|| A Phenomenological Approach to Understanding Health Literacy in Urban Women's Lives
|| In their own words: Industry efforts to undermine public health science
||Feasibility Study of a Local Health Department as a Data Warehouse
||Using GIS technology to identify geographic patterns in awareness of mammography services within African American communities
||Adolescents Pregnancy, Premature Rupture of Membranes and Neonatal Mortality in Twins
||World Trade Center Response Workers Asthma Study
||Risky Behavior: Sex, Stimulants, and HIV in the Rural South
||Epidemiological Characteristics of a Chicago-area Acanthamoeba Keratitis Outbreak
||Airborne Antibiotic Exposures in Animal Feeding Operations
||Variation in Yearly Residential Radon Concentrations in the Upper Midwest
||Efficacy of an Exercise Intervention in Pregnant Women
||The Impact of Work-Family Conflict on Maternal Health Six Months After Childbirth
||Prescription Medication Underuse by the Medicare Population, 1996-2004
||The Role of Men in Contraceptive Decision Making
||Evaluating the Effectiveness of a Published Severity Scoring Index (SSI) to Predict Death in a Cohort of Consecutive Patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS)
||Factors Associated with CDC-Defined Reportable Rocky Mountain Spotted Fever (RMSF) Cases in Oklahoma , January 2003 – May 2004
||Assessment of Genetic Factors Affecting Bone Loss: The San Antonio Family Osteoporosis Study
||Use of Pulsed-field Gel Electrophoresis to Determine the Prevalence of Epidemic Clones among Community-acquired Methicillin-resistant Staphylococcus aureus isolates
||Etiologic Classification of Birth Defects as a Tool for Public Health Prevention Activities: Findings from Utah , 1999–2003
A Phenomenological Approach to Understanding Health Literacy in Urban Women's Lives
Tifanie Hudgins, MPH, CHES. East Stroudsburg University
Health literacy is the degree to which individuals have the capacity, through communication, to understand health information and services and to make effective health decisions. Though research has documented the impact of health literacy on health outcomes, the relationship between real life situations, literacy levels and the development of health literacy is not well described. A biographical-phenomenological qualitative study was developed to explore the lives of urban, low-income women with low health literacy. Phenomenological approaches are effective at illuminating the experiences of individuals from their own perspectives and challenging normative assumptions. The study interviewees were a subgroup from several hundred women enrolled in a longitudinal cohort study on Racial Disparities in Infant Health through the University of Pennsylvania in Philadelphia . Participants completed health literacy assessments for the infant health project. Ten women, with very low health literacy scores, were eligible for this qualitative study. These women ranged in age from 19 to 46 years, 8 were African American. Each 2 hour interview was transcribed. A two -phase thematic analysis provided insights into the following: acquired life skills that allowed these women to maintain a functional existence even with low health literacy; past experiences with the healthcare system “mistakes” that influenced interactions with health care providers; and, the resiliency displayed by these women. Childhood experiences, parenting skills and styles, general well being, and desire for a better life and job provide additional insights into their lives. These findings, and their relevance for health literacy, will be discussed.
In their own words : Industry efforts to undermine public health science
Christina E. Morgan, BA, and Celeste Monforton, MPH, George Washington University School of Public Health and Health Services
For decades, corporations, trade associations and other opponents of protective (and potentially costly) workplace health standards have relied upon numerous strategies to prevent, delay, and even obstruct regulatory processes intended to safeguard the health and safety of workers. Previously confidential materials made available through litigation and Freedom of Information Act (FOIA) requests now showcase many of these deplorable tactics. Using excerpts from internal memoranda, meeting minutes, and written correspondence from a variety of industries, including tobacco, asbestos, beryllium, chromium, mining, and trucking, this poster presentation will shed light upon what takes place behind industries' closed doors. The poster, a creative multi-media collage entitled In Their Own Words, will be guided by the artistic principle of allowing the documents to speak for themselves. Those who experience In Their Own Words may be perplexed, frustrated, angered, or even amused by the recurring themes that emerge in the industries' documents. Ultimately, our goal is to promote awareness of efforts to manufacture uncertainty about scientific evidence in order to inspire public health professionals and other proponents of worker safety and health to reject efforts to subvert health-protective workplace standards.
Feasibility Study of a Local Health Department as a Data Warehouse
Ron H. Graham, MPH, RD, LD, Stark County Health Department, Consortium of Eastern Ohio Master of Public Health
The feasibility study of describes the need, design, and best practice guidelines for the development of a local health department as a data warehouse. By developing the infrastructure to collect, monitor, and react to health status trends and data is very useful to the health and medical community as well as the public health industry. Surveillance is critical to determining the health status of a population and being able to proactively foresee public health problems or critical areas of need. A literature review was conducted to identify the strengths, weakness, and benefits to a centralized data warehouse at a county or city level. The study focused on identifying the current sources of data collected by a local health department(s), the ICD-9 coding related to chronic disease, and associated hospital based data. Geographic Information Systems (GIS), HIPAA, and the hospital-based electronic medical records systems were studied for compatibility and query capabilities. Key health disease indicators were identified for initial collection and epidemiological analysis. The logistical business relationship between the hospitals, health departments, and the county auditor's office GIS department was documented and a business partner agreement form for data sharing was created. The study provided the necessary software, hardware, privacy protection, cost, and timelines for the development of a data warehouse integrated with GIS mapping and the utilization of a web-based interface for public data presentation. Best practice guidelines were developed by researching an existing city-based data warehouse and indicating areas of further research.
Using GIS technology to identify geographic patterns in awareness of mammography services within African American communities
Kassandra Alcaraz, Saint Louis University
Disparities in breast cancer mortality are, in part, due to differences in screening and early detection. However, use of available screening services requires awareness of and access to those services. This study used Geographic Information Systems (GIS) technology to determine how awareness of mammography services varies by zip code. Data for the study were obtained from the Reflections of You project, which placed computerized breast cancer education kiosks in beauty salons, Laundromats, health centers, social service agencies, churches, public libraries and health fairs between 2003-2005. The touch-screen kiosks collected information from over 5,000 users, including the zip code of their home address, and used their answers to create and print a tailored mammography magazine for each user. In addition to breast cancer knowledge questions, users answered questions about their awareness of local mammography services and their accessibility to these services. Using GIS, we examined geographic patterns awareness of mammography services and compared these to patterns of breast cancer mortality and late stage diagnosis. Results show key differences in awareness by zip code, and these differences correspond to previous GIS-generated maps from the same neighborhoods showing disparities in late-stage diagnosis of breast cancer among African American women. Recognizing specific populations that are less informed about mammography services and those that have less access to such services can inform strategic decision making about outreach for breast cancer screening. Given disparities in breast cancer mortality and late stage diagnosis, these findings can aid us in developing targeted mammography awareness and support programs.
Adolescents Pregnancy, Premature Rupture of Membranes and Neonatal Mortality in Twins
Francis Ayodele Obuseh , MS , MPH, DrPH Cand., University of Alabama at Birmingham School of Public Health
Purpose: We investigated the impact of adolescents' pregnancy on the risk for early mortality outcomes associated with premature rupture of membranes (PROM) among twins. Methods: Study involved the r etrospective cohort of twins delivered in the United States (1995-98). Generalized estimating equations were used to compute inter and intra-cluster variation for early mortality associated with PROM among twins born to adolescents (<20 years) and mature mothers (MM) (20-30 years). Results: We analyzed 28,826 adolescents and 186,386 MM. Bivariate analysis showed significant differences in demographic characteristics and neonatal pregnancy outcomes within adolescents and MM (p<0.0001). Adolescents had twice worse mortality outcomes compared to MM. They were 1.47 (CI: 1.34-1.61) times more likely to have neonatal deaths compared to MM. Intra-cluster sources of variation within adolescents showed that twins exposed to PROM had 2.96 (CI: 2.44-3.60), 2.85 (CI: 2.30-3.54) and 2.62 (CI: 1.77-3.86) fold risk for neonatal, early neonatal and late neonatal deaths respectively, compared to MM who had 3.55 (CI: 3.23-3.92), 3.68 (CI: 3.32-4.09) and 2.79 (CI: 2.27-3.43) fold risks for same outcomes. Gestational age appeared to modify mortality. Conclusion: There were higher mortality risks for twins exposed to PROM. Although adolescents represent a unique high-risk obstetric entity , PROM risk was not confounded or modified by the age of the delivering mother. Higher mortality in twins from adolescents might indicate other factors peculiar to adolescents. In our study gestational age modified the risk for early mortality associated with PROM among twins.
World Trade Center Response Workers Asthma Study
Amy E. Prestanski, School of Public Health , University at Albany State University of New York and New York State Department of Health, Center for Environmental Health
Other Authors: Matthew P. Mauer, Michele L. Herdt-Losavio-NYSDOH CEH
In response to the September 11, 2001 attack at the World Trade Center (WTC), New York State (NYS) agencies assigned employees to the site to assist with rescue and recovery, security, and assessing a range of health and safety parameters. These workers were exposed to hazardous chemicals. Methods: In this cohort study, NYS employees assigned to the WTC site between 9/11/01 and 12/23/01 were compared to similar NYS employees who were not assigned to determine if exposure to conditions at the WTC caused an increase in asthma and potentially asthma-related symptoms (cough, wheeze, chest tightness, and shortness of breath). Participants completed both an initial health and exposure questionnaire as well as an asthma questionnaire in the summer of 2003. Follow-up surveys were mailed to participants in 2004 and 2005. Results for both the initial survey and the first follow-up survey are reported elsewhere. Results: The second follow-up survey found an increased risk for potentially asthma-related symptoms. Three different exposure definitions were modeled using logistic regression; a dichotomous exposure, dust exposure assessment score, and smoke exposure assessment score. Using these definitions, the greatest increased risk was observed for wheeze in the smoke exposure definition (OR 5.0 (95% C.I. 2.3-10.7) while the least was observed for chest tightness in the dust exposure definition (OR 0.3 (95% C.I. 0.04-2.1). Conclusion: Exposure to conditions at the WTC may cause an increase risk in developing potentially asthma-related symptoms.
Risky Behavior: Sex, Stimulants, and HIV in the Rural South
Patricia B. Wright, Fay W. Boozman College of Public Health University of Arkansas for Medical Sciences
Objective: To identify racial and gender differences in HIV risk behaviors among rural stimulant users in the South. Significance: There is little research on rural stimulant use, nor regarding stimulant use and HIV/AIDS in rural areas. Methods: Participants were recruited from three rural counties in the Arkansas Delta and three rural counties in western Kentucky . Participants had to be 18 years of age or older, a resident of a participating county, used crack cocaine, powdered cocaine, or methamphetamine within the past 30 days, and currently not in substance abuse treatment. Face-to-face interviews were conducted with each participant using computer-assisted (CAPI) technology. Five HIV risk behaviors were measured: drug injection, condom use, number of sex partners, using drugs with sex, and trading sex for drugs or money. Multivariate logistic regression determined if racial and gender differences for HIV risk remained after adjusting for site, age, heavy drinking, and type of stimulant used. Results: Of 449 participants, 41% were women and 41% were African American. Significant racial and gender differences were found. Men were more likely than women to have ever injected drugs or traded sex. Blacks were more likely than whites to have ever traded sex, always used condoms, had multiple sex partners, or used drugs with sex. Blacks were less likely than whites to have ever injected drugs. Conclusions: HIV-prevention strategies should be tailored to address the specific needs and characteristics of rural stimulant users.
Epidemiological Characteristics of a Chicago-area Acanthamoeba Keratitis Outbreak
Charlotte E. Joslin, University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences and School of Public Health, Division of Epidemiology
Other Authors: Elmer Y. Tu, Timothy T. McMahon, and Joel Sugar, University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences; Doug J. Passaro and Leslie T. Stayner, University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics
Purpose: Acanthamoeba keratitis (AK) is a severe corneal infection causing scarring. It is extremely rare, with US annualized incidence rates between 1.65-2.01 cases per million contact lens wearers. The purpose is to characterize AK cases and analyze geographical distribution. Methods: All AK cases diagnosed at the UIC Cornea Service between 6/1/03–11/30/05 were included in analysis. Patients with keratitis were defined as cases through confocal microscopy, histology and/or positive cultures. Exploratory analyses were performed to evaluate the AK geographical case distribution. County population data was extracted from Census 2000 data and rates were age-standardized to Cook County . Poisson regression analysis was used to estimate the rate ratio (RR) between AK cases and county of residence. Current cases (6/1/03–11/30/05) were compared to historical cases (6/1/00–11/30/02) to determine if current AK diagnosis rates differed from historical. Results: Forty-two AK cases were diagnosed between 6/1/03–11/30/05. Average age was 28.7 ± 15.2 (SD), 52.4% were male, and 92.9% used contact lenses. Estimated RR measures demonstrated increased rates for all counties relative to Cook, which were significant for DuPage (RR=4.04; 95%CI=1.68-9.22) and Will (4.39; 1.55-10.94). Current AK diagnosis rates were significantly elevated compared to historical rates (7.00; 3.22-18.35). Conclusions: AK case frequency is increasing, and cases are unevenly distributed geographically. We are hypothesizing that recent U.S. EPA changes decreasing allowable amounts of carcinogenic disinfection byproducts in the water supply may have shifted microbial risk balances and increased AK risk. Further research is warranted to better understand the increase and unusual geographical distribution.
Airborne Antibiotic Exposures in Animal Feeding Operations
Matthew W. Murphy, University of Iowa
For over fifty years, antibiotics have been added to livestock feed to reduce disease and promote growth. This has been a controversial practice however because overuse of antibiotics leads to resistance in bacteria that may cause disease in humans. The dangers of occupational and environmental exposure to antibiotics and antibiotic-resistant micro-organisms remain largely unknown. The purpose of this project was to measure the airborne antibiotic exposures in a livestock production facility. Samples were collected in hog facility which included rooms devoted to farrowing and growing operations. The antibiotic tylosin was mixed within the feed in every experimental room, while lincomycin was not currently included in the feed but had been used in the past. Analytical methods were developed in collaboration with the University of Iowa Hygienic Laboratory to measure concentrations of tylosin and lincomycin in air samples. Inhalable (n=34), respireable (n=37), and high-volume (n=16) dust samples were collected in the facility over a two-month period. Tylosin concentrations were above the limit of quantitation (LOQ) in 93% of the samples, while lincomycin concentrations were above the LOQ in only 9% of the samples (LOQ=0.04 nanograms). The average tylosin concentrations were 3, 18, and 49 ng/m 3 in the respireable, inhalable, and high-volume samples, respectively. No occupational or environmental exposure criteria currently exist for antibiotics in air. The information collected in this study can be used to estimate workers exposures and develop interventions to reduce occupational exposures.
Variation in Yearly Residential Radon Concentrations in the Upper Midwest
Zugui Zhang, Department of Biostatistics, University of Iowa
Other Authors: Brian Smith, Department of Biostatistics, University of Iowa; Dan J. Steck, Department of Physics, Saint John's University; Carolyn Guo, Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Harvard University; and R. William Field, Department of Occupational and Environmental Health and Department of Epidemiology, College of Public Health, University of Iowa
It is well-known that inhalation of radon ( 222 Rn) and 222 Rn decay products increases the risk of lung cancer and prolonged residential radon exposure is considered the second leading cause of lung cancer. The Upper Midwest, including Iowa , has the highest radon concentration in the U.S. However, Studies examining the temporal radon variation in homes across different regions and over years are lacking, but are needed to assess the accuracy of retrospective radon exposure reconstructions that are based on a one year radon measurement. The purpose of this study is to fill this gap by examining temporal variation of radon concentrations in homes over time and investigating factors that affect the temporal variability of radon measurements. The coefficient of variation (COV) was used as a measure of relative variation between multiple measurements in different areas of the same floor. The generalized linear model analysis was applied to investigate factors related to COV. The results indicate that duration between yearly testing is the most important factor. Other factors include crawl space materials, lowest level construction materials, location of ground, and time of fireplace in use. Factors related to the COV vary for different types of homes and levels of floors. Factors affecting the COV of residential radon concentrations are similar to those affecting radon measurements, but the roles of these factors may differ. This study provides important insights into the uncertainty of residential radon gas concentrations that have been incorporated into the sensitivity analyses for the global pooling of residential radon studies.
Efficacy of an Exercise Intervention in Pregnant Women
Cathleen Fracasse, University of Massachusetts Amherst
Participation in physical activity during pregnancy has been associated with reduced risks of adverse maternal and fetal outcomes. Although the American College of Obstetricians and Gynecologists (ACOG) Guidelines recommend that pregnant women accumulate 30 minutes or more of moderate-intensity activity a day on most days, the majority of pregnant women are inactive. To date, interventions have not been conducted to increase physical activity in pregnant women. We performed a pilot intervention study based on the Stages of Motivational Readiness for Change and Social Cognitive Theory to increase walking and encourage a more active lifestyle among pregnant women. We recruited eight women from Baystate Medical Center in Springfield , MA at <16 weeks gestation. Baseline activity was assessed via the Pregnancy Physical Activity Questionnaire (PPAQ). A baseline meeting with each participant included an assessment of stage of change, a discussion of facilitators and barriers to exercise, and a determination of appropriate goals for increased exercise. Participants were provided with stage-matched manuals and an Omron pedometer with which to monitor their activity. At baseline, women reported 21.38 MET hrs/wk of exercise. After one month of follow-up, we observed a 2-fold mean increase in exercise (p=0.02) with 7 of the 8 women achieving the ACOG exercise goals. This pilot provides evidence for the efficacy of an exercise intervention in a diverse sample of pregnant women. Assessment of such an intervention is an essential first step in designing physical activity interventions to reduce risk of gestational diabetes mellitus, low birth weight and prematurity.
The Impact of Work-Family Conflict on Maternal Health Six Months After Childbirth
Mira M. Grice, MS, School of Public Health , University of Minnesota
Background : Since 1970, women of childbearing age have increased their presence in the workforce. In spite of this trend, no studies to date have specifically explored the relationship between work-family conflict and maternal health after childbirth. Methods : Employed women, 18 years of age and older, were recruited while hospitalized for childbirth (n=817; 71% response rate). Health outcomes were measured six months after childbirth using the Short Form-12 Version 2 Physical and Mental Component Summary scales. General linear models estimated the effect of work spillover to home and home spillover to work on health. Directed acyclic graphs, based on the hypothesized causal model, were used to identify potential confounders. Results : Participants averaged 30 years old, 74% were married, 85% were white, 45% were first-time mothers, and 48% had returned to work. Medium and high levels of job spillover to home resulted in significantly lower mental health scores but had no impact on physical health. Both medium and high levels of home spillover to work revealed a dose-response relationship, resulting in significantly lower physical health scores when compared to women who reported low home spillover to work. Women who found it relatively easier to take time off from work or to adjust work hours, reported higher mental health scores. Conclusions : Results illustrate the impact of work-family conflict on maternal health. Increasing job flexibility, including the ability to take time off and adjust work hours may ease the burden of balancing work and family and increase maternal health in the months following childbirth.
Prescription Medication Underuse by the Medicare Population, 1996-2004
Tami Swenson, PhD Candidate, Division of Health Services Research and Policy, School of Public Health , University of Minnesota
Objective : To determine the effectiveness of providing drug coverage to the Medicare population, it is important to establish the baseline rates of prescription medication underuse prior to the implementation of Medicare Part D. Methods : Data from the 1996-2004 Medicare Current Beneficiary Survey (MCBS) Access to Care module are used to examine prescription medication underuse for the Medicare population. Underuse is defined as prescription medications not acquired by the beneficiary during the previous 12 months. Cross-sectional and longitudinal underuse rates are examined, and logistic regression is used to determine measures associated with underuse, such as socioeconomic traits, chronic conditions, and drug coverage. Results : Cross-sectional findings show that cost reasons are the predominant factor for nonadherence and that the rate of underuse has increased from less than 3 percent to approximately 4.5 percent currently. Comparisons of the longitudinal cohorts, however, show a steady rate of approximately 10 percent reporting underuse at least once during the four-year panel. Moreover, the longitudinal rates demonstrate that over 85 percent of those reporting underuse do so for only a single year. Logistic regression results show expected patterns of association between socioeconomic conditions and drug coverage policies with the likelihood of prescription medication underuse. Conclusions : Previous studies of prescription medication underuse in the Medicare population have been based on cross-sectional surveys and have assumed that reported underuse was a regular cost-saving practice rather than episodic. The longitudinal findings in this study, however, suggest that underuse is typically an isolated event and related to expected predictors.
The Role of Men in Contraceptive Decision Making
Jennifer Gard, University of North Carolina at Chapel Hill
Other Authors: Raine-Bennett T, Boyer C, Harper C, Brown B, University of California at San Francisco
Objective: To assess young men's knowledge of, attitudes toward, and experience with both hormonal and coitus-dependent contraceptive methods and to identify barriers to use. Design, Setting, Participants: A qualitative study in which data were gathered from focus group discussions of young men aged 19-27 years (N=64) recruited through community networking in the San Francisco Bay Area. Outcomes: Qualitative analysis of focus group transcripts to determine basic awareness, knowledge, attitudes, and experience with contraceptive methods. Results: Five major themes emerged from focus group discussions. Participants' contraceptive decision-making reflects their degree of commitment with sexual partners. They expressed mistrust with casual partners regarding concern for pregnancy and disease transmission, and concern trusting all partners to effectively use hormonal contraceptives. Concerns about the negative side effects of hormonal methods on partners were also reported. They expressed willingness to communicate with partners about anxieties regarding trust and method choice. Feelings were divided on whether or not men should have equal responsibility with women in monitoring contraceptive use. Conclusions: Our findings suggest that young men's limited roles in contraceptive decision making may be due to apprehensions that are related to lack of partner trust and communication. It is important to increase the awareness about attitudes revealed in this study and to stimulate research on their influence of future programs involving male participation. Additional research should further elucidate ways to provide opportunities for young men to initiate dialogue with partners as a means of promoting greater acceptance of male participation in contraceptive decision making.
Evaluating the Effectiveness of a Published Severity Scoring Index (SSI) to Predict Death in a Cohort of Consecutive Patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS)
Reginald T. Hooks, Sara K. Vesely, James N. George, and Deirdra R.. Terrell
Objective: Evaluate the ability of a published SSI to predict death in TTP-HUS patients and determine if additional features strengthen predictive power. Introduction: Prior to availability of plasma exchange treatment, 90% of adults with TTP-HUS died. Although exchanges decreased mortality to 20%, they require personnel and large commitments of transfusion resources. The Oklahoma TTP-HUS Registry has complete data for all clinically suspected TTP-HUS patients in central, western, and southeastern Oklahoma (1989–2006). A previous study (N=38) developed a SSI to predict death based on four presenting parameters: neurological symptoms, renal impairment, platelet count, and hemoglobin value. Our study utilized the SSI to evaluate the ability to predict death for patients in our registry. Methods: Patients (N=246) were assigned classifications (0=no abnormalities, 1=mild/moderate impairment, 2=severe impairment) for the four parameters based on the SSI criteria, yielding a potential severity score of 0–8/patient. Other variables collected include age, gender, race, and potential disease etiology. Results: For each one-point increase in the SSI, the odds ratio (OR) for predicting death within 30 days is 1.57 (95%CI: 1.19-2.07). Adjusting for age, the OR is 1.42 (95%CI: 1.0601.90). Patients dying within 30 days (n=52) had a mean SSI and age of 6.27 and 59.25 respectively. Survivors (n=194) had a mean SSI and age of 5.64 and 44.26. Conclusions: Analyses indicate the SSI predicts death within 30 days in TTP-HUS patients. The SSI may allow a more rational approach to management, with more intensive treatment for severe patients, and better allocation of transfusion resources.
Factors Associated with CDC-Defined Reportable Rocky Mountain Spotted Fever (RMSF) Cases in Oklahoma , January 2003 – May 2004
Mushfiqur R Tarafder, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Other Authors: Laurence Burnsed, John Bos and Lauri Smithee, Communicable Disease Division, Oklahoma State Department of Health and Hélène Carabin, College of Public Health , University of Oklahoma Health Sciences Center
Background : Rocky Mountain Spotted Fever (RMSF), endemic in Oklahoma , is the most severe and frequently reported tick-borne rickettsial illness in United States . Objective : To describe the epidemiology of all seropositive RMSF cases reported to Oklahoma State Department of Health (OSDH) from January 2003 to May 2004 and compare CDC reportable cases to non-reportable cases. Methods : All electronic and laboratory reports sent to OSDH were investigated. Demographics, symptoms, serology, treatment and tick exposure information was collected from patients, hospitals and physicians. Cases were classified as confirmed, probable, or not a case based on CDC definition. The association between age, sex, race, hospitalization, region of residence, exposure to tick-infested area, tick bite association and case status (reportable or not) was estimated using a multivariate logistic regression. Results : Data from 291 seropositive persons were reviewed. Of these, 168 were reportable (57.7%). In 1-14 year-old group, the adjusted odds ratio (aOR) among those hospitalized was 8.74 (95% CI: 1.38;55.51). aOR for those who were hospitalized in 15-29, 30-44, 45-59, and ³ 60-year-old group were 0.65 (0.14;2.98), 3.73 (1.07;12.97), 3.97 (1.15;13.79), and 2.41 (0.72;8.11), respectively. The OR for those who were exposed to tick infested areas was 4.9 (1.61;14.98). Discussion : Age modifies the effect of hospitalization on being a reportable case with a higher probability of being reportable among the 1-14 years-old. This may be due to more severe symptoms at this age when immunity is lower. Exposure to tick-infested area is a surrogate for actual tick bite and was found strongly associated with case status.
Assessment of Genetic Factors Affecting Bone Loss: The San Antonio Family Osteoporosis Study
John R. Shaffer, University of Pittsburgh Graduate School of Public Health
Other Authors: Candace M. Kammerer, University of Pittsburgh Graduate School of Public Health; Jan M. Bruder and Richard L. Bauer, University of Texas Health Science Center; and Braxton D. Mitchell, University of Maryland School of Medicine
Background: Bone mass, the primary determinant of osteoporosis, is the net result of two factors: (1) acquisition of peak bone mass during young adulthood, and (2) subsequent rate of bone loss with age. While heritability of peak bone mass has been extensively studied, the genetic contribution to bone loss is largely unknown. We investigated the extent to which genes influence change in bone mineral density (BMD) over time in a sample of 18 extended Mexican American families (n=176, ages 45 to 78). Methods: Annual BMD change was calculated from measurements of hip, spine, and radius BMD obtained by dual x-ray absorptiometry at baseline and follow-up (3-7 years later, median=5.5 years). Maximum likelihood methods were used to estimate heritability of change in BMD while simultaneously adjusting for the effects of age, sex, and body mass index. Results and Conclusions: Heritability of change in BMD at hip, spine, and radius was 0.39 (p=0.009), 0.46 (p=0.007), and 0.45 (p=0.02), respectively. This study is the first to conclusively demonstrate the heritability of BMD change, showing that genetic factors account for approximately 40% of the variation in bone loss. Furthermore, the magnitude of heritability suggests that additional work to locate genes affecting bone loss may be fruitful. Discovery of such genes could lead to: (1) new biological targets for the treatment of osteoporosis, and/or (2) the identification of persons at risk for accelerated bone loss who would benefit from preventative interventions, resulting in improved health, improved quality of life, and reduction of medical care costs.
Use of Pulsed-field Gel Electrophoresis to Determine the Prevalence of Epidemic Clones among Community-acquired Methicillin-resistant Staphylococcus aureus isolates.
J.C. Roberts , USF Center for Biological Defense, College of Public Health , University of South Florida
Other Authors: K.K. Peak , W. Veguilla, A.Cannons, J.Cattani, USF Center for Biological Defense, College of Public Health, University of South Florida; and P.Amuso, USF Center for Biological Defense, College of Public Health, University of South Florida and Florida Department of Health, Bureau of Laboratories
Staphylococcus aureus is one of the leading causes of hospital and community-acquired infections. A number of recent studies have described outbreaks of disease caused by epidemic clones of community-acquired methicillin-resistant S. aureus (CA-MRSA). Pulsed-field gel electrophoresis (PFGE) is considered the gold standard for molecular typing of MRSAs, and has been applied to a variety of epidemiological studies. However, a national database for the comparison of PFGE patterns does not exist for S. aureus . We hypothesis that such a database will be useful not only for tracking strains involved in outbreaks, but also to demonstrate associations between specific isolates and the diseases. A total of 314 CA-MRSA isolates were characterized by PFGE using Sma I digestion. CA-MRSA isolates used in this study were obtained from Florida or Washington state. Data was analyzed using BioNumerics Ò and utilizing the epidemic isolates, pulsotypes USA100-800 as controls. Analysis of the isolates demonstrated that USA100, USA300, and USA400 are present among our isolates. This study demonstrated for the first time the presence of USA300, a strain associated with nationwide outbreaks, in Florida and Washington . Similar to recent studies, we found that the majority of our wound isolates were USA300 pulsotype. We also demonstrated that the majority of strains isolated from nasal swabs possess the USA100 pulsotype. This suggests that this pulsotype may be related to MRSA colonization, but further studies are needed. This study demonstrates the importance of a nationwide PFGE database to track the spread of MRSA.
Etiologic Classification of Birth Defects as a Tool for Public Health Prevention Activities: Findings from Utah , 1999–2003
Marcia Feldkamp , Utah Birth Defect Network, Utah Department of Health; Department of Pediatrics, University of Utah Health Sciences Center ; Doctoral Student, Public Health Program, University of Utah Health Sciences Center
Other Authors: Lorenzo Botto, Janice L. B. Byrne and John C. Carey, Utah Birth Defect Network, Utah Department of Health and Department of Pediatrics, University of Utah Health Sciences Center; and Kara Lecheminant and Sergey Krikov, Utah Birth Defect Network, Utah Department of Health
Objective: Major birth defects occur in 1 in 33 births, contribute to premature birth, and are responsible for 1 in 4 infant deaths. Birth defect surveillance programs provide the crucial public health infrastructure for assessment and prevention. In addition to monitoring occurrence, birth defect surveillance programs should help identify and track the main known causes of birth defects in the population, especially teratogens, as a guide to primary prevention activities. Methods: The Utah Birth Defect Network conducts statewide ascertainment of birth defects among all pregnancy outcomes through multiple prenatal and postnatal reporting sources. Based on all information collected, a pediatric geneticist assigns each case an etiologic class based on the clinical findings, the etiologic information from medical records, and family history. Results: From 1999 through 2003, 5,047 cases among 241,416 live born or stillborn infants were identifed. In 920 cases (18.2%) a known etiologic factor was present. In the remaining 4,127 or 81.8% of cases, etiology remained unknown. Known etiology included chromosomal conditions (745 or 81.0%), other genetic disorders (145 or 15.8%), teratogens (21 or 2.3%), and twinning (6 or 0.7%). Maternal diabetes accounted for most cases (57%) in the teratogen category. Conclusion: Non-gestational maternal diabetes related embryopathy is preventable. Birth defects related to maternal diabetes are an important clinical and public health concern because they are preventable with appropriate glycemic control before conception and during early organogenesis. Etiologic classification of birth defects can enhance a birth defect surveillance program's ability to generate valuable data for public health prevention efforts.