Showing papers by "Ohio Department of Health published in 2006"

Mortality and medical comorbidity among patients with serious mental illness.

Abstract: OBJECTIVES This study examined mortality and medical comorbidity among patients with serious mental illness in Ohio. METHODS Data for 20,018 patients admitted to an Ohio public mental health hospital between 1998 and 2002 were matched against state death records, and 608 deaths were identified. Leading causes of death and medical comorbidities, years of potential life lost (YPLL), and standardized mortality ratios were calculated for this population. RESULTS Heart disease (126 persons, or 21 percent) and suicides (108 persons, or 18 percent) were the leading causes of death. The mean+/-SD number of YPLL was 32.0+/-12.6 years. The highest cause-specific mean YPLL was for suicides (41.7+/-10.3 years). Deaths from unnatural causes had higher mean YPLL than deaths from any other causes. Cause-specific mean YPLL were higher for women than for men, except for homicides, pneumonia and influenza, and heart disease. The aggregated standardized mortality ratio from all causes of death was 3.2, corresponding to 417 excess deaths (p<.001). Obesity (144 persons, or 24 percent) and hypertension (136 persons, or 22 percent) were the most prevalent medical comorbidities. CONCLUSIONS This study demonstrated excess mortality among patients in Ohio with serious mental illness. Results highlight the need to integrate delivery of currently fragmented mental and physical health services and to target interventions that improve quality-of-life outcomes for this population.

Nationwide outbreak of listeriosis due to contaminated meat.

Abstract: We used molecular subtyping to investigate an outbreak of listeriosis involving residents of 24 US states. We defined a case as infection with Listeria monocytogenes serotype 4b yielding one of several closely related patterns when subtyped by pulsed-field gel electrophoresis. Patients infected with strains yielding different patterns were used as controls. A total of 108 cases were identified with 14 associated deaths and four miscarriages or stillbirths. A case-control study implicated meat frankfurters as the likely source of infection (OR 17.3, 95% CI 2.4-160). The outbreak ended abruptly following a manufacturer-issued recall, and the outbreak strain was later detected in low levels in the recalled product. A second strain was recovered at higher levels but was not associated with human illness. Our findings suggest that L. monocytogenes strains vary widely in virulence and confirm that large outbreaks can occur even when only low levels of contamination are detected in sampled food. Standardized molecular subtyping and coordinated, multi-jurisdiction investigations can greatly facilitate detection and control of listeriosis outbreaks.

Cryptosporidiosis Associated with Ozonated Apple Cider

Abstract: We linked an outbreak of cryptosporidiosis to ozonated apple cider by using molecular and epidemiologic methods. Because ozonation was insufficient in preventing this outbreak, its use in rendering apple cider safe for drinking is questioned.

Outbreak of pertussis among healthcare workers in a hospital surgical unit.

Abstract: Background.In September 1999, a pertussis outbreak was detected among surgical staff of a 138-bed community hospital. Patients were exposed to Bordetella pertussis during the 3-month outbreak period.Objective.To describe the outbreak among surgical staff, to evaluate implemented control measures, and to determine whether nosocomial transmission occurred.Methods.Clinical pertussis was defined as acute cough illness with a duration of 14 days or more without another apparent cause; persons with positive culture, PCR, or serologic test results were defined as having laboratory-confirmed pertussis. Surgical healthcare workers (HCWs) were interviewed regarding pertussis symptoms, and specimens were obtained for laboratory analysis. Patients exposed to B. pertussis during an ill staff member's 3-week infectious period were interviewed by phone to determine the extent of nosocomial spread.Participants.A total of 53 HCWs assigned to the surgical unit and 146 exposed patients. HCWs with pertussis were defined as case subjects; HCWs without pertussis were defined as non-case subjects.Results.Twelve (23%) of 53 HCWs had clinical pertussis; 6 cases were laboratory confirmed. The median cough duration in the 12 case subjects was 27 days (range, 20-120 days); 10 (83%) had paroxysms. Eleven (92%) of 12 case subjects and 28 (86%) of 41 non-case subjects received antibiotic treatment or prophylaxis. Seven case subjects (58%) reported they always wore a mask when near patients. Of 146 patients potentially exposed to pertussis from the 12 case subjects, 120 (82%) were interviewed; none reported a pertussis-like illness.Conclusions.Surgical staff transmitted B. pertussis among themselves; self-reported data suggests that these HCWs did not transmit B. pertussis to their patients, likely because of mask use, cough etiquette, and limited face-to-face contact. Control measures might have helped limit the outbreak once pertussis was recognized.

Update: Fusarium keratitis - United States, 2005-2006

Abstract: In April 2006, CDC reported on an ongoing multistate investigation of Fusarium keratitis occurring predominantly among contact lens wearers. This update summarizes epidemiologic developments in this investigation, which indicate an association with Bausch & Lomb's ReNu with MoistureLoc contact lens solution.

Outbreak of Cutaneous Rhizopus arrhizus Infection Associated with Karaya Ostomy Bags

Abstract: BACKGROUND We investigated an outbreak involving 2 patients hospitalized at hospital A with cutaneous Rhizopus arrhizus (oryzae) infections of surgically created stomas. METHODS A cohort study involving all patients having ileostomy or colostomy surgery during the outbreak period (January-April 2005) was performed. Environmental samples, including samples obtained from nonsterile karaya (a plant-derived adhesive) ostomy bags and from select hospital areas, were collected. A point prevalence survey was conducted at 5 unrelated hospitals to assess stoma care practices and mold contamination of karaya ostomy bags outside of hospital A. Zygomycete isolates were identified by standard methods. RESULTS Infections occurred 7 and 10 days after operations for the 2 patients; 1 patient died. In a 21-patient cohort, receiving the equivalent of > or =0.5 mg/kg per day of prednisone during the week prior to the index date was associated with infection (infection rate, 33% for patients receiving > or =0.5 mg/kg per day of prednisone vs. 0% for patients receiving <0.5 mg/kg per day of prednisone; P=.07). The time to first ostomy bag change was longer for patients with infection (median duration, 8.5 days; range, 7-10 days) than for the 19 patients without infection (median duration, 1.5 days; range, 1-17 days; P=.08). At unrelated hospitals, the median time to first ostomy bag change was 2 days (range, 1-6 days) for 18 patients after ostomy. R. arrhizus was recovered from 10 of 18 karaya ostomy bags from hospital A and from karaya ostomy bags donated from 3 of 5 other hospitals, but it was not recovered from the hospital A environment. CONCLUSIONS The initial karaya ostomy bag was likely to be the source of Rhizopus infection, and prolonged exposure before the first ostomy bag change might have precipitated infection in these susceptible individuals. Karaya might contain opportunistic molds that can pose an infectious risk among susceptible persons.

Case history of liner veneer instability

Abstract: Construction conditions experienced during installation of a landfill geocomposite liner system led to two slides on a 3H:1V slope during construction. The landfill was being developed for final disposal of flue gas desulfurization by-product material (FGD). The slides occurred in two different areas of the 3H:1V slope and encompass 10,500 and 20,235 m2 in the Fall of 1996 and Summer of 1997, respectively. The slides developed by movement along the PVC geomembrane/compacted clay liner interface during or shortly after placement of the protective FGD cover material over the drainage sand layer. Laboratory direct shear tests revealed that the shear strength of this interface is sensitive to the moisture content of the exposed compacted clay liner. The direct shear tests revealed reductions in the available shear strength of 35% and 37% for the peak and large displacement values as the compacted clay liner moisture content increased by 8 percentage points. In addition, shear stresses induced by surface traff...