Biomedical subjects

J L Hadler

Publications and source records attributed to J L Hadler.

46 records · Page 3Linked to original sources

PubMed1988

A large Clostridium perfringens foodborne outbreak with an unusual attack rate pattern.

On November 7, 1985, a Clostridium perfringens gastroenteritis outbreak occurred in approximately 44% of the 1,362 employees at a Connecticut factory. Although the same foods were served to all three shifts at an employee banquet on November 6, the attack rate was almost twice as high for those who ate on the day shift (attack rate = 50%) than for those on the evening shift (attack rate = 20%) or night shift (attack rate = 29%). Among employees of the day shift, attack rates were highest for those who ate during the first 30 minutes of the 2.5-hour day shift serving period and decreased throughout the serving period. The one-hour evening shift serving period had a similar trend toward higher attack rates earlier in the serving period. Four main-course foods were significantly associated with illness, and over 95% of the employees had eaten each of them. Stratified analysis indicated that gravy was the responsible food and, furthermore, that the decreasing attack rate pattern within serving periods occurred only for those who ate gravy. The gravy had been prepared 12-24 hours in advance of banquet service. After it was prepared, the gravy was improperly cooled and was reheated shortly before and throughout the serving periods. Persons who ate gravy that had been reheated for the longest period of time had the lowest attack rate, probably because they were exposed to a lower concentration of organisms. This outbreak underscores the need for properly reheating food to prevent C. perfringens gastroenteritis and suggests that analysis of attack rate trends may provide important epidemiologic clues to understanding the causes of foodborne disease outbreaks.

Clostridium Infections↗

PubMed1988

Community health effects of a municipal water supply hyperfluoridation accident.

For 12 hours, excess hydrofluorosilicic acid was diverted to a 127-home community water supply. Fluoride levels peaked at 51 parts per million (ppm). Water acidification caused copper to leach from the domestic plumbing; raising copper levels to 25-41 ppm. Fifty-two (33 per cent) of those who drank hyperfluoridated water developed mild gastroenteritis. Vomiting was uncommon and symptom onsets usually occurred greater than 30 minutes after drinking water; suggesting that fluoride, rather than copper, caused illness. Skin contact with hyperfluoridated water caused itching and skin rashes.

Accidents, Occupational↗

PubMed1988

AIDS in Connecticut.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

PubMed1985

The diagnosis and evaluation of child maltreatment.

Child maltreatment continues to be one of the most common and most difficult problems seen in the emergency room. An early estimate indicated that up to 10% of children under age 6 seen in emergency departments have some form of nonaccidental injury. Recent data suggest that approximately 1% of the child population are victims of maltreatment each year. Many of these cases involve only subtle signs and have great potential to pass undetected. This article provides a review of the various forms of maltreatment, with emphasis on the key points involved in the history, physical examination, and management. The protocol for evaluating maltreatment from the North Carolina Memorial Hospital is presented. This framework will aid the physician in the crucial first step of identifying maltreatment, which, along with diligent follow-up and the assistance of the available social services, offers the best hope for further prevention.

Bone and Bones↗

PubMedDate not supplied

A multistate outbreak of Escherichia coli O157:H7 infections associated with consumption of mesclun lettuce.

BACKGROUND: An outbreak of Escherichia coli O157:H7 infections in Connecticut and Illinois during May 28 to June 27, 1996, was investigated to determine the source of infections. METHODS: Independent case-control studies were performed in both states. Pulsed-field gel electrophoresis (PFGE) was performed on E. coli O157:H7 isolates. A case-patient was defined as a Connecticut or northern Illinois resident with diarrhea whose stool culture yielded E. coli O157:H7 of the outbreak-associated PFGE subtype. Controls were town-, age-, and sex-matched to case-patients. We traced implicated lettuce to the farm level and performed environmental investigations to identify unsafe lettuce production practices. RESULTS: In Connecticut and Illinois, infection was associated with consumption of mesclun lettuce (Connecticut matched odds ratio [MOR], undefined; 95% confidence interval [CI], 3.4 to infinity; and Illinois MOR, undefined; 95% CI, 1.4 to infinity). We traced implicated lettuce to a single grower-processor. Cattle, a known E. coli O157:H7 reservoir, were found near the lettuce fields. Escherichia coli (an indicator of fecal contamination) was cultured from wash water and finished lettuce. A trace-forward investigation identified 3 additional states that received implicated lettuce; E. coli O157:H7 isolates from patients in 1 of these states matched the outbreak-associated PFGE subtype. CONCLUSIONS: This multistate outbreak of E. coli O157:H7 infections was associated with consumption of mesclun lettuce from a single producer. Molecular subtyping facilitated the epidemiological investigation. This investigation increased the knowledge about current production practices that may contribute to the contamination of lettuce by microbial pathogens. Lettuce production practices should be monitored for microbiological safety.

Adolescent↗

PubMedDate not supplied

The syphilis epidemic in Connecticut: relationship to drug use and prostitution.

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.

Connecticut↗

PubMedDate not supplied

Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut.

Laboratory-based surveillance of Lyme disease in Connecticut during 1984 and 1985 identified 3,098 persons with suspected Lyme disease; 1,149 were defined as cases. Lyme disease incidence in Connecticut towns ranged from none to 1,407 cases per 100,000 population in 1985. A comparison of 1985 data with data from 1977 epidemiologic studies indicated that incidence increased by 129 percent to 453 percent in towns previously known to be endemic for Lyme disease and that Lyme disease had spread northward into towns thought to be free of Lyme disease in 1977. Children aged five to 14 years had the highest incidence. Of persons with Lyme disease, 83 percent had erythema migrans, 24 percent had arthritis, 8 percent had neurologic sequelae, and 2 percent had cardiac sequelae. The distribution of symptoms was age-dependent: case-persons less than 20 years old were almost twice as likely to have arthritis than older case-persons (35 percent versus 18 percent). Of persons with arthritis, 92 percent of those less than 20 years of age, compared to 68 percent of older persons, did not have antecedent erythema migrans. We conclude that Lyme disease is increasing in incidence and geographic distribution in Connecticut. Of those with Lyme disease, children may be more likely than adults to develop arthritis and have it as their first major disease manifestation.

Adolescent↗

PubMedDate not supplied

Training public health students to investigate disease outbreaks--examples of community service.

In a cooperative effort among the Centers for Disease Control, the Yale University Department of Epidemiology, and the Connecticut State Department of Health Services, an epidemiology demonstration training program was established in which student-faculty rapid response teams responded to requests from the State and from local health departments to investigate acute disease outbreaks or the health effects of natural experiments. Over five academic semesters, 23 teams, consisting of a total of 76 students, responded to requests and produced reports regarding the etiology and recommendations for control to the appropriate agencies. By the end of the fifth semester, there had been three papers or reports published in medical or public health journals, two papers accepted for publication, four presentations at meetings, and five additional manuscripts had been submitted to journals or were being prepared for submission. Throughout the experience, a high level of cooperation between local and State health departments and the school of public health was maintained. Involved students, faculty, and State investigators believed the experience to be highly productive and worthwhile.

Disease Outbreaks↗

PubMedDate not supplied

Hepatitis B vaccine responsiveness in Connecticut public safety personnel.

OBJECTIVE: To determine the level and determinants of vaccine response in recently inoculated public safety personnel. DESIGN: Prevalence survey. PARTICIPANTS: Public safety personnel who had completed vaccination 1 to 6 months prior to testing and had no serological evidence of previous exposure to hepatitis B virus. MAIN OUTCOME MEASURE: An inadequate level of antibody to hepatitis B surface antigen was defined as less than 10 mlU/mL. RESULTS: All subjects in the study had been vaccinated using Recombivax HB, a recombinant hepatitis B vaccine. Of 528 individuals, 11.9% were found to have no or inadequate levels of antibody. The frequency of inadequate level of antibody increased significantly relative to age, from 2.8% among those younger than 30 years to 42.1% among those older than 60 years (P < .0001). Smoking (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.0 to 6.4), extreme obesity (OR, 13.3; 95% CI, 3.8 to 49.1), and increasing time interval since completing the vaccine series (P < .01) were also associated with inadequate levels of antibody. These findings were confirmed by multivariate analysis using logistic regression. CONCLUSIONS: Routine immunization of public safety personnel should include selective use of postvaccine testing. Postvaccination testing optimally should be performed in the 30- to 90-day interval after the last vaccine dose. New vaccination strategies are needed to improve response rates in persons with predictably poor response to hepatitis B vaccine.

Adult↗

PubMedDate not supplied

The need for epidemic intelligence.

The past decade has witnessed an unprecedented upturn in tuberculosis morbidity and outbreaks of difficult- to-treat and highly lethal multidrug-resistant tuberculosis. In the early 1990s, a national consensus developed among public health officials to define more comprehensively the problem, and in January 1993, expanded tuberculosis surveillance was implemented nationwide. Carefully selected epidemiologic and case management variables were added to the Report of Verified Case of Tuberculosis form. Information is collected on the health status and treatment of patients, including human immunodeficiency virus status, drug susceptibility test results, and the initial drug regimen. Completion of therapy and use of directly observed therapy are also monitored. The new surveillance system allows a comparison of the quality of care of patients in the public and private sectors. Additional epidemiologic variables include membership in high-risk groups (the homeless, residents of correctional or long-term care facilities, migrant workers, health care workers, and correctional employees) and substance abuse (injecting drug use, non-injecting drug use, and excess alcohol use). The additional information derived from expanded tuberculosis surveillance is crucial to optimal patient management, policy development, resource allocation, as well as program planning, implementation, and evaluation at Federal, State, and local levels.

AIDS-Related Opportunistic Infections↗