Timothy S. Naimi

Bio: Timothy S. Naimi is an academic researcher from Boston University. The author has contributed to research in topics: Binge drinking & Poison control. The author has an hindex of 50, co-authored 173 publications receiving 14261 citations. Previous affiliations of Timothy S. Naimi include University of Massachusetts Medical School & University of Victoria.

Community-acquired methicillin-resistant staphylococcus aureus carrying panton-valentine leukocidin genes: worldwide emergence

Abstract: Infections caused by community-acquired (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have been reported worldwide. We assessed whether any common genetic markers existed among 117 CA-MRSA isolates from the United States, France, Switzerland, Australia, New Zealand, and Western Samoa by performing polymerase chain reaction for 24 virulence factors and the methicillinresistance determinant. The genetic background of the strain was analyzed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). The CAMRSA strains shared a type IV SCCmec cassette and the Panton-Valentine leukocidin locus, whereas the distribution of the other toxin genes was quite specific to the strains from each continent. PFGE and MLST analysis indicated distinct genetic backgrounds associated with each geographic origin, although predominantly restricted to the agr3 background. Within each continent, the genetic background of CA-MRSA strains did not correspond to that of the hospital-acquired MRSA.

Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection.

Abstract: Context Methicillin-resistant Staphylococcus aureus (MRSA) has traditionally been considered a health care–associated pathogen in patients with established risk factors. However, MRSA has emerged in patients without established risk factors (community-associated MRSA). Objective To characterize epidemiological and microbiological characteristics of community-associated MRSA cases compared with health care–associated MRSA cases. Design, Setting, and Patients Prospective cohort study of patients with MRSA infection identified at 12 Minnesota laboratory facilities from January 1 through December 31, 2000, comparing community-associated (median age, 23 years) with health care–associated (median age, 68 years) MRSA cases. Main Outcome Measures Clinical infections associated with either communityassociated or health care–associated MRSA, microbiological characteristics of the MRSA isolates including susceptibility testing, pulsed-field gel electrophoresis, and staphylococcal exotoxin gene testing. Results Of 1100 MRSA infections, 131 (12%) were community-associated and 937 (85%) were health care–associated; 32 (3%) could not be classified due to lack of information. Skin and soft tissue infections were more common among communityassociated cases (75%) than among health care–associated cases (37%) (odds ratio [OR], 4.25; 95% confidence interval [CI], 2.97-5.90). Although communityassociated MRSA isolates were more likely to be susceptible to 4 antimicrobial classes (adjusted OR, 2.44; 95% CI, 1.35-3.86), most community-associated infections were initially treated with antimicrobials to which the isolate was nonsusceptible. Communityassociated isolates were also more likely to belong to 1 of 2 pulsed-field gel electrophoresis clonal groups in both univariate and multivariate analysis. Communityassociated isolates typically possessed different exotoxin gene profiles (eg, Panton Valentine leukocidin genes) compared with health care–associated isolates. Conclusions Community-associated and health care–associated MRSA cases differ demographically and clinically, and their respective isolates are microbiologically distinct. This suggests that most community-associated MRSA strains did not originate in health care settings, and that their microbiological features may have contributed to their emergence in the community. Clinicians should be aware that therapy with -lactam antimicrobials can no longer be relied on as the sole empiric therapy for severely ill outpatients whose infections may be staphylococcal in origin.

Binge drinking among US adults.

Abstract: ContextBinge drinking (consuming ≥5 alcoholic drinks on 1 occasion) generally results in acute impairment and has numerous adverse health consequences. Reports indicate that binge drinking may be increasing in the United States.ObjectivesTo quantify episodes of binge drinking among US adults in 1993-2001, to characterize adults who engage in binge drinking, and to describe state and regional differences in binge drinking.Design, Setting, and ParticipantsThe Behavioral Risk Factor Surveillance System, a random-digit telephone survey of adults aged 18 years or older that is conducted annually in all states. The sample size ranged from 102 263 in 1993 to 212 510 in 2001.Main Outcome MeasuresBinge-drinking prevalence, episodes, and episodes per person per year.ResultsBetween 1993 and 2001, the total number of binge-drinking episodes among US adults increased from approximately 1.2 billion to 1.5 billion; during this time, binge-drinking episodes per person per year increased by 17% (from 6.3 to 7.4, P for trend = .03). Between 1995 and 2001, binge-drinking episodes per person per year increased by 35% (P for trend = .005). Men accounted for 81% of binge-drinking episodes in the study years. Although rates of binge-drinking episodes were highest among those aged 18 to 25 years, 69% of binge-drinking episodes during the study period occurred among those aged 26 years or older. Overall, 47% of binge-drinking episodes occurred among otherwise moderate (ie, non-heavy) drinkers, and 73% of all binge drinkers were moderate drinkers. Binge drinkers were 14 times more likely to drive while impaired by alcohol compared with non–binge drinkers. There were substantial state and regional differences in per capita binge-drinking episodes.ConclusionsBinge drinking is common among most strata of US adults, including among those aged 26 years or older. Per capita binge-drinking episodes have increased, particularly since 1995. Binge drinking is strongly associated with alcohol-impaired driving. Effective interventions to prevent the mortality and morbidity associated with binge drinking should be widely adopted, including screening patients for alcohol abuse in accordance with national guidelines.

Binge Drinking and Associated Health Risk Behaviors Among High School Students

Abstract: OBJECTIVES. Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years. Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming ≥5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors. METHODS. We analyzed data on current drinking, binge drinking, and other health risk behaviors from the 2003 National Youth Risk Behavior Survey. Prevalence estimates and 95% confidence intervals were calculated by using SAS and SUDAAN statistical software. Logistic regression was used to examine the associations between different patterns of alcohol consumption and health risk behaviors. RESULTS. Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade. Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs. A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors. CONCLUSIONS. Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors. Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015

Abstract: BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). FINDINGS Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. INTERPRETATION Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. FUNDING Bill & Melinda Gates Foundation.

Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States

Abstract: ContextAs the epidemiology of infections with methicillin-resistant Staphylococcus aureus (MRSA) changes, accurate information on the scope and magnitude of MRSA infections in the US population is needed.ObjectivesTo describe the incidence and distribution of invasive MRSA disease in 9 US communities and to estimate the burden of invasive MRSA infections in the United States in 2005.Design and SettingActive, population-based surveillance for invasive MRSA in 9 sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care–associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA).Main Outcome MeasuresIncidence rates and estimated number of invasive MRSA infections and in-hospital deaths among patients with MRSA in the United States in 2005; interval estimates of incidence excluding 1 site that appeared to be an outlier with the highest incidence; molecular characterization of infecting strains.ResultsThere were 8987 observed cases of invasive MRSA reported during the surveillance period. Most MRSA infections were health care–associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100 000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older (127.7 per 100 000; interval estimate, 92.6-156.9), blacks (66.5 per 100 000; interval estimate, 43.5-63.1), and males (37.5 per 100 000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among patients with MRSA infection during the surveillance period. In 2005, the standardized mortality rate was 6.3 per 100 000 (interval estimate, 3.3-7.5). Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care–associated infections in all surveillance areas.ConclusionsInvasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution.

Antibacterial resistance worldwide: causes, challenges and responses.

Abstract: The optimism of the early period of antimicrobial discovery has been tempered by the emergence of bacterial strains with resistance to these therapeutics. Today, clinically important bacteria are characterized not only by single drug resistance but also by multiple antibiotic resistance--the legacy of past decades of antimicrobial use and misuse. Drug resistance presents an ever-increasing global public health threat that involves all major microbial pathogens and antimicrobial drugs.