ad exposures per household varied substantially across designated market areas. After adjustment for socioeconomic, demographic, and clinical characteristics, each 100-unit increase in advertisement viewership was associated with a 2.22% [95% confidence interval (CI), 0.30%-4.19%] increase in statin sales. Similar patterns were observed between DTCA and statin dispensing among the commercially insured. DTCA was associated with increases in high cholesterol-related outpatient visits among adults 18-45 years of age (3.15% increase in visits per 100-unit increase in viewership, 95% CI, 0.98%-5.37%) but not among those 46-65 years of age (0.51%, 95% CI, -1.49% to 2.55%). CONCLUSION:DTCA for statins is associated with increases in statin utilization and hyperlipidemia-related outpatient visits, especially for young adults.

背景与目标：