Design and technology combine to good effect.

As flooring specialist, Gerflor, marks over 60 years supplying the healthcare sector, Virginia Harris, the company's Scottish sales and specification executive, takes a look at some of the recent trends in healthcare flooring, where attractive aesthetics, sustainability, a hard-wearing and robust construction, and cleaning and infection control considerations, are among the key criteria on specifiers' lists. She also considers the crossover between design and new product development.

Prevention and control of coronary heart disease and stroke--nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention.

Successful prevention and control of coronary heart disease and stroke requires extensive collaboration and strategic partnerships with many health and non-health-related organizations and agencies in the voluntary, public, and private sectors. To assure a common language and purpose and to facilitate communication in these multiple settings, a simplified classification of prevention levels for public health practice is essential. This statement proposes three levels of prevention (health promotion, primary prevention, and secondary prevention) as a guide for public health practice. This statement is also intended to inform the design, implementation, and evaluation of programs and research initiatives that address the prevention and control of coronary heart disease and stroke, and to enhance communication and dialogue among health professionals, policymakers, and the public.

REACH 2010 Surveillance for Health Status in Minority Communities --- United States, 2001--2002.

PROBLEM/CONDITION: The U.S. population continues to diversify, and certain racial/ethnic minorities are growing at a substantially more rapid pace than the majority population. Limited large-scale population-based surveys and surveillance systems are designed to monitor the health status of minority populations. The Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey is conducted annually in minority communities in the United States. The survey focuses on four minority populations (blacks, Hispanics, Asians/Pacific Islanders [A/PIs], and American Indians). REPORTING PERIOD COVERED: 2001-2002. DESCRIPTION OF SYSTEM: Telephone (n = 18 communities) and face-to-face (n = 3 communities) interviews were conducted in 21 communities located in 14 states (Alabama, California, Georgia, Illinois, Louisiana, Massachusetts, Michigan, New York, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Washington). An average of 1,000 minority residents aged >/=18 years in each community was sampled. Interviews were administered in English, Spanish, Vietnamese, Khmer, or Mandarin Chinese. The median response rate for household screenings was 74.0% for households that were reached and 72.0% for family members interviewed. The self-reported data from the community were compared with data derived from the Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan/micropolitan statistical area (MMSA) or the state where the community was located and compared with national estimates from BRFSS. RESULTS: Reported education level and household income were markedly lower in minority communities than the general population living in the comparison MMSA or state. More minorities reported being in fair or poor health, but they did not see a doctor because of the cost. Substantial variations were observed in the prevalence of health-risk factors and selected chronic conditions among minority populations and in communities within the same racial/ethnic minority. The median prevalence of obesity among A/PI men and women was 2.9% and 3.6%, respectively, whereas 39.2% and 37.5% of American Indian men and women were obese, respectively. Cigarette smoking was common in American Indian communities, with a median of 42.2% for men and 36.7% for women. Compared with the national level, fewer minority adults reported eating >/=5 fruits and vegetables daily and met recommendations for moderate or vigorous leisure-time physical activity. American Indian communities had a high prevalence of self-reported cardiovascular disease, hypertension, high blood cholesterol, and diabetes. A high prevalence of hypertension and diabetes was also observed in black communities (32.0% and 10.9%, respectively, for men and 40.4% and 14.3%, respectively, for women). Compared with the general U.S. population, a substantially lower percentage of Hispanics and A/PIs had reported receiving preventive services (e.g., cholesterol screenings; glycosylated hemoglobin tests and foot examinations for patients with diabetes; mammograms and Papanicolaou smear tests; and vaccination for influenza and pneumonia among adults aged >/=65 years). INTERPRETATION: Data from the REACH 2010 Risk Factor Survey demonstrate that residents in the minority communities bear greater risks for disease compared with the general population living in the same MMSA or state. Substantial variations in the prevalence of risk factors, chronic conditions, and use of preventive services among different minority populations and in communities within the same racial/ethnic population provide opportunities for public health interventions. These variations also indicate that different racial/ethnic populations and different communities should have different priorities in eliminating health disparities. PUBLIC HEALTH ACTIONS: The continuous surveillance of health status in minority communities is necessary so that culturally sensitive prevention strategies can be tailored to these communities and program interventions evaluated.

Surveillance for certain health behaviors among selected local areas--United States, Behavioral Risk Factor Surveillance System, 2002.

PROBLEM: Monitoring risk behaviors for chronic diseases and participation in preventive practices are important for developing effective health education and intervention programs to prevent morbidity and mortality. Therefore, continual monitoring of these behaviors and practices at the state, city, and county levels can assist public health programs in evaluating and monitoring progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2002 are presented for states, selected metropolitan, and micropolitan statistical areas (MMSA), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an on-going, state-based, telephone survey of the civilian, noninstitutionalized population aged >18 years. All 50 states, the District of Columbia (DC), Guam, the Virgin Islands, and the Commonwealth of Puerto Rico participated in BRFSS during 2002. Metropolitan and MMSA and their counties with >500 respondents or a minimum sample size of 19 per weighting class were included in the analyses for a total of 98 MMSA and 146 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state, county, and MMSA. Obesity ranged from 27.6% in West Virginia, 29.4% in Charleston, West Virginia, and 32.0% in Florence County, South Carolina, to 16.5% in Colorado, 12.8% in Bethesda-Frederick-Gaithersburg, Maryland, and 11.8% in Washington County, Rhode Island. No leisuretime physical activity ranged from 33.6% in Tennessee, 36.8% in Miami-Miami Beach-Kendall, Florida, and 36.8% in Miami-Dade County, Florida to 15.0% in Washington, 13.8% in Seattle-Bellevue-Everett Washington, and 11.4% in King County, Washington. Cigarette smoking ranged from 32.6% in Kentucky, 32.8% in Youngstown-Warren- Boardman, Ohio-Pennsylvania, and 31.1% in Jefferson County, Kentucky to 16.4% in California, 13.8% in Ogden- Clearfield, Utah, and 10.9% in Davis County, Utah. Binge drinking ranged from 24.9% in Wisconsin, 26.1% in Fargo, North Dakota-Minnesota, and 25.1% Cass County, North Dakota, to 7.9% in Kentucky, 8.2% in Greensboro- High Point, North Carolina, and 6.6% in Henderson County, North Carolina. At risk for heavy drinking ranged from 8.7% in Arizona, 9.5% in Lebanon, New Hampshire-Vermont, and 11.3% in Richland County, South Carolina, to 2.8% in Utah, 1.9% in Ogden-Clearfield, Utah, and 1.7% in King County, New York. Adults who were told they had diabetes ranged from 10.2% in West Virginia, 11.1% in Charleston, West Virginia, and 11.1% in Richland, South Carolina, to 3.5% in Alaska, 2.7% in Anchorage, Alaska, and 2.4% in Weber County, Utah. Percentage of adults aged>50 years who were ever screened for colorectal cancer ranged from 64.8% in Minnesota, 67.9% in Minneapolis-St. Paul-Bloomington Minnesota-Wisconsin, and 73.6% in Ramsey County, Minnesota, to 39.2% in Hawaii, 30.7% in Kahului-Wailuku, Hawaii, and 30.7% in Maui County, Hawaii. Persons aged >65 years who had received pneumococcal vaccine ranged from 72.5% in North Dakota, 74.8% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 73.1% in Milwaukee County, Wisconsin, to 47.9% in DC, 47.5% in New York-Wayne-White Plains, New York, New Jersey, and 47.9% in DC County, DC. Older adults who had received influenza vaccine ranged from 76.6% in Minnesota, 80.0% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 76.3% in Middlesex County, Massachusetts, to 57.0% in Florida, 55.8% in Houston-Baytown-Sugar Land, Texas, and 56.2% in Cook County, Illinois. INTERPRETATION: BRFSS data indicate substantial variation in high-risk behaviors, participation in preventive healthcare services, and screening among U.S. adults at states and selected local areas, indicating a need for continued efforts to evaluate public health programs or policies designed to reduce morbidity and mortality. PUBLIC HEALTH ACTIONS: Data from BRFSS are useful in developing and guiding public health programs and policies. Therefore, states, selected MMSA, and their counties can use BRFSS data as a tool to prevent premature morbidity and mortality among adult population and to assess progress toward national health objectives. The data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and serve as a baseline for future surveillance at the local level in the United States.

Calcium and its role in the nuclear translocation and activation of cytosolic phospholipase A2 in cells rendered sensitive to TNF-induced apoptosis by cycloheximide.

In these experiments, we investigated the role of calcium as a second messenger in the apoptotic activation of cytosolic phospholipase A(2) (cPLA(2)). As our model, we used a murine fibroblast cell line (C3HA) that was induced to undergo apoptosis by a combination of TNF and cycloheximide. Using fura 2 Ca(2+) imaging, we found strong evidence for an intracellular calcium response after 1 h of treatment, which correlated with the onset of phosphatidylserine externalization, but preceded effector procaspase processing by several hours. The response was strongest in the perinuclear region, where mean levels rose 83% (144 +/- 14 nM in untreated cells vs 264 +/- 39 nM in treated), while cells displaying morphological evidence of apoptosis had the highest levels of calcium (250-1000 nM). Verapamil blocked this response, indicating an extracellular source for the calcium. Fluorescence microscopy revealed a pattern of nuclear translocation of cPLA(2) during apoptosis, which was also blocked by verapamil, indicating an important role for calcium in this process. In addition, we found that verapamil prevented the release of [(3)H]arachidonic acid from C3HA cells induced to undergo apoptosis by the chemotherapeutic agents vinblastine, melphalan, and cis-platinum. Together, these data suggest that calcium is important for cPLA(2) activation by diverse apoptotic stimuli.

Vaccine-induced immunity in baboons by using DNA and replication-incompetent adenovirus type 5 vectors expressing a human immunodeficiency virus type 1 gag gene.

The cellular immunogenicity of formulated plasmid DNA and replication-defective human adenovirus serotype 5 (Ad5) vaccine vectors expressing a codon-optimized human immunodeficiency virus type 1 gag gene was examined in baboons. The Ad5 vaccine was capable of inducing consistently strong, long-lived CD8(+)-biased T-cell responses and in vitro cytotoxic activities. The DNA vaccine-elicited immune responses were weaker than those elicited by the Ad5 vaccine and highly variable; formulation with chemical adjuvants led to moderate increases in the levels of Gag-specific T cells. Increasing the DNA-primed responses with booster doses of either Ad5 or modified vaccinia virus Ankara vaccines suggests a difference in the relative levels of cytotoxic and helper responses. The implications of these results are discussed.

Comparative immunogenicity in rhesus monkeys of DNA plasmid, recombinant vaccinia virus, and replication-defective adenovirus vectors expressing a human immunodeficiency virus type 1 gag gene.

Cellular immune responses, particularly those associated with CD3(+) CD8(+) cytotoxic T lymphocytes (CTL), play a primary role in controlling viral infection, including persistent infection with human immunodeficiency virus type 1 (HIV-1). Accordingly, recent HIV-1 vaccine research efforts have focused on establishing the optimal means of eliciting such antiviral CTL immune responses. We evaluated several DNA vaccine formulations, a modified vaccinia virus Ankara vector, and a replication-defective adenovirus serotype 5 (Ad5) vector, each expressing the same codon-optimized HIV-1 gag gene for immunogenicity in rhesus monkeys. The DNA vaccines were formulated with and without one of two chemical adjuvants (aluminum phosphate and CRL1005). The Ad5-gag vector was the most effective in eliciting anti-Gag CTL. The vaccine produced both CD4(+) and CD8(+) T-cell responses, with the latter consistently being the dominant component. To determine the effect of existing antiadenovirus immunity on Ad5-gag-induced immune responses, monkeys were exposed to adenovirus subtype 5 that did not encode antigen prior to immunization with Ad5-gag. The resulting anti-Gag T-cell responses were attenuated but not abolished. Regimens that involved priming with different DNA vaccine formulations followed by boosting with the adenovirus vector were also compared. Of the formulations tested, the DNA-CRL1005 vaccine primed T-cell responses most effectively and provided the best overall immune responses after boosting with Ad5-gag. These results are suggestive of an immunization strategy for humans that are centered on use of the adenovirus vector and in which existing adenovirus immunity may be overcome by combined immunization with adjuvanted DNA and adenovirus vector boosting.

Replication-incompetent adenoviral vaccine vector elicits effective anti-immunodeficiency-virus immunity.

Recent studies of human immunodeficiency virus type 1 (HIV-1) infection in humans and of simian immunodeficiency virus (SIV) in rhesus monkeys have shown that resolution of the acute viral infection and control of the subsequent persistent infection are mediated by the antiviral cellular immune response. We comparatively assessed several vaccine vector delivery systems-three formulations of a plasmid DNA vector, the modified vaccinia Ankara (MVA) virus, and a replication incompetent adenovirus type 5 (Ad5) vector-expressing the SIV gag protein for their ability to elicit such immune responses in monkeys. The vaccines were tested either as a single modality or in combined modality regimens. Here we show that the most effective responses were elicited by a replication-incompetent Ad5 vector, used either alone or as a booster inoculation after priming with a DNA vector. After challenge with a pathogenic HIV-SIV hybrid virus (SHIV), the animals immunized with Ad5 vector exhibited the most pronounced attenuation of the virus infection. The replication-defective adenovirus is a promising vaccine vector for development of an HIV-1 vaccine.