ATP as a marker for surface contamination of biological origin in schools and as a potential approach to the measurement of cleaning effectiveness.

To address the need for a quantitative approach to the measurement of cleaning effectiveness, related to biologically derived surface contamination, three commercially available adenosine triphosphate (ATP) test systems were used to collect multiple samples measured in relative light units (RLUs) from 27 elementary schools in the southwestern United States before and after a standardized cleaning protocol. The database consisted of 6480 ATP measurements from four critical surfaces (student desktops, cafeteria tabletops, and restroom sinks and stall doors). Data was assessed according to ranges of ATP values before and after cleaning. Results showed the potential for such data to provide the basis for a standardized approach to the measurement of cleaning effectiveness, based on detection and quantification of pollutant loads of biological origin, across critical surfaces in school building environments. It is anticipated that verification of this data in school buildings across different geographic and climatic regions will lead to the establishment of "acceptable" ranges of ATP values that can be used as a practice-based approach to improving cleaning practices and contributing to healthier school environments.

Bacterial amplification and in-place carpet drying: implications for category 1 water intrusion restoration.

The study described in this article investigated whether in-place carpet drying processes resulted in bacterial amplification following water intrusion from a clean water source (category 1) in a residential indoor environment. Bacterial amplification was examined after wetting a 10-year-old carpet and pad that had no history of water intrusion. Three test areas were extracted and dried using industry-recommended procedures for in-place drying and compared to a control area that was not extracted or dried. Results from carpet, pad, and subsurface dust demonstrated that bacterial amplification occurred in all test areas. CFUs of bacteria per gram of carpet surface dust and subsurface dust prior to water intrusion were lower than levels in subsurface dust after in-place drying. The authors' study contributes to information regarding the restoration of water-based carpet damage by professional water damage restoration companies, building maintenance personnel, and housekeeping managers. Results suggest that the appropriate response time for carpet pad salvage is considerably shorter than the current industry recommendation of 72 hours.

Environmental health risks associated with off-campus student-tenant housing.

While previous studies have established an association between poor housing conditions and adverse health effects, none has specifically addressed health and safety risks to the college student population in rental housing. A needs-assessment survey was conducted to determine the prevalence of adverse health and safety conditions in off-campus student housing associated with a large university in the western United States. Results from 1959 student-tenant surveys revealed problems with installed appliances (39.6%); visible mold (39.3%); heating/cooling systems (31.9%); indoor dampness/water damage (24.9%); security locks (23.4%); ants (17.1%); electrical wiring (11.3%); malfunctioning or missing smoke alarms (11.2%); broken steps/handrails (7.8%); and mice (4.8%), among other problems. Reported health effects associated with housing included headaches, coughing, sneezing, nausea, and dizziness, and these effects were found to significantly correlate with increased environmental problems. The results of this study indicate a need to inform college students about environmental health and safety problems in leased housing, to promote responsibility of landlords to provide safe and healthful environments, and to raise awareness of this issue for public health and housing officials in university communities across the country.

Female Genital Cutting: Clinical knowledge, Attitudes, and Practices from a Provider survey in the US.

Migration from countries where female genital cutting (FGC) is practiced means women's healthcare providers need to meet this population's unique healthcare needs. We explored providers' FGC-related experience, knowledge of the cultural practice, prior training, attitudes towards medicalization, including reinfibulation, and clinical practice. An online, 53-question survey to a multidisciplinary sample of women's health providers in the US were recruited by email via professional organizations, medical departments, and the authors' professional networks. From a total of 508 usable surveys, nearly half of respondents did not receive formal FGC training, but a majority had cared for FGC-affected women in their practice. A 'know-do' gap existed with managing infibulated patients; and surgical defibulation procedures were not routinely offered. Most respondents (79%, n = 402) reported a desire for additional education. Women's healthcare providers in the US, regardless of disciplinary backgrounds, are inadequately prepared to meet the needs of FGC-affected women. To address these, FGC content needs to be embedded in educational and training curricula, and ongoing clinical mentorship made available.

Knowledge of the effects of indoor air quality on health among women in Jordan.

OBJECTIVE: To assess the extent of knowledge about symptoms relating to respiratory illnesses and home environments among a random sample of 200 urban Jordanian women. METHOD: This customized, validated, cross-sectional questionnaire evaluated the knowledge of these women about the association between the indoor environment and health, the presence or absence of indoor discomforts, symptoms of respiratory illnesses, and behaviors related to the home environment such as cleaning practices. RESULTS: Results showed an alarming rate of smoking in the homes; the extent of knowledge was moderate but higher among those exhibiting symptoms and those with children. Cleaning practices associated with healthy home environments were reported at a high rate but seemed to be based on cultural influences. CONCLUSIONS: This type of information is crucial to the formation of health education programs and policy recommendations for pollutant source and exposure reductions in homes in the Middle East and other developing countries.

Investigation of Knowledge and Perception of Tuberculosis Among Hispanics in Utah County, Utah.

This study aimed to assess extent of knowledge and perceptions of TB within the growing Hispanic community of Utah County, Utah, and the need for focused community educational intervention within that demographic. A mixed-method approach was used and included a survey of 166 adult males and females, and two focus groups with Hispanic women. TB was better known for its ability to kill (92.8 %) than for being contagious (64.5 %); while most knew that TB mainly affects the lungs (77.7 %) and is spread through coughing (75.3 %). Few believed that overcrowded living conditions were a risk factor for TB (30.1 %). Many believed that TB could be cured with medicine (75.3 %). And 65.7 % reported they had been tested for TB, and 7 % had been told by a doctor they had TB. Focus group data showed while most had knowledge of major TB symptoms, some had key misperceptions about disease transmission, testing, TB vaccine, and various protective factors. Enhanced education and dissemination of information on TB, to include an emphasis on symptoms, testing, and treatment within this demographic is recommended. A culturally-appropriate intervention should utilize a participatory approach, to include the local health department in partnership with various Hispanic community-based organizations.

Establishment of stably EBV-transformed cell lines from residual clinical blood samples for use in performance evaluation and quality assurance in molecular genetic testing.

Positive control materials for clinical molecular genetic testing applications are currently in critically short supply or non-existent for many genetically based diseases of public health importance. Here we demonstrate that anonymous, residual, clinical blood samples are potential sources of viable lymphocytes for establishing Epstein-Barr virus (EBV)-transformed blood lymphocyte cell lines. We attempted to transform 34 residual blood samples, and analyzed transformation success with respect to sample age, anticoagulant, storage temperature, volume, hemolysis, and patient age and sex. In univariate analysis, sample age was significantly associated with transformation success (P = 0.002). The success rate was 67% (6 of 9) for samples 1 to 7 days old, 38% (3 of 8) for samples 8 to 14 days old and 0% for samples 15 to 21 (0 of 11) days old. When we controlled for sample age in multivariate logistic regression, anticoagulant and storage temperature approached significance (P = 0.070 and 0.087, respectively; samples in acid citrate dextrose (ACD) and refrigerated samples were more likely to transform). Based on these findings, we suggest that samples collected in either ACD or ethylene diamine tetraacetic acid, and up to 14 days old (refrigerated) or 7 days old (stored ambient), are reasonable candidates for EBV transformation. The transformation rate for samples that met these criteria was 63% (10 of 16). Implementation of this process could help alleviate the shortage of positive control materials for clinical molecular genetic testing.

Determining responsibility for smoking in society: accountability continuum for Jordanian college students and its implication on FCTC implementation.

As one of the first countries to ratify the WHO Framework Convention on Tobacco Control, Jordan has signaled an interest in stronger anti-tobacco restrictions. This study examines whether Jordanian students believe smoking is an individual right or a social issue, and if they would support more stringent policies and enforcement. Undergraduate Jordanian students (n = 1211) from public and private universities completed the survey. Never smokers scored significantly higher on smoking being a social issue that required public policy response (p-value < .001); whereas smokers scored significantly higher with all individual right items. Ample opportunity exists for developing and enforcing stronger tobacco policies both on college campus and generally in the country. However, increasing tobacco taxes may need to be preceded by health communication campaigns that increase knowledge of the effectiveness of the tobacco tax in reducing use and resultant premature deaths.

Chronic respiratory illnesses in Jordan: pulmonary physicians' experiences in risk reduction.

Chronic respiratory diseases are on the rise in Jordan. However, there is limited research on the symptoms reported by patients, the triggers associated with their illnesses, and the health education efforts of pulmonary physicians. Thus, the purpose of this qualitative study was to understand these issues from physicians' perspectives. Fourteen face-to-face interviews were done with pulmonary physicians in their clinics in Amman, Jordan. Physicians indicated that cultural barriers existed such as the social acceptance of smoking, prevalence of olive trees, and cultural practices such as kissing as a form of greeting. In addition, health education materials were scarce and of poor quality. Implications for health education are discussed.

Current smoking practices among Jordanian college students: a pilot study.

This pilot study gauges the smoking rates among college students in Jordan, attitudes toward tobacco policies, knowledge of smoking hazards, and identifies methods of quitting for former smokers. The sample (n=296) was taken from students attending a General Education course at the University of Jordan. Results show that the majority of respondents (70.3%) had never smoked, 2.8% were former smokers, while 26.9% were current smokers. For former smokers, the main reported reason for quitting was concern for health (63.6%) and the two methods used to quit smoking were: 1) cold turkey (by themselves) (66. 7%); and 2) cut-down smoking and then quit by themselves (33.3%). In addition, a higher level of knowledge related to health effects of tobacco and a higher need for tobacco-related policies was identified by the former/never smokers. Implications for health education are discussed.

Genetically characterized positive control cell lines derived from residual clinical blood samples.

BACKGROUND: Positive control materials for clinical diagnostic molecular genetic testing are in critically short supply. High-quality DNA that closely resembles DNA isolated from patient specimens can be obtained from Epstein-Barr virus (EBV)-transformed peripheral blood lymphocyte cell lines. Here we report the development of a process to (a) recover residual blood samples with clinically important mutations detected during routine medical care, (b) select samples likely to provide viable lymphocytes for EBV transformation, (c) establish stable cell lines and confirm the reported mutation(s), and (d) validate the cell lines for use as positive controls in clinical molecular genetic testing applications. METHODS: A network of 32 genetic testing laboratories was established to obtain anonymous, residual clinical samples for transformation and to validate resulting cell lines for use as positive controls. Three panel meetings with experts in molecular genetic testing were held to evaluate results and formulate a process that could function in the context of current common practices in molecular diagnostic testing. RESULTS: Thirteen laboratories submitted a total of 113 residual clinical blood samples with mutations for 14 genetic disorders. Forty-one EBV-transformed cell lines were established. Thirty-five individual point and deletion mutations were shown to be stable after 20 population doublings in culture. Thirty-three cell lines were characterized for specific mutations and validated for use as positive controls in clinical diagnostic applications. CONCLUSIONS: A process for producing and validating positive control cell lines from residual clinical blood samples has been developed. Sustainable implementation of the process could help alleviate the current shortage of positive control materials.

Quality assurance in human molecular genetics testing: status and recommendations.

OBJECTIVE: The role of genetic testing has expanded with rapidly developing technology and completion of the International Human Genome Project. Development of universally acceptable quality control methods and quality assurance standards trails technology. The principle that high-quality genetic testing is important for public health motivated the Centers for Disease Control and Prevention to formulate ways for improving quality assurance of human molecular genetics testing. PARTICIPANTS: Twenty-eight panelists were chosen based on expertise in molecular genetics testing and knowledge of quality assurance practices. Representatives of professional organizations, industries, and federal agencies participated in one or more of 3 panel meetings. Consensus recommendations were developed by the 15 panelists in the third meeting. EVIDENCE: Evidence was derived from experts' opinion during 3 panel meetings. Data compiled through laboratory visits and literature review were used as reference information. Need for this project was derived from the Final Report of the Task Force on Genetic Testing, produced by the National Institutes of Health and the Department of Energy in 1997, and the Summary Report of the Subcommittee Meeting on Genetics of the Clinical Laboratory Improvement Act Advisory Committee in 1997. CONSENSUS PROCESS: Research and development needs were identified using a participatory visioning approach. A modified nominal group process was used to reach consensus. CONCLUSIONS: Five core consensus recommendations were made: research for developing positive samples for quality assurance purposes, performance evaluation programs supplementing those in existence, establishment and support of laboratory-oriented consortia, establishment of a laboratory-focused database, and support of molecular genetics training programs.