|| Duck husbandry practices and farmers? Beliefs about avian influenza in South Vietnam
|| Healthcare and Ohio's Public Schools: Trends in Personnel Service Delivery Systems
||Temporal and Geographic Trends in Babesiosis and Human Granulocytic Anaplasmosis
||Swine workers: An emerging risk group for community-associated methicillin-resistant Staphylococcus aureus (MRSA)
||Acculturation and Self-Reported Health Among Hispanics Using a Socio-Behavioral Model: The North Texas Healthy Heart Study
||Association between periconceptional maternal fish consumption and birth defects
||Obtaining Miner and Mine Operator Participation in a Knowledge, Attitudes and Practices Survey of Kentucky Coal Miners
||Type 2 Diabetes Peer Counseling Intervention Improves Knowledge and Self-Management Skills
|| 2,4,6-Trinitrotoluene (TNT) Air Concentrations, Hemoglobin Changes, and Anemia Cases in Respirator Protected TNT Munitions Demilitarization Workers
||Acceptability Survey of HPV Vaccine Among Female Sex Workers in Lima, Peru
||Molecular Epidemiology of Influenza A (H1N1) in Hawaii
||Influence of Active-Coping on Medication Adherence in a Low-Income Hypertensive African-American Community: A New Application of John Henryism
|| Meth Mouth: The Effect of Drug Use Patterns, Behavior and Knowledge on Caries Status between Methamphetamine Users and Non-Users
||Development and Validation of an Inflammatory Index
||Modeling the Cost Effectiveness of Facility-wide Active Surveillance for Methicillin-resistant Staphylococcus aureus (MRSA) in Acute Care Hospitals
||Evaluation of a Statewide Foodborne Illness Complaint System
||Cost-Effectiveness of Testing High-Risk Women for Mutations in the BRCA 1 and BRCA 2 Genes: Does Early Detection Lead to Better Health and Economic Outcomes?
||Second Hand Smoke in Oklahoma: What People Know, What People do to Prevent Harm
||Neither Mycoplasma genitalium nor Chlamydia trachomatis in early pregnancy are associated with spontaneous abortion among young women recruited from an urban emergency department
Duck husbandry practices and farmers? Beliefs about avian influenza in South Vietnam
Tran Huynh, University of Minnesota School of Public Health
Vietnam is one of the countries that experienced the highest economic and human loss from highly pathogenic avian influenza H5N1 outbreaks. Poultry farmers may be at increased risk of avian influenza because of their regular contact with poultry. The goal of this project was to learn about duck husbandry practices and to elicit information about beliefs about avian influenza among duck farmers in Vietnam. Qualitative data were collected from 4 focus groups with 40 duck farmers in South Vietnam. Field observations were also made of 3 duck farming grounds. Audio files were transcribed and translated from Vietnamese to English and the text narratives were analyzed. Scavenging duck farming, where ducks are herded to rice fields to search for food, is a common practice. Knowledge about the transmission of H5N1 was generally low. Recognizing symptoms of bird flu from other poultry diseases was problematic. Risky poultry handling practices, such as limited use of personal protective equipment (PPE) such as gloves and masks, and lack of frequent hand wash after contact with poultry, and preparing sick or dead ducks for eating, were prevalent among participants. Farmers believed their risk of bird flu infection was low and described numerous barriers to using PPE and hand hygiene, which include discomfort, inconvenience, and unavailability of PPE. Findings suggest intervention at the grassroots level is needed to increase awareness about the risk and severity of avian influenza to humans.
Healthcare and Ohio's Public Schools: Trends in Personnel Service Delivery Systems
Thomas Albani, Consortium of Eastern Ohio Master of Public Health
Ohio's 612 public school systems are not required by state law to have a school nurse on staff. However, Ohio law does define a school nurse and specifies requirements for licensure should a school employ school nurses. Personnel structures in place to provide health care services to Ohio's school children have been circumventing existing regulation in the name of fiscal necessity with increasing frequency. Telephone surveys were conducted to 612 schools in Ohio to determine who is providing healthcare services in Ohio's public schools. Personnel credentials (e.g. licensed school nurse), employer of health care personnel (e.g. school district) as well as poverty levels (% of students on free or reduced lunch) in school districts were explored. Approximately 61.8% of school districts utilize licensed school nurses to provide health care services in schools. Less than 7.4 % of Ohio's public schools meet the Healthy People 2010 goal for a ratio of 1 school nurse to 750 school students. Nearly 12.1% of school districts have ratios greater than 1:3000. Twenty percent of school districts contract with local health departments for school health services. When public health nurses (PHN) are used to provide services, the school district's nurse to student ratios worsen, due to less than 5% of school districts using PHN's provide full time services. As the poverty level of a school district increases, ratios of registered nurses to students were not shown to have any strong correlation either negatively or positively, with a Pearson coefficient of -0.067.
Temporal and Geographic Trends in Babesiosis and Human Granulocytic Anaplasmosis
Nicole Spencer, University at Albany School of Public Health
Babesiosis and Human Granulocytic Anaplasmosis (HGA) are tick-borne diseases transmitted by the deer tick or black-legged tick (Ixodes scapularis), the same vector that carries Lyme disease. While Lyme disease is the most prevalent and well-known tick-borne disease, cases of babesiosis and HGA have continued to increase in New York State since they became reportable in 1986 and 1996 respectively. The objective of the study was to determine the incidence of both diseases over time and the counties of New York State most at risk, and to determine if the trends match those exhibited by Lyme disease. SAS was used to calculate descriptive statistics of demographic data and incidences by county of babesiosis and HGA, as well as to analyze data over time. Analysis of Variance (ANOVA) was used to compare incidences between counties. ArcGIS was used to map the frequency of disease in each county. There has been a significant increase in the incidence of babesiosis over time in New York State (p=.0002) with a dramatic increase in the East Hudson Valley Region (p<.0001). HGA has also seen a large increase in incidence over time (p=.0095) especially within Dutchess and Columbia counties (p<.0001). The disease frequency pattern shows that babesiosis and HGA are spreading farther north and west than has been seen before, and are following the same historical patterns as the spread of Lyme disease. The patterns of Lyme disease spread can be used to predict future patterns of babesiosis and HGA and provide appropriate recommendations to local health departments.
Swine workers: An emerging risk group for community-associated methicillin-resistant Staphylococcus aureus (MRSA)
Abby Harper, University of Iowa College of Public Health
Over the past decade, the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has undergone significant changes. Once primarily a hospital-based pathogen, MRSA is now found increasingly in the community, and this bacterium has caused serious infections in individuals with no history of hospitalization. Recent research has also shown that swine and swine farmers are colonized with MRSA at high levels in the Netherlands and Canada. With Iowa raising 16 million hogs a year in a $4 billion a year industry, we set out to examine the prevalence of MRSA in swine from Iowa and Illinois. Therefore, we collected samples from swine on 10 different farms (7 confinement, 3 organic/antibiotic free) in Iowa and Illinois. To date, no MRSA has been found on organic farms in Iowa. Nasal swabs were taken from 474 swine. Overall MRSA prevalence in swine was found to be 32% (151/474). MRSA prevalence in confinement swine was 40% (151/382). These results show that colonization of swine by MRSA is very common on the farm system we examined in the Midwestern U.S., adding to the concern about domestic animal species as a reservoir of this bacterium. In addition to swine, nasal and pharyngeal swabs were taken from humans. Overall MRSA prevalence in humans was 42% (20/48). Humans working in confinement operations had a prevalence of 63% (20/32). Individuals exposed to swine, especially in confinement operations, are risk for MRSA carriage. Additional studies are ongoing to examine the carriage rates of MRSA in rural Iowa.
Acculturation and Self-Reported Health Among Hispanics Using a Socio-Behavioral Model: The North Texas Healthy Heart Study
Katandria Johnson, University of North Texas Health Science Center
Acculturation is defined as continuous, firsthand contact with other cultures functioning at both group and individual levels (Castro 2007). It is reflected in our culturally diverse society, calling for a greater understanding of the environmental and cultural impact on health (Castro 2007). This study investigated the relationship between acculturation and self-rated health (SRH) among Hispanics. Hispanic participants (n=135) were assessed on acculturation, various psychosocial factors, and a self-reported single item general health status measure. Participants underwent a comprehensive interview utilizing a standardized questionnaire on acculturation, various psychosocial factors, and a self-reported single item health indicator. Health status was ascertained by the question, “In general, would you say your health is: excellent, very good, good, fair, or poor” (Cohen, Kamarck, and Mermelstein, 1983). In addition, physiological measurements and demographic characteristics including age, gender, body mass index (BMI), medical history, and socioeconomic status were also obtained. Univariate analyses found Mexican-oriented participants 3.16 times more likely to report fair/poor SRH (95% CI 1.37, 7.25) compared to Anglo-oriented Hispanics. Acculturation was also associated with SRH in multiple regression models controlling for enabling or need factors, but not predisposing factors. Acculturation status is a powerful determinant of SRH and should be used as a tool in medical and public health to better understand the role of acculturation in Hispanic behaviors, health outcomes and health care use. Such research findings will contribute to the design of culturally sensitive prevention and treatment strategies for racially/ethnically diverse and immigrant populations.
Association between periconceptional maternal fish consumption and birth defects
Michelle Steck, Texas A&M Health Science Center School of Rural Public Health
Maternal fish consumption is useful in fetal development due to low saturated fat, high unsaturated fat, beneficial proteins and essential nutrients. However, fish consumption may expose the fetus to harmful environmental contaminants, which have been linked to neuro-developmental problems in human offspring and structural malformations in animal fetuses. The National Birth Defects Prevention Study (NBDPS) collects data on birth defects; maternal dietary history and socio-demographic characteristics. We used logistic regression and calculated odds ratios (OR) and their 95% confidence intervals (CI) to assess the relationship between periconceptional maternal fish consumption and the occurrence of birth defects in the NBDPS population. Adjusted odds ratios suggested that compared with mothers who ate fish less than once a month, mothers who ate 3-5oz of fish 1-3 times/month were significantly protected from oral clefts (OR=0.82, CI=0.73-0.93), anomalous pulmonary venous return (OR=0.54, CI=0.36-0.81) and anorectal atresia/stenosis (OR=0.78, CI=0.62-0.98). However, high levels of fish consumption increased risk for perimembranous ventricular septal defects (OR=1.25, CI=1.03-1.51) and amniotic band syndrome (OR=1.60, CI=1.01-2.55). Our findings suggest that women who are planning to become pregnant should be eating 3-5oz of fish 1-3 times per month to protect against birth defects; however it might confer risk to consume higher amounts.
Obtaining Miner and Mine Operator Participation in a Knowledge, Attitudes and Practices Survey of Kentucky Coal Miners
William Willis, University of Louisville School of Public Health and Information Sciences
Kentucky coal miners have low participation rates in the federally funded Coal Worker's X-ray Surveillance Program (CWXSP). To better understand reasons for lack of participation, a knowledge, attitudes, and practices (KAP) survey was conducted among Kentucky's active underground miners. The intent of the survey was to evaluate miners' KAP regarding the CWXSP to identify specific interventions that may lead to policy changes to increase participation. To interview coal miners at the work site, it was essential to obtain cooperation from coal mine operators/owners. The interviewers obtained endorsement of the survey from the Kentucky Coal Association. Mines were selected from Eastern and Western Kentucky using a stratified random sampling method to allow evaluation of differences between regions. Mine operators were contacted to request participation of their employees and informational flyers were distributed pre-visit. Miners were encouraged to participate with multiple incentives donated from non-governmental organizations. Miners were recruited and interviewed anonymously during shift change at the coal mine to ensure they were currently working as a miner. Of the 183 active underground mines in Kentucky, 61 were contacted for participation; 4 mines responded favorably and 212 coal miners were interviewed. This evaluation determined that mine participation in the survey depended on the development of personal relationships with mine operators, providing incentives, emphasis on state-level involvement, and gaining trust among the rural mining communities. This methodology may assist other investigators to conduct studies targeting coal mines.
Type 2 Diabetes Peer Counseling Intervention Improves Knowledge and Self-Management Skills
Robert Cruz, University of Connecticut
Between 2000 and 2006 Hispanics growth rate (24.3%) was more than three times the growth rate of the total population (6.1%) in the U.S. Relative to non-Hispanic Whites, Latinos have 60% higher mortality rates due to Diabetes, are at greater risk of being hospitalized due to diabetes complications and have greater lower extremity amputation. The objectives of this study are to: 1) report participant's level of satisfaction in the intervention arm of a parallel randomized-controlled peer counseling trial and 2) show participants pre-post knowledge in response to peer counseling. The DIALBEST peer counseling intervention included 17 sessions on nutrition, diabetes and medication management. Participants' mean age was 56 ± 11.6 years and 69% were women. 89.2% of participants preferred to be counseled in Spanish and had high school or less education. Preliminary findings show that 86% of those who could not identify carbohydrates sources at baseline were able to do so after the intervention. Likewise, 83% of those who could not identify at baseline which foods were likely to increase blood sugar answered correctly after being exposed to the peer counselors. The corresponding improvement for food label understanding was 82%. 97% of participants reported that their blood sugar monitoring and medication adherence had improved after peer counseling sessions. Preliminary results from this study suggest improvements on blood sugar monitoring, physical activity and medication adherence in response to peer counseling. All participants reported feeling better prepared to take care of their diabetes needs after being exposed to the peer counselor interventions.
2,4,6-Trinitrotoluene (TNT) Air Concentrations, Hemoglobin Changes, and Anemia Cases in Respirator Protected TNT Munitions Demilitarization Workers
Mel Bradley, University of South Florida College of Public Health
2,4,6-Trinitrotoluene (TNT) is an explosive used in munitions production that is known to cause both aplastic and hemolytic anemia in exposed workers. Anemia in a TNT worker is considered a SHE(O). Deaths have been reported secondary to aplastic anemia. Studies have shown that TNT systemic absorption is significant by both the respiratory and dermal routes. No studies encountered looked at hemoglobin change or anemia cases in respiratory protected workers. We hypothesized respiratory protection is insufficient to protect TNT workers from the risk of anemia development and hemoglobin concentration drop. A records review of eight groups of respiratory protected TNT workers' pre-exposure hemoglobin levels were compared with their during-exposure hemoglobin levels for statistically significant (alpha level 0.05) hemoglobin level changes; and anemia cases were recorded. Mean hemoglobin changes within each of the 8 groups of workers were then regressed on mean TNT air concentrations using air sampling that was performed closest in time to during-exposure hemoglobin follow-ups. Statistically significant hemoglobin level drops and anemia cases were apparent at TNT air concentrations about the REL and PEL in respiratory protected workers. There were no anemia cases or statistically significant hemoglobin level drops at concentrations about the TLV, however. For TNT air concentrations from 0.12mg/m^3 to 0.31mg/m^3 there was a strong positive linear association with regard to magnitude of hemoglobin change (r=0.996). Conclusion: Respiratory protection may be inadequate to prevent workers who are at risk for TNT skin absorption from developing anemia.
Acceptability Survey of HPV Vaccine Among Female Sex Workers in Lima, Peru
Brandon Brown, Johns Hopkins Bloomberg School of Public Health
The objectives of the study were to determine the level of awareness of human papillomavirus (HPV), and investigate the potential acceptability of HPV vaccine among female sex workers (FSWs) in Peru. Behavioral and vaccine related knowledge data were collected from FSWs aged 18-29 in Lima, Peru. These questionnaires were administered individually by trained interviewers at Patrucco Clinic and surrounding sex venues using convenience sampling. The average age of the 319 women was 24 years, and the mean age of first sex work is 20.5 years. Less than half (44%) of FSWs had heard of HPV and 47% correctly reported HPV as the cause of cervical cancer. 65% of women reported that condoms prevent HPV infection, while only 7% knew of a vaccine to prevent cervical cancer. Overall, clinic attendees were more knowledgeable about HPV than women approached at sex venues. Nearly 100% of participants would like to receive HPV vaccine, but many listed potential barriers to vaccination. Only eight women said they would not pay for an HPV vaccine, while the average amount women were willing to pay is 27.7 dollars (range 1.8-357 dollars). 99% of women reported being able to complete all 3 vaccine doses. FSWs are a population at high risk of HPV infection and subsequent cervical cancer, thus they should have access to HPV vaccine. Due to low knowledge of HPV and cervical cancer, FSWs should be targeted for HPV education campaigns. Barriers to vaccination of FSWs can be overcome.
Molecular Epidemiology of Influenza A (H1N1) in Hawaii
Denise Nelson, University of Hawaii at Manoa
Influenza is a high impact viral infection causing seasonal outbreaks as well as periodic epidemics and pandemics throughout the world. The state of Hawai‘i is vulnerable to the spread of type A influenza due to its unique geographic positioning and heavily trafficked travel patterns. Through the usage of epidemiological research in conjunction with laboratory methods, we are able to trace viral origins and show phylogenetic relationships. In collaboration with the Hawai‘i Department of Health State Laboratory and Disease Outbreak Control Divisions, we present a pilot study in which viral isolates collected from individuals in Hawai‘i infected with H1N1 influenza are extracted, amplified, cleaned and sequenced for the hemagglutinin gene to show evolutionary relationships and circulatory patterns. Implications of molecular data are supported by epidemiologic information. Phylogenetic analysis suggests that Hawai‘i acts as both a source population and sink population for type A influenza virus: in some instances Hawai‘i isolates represented the earliest instance of a strain subsequently seen elsewhere; in other instances Hawai‘i isolates clustered with strains observed earlier in other regions. Through the usage of molecular methods, we hope to develop an improved understanding of influenza dynamics in Hawai‘i. Targeting an area of geographic importance, such as Hawai‘i, assists in providing a depiction of how location and the distribution of populations play a role in the spread of infectious disease. Enhanced understanding may help to improve efficiency and effectiveness of public health related preparation and response efforts, and reduce the impact of influenza on the state and its visitors.
Influence of Active-Coping on Medication Adherence in a Low-Income Hypertensive African-American Community: A New Application of John Henryism
Uchechi Acholonu, University of California, Los Angeles School of Public Health
In addition to improved dietary habits and increased physical activity, effective blood pressure control often requires high levels of medication adherence (Weir et al. 2000, Oparil et al. 2001). Levels of adherence to antihypertensive medications are lower among African-Americans compared to Whites (Charles et al. 2003). Psychosocial factors, such as active-coping levels, may play a significant role in this disparity. Using cross-sectional baseline data from the Community Hypertension Intervention Project (Ward et al. 1998), we examined the association between active-coping and medication adherence. Active-coping was operationalized using a short version of the John Henryism Active Coping Scale (James et al. 1983); the 8-item Morisky Scale was used to measure medication adherence (Morisky et al. 2008). Chi-square statistic and binomial logistic regression analyses were used to test for medication adherence differences and the effect of active-coping levels on medication adherence. There was a statistically significant difference in medication adherence between high and low active-coping groups (2=7.14, p=0.008). After adjusting for relevant covariates, African-Americans with higher levels of active-coping had 38% greater odds of medication adherence than African-Americans with lower levels of active-coping (OR=1.38, 95% CI=1.00-1.89). Several factors influence medication adherence levels among hypertensive African-Americans. As demonstrated by this study, active-coping is one such factor. Understanding how African-Americans actively cope with the demands of a medical regimen, in addition to daily stressors, is important for designing public health interventions aimed at increasing medication adherence in the African-American community, and ultimately eliminating disparities in blood pressure control.
Meth Mouth: The Effect of Drug Use Patterns, Behavior and Knowledge on Caries Status between Methamphetamine Users and Non-Users
Ronni Brown-Kimbrew, University of California, Los Angeles School of Public Health
The study examined the impact of drug use patterns on the development of “meth mouth”; an accelerated form of dental decay associated with methamphetamine use. Sixty adult inmates with a history of methamphetamine use (MA users) and 40 adult inmates with no history of methamphetamine use (non-MA users) participated in this case-control study at the Sonoma County Jail. Participants completed a questionnaire regarding dietary habits, oral hygiene behaviors, access to dental care and knowledge of “meth mouth”. MA users were asked about their pattern of drug use, history of xerostomia and their perceptions of the drug's impact on their dental health. Oral examinations were performed and the number of decayed, missing or filled permanent teeth were counted and combined to produce a DMFT score. MA users had significantly higher DMFT scores (P=0.029) and were more knowledgeable about “meth mouth” (0.010) than non-MA users. MA users were more likely to recall xerostomia (P=0.000) during drug use and to report a decline in their dental health after exposure to the drug (P=0.000). There were no significant differences in DMFT scores based upon the pattern of drug use. The majority of participants had not received information about “meth mouth” and few cited a physician or dentist with informing them about the disease. With an estimated health care cost of $351.3 million dollars per year associated with methamphetamine abuse, health professionals must discuss the physical effects of the drug with their patients; “meth mouth” being one effect with lifelong negative implications for the user.
Development and Validation of an Inflammatory Index
Philip Cavicchia, University of South Carolina Arnold School of Public Health
Chronic inflammation is associated with a number of chronic conditions, such as cancer, cardiovascular disease, obesity, insulin resistance, depression, and dementia. The ability to decrease levels of inflammation may help prevent or treat these conditions. Diet has consistently been shown to modulate inflammation. We sought to develop and validate an Inflammatory Index (II), designed to assess the inflammatory potential of an individual's diet. The II was developed based on results of an extensive literature search. Using data from the SEASONS study, a longitudinal trial that carefully measured diet and the inflammatory marker C-reactive protein (CRP), analyses was carried out to determine the association between CRP and II score. Important potential confounders of the diet-CRP association were controlled in the analytic models. Results based on continuous measures of CRP suggested that increasing II score (representing movement towards an anti-inflammatory diet) was associated with a decrease in CRP. We performed additional analysis using CRP as a dichotomous variable using a CRP value of 3mg/L as a cutoff point and found that an anti-inflammatory diet along the continuum of the II was associated with a significant decrease in the odds of an elevated CRP. Results provide construct validation of the II and additional evidence that diet plays a role in the regulation of inflammation, even after careful control of a wide variety of potential confounders. Also, results provide evidence for one of the mechanisms in which dietary factors may decrease the risk of cancer, cardiovascular disease and other inflammatory related conditions.
Modeling the Cost Effectiveness of Facility-wide Active Surveillance for Methicillin-resistant Staphylococcus aureus (MRSA) in Acute Care Hospitals
Rachel Bailey, University of Pittsburgh Graduate School of Public Health
Our goal was to determine the thresholds of prevalence levels of MRSA in acute care hospitals that make universal surveillance (i.e. admission culture of all patients) cost effective. We developed a computer simulation model representing the decision to perform universal surveillance versus no surveillance using TreeAge Pro 2008. A model outlining the choices and assumptions made by hospital administration when designing an MRSA surveillance program was created using data from prior studies. Inputs included sensitivity and specificity of surveillance, MRSA prevalence, R0, probabilities of medical outcomes of MRSA and all associated costs. Sensitivity analyses were performed by systematically varying the prevalence of MRSA and R0 since these variables are unknown. 100,000 Monte Carlo simulations were performed for each pairing of variables. Performing universal MRSA surveillance was cost-effective [incremental cost-effectiveness ratio (ICER) <$50,000 per quality-adjusted life year (QALY)] at the following MRSA R0 and prevalence combinations: R0 ≥0.25 and prevalence ≥ 0.01. In fact, surveillance was the dominant strategy when R0 =1.5 and prevalence ≥ 0.15; R0 =2.0 and prevalence ≥ 0.10; R0 ≥ 2.5 and prevalence ≥ 0.05. MRSA surveillance of medical hospital admissions appears to be cost-effective at a wide-range of prevalence and R0 values. Hospital administrators need realistic estimates of these variables in their facility to design cost-effective surveillance. All hospitals should consider performing universal MRSA surveillance based on our model. Further research to determine realistic estimates of R0 and prevalence can assist in creating better public health surveillance policy.
Evaluation of a Statewide Foodborne Illness Complaint System
John Li, University of Minnesota School of Public Health
The purpose of this study was to analyze the effectiveness of using a foodborne illness complaints system to detect outbreaks, and to determine if using symptom information could help to identify particular pathogens. Complaints data from 2001-2006 was obtained from the Minnesota State Department of Health. Complaints were linked to outbreaks to determine those that were associated with outbreaks and types of pathogens involved. Descriptive statistics were carried out comparing outbreak associated and non-outbreak associated calls. Symptom information was coded into various symptom profiles representing all combinations of the 6 individual symptoms. Profiles were examined to determine their predictive ability in identifying particular pathogens. We found that the vast majority, 75.8%, of food related outbreaks in Minnesota were detected through the complaints system. The most commonly detect pathogen was norovirus, followed by Salmonella, and Clostridium perfringens. There was also evidence that by focusing on particular symptom profiles public health officials may be better able to select out certain pathogens. We found that profiles including vomiting and diarrhea were predictive of Norovirus, and those that included cramps and diarrhea were more predictive of Salmonella. Complaint systems can be a very effective tool in detecting foodborne illness outbreaks especially those not targeted by pathogen specific surveillance. Further analysis of the data showed that use of symptom profiles may help in focusing complaints on certain pathogen types. Eliminating calls with vomiting in their symptom profile greatly reduces the amount of Norovirus related complaints.
Cost-Effectiveness of Testing High-Risk Women for Mutations in the BRCA 1 and BRCA 2 Genes: Does Early Detection Lead to Better Health and Economic Outcomes?
Michelle Wilkinson, University of North Carolina at Chapel Hill Gillings School of Global Public Health
Breast cancer is the leading cause of cancer deaths for women aged 40-59. Lifetime risk for breast cancer in America is 12%, but women with BRCA mutations are at substantially higher risk. The objective was to analyze the cost-effectiveness of screening high-risk women for mutated BRCA genes. Cost-effectiveness study using Microsoft Excel to model a decision tree and Oracle Crystal Ball to run Monte Carlo simulations testing for sensitivity. Costs and outcomes discounted at 3%.The data sources were American Cancer Society, National Cancer Institute, peer-reviewed cost-effectiveness studies, and the target population was a hypothetical cohort of 50,000 high-risk, 30-year-old women with a family history of breast cancer. Cohort followed for duration of natural lifespan or until breast cancer death. Perspective: Societal Interventions: Genetic screening for BRCA gene; women with mutations can have: surveillance, mastectomy, oophorectomy, tamoxifen chemopreventive therapy or both surgeries. Outcome Measures: Incremental cost, life-years saved, incremental quality adjusted life years (QALY), deaths averted, cost per life-year saved, cost per QALY. All costs 2008 US$. Results of Base-Case Analysis: Incremental Cost-Effectiveness Ratio (ICER) $3,230 per QALY. Base-case is cost-effective at threshold value of $50,000/QALY. Results of Sensitivity Analysis: Probabilities for developing breast cancer with and without BRCA mutation have most effect on one-way sensitivity. Probabilistic sensitivity shows cost/QALY is cost-effective 76% of the time. Limitations: Relapse is not considered. Branches in the decision-tree with three or more options were not tested for sensitivity. Conclusions: Genetic screening for high-risk women should be undertaken, provided the test results are confidential.
Second Hand Smoke in Oklahoma: What People Know, What People do to Prevent Harm
Shirley James, University of Oklahoma College of Public Health
No level of second hand smoke (SHS) exposure is safe. Health risks include heart disease in adults, otitis media in children, and sudden infant death syndrome. The goal of this study was to analyze associations between SHS knowledge and preventive measures Oklahomans are willing to take to reduce their exposure. As part of a longitudinal study, we surveyed 4001 Oklahomans using cellular and land phone lines with standard survey procedures. The study weighted the data for age, type of phone, and demographics of Oklahomans. Data analysis included summary statistics, measures of association, and inferential statistics, using procedures appropriate for weighted data. While 63.8% of Oklahomans know that SHS is very harmful to one's health, only 59.1% have full smoking bans in their automobiles, 70.7% in their homes, and 23.2% would be very likely to ask others not to smoke in their presence. People who believe that SHS is very harmful are 3.4 (95% CI= 2.8, 4.0) times more likely to have full smoking bans in their homes, 3.4 (95% CI= 2.8, 4.0) times more likely to have full smoking bans in their cars, and 4.5 (95% CI = 3.7, 5.4) times more likely to ask others not to smoke in their presence than those who believe that SHS is somewhat harmful, not very harmful or not harmful at all. This study demonstrated the need for Oklahomans to obtain knowledge about the dangers of SHS and to use this knowledge to protect themselves and their families.
Neither Mycoplasma genitalium nor Chlamydia trachomatis in early pregnancy are associated with spontaneous abortion among young women recruited from an urban emergency department
Vanessa Short, University of Pittsburgh Graduate School of Public Health
Spontaneous abortion (SAB), loss of a conceptus prior to 20 weeks, is the most common adverse pregnancy outcome. As genital tract infections may cause SABs and the prevalence and consequences of the sexually transmitted pathogen Mycoplasma genitalium (Mg) in pregnant women is unknown, we assessed the relationship between prenatal Mg infection and SAB. We conducted a nested case-control study among predominately young, African-American pregnant women recruited from an urban emergency department. Mg was measured by polymerase chain reaction in urine collected at enrollment from 82 women who subsequently experienced a SAB and 134 control women who maintained their pregnancies past 22 weeks gestation. Clinical, demographic and behavioral characteristics of cases and controls were compared. The relationship between Mg and subsequent SAB was evaluated, adjusting for age, smoking, Chlamydia trachomatis (Ct) infection, and previous SAB. The prevalence of Mg at enrollment was only slightly less than that of Ct (5.6% vs. 6.9%). Neither Mg (AOR 0.6, 95% CI 0.1-2.3) nor Ct (AOR 0.4 95% CI 0.1-1.6) were independently associated with SAB. After adjusting for Ct, Mg was associated with nulliparity (AOR 3.4, 95% CI 1.0-11.6), history of pelvic inflammatory disease (PID) (AOR 3.9, 95% CI 0.9-16.1), prior Ct infection (AOR 3.0, 95% CI 0.8-10.5) and problems getting pregnant (AOR 4.8, 95% CI 0.9-25.7), although not all relationships were statistically significant. Our study suggests pregnant women infected with Mg don't have an increased risk of SAB, but report a history of reproductive morbidities, including other STDs and PID.