Search PubMed⌕ Search

Biomedical subjects

J L Hadler

Publications and source records attributed to J L Hadler.

At least 37 records · Page 2Linked to original sources
PubMed1995

The role of heightened surveillance in an outbreak of Escherichia coli O157.H7.

After instituting laboratory screening for Escherichia coli O157.H7, a Connecticut hospital isolated the organism from four persons in September 1993. As a result, an outbreak of E. coli O157.H7 associated with a country club was detected. The club had served hamburger from the same shipment at two picnics. Attendees of two picnics were interviewed, stool cultures were obtained from symptomatic persons, and the remaining hamburger was cultured. Twenty (22%) of 89 persons who ate hamburger became ill, compared with 1 of 60 who did not eat hamburger (relative risk = 13.5, 95% confidence interval 3.2-56.3). Among persons who ate hamburgers, illness was strongly associated with eating hamburger that was not thoroughly cooked (P < 0.001). All 20 samples from 5 remaining boxes of patties yielded E. coli O157.H7. Isolates from hamburger and case-patients were indistinguishable by pulsed-field gel electrophoresis. Heightened surveillance can rapidly identify outbreaks and may mitigate their impact. However, continued review of food safety issues is necessary if E. coli O157.H7 outbreaks are to be prevented.

Adolescent↗
PubMed1995

Cat-scratch disease--Connecticut, 1992-1993.

A prospective population-based surveillance system was established to characterize the epidemiology of cat-scratch disease (CSD) among residents of Connecticut who were reported to the state health department with a diagnosis of suspected CSD. During 1992 and 1993, 246 persons met the case definition, for an average statewide annual incidence of 3.7/100,000 persons. The median age of patients with CSD was 14 years (range, 1-64), and 52% were female. The age-specific attack rate was highest among persons < 10 years of age (9.3/100,000) and decreased with increasing age. Symptoms in addition to adenopathy were noted by 74% of case-patients. Eleven percent of all case-patients were hospitalized. There were no deaths. Most patients with clinically diagnosed CSD developed an immunologic response to Bartonella species. Our data suggest that although CSD is primarily a disease of younger persons, the age spectrum is wider than was commonly appreciated.

Adolescent↗
PubMed1994

Dose-response effects in an outbreak of Salmonella enteritidis.

The effects of ingested Salmonella enteritidis (SE) dose on incubation period and on the severity and duration of illness were estimated in a cohort of 169 persons who developed gastroenteritis after eating hollandaise sauce made from grade-A shell eggs. The cohort was divided into three groups based on self-reported dose of sauce ingested. As dose increased, median incubation period decreased (37 h in the low exposure group v. 21 h in the medium exposure group v. 17.5 h in the high exposure group, P = 0.006) and greater proportions reported body aches (71 v. 85 v. 94%, P = 0.0009) and vomiting (21 v. 56 v. 57%, P = 0.002). Among 118 case-persons who completed a follow-up questionnaire, increased dose was associated with increases in median weight loss in kilograms (3.2 v. 4.5 v. 5.0, P = 0.0001), maximum daily number of stools (12.5 v. 15.0 v. 20.0, P = 0.02), subjective rating of illness severity (P = 0.0007), and the number of days of confinement to bed (3.0 v. 6.5 v. 6.5, P = 0.04). In this outbreak, ingested dose was an important determinant of the incubation period, symptoms and severity of acute salmonellosis.

Adult↗
PubMed1994

Predictors of outcome in methadone programs: effect of HIV counseling and testing.

OBJECTIVE: To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes. DESIGN: Retrospective record review. SETTING: Four methadone maintenance programs in four cities in Connecticut, USA. PARTICIPANTS: Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part. INTERVENTIONS: HIV counseling and testing. MAIN OUTCOME MEASURES: Risk of treatment discontinuation and persistent in-treatment illicit drug use. RESULTS: The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pretreatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54% vs 59%; P = 0.08) but were less likely to show persistent illicit drug use (46% vs 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50% vs 52%), but more often showed persistent illicit drug use (57% vs 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for noncompliance with clinic rules, usually for failing to pay fees. CONCLUSIONS: HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.

AIDS Serodiagnosis↗
PubMed1993

Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test.

BACKGROUND: Although cat scratch disease is commonly diagnosed in patients who have unexplained regional lymphadenopathy after encounters with cats, its epidemiology and the risk factors for disease are not clearly defined, and there is no generally accepted diagnostic test. METHODS: We conducted a physician survey to identify cases of cat scratch disease occurring over a 13-month period in cat owners in Connecticut. We interviewed both the patients (or their parents) and controls matched for age who owned cats. Serum from the patients was tested for antibodies to Rochalimaea henselae with a new, indirect fluorescent-antibody test. RESULTS: We identified 60 patients with cat scratch disease and 56 age-matched subjects. Patients were more likely than controls to have at least one pet kitten 12 months old or younger (odds ratio, 15), to have been scratched or bitten by a kitten (odds ratio, 27), and to have had at least one kitten with fleas (odds ratio, 29). A conditional logistic-regression analysis found that in kitten-owning households, patients were more likely than controls to have been scratched or bitten by a cat or kitten (odds ratio, 12.4; 95 percent confidence interval, 1.0 to 150). Of 45 patients, 38 had serum samples with titers of 1:64 or higher for antibody to R. henselae, as compared with 4 of 112 samples from controls (P < 0.001). The positive predictive value of the serologic test was 91 percent. Of 48 serum samples from patients' cats, 39 were positive for antibodies to R. henselae, as compared with positive samples from 11 of 29 control cats (P < 0.001). CONCLUSIONS: Cat scratch disease is strongly associated with owning a kitten, and fleas may be involved in its transmission. The serologic test for rochalimaea may be useful diagnostically, and our results suggest an etiologic role for this genus.

Adolescent↗
PubMed1993

Foodborne giardiasis in a corporate office setting.

Giardiasis is the most commonly reported intestinal protozoal infection worldwide, but its relatively long incubation period and often insidious onset make detection of common-source outbreaks difficult. Few well-documented foodborne outbreaks of giardiasis have been reported. In November 1990, such an outbreak among insurance company employees resulted in 18 laboratory-confirmed and 9 suspected cases of giardiasis. A case-control study of 26 ill and 162 well employees implicated raw sliced vegetables served in the employee cafeteria and prepared by a food handler infected with Giardia lamblia as the probable vehicle (odds ratio, 5.1; 95% confidence interval, 1.4-22.7). This outbreak illustrates the potential for transmission of Giardia organisms to occur in commercial establishments through a frequently served food item.

Disease Outbreaks↗
PubMed1992

Predictors of outcome in methadone programs: effect of HIV counseling and testing.

OBJECTIVE: To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes. DESIGN: Retrospective record review. SETTING: Four methadone maintenance programs in four cities in Connecticut, USA. PARTICIPANTS: Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part. INTERVENTIONS: HIV counseling and testing. MAIN OUTCOME MEASURES: Risk of treatment discontinuation and persistent in-treatment illicit drug use. RESULTS: The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pre-treatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54 versus 59%; P = 0.08) but were less likely to show persistent illicit drug use (46 versus 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50 versus 52%), but more often showed persistent illicit drug use (57 versus 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for non-compliance with clinic rules, usually for failing to pay fees. CONCLUSIONS: HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.

Adult↗
PubMed1991

Transfusion-transmitted babesiosis: a case report from a new endemic area.

The seventh documented case of babesiosis transmitted by transfusion is reported. Both the donor and the recipient are residents of Connecticut, where the presence of endemic babesiosis has only recently been established. As the range of Babesia microti, and its vector the Ixodes dammini tick, continues to expand, clinicians and blood bank directors should be aware that cases of transfusion-transmitted babesiosis may occur in newly endemic areas.

Animals↗
PubMed1991

Occupational risk factors for infection with parvovirus B19 among pregnant women.

To identify exposures associated with parvovirus B19 infection during pregnancy, two groups of pregnant women were studied during an outbreak of erythema infectiosum (EI). Of 796 pregnant women from Connecticut who were tested serologically because of perceived exposure to B19, 53% (419/796) had serologic evidence of previous B19 infection, and 6% (23/376) of the rest had evidence of recent infection. Of 121 pregnant women who had not requested testing but who lived in a community where a large outbreak of EI had occurred among schoolchildren, 36% (43/121) had serologic evidence of previous infection, and only 3% (2/78) of the rest had had a recent infection. In the exposed group, 479 women returned a supplemental exposure questionnaire. The highest infection rates among susceptible women were for schoolteachers (16%, 10/64), followed by day care workers (9%, 2/22) and homemakers (9%, 4/46). Women working outside the home but not in school or day care settings had the lowest risk (4%, 3/80). This study suggests that there is risk for B19 infection in selected occupational settings and in households.

Child Day Care Centers↗
PubMed1991

Evaluation of the effect of school-based education on adolescents' AIDS knowledge and attitudes.

To measure the effect of school-based education on adolescents' AIDS knowledge and attitudes, we conducted surveys in two high schools and compared them to a baseline survey conducted in the same schools the previous year. One month before the follow-up survey, students in one of the two schools (the intervention school) had received a two-day education program about AIDS; students in the other (control) school had received no specific AIDS education. Students in both schools showed increases in AIDS knowledge between the baseline and follow-up surveys. Students in the intervention school were more likely than students in the control school to answer questions correctly about the safety of blood donation (82% vs 73%) and the possibility of HIV transmission from a former intravenous drug user (85% vs 67%); they were also less likely than students in the control school to believe persons with AIDS should have certain restriction on their activities. We conclude that while students' level of knowledge about AIDS and HIV has been improving over time even without intervention, specific education programs can still transmit important information, including information that is necessary to prevent or change risky behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Providing HIV counseling and testing services in methadone maintenance programs.

Counseling about AIDS and optional confidential testing for antibody to HIV-1 have been available in state-supported methadone maintenance programs in Connecticut since 1 January 1987. In the first 2 years of the program, 2118 people received pre-test counseling. Overall, 1521 people agreed to anti-HIV-1-antibody testing and 1010 received post-test counseling. Other than the pre- and post-test counseling sessions, a total of 1600 HIV counseling sessions were conducted. This is the first statewide program for providing HIV counseling and testing in methadone maintenance programs in the United States. Our experience suggests that the prevention of both drug use and HIV-1 transmission can be integrated in drug treatment centers.

AIDS Serodiagnosis↗
PubMed1989

Epidemiology of a cluster of Henoch-Schönlein purpura.

We investigated a case cluster of Henoch-Schönlein purpura that occurred in Connecticut during the fall and winter of 1987-1988. In Hartford County, where the case finding was most complete, 16 children were identified with disease onset during the 7-month cluster period (incidence, 1.7 cases per 10,000 children per year) compared with only 3 children with disease onset during the preceding 7 months. The incidence in Hartford County was higher among urban (4.8/10,000) and Hispanic (8.6/10,000) children and children in lower socioeconomic groups (6.9/10,000) than among suburban children or children in higher socioeconomic or different racial groups (0.9 to 1.1 per 10,000). We performed a case-control study involving 14 of the 16 case children from Hartford County, 10 case children from nearby areas, and 47 control children matched to the case children by age and race. Case children were more likely than control children to have had a sore throat during the month before the onset of Henoch-Schönlein purpura (52% vs 22%; odds ratio, 3.8; 95% confidence interval, 1.1 to 13). This difference and other smaller differences between case and control children suggest that the cluster may have been caused by person-to-person spread of an infectious agent of the respiratory tract to susceptible hosts. To our knowledge this is the first report of a cluster of Henoch-Schönlein purpura, and it provides clues for a better understanding of the etiology and epidemiology of the disease.

Antibodies, Bacterial↗
PubMed1989

The epidemiology of Lyme disease in Connecticut.

The overall incidence for Lyme disease for Connecticut residents in 1988 was 22 per 100,000. The highest rates were among residents of New London (108 per 100,000) and Middlesex Counties (72 per 100,000), although the greatest increase in incidence between 1985 and 1988 occurred among residents of Fairfield County (2 per 100,000 in 1985, 14 per 100,000 in 1988). Lyme disease is a statewide problem; in 1988 cases were reported among residents of 104 of Connecticut's 169 towns and cities. The disease burden in some communities is high with case rates approaching 1% of the population per year. Data from 1977 and 1985 suggest a three- to eightfold increase during that period in the occurrence of Lyme disease in the communities near the mouth of the Connecticut River. Continued reporting of cases with supporting clinical information is needed to improve Lyme disease surveillance and establish disease trends.

Connecticut↗
PubMed1989

Lyme disease prevention--knowledge, beliefs, and behaviors among high school students in an endemic area.

We surveyed 153 high school students in an area highly-endemic for Lyme disease. All students were familiar with Lyme disease; 14 students reported having had the disease. Ninety per cent of students believed tick-avoidance behavior could prevent Lyme disease, but fewer than half reported practicing any preventive behaviors. Students who believed a specific behavior was preventive were 3-6 times more likely than others to practice that behavior. Schools in endemic areas should educate students about Lyme disease.

Connecticut↗