Showing papers by "Centers for Disease Control and Prevention published in 1997"
TL;DR: Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast cancer diagnosed in women using HRT and associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body- mass index.
2,343 citations
TL;DR: Dual‐energy X‐ray absorptiometry measurements of femoral bone mineral density (BMD) from the third National Health and Nutrition Examination Survey (NHANES III, 1988–1994) are used to estimate the overall scope of the disease in the older U.S. population and explore different approaches for defining low BMD in older men in that age range.
Abstract: Data on the number of U.S. women with low femoral bone mineral density (BMD) are currently available only from indirect estimates. We used dual-energy X-ray absorptiometry (DXA) measurements of femoral BMD from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III, 1988-1991) to estimate prevalences of low femoral BMD in women ages 50 years and older using an approach proposed recently by an expert panel of the World Health Organization (WHO). Cutpoints for low BMD were derived from BMD data of 194 non-Hispanic white (NHW) women aged 20-29 years from the NHANES III dataset. The prevalence of older U.S. women with femoral osteopenia (BMD between 1 standard deviation [SD] and 2.5 SD below the mean of young NHW women) ranged from 34-50% in four different femur regions, which corresponds to approximately 12-17 million women. The prevalence with osteoporosis (BMD > 2.5 SD below the mean of young NHW women) ranged from 17-20%, or approximately 6-7 million women. Prevalences were 1.3-2.4 times higher in NHW women than non-Hispanic black women (NHB), and 0.8-1.2 times higher in NHW versus Mexican American (MA) women. The estimated numbers of NHW, NHB, and MA women with osteopenia were 10-15 million, 800,000-1.2 million, and 300,000-400,000, respectively; corresponding figures for osteoporosis were 5-6 million, 200,000-300,000, and 100,000 respectively. Thus, the first data on BMD from a nationally representative sample of older women show a substantial number with low femoral BMD.(ABSTRACT TRUNCATED AT 250 WORDS)
1,396 citations
TL;DR: Bacterial meningitis in the United States is now a disease predominantly of adults rather than of infants and young children, largely as a result of a 94 percent reduction in the number of cases of H. influenzaeMeningitis due to vaccine-related decline.
Abstract: Background Before the introduction of the conjugate vaccines, Haemophilus influenzae type b was the major cause of bacterial meningitis in the United States, and meningitis was primarily a disease of infants and young children. We describe the epidemiologic features of bacterial meningitis five years after the H. influenzae type b conjugate vaccines were licensed for routine immunization of infants. Methods Data were collected from active, population-based surveillance for culture-confirmed meningitis and other invasive bacterial disease during 1995 in laboratories serving all the acute care hospitals in 22 counties of four states (total population, more than 10 million). The rates were compared with those for 1986 obtained by similar surveillance. Results On the basis of 248 cases of bacterial meningitis in the surveillance areas, the rates of meningitis (per 100,000) for the major pathogens in 1995 were Streptococcus pneumoniae, 1.1; Neisseria meningitidis, 0.6; group B streptococcus, 0.3; Listeria mono...
1,248 citations
TL;DR: Iron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age and were more likely in those who are minority, low income, and multiparous.
Abstract: Objective. —To determine the prevalence of iron deficiency and iron deficiency anemia in the US population. Design. —Nationally representative cross-sectional health examination survey that included venous blood measurements of iron status. Main Outcome Measures. —lron deficiency, defined as having an abnormal value for at least 2 of 3 laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin); and iron deficiency anemia, defined as iron deficiency plus low hemoglobin. Participants. —A total of 24 894 persons aged 1 year and older examined in the third National Health and Nutrition Examination Survey (1988-1994). Results. —Nine percent of toddlers aged 1 to 2 years and 9% to 11% of adolescent girls and women of childbearing age were iron deficient; of these, iron deficiency anemia was found in 3% and 2% to 5%, respectively. These prevalences correspond to approximately 700000 toddlers and 7.8 million women with iron deficiency; of these, approximately 240 000 toddlers and 3.3 million women have iron deficiency anemia. Iron deficiency occurred in no more than 7% of older children or those older than 50 years, and in no more than 1% of teenage boys and young men. Among women of childbearing age, iron deficiency was more likely in those who are minority, low income, and multiparous. Conclusion. —lron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age.
1,200 citations
TL;DR: The seroprevalence of HSV-2 in persons 12 years of age or older in the United States was 21.9 percent (95 percent confidence interval, 20.2 to 23.6 percent), corresponding to 45 million infected people in the noninstitutionalized civilian population.
Abstract: Background Herpes simplex virus type 2 (HSV-2) infection is usually transmitted sexually and can cause recurrent, painful genital ulcers. In neonates the infection is potentially lethal. We investigated the seroprevalence and correlates of HSV-2 infection in the United States and identified changes in HSV-2 seroprevalence since the late 1970s. Methods Serum samples and questionnaire data were collected during the National Health and Nutrition Examination Surveys (NHANES) II (1976 to 1980) and III (1988 to 1994). HSV-2 antibody was assessed with an immunodot assay specific for glycoprotein gG-2 of HSV-2. Results From 1988 to 1994, the seroprevalence of HSV-2 in persons 12 years of age or older in the United States was 21.9 percent (95 percent confidence interval, 20.2 to 23.6 percent), corresponding to 45 million infected people in the noninstitutionalized civilian population. The seroprevalence was higher among women (25.6 percent) than men (17.8 percent) and higher among blacks (45.9 percent) than whites...
1,097 citations
TL;DR: Although the incidence of acute hepatitis C has declined, there is a large reservoir of chronically infected Americans who can serve as a source of transmission to others and who are at risk of the severe consequences of chronic liver disease.
1,041 citations
TL;DR: A case–control study of health care workers with occupational, percutaneous exposure to HIV-infected blood showed that significant risk factors for seroconversion were deep injury, injury with a device that was visibly contaminated with the source patient's blood, and a procedure inv...
Abstract: Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 percent, but the factors that influence this risk are not well understood. Methods We conducted a case–control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio = 15; 95 percent confidence interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio = 6.2; 95 percent confidence interval, 2.2 to 21), a procedure inv...
976 citations
Scripps Research Institute1, University of Vienna2, Arthritis Foundation3, Royal Perth Hospital4, University of Calgary5, Flinders Medical Centre6, Georgia Regents University7, University of Erlangen-Nuremberg8, Mount Sinai St. Luke's and Mount Sinai Roosevelt9, Centers for Disease Control and Prevention10, University of Connecticut11, Juntendo University12, Statens Serum Institut13, Tulane University14
TL;DR: It is recommended that laboratories performing immunofluorescent ANA tests should report results at both the 1:40 and 1:160 dilutions, and should supply information on the percentage of normal individuals who are positive at these dilutions.
Abstract: Objective. To determine the range of antinuclear antibodies (ANA) in “healthy” individuals compared with that in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc; scleroderma), Sjogren's syndrome (SS), rheumatoid arthritis (RA), or soft tissue rheumatism (STR).
Methods. Fifteen international laboratories experienced in performing tests for ANA by indirect immunofluorescence participated in analyzing coded sera from healthy individuals and from patients in the 5 different disease groups described above. Except for the stipulation that HEp-2 cells should be used as substrate, each laboratory used its own in-house methodology so that the data might be expected to reflect the output of a cross-section of worldwide ANA reference laboratories. The sera were analyzed at 4 dilutions: 1:40, 1:80, 1:160, and 1:320.
Results. In healthy individuals, the frequency of ANA did not differ significantly across the 4 age subgroups spanning 20–60 years of age. This putatively normal population was ANA positive in 31.7% of individuals at 1:40 serum dilution, 13.3% at 1:80, 5.0% at 1:160, and 3.3% at 1:320. In comparison with the findings among the disease groups, a low cutoff point at 1:40 serum dilution (high sensitivity, low specificity) could have diagnostic value, since it would classify virtually all patients with SLE, SSc, or SS as ANA positive. Conversely, a high positive cutoff at 1:160 serum dilution (high specificity, low sensitivity) would be useful to confirm the presence of disease in only a portion of cases, but would be likely to exclude 95% of normal individuals.
Conclusion. It is recommended that laboratories performing immunofluorescent ANA tests should report results at both the 1:40 and 1:160 dilutions, and should supply information on the percentage of normal individuals who are positive at these dilutions. A low-titer ANA is not necessarily insignificant and might depend on at least 4 specific factors. ANA assays can be a useful discriminant in recognizing certain disease conditions, but can create misunderstanding when the limitations are not fully appreciated.
770 citations
TL;DR: It is proposed that a critical determinant of life-time disease risk is the ability to develop clinical immunity early in life during a period when other protective mechanisms may operate, and measures which reduce parasite transmission, and thus immunity, may lead to a change in both the clinical spectrum of severe disease and the overall burden of severe malaria morbidity.
705 citations
Journal Article•
TL;DR: In the past, the central challenge of foodborne disease lay in preventing the contamination of human food with sewage or animal manure, but the future will increasingly depend on controlling contamination of feed and water consumed by the animals themselves.
Abstract: The epidemiology of foodborne disease is changing. New pathogens have emerged, and some have spread worldwide. Many, including Salmonella, Escherichia coli O157:H7, Campylobacter, and Yersinia enterocolitica, have reservoirs in healthy food animals, from which they spread to an increasing variety of foods. These pathogens cause millions of cases of sporadic illness and chronic complications, as well as large and challenging outbreaks over many states and nations. Improved surveillance that combines rapid subtyping methods, cluster identification, and collaborative epidemiologic investigation can identify and halt large, dispersed outbreaks. Outbreak investigations and case-control studies of sporadic cases can identify sources of infection and guide the development of specific prevention strategies. Better understanding of how pathogens persist in animal reservoirs is also critical to successful long-term prevention. In the past, the central challenge of foodborne disease lay in preventing the contamination of human food with sewage or animal manure. In the future, prevention of foodborne disease will increasingly depend on controlling contamination of feed and water consumed by the animals themselves.
607 citations
TL;DR: Results from this study and other recent studies suggest that the increase in body mass index in the United States that occurred during the 1980s may portend an increase in the incidence of non-insulin-dependent diabetes mellitus with important public health consequences in future years.
Abstract: To examine how long-term patterns of weight change affect the risk for diabetes, especially non-insulin-dependent diabetes mellitus, the authors examined the relation of weight change over a period of about 10 years (from the baseline examination in 1971-1975 until the first follow-up examination in 1982-1984) to the 9-year incidence of diabetes mellitus (1984-1992) in a national cohort of 8,545 US adults from the National Health and Nutrition Examination Survey Epidemiologic Followup Study. Diabetes incidence was identified from death certificates, hospitalization and nursing home records, and self-report. In this cohort, 487 participants developed diabetes. The hazard ratios were 2.11 (95% confidence interval (CI) 1.40-3.18) for participants who gained 5- < 8 kg, 1.19 (95% CI 0.75-1.89) for participants who gained 8- < 11 kg, 2.57 (95% CI 1.84-3.85) for participants who gained 11- < 20 kg, and 3.85 (95% CI 2.04-7.22) for participants who gained 20 kg or more compared with participants whose weights remained relatively stable. The authors found no evidence that the results differed by age, sex, or race. They estimated that the population attributable risk was 27% for weight increases of 5 kg or more. Results from this study and other recent studies suggest that the increase in body mass index in the United States that occurred during the 1980s may portend an increase in the incidence of non-insulin-dependent diabetes mellitus with important public health consequences in future years.
TL;DR: Amebas belonging to the genera Naegleria, Acanthamoeba and Balamuthia are free‐living, amphizoic and opportunistic protozoa that are ubiquitous in nature.
Abstract: Amebas belonging to the genera Naegleria, Acanthamoeba and Balamuthia are free-living, amphizoic and opportunistic protozoa that are ubiquitous in nature. These amebas are found in soil, water and air samples from all over the world. Human infection due to these amebas involving brain, skin, lung and eyes has increased significantly during the last 10 years. The epidemiology, immunology, protozoology, pathology, and clinical features of the infections produced by these protozoa differ strikingly. Infection by the pathogenic Naegleria fowleri is acquired by exposure to polluted water in ponds, swimming pools and man-made lakes. Raised temperatures during the hot summer months or warm water from power plants facilitate the growth of N. fowleri. N. fowleri is a thermophilic ameba that grows well in tropical and subtropical climates. The CNS infection, called Primary Amebic Meningoencephalitis (PAM), produced by N. fowleri is characterized by an acute fulminant meningoencephalitis leading to death 3-7 days after exposure. Victims are healthy, young individuals with a history of recent water-related sport activities. The portal of entry is the olfactory neuroepithelium. The pathologic changes are an acute hemorrhagic necrotizing meningoencephalitis with modest purulent exudate, mainly at the base of the brain, brain-stem and cerebellum. Trophozoites can be seen within the CNS lesions located mainly around blood vessels. Thus far 179 cases have been reported; 81 in the USA alone. Balamuthia mandrillaris and several species of Acanthamoeba are pathogenic "opportunistic" free-living amebas which cause Granulomatous Amebic Encephalitis (GAE) in humans and animals. GAE is an infection, usually seen in debilitated, malnourished individuals, in patients undergoing immunosuppressive therapy for organ transplants and in Acquired Immunodeficiency Syndrome (AIDS). The granulomatous component is negligible, particularly in immunocompromised individuals. Pathologically these amebas produce a patchy, chronic or subacute granulomatous encephalitis with the presence of trophozoites and cysts. The portal of entry is probably through the respiratory tract or an ulceration of the skin reaching the CNS by hematogenous spread. As of October 1, 1996, 166 cases (103 due to Acanthamoeba and 63 due to Balamuthia) of GAE have been reported from around the world. Of these 103 cases due to Acanthamoeba (72 have been reported in the USA alone, > 50 in AIDS). It is well known that several species of Acanthamoeba can also produce, chronic sight threatening ulceration of the cornea called Acanthamoeba keratitis (AK), mostly in contact lens wearers or in individuals with minor corneal abrasions. Hundreds of cases of AK have been documented world wide.
TL;DR: Chocolate milk served at the picnic was found to be contaminated with Listeria monocytogenes, and sporadic cases of invasive listeriosis may be due to unrecognized outbreaks caused by contaminated food.
Abstract: Background After an outbreak of gastroenteritis and fever among persons who attended a picnic in Illinois, chocolate milk served at the picnic was found to be contaminated with Listeria monocytogenes. Methods In investigating this outbreak, we interviewed the people who attended the picnic about what they ate and their symptoms. Surveillance for invasive listeriosis was initiated in the states that receive milk from the implicated dairy. Stool and milk samples were cultured for L. monocytogenes. Serum samples were tested for IgG antibody to listeriolysin O. Results Forty-five persons had symptoms that met the case definition for illness due to L. monocytogenes, and cultures of stool from 11 persons yielded the organism. Illness in the week after the picnic was associated with the consumption of chocolate milk. The most common symptoms were diarrhea (present in 79 percent of the cases) and fever (72 percent). Four persons were hospitalized. The median incubation period for infection was 20 hours (range, 9 ...
TL;DR: The influenza epidemic severity index was useful for categorizing severity and provided improved seasonal estimates of the total number of influenza-related deaths.
Abstract: Objectives The purpose of this study was to assess the impact of recent influenza epidemics on mortality in the United States and to develop an index for comparing the severity of individual epidemics. Methods A cyclical regression model was applied to weekly national vital statistics from 1972 through 1992 to estimate excesses in pneumonia and influenza mortality and all-cause mortality for each influenza season. Each season was categorized on the basis of increments of 2000 pneumonia and influenza excess deaths, and each of these severity categories was correlated with a range of all-cause excess mortality. Results Each of the 20 influenza seasons studied was associated with an average of 5600 pneumonia and influenza excess deaths (range, 0-11,800) and 21,300 all-cause excess deaths (range, 0-47,200). Most influenza A(H3N2) seasons fell into severity categories 4 to 6 (23,000-45,000 all-cause excess deaths), whereas most A(H1N1) and B seasons were ranked in categories 1 to 3 (0-23,000 such deaths). Conclusions From 1972 through 1992, influenza epidemics accounted for a total of 426,000 deaths in the United States, many times more than those associated with recent pandemics. The influenza epidemic severity index was useful for categorizing severity and provided improved seasonal estimates of the total number of influenza-related deaths.
TL;DR: Improved surveillance that combines rapid subtyping methods, cluster identification, and collaborative epidemiologic investigation can identify and halt large, dispersed outbreaks and better understanding of how pathogens persist in animal reservoirs is critical to successful long-term prevention.
Abstract: The epidemiology of foodborne disease is changing. New pathogens have emerged, and some have spread worldwide. Many, including Salmonella, Escherichia coli O157:H7, Campylobacter, and Yersinia enterocolitica, have reservoirs in healthy food animals, from which they spread to an increasing variety of foods. These pathogens cause millions of cases of sporadic illness and chronic complications, as well as large and challenging outbreaks over many states and nations. Improved surveillance that combines rapid subtyping methods, cluster identification, and collaborative epidemiologic investigation can identify and halt large, dispersed outbreaks. Outbreak investigations and case-control studies of sporadic cases can identify sources of infection and guide the development of specific prevention strategies. Better understanding of how pathogens persist in animal reservoirs is also critical to successful long-term prevention. In the past, the central challenge of foodborne disease lay in preventing the contamination of human food with sewage or animal manure. In the future, prevention of foodborne disease will increasingly depend on controlling contamination of feed and water consumed by the animals themselves.
TL;DR: This large outbreak of salmonellosis was caused by intentional contamination of restaurant salad bars by members of a religious commune and demonstrates the vulnerability of self-service foods to intentional contamination.
Abstract: Context. —This large outbreak of foodborne disease highlights the challenge of investigating outbreaks caused by intentional contamination and demonstrates the vulnerability of self-service foods to intentional contamination. Objective. —To investigate a large community outbreak of Salmonella Typhimurium infections. Design. —Epidemiologic investigation of patients with Salmonella gastroenteritis and possible exposures in The Dalles, Oregon. Cohort and case-control investigations were conducted among groups of restaurant patrons and employees to identify exposures associated with illness. Setting. —A community in Oregon. Outbreak period was September and October 1984. Patients. —A total of 751 persons with Salmonella gastroenteritis associated with eating or working at area restaurants. Most patients were identified through passive surveillance; active surveillance was conducted for selected groups. A case was defined either by clinical criteria or by a stool culture yielding S Typhimurium. Results. —The outbreak occurred in 2 waves, September 9 through 18 and September 19 through October 10. Most cases were associated with 10 restaurants, and epidemiologic studies of customers at 4 restaurants and of employees at all 10 restaurants implicated eating from salad bars as the major risk factor for infection. Eight (80%) of 10 affected restaurants compared with only 3 (11%) of the 28 other restaurants in The Dalles operated salad bars (relative risk, 7.5; 95% confidence interval, 2.4-22.7; P Conclusions. —This outbreak of salmonellosis was caused by intentional contamination of restaurant salad bars by members of a religious commune.
TL;DR: The diagnostic methods for C. trachomatis infection that are currently approved for use in the United States are described and compared, including the newest DNA amplification technologies which are yet to be licensed for commercial use.
Abstract: Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed.
TL;DR: Underreporting of energy intake was highest in women and persons who were older, overweight, or trying to lose weight, and was associated with diets lower in fat and alcohol when expressed as a percentage of total energy intake.
TL;DR: Results from the 1995 National College Health Risk Behavior Survey suggest that many students' behaviors increase their likelihood of adverse health outcomes, and can be used by those responsible for the health and education of college students to reduce risks associated with the leading causes of mortality and morbidity.
Abstract: Results from the 1995 National College Health Risk Behavior Survey, which monitored health risk behaviors among US college and university undergraduates, suggest that many students' behaviors increase their likelihood of adverse health outcomes. During the 30 days preceding the survey, 34% of the participants had consumed five or more alcoholic drinks on at least one occasion, and 27% had drunk alcohol and driven a car. Thirty-one percent had smoked cigarettes regularly during their lifetimes, 49% had ever used marijuana, 30% had used a condom during their last sexual intercourse, 21% were overweight, and 38% had participated in vigorous physical activity on 3 or more of the 7 days preceding the survey. These data were analyzed by gender, age group, race and ethnicity, and institution type. They can be used by those responsible for the health and education of college students to reduce risks associated with the leading causes of mortality and morbidity.
TL;DR: Anxiety and depression are predictive of later incidence of hypertension and prescription treatment for hypertension in a population-based sample of 2992 initially normotensive persons.
Abstract: Objective To test the hypothesis that symptoms of anxiety and depression increase the risk of experiencing hypertension, using the National Health and Nutrition Examination I Epidemiologic Follow-up Study. Design A cohort of men and women without evidence of hypertension at baseline were followed up for 7 to 16 years. The association between 2 outcome measures (hypertension and treated hypertension) and baseline anxiety and depression was analyzed using Cox proportional hazards regression adjusting for hypertension risk factors (age; sex; education; cigarette smoking; body mass index; alcohol use; history of diabetes, stroke, or coronary heart disease; and baseline systolic blood pressure). Analyses were stratified by race and age (white persons aged 25-44 years and 45-64 years and black persons aged 25-64 years). Setting General community. Participants A population-based sample of 2992 initially normotensive persons. Main outcome measures Incident hypertension was defined as blood pressure of 160/95 mm Hg or more, or prescription of antihypertensive medications. Treated hypertension was defined as prescription of antihypertensive medications. Results In the multivariate models for whites aged 45 to 64 years, high anxiety (relative risk [RR], 1.82; 95% confidence interval [CI], 1.30-2.53) and high depression (RR, 1.80; 95% CI, 1.16-2.78) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 2.36; 95% CI, 1.73-3.23) and high depression (RR, 1.89; 95% CI, 1.25-2.85). For blacks aged 25 to 64 years, high anxiety (RR, 2.74; 95% CI, 1.35-5.53) and high depression (RR, 2.99; 95% CI, 1.41-6.33) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 3.24; 95% CI, 1.59-6.61) and high depression (RR, 2.92; 95% CI, 1.37-6.22). For whites aged 25 to 44 years, intermediate anxiety (RR, 1.62; 95% CI, 1.18-2.22) and intermediate depression (RR, 1.60; 95% CI, 1.17-2.17) remained independent predictors of treated hypertension only. Conclusion Anxiety and depression are predictive of later incidence of hypertension and prescription treatment for hypertension.
TL;DR: Strain typing cannot be used to replace a sound epidemiological investigation, but serves as a useful adjunct to such investigations as an integral part of epidemiological investigations of nosocomial infections.
Abstract: Strain typing is an integral part of epidemiological investigations of nosocomial infections. Methods for distinguishing among bacterial strains have improved dramatically over the last 5 years, due mainly to the introduction of molecular technology. Although not all molecular techniques are equally effective for typing all organisms, pulsed-field gel electrophoresis is the technique currently favored for most nosocomial pathogens. Criteria to aid epidemiologists in interpreting results have been published. Nucleic acid amplification-based typing methods also are applicable to many organisms and can be completed within a single day, but interpretive criteria still are under debate. Strain typing cannot be used to replace a sound epidemiological investigation, but serves as a useful adjunct to such investigations.
TL;DR: Data from two birth defects surveillance systems in the United States showed an approximate doubling of hypospadias rates in the 1970s and 1980s, which would represent the largest number of cases and the first report of an increase in hypos padias rates outside of Europe.
Abstract: Objective. Hypospadias is a common congenital anomaly, the cause of which is unknown. Unexplained increases in the rates of hypospadias occurred in five European countries in the 1970s and 1980s. We examined data from two birth defects surveillance systems in the United States for evidence of similar trends. Methodology. The Metropolitan Atlanta Congenital Defects Program (MACDP) provided birth prevalence rates from 1968 to 1993. The nationwide Birth Defects Monitoring Program (BDMP) provided rates from 1970 to 1993. MACDP data are population-based and could be categorized by the severity of the hypospadias. BDMP data allowed analysis of rate trends for the four census regions of the United States. Results. Data from both surveillance systems showed an approximate doubling of hypospadias rates in the 1970s and 1980s. MACDP data showed that the rate of severe cases increased while the ratio of mild to severe cases decreased. BDMP data showed that hypospadias rates increased markedly in all four regions of the United States. Conclusions. The observed increases are unlikely to be attributable to increased sensitivity of the surveillance systems or the identification of more mild cases by physicians over time, because either trend would have increased rather than decreased the ratio of mild to severe cases. If real, these trends represent the largest number of cases and the first report of an increase in hypospadias rates outside of Europe. Additional investigation of a possible increase in hypospadias rates is warranted.
TL;DR: After treatment for primary or secondary syphilis, the HIV-infected patients responded less well serologically than the patients without HIV infection, but clinically defined failure was uncommon in both groups.
Abstract: Background Reports of neurosyphilis and invasion of cerebrospinal fluid by Treponema pallidum in patients with human immunodeficiency virus (HIV) infection have led to doubts about the adequacy of the recommended penicillin G benzathine therapy for early syphilis. Methods In a multicenter, randomized, double-blind trial, we assessed two treatments for early syphilis: 2.4 million units of penicillin G benzathine and that therapy enhanced with a 10-day course of amoxicillin and probenecid. The serologic and clinical responses of patients with and without HIV infection were studied during one year of follow-up. Results From 1991 through 1994, 541 patients were enrolled, including 101 patients (19 percent) who had HIV infection but differed little from the uninfected patients in their clinical presentations. The rates at which chancres and rashes resolved did not differ significantly according to treatment assignment or HIV status. Serologically defined treatment failures were more common among the HIV-infect...
TL;DR: A model is constructed that compares the impact of three classic agents of biologic warfare when released as aerosols in the suburb of a major city and provides economic justification for preparedness measures.
Abstract: Understanding and quantifying the impact of a bioterrorist attack are essential in developing public health preparedness for such an attack. We constructed a model that compares the impact of three classic agents of biologic warfare (Bacillus anthracis, Brucella melitensis, and Francisella tularensis) when released as aerosols in the suburb of a major city. The model shows that the economic impact of a bioterrorist attack can range from an estimated $477.7 million per 100,000 persons exposed (brucellosis scenario) to $26.2 billion per 100,000 persons exposed (anthrax scenario). Rapid implementation of a postattack prophylaxis program is the single most important means of reducing these losses. By using an insurance analogy, our model provides economic justification for preparedness measures.
TL;DR: The incidence of necrotizing fasciitis caused by group A streptococcus increased in Ontario between 1992 and 1995 and was associated with the presence of hypotension, Strep TSS, or bacteremia, but not with M-type or the absence of pyrogenic exotoxin genes.
TL;DR: Tabular data for population prevalence estimates from the third National Health and Nutrition Examination Survey (NHANES III) at selected gender- and age-specific BMI levels ranging from < 18.0 to > 45.0 are presented and compared with various examples of BMI criteria reported in the scientific literature.
Abstract: Body mass index (BMI; kg/m2) distributions are commonly reported in the scientific literature to describe weight for stature. These data are collected for various groups of subjects in local health and body composition studies, and comparisons with national distributions are often desirable. Tabular data for population prevalence estimates from the third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) at selected gender- and age-specific BMI levels ranging from 45.0 are presented and compared with various examples of BMI criteria reported in the scientific literature. NHANES III was a statistically representative national probability sample of the civilian, noninstitutionalized population of the United States in which height and weight were measured as part of a more comprehensive health examination. The implications of varying population prevalence estimates based on varying BMI cutoff points are briefly discussed for selected examples including World Health Organization over-weight/obesity criteria and the U.S. Dietary Guidelines for Americans. The median BMI for U.S. adults aged 20 years and older is 25.5 kg/m2. Median stature and weight for men are 175.5 cm and 80.0 kg and for women are 161.6 cm and 65.6 kg, respectively. The percentage of the population with BMI or = 19.0 to or = 25.0 is 59.4% for men, 50.7% for women. An estimated 97.1 million adults have a BMI > or = 25.0. Additional prevalence estimates based on other BMI cutoff points and ages are presented.
TL;DR: Addressing emerging foodborne diseases will require more sensitive and rapid surveillance, enhanced methods of laboratory identification and subtyping, and effective prevention and control.
Abstract: The epidemiology of foodborne diseases is rapidly changing. Recently described pathogens, such as Escherichia coli O157:H7 and the epidemic strain of Salmonella serotype Typhimurium Definitive Type 104 (which is resistant to at least five antimicrobial drugs), have become important public health problems. Well-recognized pathogens, such as Salmonella serotype Enteritidis, have increased in prevalence or become associated with new vehicles. Emergence in foodborne diseases is driven by the same forces as emergence in other infectious diseases: changes in demographic characteristics, human behavior, industry, and technology; the shift toward a global economy; microbial adaptation; and the breakdown in the public health infrastructure. Addressing emerging foodborne diseases will require more sensitive and rapid surveillance, enhanced methods of laboratory identification and subtyping, and effective prevention and control.
TL;DR: There was a significant stepwise decrease in the percentage of resistant organisms isolated from patients in the intensive care unit (ICU), non-ICU inpatients, and outpatients.
Abstract: To compare the occurrence of antimicrobial resistance in hospitals with that in the community, we analyzed data for isolates collected from inpatients and outpatients in eight U.S. hospitals. The percentage of resistant isolates from inpatients was higher than that from outpatients for the following combinations of antimicrobials and organisms: methicillin/coagulase-negative Staphylococcus (49.0% vs. 36.0%, respectively; P < .01); methicillin/Staphylococcus aureus (33.0% vs. 14.5%, respectively; P < .01); ceftazidime/Enterobacter cloacae (26.0% vs. 12.0%, respectively; P < .01); imipenem/Pseudomonas aeruginosa (12.0% vs. 6.5%, respectively; P < .01); ceftazidime/P. aeruginosa (7.8% vs. 4.0%, respectively; P < .01); and vancomycin/Enterococcus species (6.3% vs. 1.4%, respectively; P < .01). There was a significant stepwise decrease in the percentage of resistant organisms isolated from patients in the intensive care unit (ICU), non-ICU inpatients, and outpatients. These results suggest that resources allocated to control antimicrobial resistance should continue to be focused in the hospital, particularly in the ICU.
TL;DR: The prevalence of overweight increased among some sex and age groups of preschool children between 1971 through 1974 and 1988 through 1994 compared with 5.8% of 4-and 5-year-old girls as discussed by the authors.
Abstract: Objective. To examine the prevalence of overweight among US preschool children 2 months through 5 years of age between the years 1971 through 1974 and 1988 through 1994. Design. Nationally representative cross-sectional surveys with a physical examination, including measurement of stature, length, and weight. Between 1200 and 7500 children younger than 6 years were examined in each of four different surveys during 1971 through 1974 (first National Health and Nutrition Examination Survey [NHANES I]), 1976 through 1980 (NHANES II), 1982 through 1984 (Hispanic Health and Nutrition Examination Survey), and 1988 through 1994 (NHANES III). Results. The prevalence of overweight increased among some sex and age groups of preschool children between 1971 through 1974 and 1988 through 1994. More than 10% of 4- and 5-year-old girls were overweight in 1988 through 1994 compared with 5.8% in 1971 through 1974. However, there was no change during this period in the prevalence of overweight among 1- and 2- to 3-year-old children. During 1988 through 1994, the prevalence of overweight among children 2 months through 5 years of age was consistently higher in girls than boys. Mexican-American children had a higher prevalence of overweight than non-Hispanic black and non-Hispanic white children. These results parallel what has been reported for older children and adults in the United States. Conclusion. These results show that in the last 20 years the prevalence of overweight has increased among 4- and 5-year-old children but not among younger children. These findings suggest that efforts to prevent overweight, including encouragement of physical activity and improved diets, should begin in early childhood. overweight, anthropometry, preschool children.
TL;DR: Comparing the changes in cervical cancer incidence at different ages after the introduction of screening in different populations, and addressing the impact of organized and opportunistic smear taking, organized screening may not bemarkedly superior to opportunistic screening.
Abstract: Because Pap-smear screening can detect pre-invasive cervical cancer, such screening can markedly reduce the occurrence of invasive cancer. However, its impact in different populations is uncertain. This study compares the changes in cervical cancer incidence at different ages after the introduction of screening in different populations, and addresses the impact of organized and opportunistic smear taking. We identified 17 cancer registries large enough and existing long enough to analyze screening effects. For each registry, we calculated the relative reduction in age-specific incidence rates and in incidence rates age-standardized to the world population after the introduction of cytologic screening. In 11 of the 17 populations, age-standardized incidence rates declined markedly from 27 percent in Norway and to 77 percent in Finland. Age-specific declines were confined to women aged 30 to 70 years old with a nadir around ages 40 to 55. In six other populations, age-standardized incidence rates declined less than 25 percent, an amount too small to provide unambiguous evidence of a screening effect. In several populations, cytologic screening had a more pronounced effect than is generally recognized. Because age-specific declines in cervical cancer incidence rates were strikingly similar in populations with widely different screening practices, organized screening may not be markedly superior to opportunistic screening. The reduction in reported cancer incidence because of screening is smaller in younger and older women.