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Biomedical subjects

G Birkhead

Publications and source records attributed to G Birkhead.

At least 19 recordsLinked to original sources
PubMed2001

A new paradigm for HIV care: ethical and clinical considerations.

Although dramatic advances in clinical treatment have greatly improved the lives of many people with HIV/AIDS, many other patients do not have information about or access to these treatments because of health care providers' presumptive judgments about patients' ability to adhere to medical regimens. The authors contend that with sufficient support and education most patients, even those with difficult social and medical problems, can be helped to initiate and maintain HIV treatment in accordance with current clinical standards. This commentary delineates a new paradigm for HIV care in which patients and providers collaborate on individualized plans to establish patients' readiness for treatment, ensure maintenance of treatment, and make use of the social services necessary to accomplish these goals. Providers have an ethical responsibility to do everything possible to see that patients who might benefit from new HIV treatments have a fair opportunity to do so, and health systems have a responsibility to facilitate this process. Substantial progress toward meeting these responsibilities can be made within the current health care environment.

Ethics, Medical↗
PubMed1999

Mandatory reporting of diseases and conditions by health care professionals and laboratories.

CONTEXT: Surveillance is a key component of the core public health function of health assessment. Systematic reporting by health care professionals and laboratories, which may vary by state law, statute, or regulation, continues to provide essential data for assessing public health. OBJECTIVE: To describe the state and territorial reporting requirements for diseases and conditions recommended for national public health surveillance. DESIGN, SETTING, AND PARTICIPANTS: Between May and August 1997, the state and territorial epidemiologists from all 50 states, in addition to New York City, Puerto Rico, and Guam, completed questionnaires indicating which diseases and conditions were reportable by health care professionals and laboratories in their jurisdictions. The surveys were subsequently updated to reflect reporting requirements current as of January 1, 1999. The overall response rate for the survey was 100% for US states and 90% overall, including the territories. MAIN OUTCOME MEASURE: State and territorial reporting requirements for diseases and conditions of public health concern. RESULTS: Of the 58 diseases and conditions recommended for national reporting, 35 (60%) were reportable in greater than 90% of the states and territories, 15 (26%) were reportable in 75% to 90%, and 8 (14%) were reportable in less than 75%. Nineteen of the infectious diseases were reportable in all of the states and territories that responded. CONCLUSIONS: Required reporting varies substantially by state or territory. Health care professionals are integral to public health efforts at the local, state, and national levels.

Communicable Diseases↗
PubMed1997

Swimming-associated haemorrhagic colitis due to Escherichia coli O157:H7 infection: evidence of prolonged contamination of a fresh water lake.

We describe an Escherichia coli O157:H7 outbreak associated with a fresh water lake at a county park. Campers were surveyed for diarrhoeal illness within 10 days of their visit, and a case-control study of day visitors was conducted. A confirmed case was a symptomatic person with a stool culture positive for E. coli O157:H7 and a probable case was a person with bloody diarrhoea. Clinical isolates of E. coli O157 were subtyped by pulsed field gel electrophoresis (PFGE). In the camper survey, 12 (38%) of 32 swimmers had a diarrhoeal illness (relative risk [RR] = 12.4; 95% confidence interval [CI] = 1.7-89.7). For the case-control study, the 12 cases were more likely than controls to have purposefully ingested lake water (odds ratio [OR] = 6.9, 95% CI = 0.9-55.8). The PFGE patterns of six clinical isolates were indistinguishable. This report further demonstrates that contaminated fresh-water lakes can be the source of community outbreaks of E. coli O157:H7.

Adolescent↗
PubMed1996

Assessment of surveillance for meningococcal disease in New York State, 1991.

Prevention of meningococcal disease relies in part on the prompt treatment of household and other close contacts of cases. New York State requires that all meningococcal disease cases be reported within 24 hours of diagnosis to ensure that chemoprophylaxis is given to all exposed persons. The authors used a capture-recapture method to assess completeness of reporting of meningococcal disease in 1991 by comparing persons reported to the Department of Health surveillance system with patients listed in the New York State computerized hospital discharge data set who had a discharge diagnosis of meningococcal disease. Medical records of persons identified from the discharge data set were reviewed to verify the diagnosis of meningococcal disease, and timeliness of reporting was assessed by reviewing surveillance case reports. In 1991, 110 cases of meningococcal disease were reported to the Department of Health and 197 patients were identified from hospital discharge data, of which charts were reviewed for 179 (91%). Of the charts reviewed, 116 (65%) had confirmed or probable meningococcal disease, and 57 (32%) did not have the disease. Completeness of reporting to the notifiable disease surveillance system was estimated to be 93%, and 78% were reported within 2 days of diagnosis. Errors of physicians and medical records departments contributed to the misclassification of medical records. The authors conclude that notifiable disease surveillance for meningococcal disease is relatively complete, but there is a delay in reporting some cases. Frequent errors may make invalidated hospital discharge data unsuitable for communicable disease surveillance.

Abstracting and Indexing↗
PubMed1995

Knowledge and attitudes of healthcare workers about influenza: why are they not getting vaccinated?

In a survey of employees at a chronic care psychiatric facility following an influenza outbreak, previous influenza vaccination (relative risk [RR], 69.7; 95% confidence interval [CI95], 25.2 to 192.4), age > or = 50 years (RR, 2.4; CI95, 1.3 to 4.5), and knowledge that vaccine does not cause influenza (RR, 2.3; CI95, 1.3 to 3.7) were the factors most predictive of current influenza vaccination. Medical personnel were less likely than nonmedical employees to be vaccinated (RR, 0.5; CI95, 0.3 to 0.9). Educational efforts to address misconceptions about vaccination plus more vigorous administrative measures to vaccinate employees should be considered.

Adolescent↗
PubMed1995

Reptile-associated salmonellosis in New York State.

To determine the association between reptile ownership and salmonellosis caused by certain rare serotypes of Salmonella, we reviewed 1993 New York State Salmonella case reports and conducted a matched case-control study. Cases were persons identified from 1993 New York State laboratory records who had salmonellosis caused by Salmonella serotypes commonly isolated from reptiles. Controls were selected from 1993 New York State shigellosis cases and matched for age and date of diagnosis. Of 674 Salmonella case reports 27 (4%) noted reptile exposure before onset of illness. For the case-control study we identified 42 persons with selected Salmonella serotypes, of whom we contacted 24 (57%). Twelve of 24 case patients and 2 of 28 controls owned reptiles (matched odds ratio, 6.6; 95% confidence interval, 1.4 to 31.0). Ten case-patients but no controls owned iguanas (MOR = undefined; 95% confidence interval, 2.24-infinity). Ten of 12 case patients who owned reptiles were < or = 6 months of age. Salmonellosis caused by certain serotypes is associated with reptile exposure. Reptiles may be unfit pets for homes with infants.

Adolescent↗
PubMed1992

Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophila isolates obtained during a nosocomial outbreak.

Because of the ubiquity of Legionella isolates in aquatic habitats, epidemiologic evaluation of Legionella pneumophila strains is important in the investigation and subsequent control of nosocomial outbreaks of legionellosis. In this study, ribotyping and restriction enzyme analysis by pulsed-field gel electrophoresis (PFGE) were used to compare isolates of L. pneumophila obtained from patients and the environment during a nosocomial outbreak with unrelated control strains. Restriction enzyme analysis by PFGE resolved 14 different patterns among the L. pneumophila serogroup 1 and L. pneumophila serogroup 6 isolates involved in the study. Two of the patterns were observed in the three L. pneumophila serogroup 6 isolates from patients with confirmed nosocomial infections and environmental isolates from the potable water supply, which was, therefore, believed to be the source of the patients' infections. Three more patterns that were not present in isolates from patients with legionellosis were seen in isolates from the hospital environment, demonstrating the presence of multiple strains in the hospital environment. In the outbreak, one distinct pattern occurred among the L. pneumophila serogroup 1 isolates from patients with nosocomial infections, suggesting a common source; however, the source could not be determined. By comparison, ribotyping generated five patterns. However, some control strains of both L. pneumophila serogroups 1 and 6 possessed the same ribotypes as were present in the outbreak isolates. Both techniques were used successfully to subtype the isolates obtained during the investigation of the outbreak. Furthermore, restriction enzyme analysis by PFGE was useful for subdividing ribotypes and for distinguishing strains involved in the outbreak from epidemiologically unrelated strains.

Adult↗
PubMed1991

Timeliness of national reporting of communicable diseases: the experience of the National Electronic Telecommunications System for Surveillance.

The timeliness of reporting four nationally notifiable diseases was examined using data reported via the National Electronic Telecommunications System for Surveillance. Timeliness of reporting varied by disease (bacterial meningitis: median 20 days; salmonellosis: median 22 days; shigellosis: median 23 days; and hepatitis A: median 33 days) and by state. These findings indicate a need to standardize surveillance definitions and to account for reporting differences between states in interpreting regional disease trends or detecting multistate disease outbreaks.

Communicable Diseases↗
PubMed1990

Increased morbidity in surgical patients undergoing secondary (incidental) cholecystectomy.

Using computerized hospital discharge abstracts for all Vermont residents hospitalized during 1983 and 1984, we examined the question of whether increased morbidity occurs in patients undergoing secondary (incidental) cholecystectomy. Among a cohort of 4183 patients undergoing a primary surgical procedure in which secondary cholecystectomy might have been considered. 69 patients had a secondary cholecystectomy. The surgical wound infection rate was 8.7% in the secondary cholecystectomy group compared to 2.4% in the rest of the cohort (relative risk, 3.7, 95% C.I. 1.7, 8.1). Other postoperative complications occurred in 10.1% of those undergoing secondary cholecystectomy compared to 4.1% in those who did not (relative risk, 2.5, 95% C.I. 1.2, 5.1). The adjusted relative risk for wound infection was 3.3 (95% C.I. 1.4,8.0) and for other surgical complications was 1.7 (95% C.I. 0.8, 3.8). Postoperative length of hospital stay was longer for the secondary cholecystectomy group (mean, 13.8 days) than in the comparison group (mean 8.9 days, p = 0.001). These data suggest that patients undergoing a secondary cholecystectomy may have an increased risk of surgical wound infection and possibly other surgical complications.

Adolescent↗
PubMed1989

Investigation of a cluster of deaths of adolescents from asthma: evidence implicating inadequate treatment and poor patient adherence with medications.

We investigated a cluster of five deaths of adolescents from asthma in St. Louis during a 3-month period in 1987. Although the cluster represented a statistically significant increase in the number of asthma deaths in this age group over that observed in previous years, no common exposure to environmental, infectious, or therapeutic agents could be identified. The patterns of hospital admissions for asthma and emergency room visits at the two pediatric hospitals in the community did not suggest an increase in the frequency or severity of asthma during this time. Despite the lack of evidence for common exposure, the decedents shared many personal and medical characteristics. All decedents were black patients and were of lower socioeconomic status. All were adolescents and were responsible for regulating their own medication schedules. Lack of appreciation of the severity of their asthma by medical personnel and the patients' families was evident. For example, two patients with severe asthma had not been prescribed inhaled corticosteroids. In addition, the four decedents tested had markedly subtherapeutic or zero serum theophylline levels measured at the time of the fatal episode, even though appropriate amounts of theophylline had been prescribed. Their theophylline levels were substantially lower than levels in patients of the same age observed at the emergency room or hospitalized for asthma during the same time period. Continued efforts to educate adolescent patients, their families, and medical care providers about the treatment of asthma are warranted.

Adolescent↗
PubMed1989

Epidemiologic surveillance for endemic Giardia lamblia infection in Vermont. The roles of waterborne and person-to-person transmission.

The authors studied 1,211 laboratory-confirmed, non-outbreak-related cases of giardiasis in Vermont residents reported through Vermont's laboratory-based active surveillance system between 1983 and 1986. Giardiasis was the most common reportable disease in the state, with an average annual incidence rate of 45.9 cases per 100,000 population per year. This rate is higher than that in other states reporting giardiasis incidence. Morbidity from giardiasis was also significant in that 30% of cases reported symptoms lasting four or more weeks. Waterborne transmission was suggested to be an important cause of non-outbreak-related cases because rates of infection were highest in persons receiving nonfiltered municipal or nonmunicipal residential drinking water. Rates were also higher at higher elevations, where water supplies may be difficult to protect from contamination. In addition, the pattern of age-specific incidence rates and the high estimated incidence of infection in children attending day care suggested that person-to-person transmission also played a role in causing non-outbreak-related cases. Routine surveillance data can serve to indicate likely important routes of transmission of giardiasis in the community.

Adolescent↗
PubMed1989

Elevated levels of immunoglobulin A to Giardia lamblia during a waterborne outbreak of gastroenteritis.

During an outbreak of diarrheal illness among residents of a trailer park in rural Vermont, 37 (30%) of 122 residents met the case definition of outbreak-related giardiasis. Convalescent-phase sera from 24 residents and 20 nonresident control subjects were tested by enzyme-linked immunosorbent assay for immunoglobulin G (IgG), IgM, and IgA antibodies to Giardia lamblia. Residents showed higher levels of parasite-specific antibody than did nonresident controls for IgG and IgA but not IgM. Nine residents with giardiasis had a higher median level of G. lamblia-specific IgA but not IgG or IgM than 15 healthy residents (0.61 versus 0.16 optical density units; P = 0.004). Moreover, parasite-specific IgA levels were higher in those consuming tap water than in those who did not (0.31 versus 0.08 optical density units; P = 0.03) and increased with increasing water consumption. Levels of serum antibody to G. lamblia, particularly IgA, may be useful in determining exposure to G. lamblia-contaminated water and illness from G. lamblia during waterborne outbreaks of diarrheal illness.

Adult↗
PubMed1988

Characterization of an outbreak of Clostridium perfringens food poisoning by quantitative fecal culture and fecal enterotoxin measurement.

Published criteria for implicating Clostridium perfringens as the cause of food-poisoning outbreaks include finding a median fecal C. perfringens spore count of greater than 10(6)/g among specimens from ill persons. We investigated a food-poisoning outbreak with the epidemiologic characteristics of C. perfringens-related disease in a nursing home in which the median fecal spore count for ill patients (2.5 X 10(7)/g) was similar to that for well patients (4.0 X 10(6)/g), making the etiology of the outbreak uncertain. All ill and well patients tested had eaten turkey, the implicated food item. C. perfringens enterotoxin was detected by reverse passive latex agglutination in fecal specimens from six of six ill and none of four well patients who had eaten turkey (P = 0.005), suggesting that this organism had caused the outbreak. This investigation suggests that detection of fecal C. perfringens enterotoxin is a specific way to identify this organism as the causative agent in food-poisoning outbreaks.

Aged↗
PubMed1988

Investigation of possible health effects of community exposure to fermenting wood chips.

We conducted a case-control study of emergency room (ER) patients to evaluate whether asthma is caused by living near a wood-chip fueled power plant that released wood-chip fermentation products. Only eight (29 per cent) of 28 asthma patients seen in the ER during an 11-week period lived within 1.5 miles of the plant compared with 18 (34 per cent) of 54 control patients matched for severity of diagnosis and seen during the same period (Mantel-Haenszel odds ratio controlling for age = 0.96).

Adult↗