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M Beller

Publications and source records attributed to M Beller.

At least 37 records · Page 2Linked to original sources
PubMed1997

Alcohol-related injury death and alcohol availability in remote Alaska.

CONTEXT: Injury is a major public health problem in Alaska, and alcohol consumption and injury death are associated. OBJECTIVE: To determine the association between injury death, particularly alcohol-related injury death, and alcohol availability in remote Alaska. DESIGN, SETTING, AND PARTICIPANTS: Survey using death certificate data and medical examiner records to compare mortality rates for total injury and alcohol-related injury during 1990 through 1993 among Alaskans aged 15 years and older who had resided in remote villages of fewer than 1000 persons. MAIN OUTCOME MEASURES: Rate ratios of injury death among residents of wet villages (ie, those without a restrictive alcohol law) as compared with injury death among residents of dry villages (ie, those with laws that prohibited the sale and importation of alcohol). RESULTS: Of 302 injury deaths, blood alcohol concentrations (BACs) were available for 200 deaths (66.2%). Of these, 130 (65.0%) had a BAC greater than or equal to 17 mmol/L (> or =80 mg/dL) and were, therefore, classified as alcohol related. The total injury mortality rate was greater among Alaska Natives from wet villages (rate ratio [RR],1.6; 95% confidence interval [CI], 1.3-2.1), whereas this difference was not present for nonnatives (RR, 1.1; 95% CI, 0.3-3.8). For Alaska Natives, the alcohol-related injury mortality rate was greater among residents of wet villages (RR, 2.7; 95% CI, 1.9-3.8) than among residents of dry villages. The strength of this association was greatest for deaths due to motor vehicle injury, homicide, and hypothermia. CONCLUSIONS: Although insufficient data existed to adjust for the effects of all potential confounders, residence in a wet village was associated with alcohol-related injury death among Alaska Native residents of remote Alaska villages. These findings indicate that measures limiting access to alcoholic beverages in this region may decrease alcohol-related injury deaths.

Accidents↗
PubMed1997

Outbreak of viral gastroenteritis due to a contaminated well. International consequences.

CONTEXT: Small round-structured viruses (SRSVs) are known to cause viral gastroenteritis, but until now have not been confirmed in the implicated vehicle in outbreaks. OBJECTIVE: Investigation of a gastroenteritis outbreak. DESIGN: After applying epidemiologic methods to locate the outbreak source, we conducted environmental and laboratory investigations to elucidate the cause. SETTING: Tourists traveling by bus through Alaska and the Yukon Territory of Canada. PARTICIPANTS: Staff of a restaurant at a business complex implicated as the outbreak source, convenience sample of persons on buses that had stopped there, and bus employees. MAIN OUTCOME MEASURES: Odds ratios (ORs) for illness associated with exposures. Water samples from the restaurant and stool specimens from tourists and restaurant staff were examined by nucleic acid amplification using reverse transcription polymerase chain reaction and sequencing of viral amplification products. RESULTS: The itineraries of groups of tourists manifesting vomiting or diarrhea were traced back to a restaurant where buses had stopped 33 to 36 hours previously. Water consumption was associated with illness (OR, 5.3; 95% confidence interval [CI], 2.3-12.6). Eighteen of 26 employees of the business complex were ill; although not the index case, an employee ill shortly before the outbreak lived in a building connected to a septic pit, which was found to contaminate the well supplying the restaurant's water. Genotype 2/P2B SRSV was identified in stool specimens of 2 tourists and 1 restaurant employee. Stools and water samples yielded identical amplification product sequences. CONCLUSIONS: The investigation documented SRSVs in a vehicle epidemiologically linked to a gastroenteritis outbreak. The findings demonstrate the power of molecular detection and identification and underscore the importance of fundamental public health practices such as restaurant inspection, assurance of a safe water supply, and disease surveillance.

Base Sequence↗
PubMed1997

Statewide assessment of lead poisoning and exposure risk among children receiving Medicaid services in Alaska.

OBJECTIVE: Lead poisoning is a well-recognized public health concern for children living in the United States. In 1992, Health Care Financing Administration (HCFA) regulations required lead poisoning risk assessment and blood lead testing for all Medicaid-enrolled children ages 6 months to 6 years. This study estimated the prevalence of blood lead levels (BLLs) >/=10 microg/dL (>/=0.48 micromol/L) and the performance of risk assessment questions among children receiving Medicaid services in Alaska. DESIGN: Measurement of venous BLLs in a statewide sample of children and risk assessment using a questionnaire modified from HCFA sample questions. SETTING: Eight urban areas and 25 rural villages throughout Alaska. PATIENTS: Nine hundred sixty-seven children enrolled in Medicaid, representing a 6% sample of 6-month- to 6-year-old Alaska children enrolled in Medicaid. OUTCOME MEASURE(S): Determination of BLL and responses to verbal-risk assessment questions. RESULTS: BLLs ranged from <1 microg/dL (<0.048 micromol/L) to 21 microg/dL (1.01 micromol/L) (median, 2.0 microg/dL or 0.096 micromol/L). The geometric mean BLLs for rural and urban children were 2.2 microg/dL (0.106 micromol/L) and 1.5 microg/dL (0.072 micromol/L), respectively. Six (0.6%) children had a BLL >/=10 microg/dL; only one child had a BLL >/=10 microg/dL (11 microg/dL or 0.53 micromol/L) on retesting. Children whose parents responded positively to at least one risk factor question were more likely to have a BLL >/=10 microg/dL (prevalence ratio = 3.1; 95% confidence interval = 0.4 to 26.6); the predictive value of a positive response was <1%. CONCLUSIONS: In this population, the prevalence of lead exposure was very low (0.6%); only one child tested (0.1%) maintained a BLL >/=10 microg/dL on confirmatory testing; no children were identified who needed individual medical or environmental management for lead exposure. Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska. Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations.

Alaska↗
PubMed1996

A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine.

OBJECTIVE: To stop an epidemic of hepatitis A in rural Alaska by mass immunization of susceptible persons with 1 dose of an inactivated hepatitis A vaccine. DESIGN: Nonrandomized, uncontrolled trial. Hepatitis A vaccine was offered to all persons in susceptible age groups in villages with documented cases of hepatitis A. Immune globulin was not offered at the time of vaccination. SETTING: Twenty-five rural communities located in interior Alaska and along the northwest coast of the Bering Sea and Arctic Ocean. PARTICIPANTS: Persons without a history of acute hepatitis A in age groups selected by applying results of a previous serosurvey conducted on serum collected before the epidemic. INTERVENTION: One dose of a formalin-inactivated hepatitis A vaccine was given to each participant. Adults 20 years of age and older received 1440 enzyme-linked immunosorbent assay units and persons younger than 20 years received 720 enzyme-linked immunosorbent assay units. Prevaccination and postvaccination levels of antibody to hepatitis A IgG were obtained from 136 participants. MAIN OUTCOME MEASURES: An active surveillance system was established to detect persons with symptomatic illnesses compatible with hepatitis A; persons who met the illness criteria were tested for antibody to hepatitis A IgM. One area (the Kotzebue region), where all communities were offered vaccine, was selected for intensive surveillance and analysis. RESULTS: During the 12-month period before the vaccine trial, 529 cases of icteric hepatitis A were reported, and 443 were confirmed to be positive for antibody to hepatitis A IgM. Hepatitis A vaccine was administered to 4930 persons, 3517 of whom were younger than 20 years. After vaccination began, 237 persons positive for antibody to hepatitis A IgM were identified during a 60-week surveillance period; 46 were vaccines and 191 were unvaccinated susceptible persons. In the Kotzebue region, in communities in which more than 80% of persons considered susceptible were vaccinated, the outbreak ceased in 4 to 8 weeks, whereas in 1 large community in which less than 50% of susceptible persons were vaccinated, the outbreak continued for more than 50 weeks. More than 90% of seronegative persons developed antibody to hepatitis A IgG 3 to 4 weeks after vaccination. CONCLUSION: This trial suggested that by providing both short-term and long-term protection, hepatitis A vaccine used without immune globulin halted an established epidemic of hepatitis A in rural Alaska.

Adolescent↗
PubMed1994

Protective effect of conventional cooking versus use of microwave ovens in an outbreak of salmonellosis.

The authors conducted an investigation to determine the extent and source of an outbreak of Salmonella typhimurium gastroenteritis that occurred following a community picnic in Juneau, Alaska, in 1992, and to evaluate risk factors for illness. A case-control study among 54 picnic attendees and a retrospective cohort study among 60 members of 17 households who had taken home leftover food from the picnic were conducted. A case was defined as diarrhea with onset 12-72 hours after eating food that had been prepared for the picnic. The case-control study associated illness with eating roast pork from one of two pigs that had been flown in from a Seattle, Washington, restaurant. The roast pork was taken home by persons from at least the 17 households included in the cohort study. The cohort study identified 43 persons who ate roast pork, of whom 21 (49%) became ill. This compared with only one case of illness among 17 cohort members who had not eaten roast pork (relative risk = 8.3, 95% confidence interval 1.2-57.0). Of 30 persons who ate reheated meat, all 10 who used a microwave oven became ill, compared with none of 20 who used a conventional oven or skillet. The Seattle restaurant had prepared the roast pork by first thawing two frozen pigs for several hours at room temperature and then cooking them in a gas-fired flame broiler. One of the pigs was left unrefrigerated for 17-20 hours after cooking. Compared with conventional methods of reheating, microwave ovens had no protective effect in preventing illness. To prevent outbreaks such as this one, care must be taken to assure that food is both properly cooked and handled and properly reheated.

Adolescent↗
PubMed1994

Acute fluoride poisoning from a public water system.

BACKGROUND: Acute fluoride poisoning produces a clinical syndrome characterized by nausea, vomiting, diarrhea, abdominal pain, and paresthesias. In May 1992, excess fluoride in one of two public water systems serving a village in Alaska caused an outbreak of acute fluoride poisoning. METHODS: We surveyed residents, measured their urinary fluoride concentrations, and analyzed their serum-chemistry profiles. A case of fluoride poisoning was defined as an illness consisting of nausea, vomiting, diarrhea, abdominal pain, or numbness or tingling of the face or extremities that began between May 21 and 23. RESULTS: Among 47 residents studied who drank water obtained on May 21, 22, or 23 from the implicated well, 43 (91 percent) had an illness that met the case definition, as compared with only 6 of 21 residents (29 percent) who drank water obtained from the implicated well at other times and 2 of 94 residents (2 percent) served by the other water system. We estimated that 296 people were poisoned; 1 person died. Four to five days after the outbreak, 10 of the 25 case patients who were tested, but none of the 15 control subjects, had elevated urinary fluoride concentrations. The case patients had elevated serum fluoride concentrations and other abnormalities consistent with fluoride poisoning, such as elevated serum lactate dehydrogenase and aspartate aminotransferase concentrations. The fluoride concentration of a water sample from the implicated well was 150 mg per liter, and that of a sample from the other system was 1.1 mg per liter. Failure to monitor and respond appropriately to elevated fluoride concentrations, an unreliable control system, and a mechanism that allowed fluoride concentrate to enter the well led to this outbreak. CONCLUSIONS: Inspection of public water systems and monitoring of fluoride concentrations are needed to prevent outbreaks of fluoride poisoning.

Adolescent↗
PubMed1994

An outbreak of tinea corporis gladiatorum on a high school wrestling team.

BACKGROUND: An outbreak of tinea corporis occurred in members of a high school wrestling team during the 1992-1993 season. OBJECTIVE: To control the outbreak, we conducted an epidemiologic investigation. METHODS: We examined 28 team members and obtained skin scrapings from 16. To control the outbreak we recommended (1) griseofulvin for 1 month to treat persons with more than two lesions or any facial lesion(s) and topical ketoconazole or econazole for 1 month to treat all others and (2) that wrestlers be excluded from wrestling until 10 days of topical treatment or 15 days of oral treatment had been completed. RESULTS: Twenty-one wrestlers had lesions consistent with tinea corporis and 10 had Trichophyton tonsurans infection confirmed by culture. A new eruption developed in 12 wrestlers after the recommendations were implemented. CONCLUSION: This is the third and largest outbreak of tinea corporis gladiatorum to be described in the United States. Appropriate control measures have not yet been established.

Adolescent↗
PubMed1994

Survey of fox trappers in northern Alaska for rabies antibody.

The purpose of this research was to determine whether trappers in northern Alaska acquired immunity to rabies virus from non-bite exposures while trapping and skinning arctic foxes (Alopex lagopus). In coastal Alaska recurring epizootics presumably provide trappers ample opportunity for contact with rabid animals. Serum neutralization analyses of blood samples collected from 26 individuals were conducted. All but three had negative rabies neutralizing antibody levels (< 0.05 I.U./ml). Two of these had previously received rabies vaccine but one individual who had trapped for about 47 years with an estimated harvest of over 3000 foxes and who had never received pre- or post-exposure rabies vaccination had a rabies serum neutralizing antibody concentration of 2.30 I.U./ml. This represents the first report of an unvaccinated person acquiring rabies virus antibody with a titre above the 0.5 I.U./ml level considered acceptable by the World Health Organization.

Adult↗
PubMed1994

Moose soup shigellosis in Alaska.

Following a community gathering held in early September 1991, an outbreak of gastroenteritis occurred in Galena, Alaska. We conducted an epidemiologic investigation to determine the cause of the outbreak. A case of gastroenteritis was defined as diarrhea or at least 2 other symptoms of gastrointestinal illness occurring in a Galena resident within a week of the gathering. Control subjects included asymptomatic residents who either resided with an affected person or were contacted by us during a telephone survey. Of 25 case-patients, 23 had attended the gathering compared with 33 of 58 controls. Among persons who attended the gathering and from whom we obtained a food consumption history, 17 of 19 case-patients and 11 of 22 controls ate moose soup. No other foods served at the gathering were associated with illness. Ten case-patients had culture-confirmed Shigella sonnei. Many pots of moose soup were served each day, and persons attended the gathering and ate moose soup on more than 1 day. Moose soup was prepared in private homes, allowed to cool, and usually served the same day. We identified 5 women who had prepared soup for the gathering and in whose homes at least 1 person had a gastrointestinal illness occur at the time of or shortly before soup preparation. This investigation suggests that eating contaminated moose soup at a community gathering led to an outbreak of shigellosis and highlights the risk of eating improperly prepared or stored foods at public gatherings.

Adolescent↗
PubMed1992

Clinical evaluation of oral fluid samples for diagnosis of viral hepatitis.

Oral fluid samples were compared with serum samples as a specimen source for hepatitis A, B, and C virus markers. Oral fluid was obtained with a treated absorbent pad and tested by using existing commercial enzyme immunoassays with only minor modifications. Compared with serum sampling the sensitivity and specificity of oral sampling were 100% (51 of 51 samples) and 98% (46 of 47 samples) for hepatitis A virus immunoglobulin M, 100% (29 of 29 samples) and 100% (29 of 29 samples) for hepatitis B virus surface antigen, and 100% (13 of 13 samples) and 100% (13 of 13 samples) for hepatitis C virus antibody, respectively. The decline of hepatitis A virus immunoglobulin M in oral samples was parallel to, though somewhat more rapid than, that of hepatitis A virus immunoglobulin M in serum samples. It is proposed that oral sampling represents a safer and more convenient procedure for reliable hepatitis virus testing than blood sampling and that it has wide application in patient and outbreak management.

Antibodies, Viral↗
PubMed1992

Hepatitis A outbreak in Anchorage, Alaska, traced to ice slush beverages.

The Alaska Department of Health and Social Services investigated a community outbreak of hepatitis A in Anchorage. A total of 57 persons who had hepatitis A between June and September 1988 were studied. Patients ranged from 1 to 54 years of age. A market was implicated as the source of the outbreak. An employee who prepared beverage mixtures in a bathroom was a contact of a person who had had hepatitis A 2 months before the outbreak; the employee was reported to have been jaundiced 3 to 4 weeks before the peak of the outbreak. The administration of immune globulin had an efficacy of 100% (95% confidence limits 69, 100%) in preventing hepatitis A among household contacts of primary cases. Similar beverages are sold by convenience markets and many other businesses nationwide. It is important to ensure that safe food-handling practices are followed by such establishments.

Adolescent↗