Biomedical subjects

M J Trepka

Publications and source records attributed to M J Trepka.

12 recordsLinked to original sources

PubMed2003

Prevalence of and risk factors for hepatitis C virus infection among STD clinic clientele in Miami, Florida.

OBJECTIVES: Hepatitis C virus (HCV) is the most common chronic blood borne viral infection in the United States. We assessed the HCV prevalence, risk factors, and sensitivity of the Centers for Disease Control and Prevention's (CDC) routine screening criteria among clients of a large urban sexually transmitted disease (STD) clinic. METHODS: Participants were recruited from a public STD clinic in Miami, Florida, and were interviewed regarding known and potential risk factors. The survey assessed CDC screening criteria, as well as other risk factors (for example, intranasal drug use, history of incarceration, exchanging sex for money, number of lifetime sex partners, and history of an STD). Testing was done by enzyme immunoassay (EIA) and confirmed by recombinant immunoblot assay (RIBA). RESULTS: The prevalence of anti-HCV positivity was 4.7%. Four variables were significantly associated with being anti-HCV positive, independent of confounding factors. These included injection drug use (odds ratio (OR) = 31.6; 95% confidence intervals (CI) 11.0 to 90.5); history of incarceration (OR = 3.0; 95% CI 1.1 to 8.1); sexual contact with an HCV positive person (OR 12.7; 95% CI 2.5 to 64.7); and older age (OR 1.4; 95% CI 1.2, 1.6). The sensitivity of CDC's routine screening criteria was 69% and specificity was 91%. CONCLUSIONS: The prevalence of anti-HCV in this clinic was similar to that determined in studies of comparable populations. Having sexual contact with an HCV positive person and history of incarceration were independently associated with being anti-HCV positive. CDC's screening criteria identified approximately two thirds of the anti-HCV positive participants.

Adolescent↗

PubMed2001

The effect of a community intervention trial on parental knowledge and awareness of antibiotic resistance and appropriate antibiotic use in children.

BACKGROUND: Overuse of antibiotics for children's upper respiratory infections is widespread and contributes to the emergence of antibiotic-resistant bacteria. OBJECTIVE: To assess changes in knowledge and awareness regarding antibiotic resistance and appropriate antibiotic use after community-wide educational interventions to reduce inappropriate antibiotic use. DESIGN: Baseline survey conducted during June through July 1997 and postintervention survey of baseline participants during June through August 1998. SETTING: Communities in northern Wisconsin. PARTICIPANTS: Parents of 729 randomly selected children <4 years of age were called until 215 in each of the intervention and control areas were reached. Of the 430 baseline participants, 365 (85%) participated in the postintervention survey. INTERVENTION: Parent-oriented activities included distribution of materials and presentations. Physician-oriented activities included formal presentations and small group meetings. OUTCOME MEASURE: Change in awareness about antibiotic resistance and knowledge about antibiotic indications. RESULTS: A higher proportion of parents in the intervention area (53%) were exposed to 2 or more local educational messages, compared with the control area (23%). From the baseline to the postintervention survey, the percentage of parents with a high degree of antibiotic resistance awareness increased more in the intervention area (58% to 73%) than in the control area (60% to 65%). In the intervention area, there was also a larger increase in knowledge regarding appropriate indications for antibiotic use, compared with the control area. The proportion of parents who expected an antibiotic for their child and did not receive one declined in the intervention area (14% to 9%), while it increased in the control area (7% to 10%). In addition, the percentage of parents in the intervention area who brought their child to another physician because they did not receive an antibiotic decreased (5% to 2%), while it increased in the control area (2% to 4%). CONCLUSION: Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians.

Adult↗

PubMed2000

Impact of Haemophilus influenzae type b (Hib) conjugate vaccines on Haemophilus influenzae meningitis in Wisconsin.

The first effective Haemophilus influenzae type b (Hib) conjugate vaccines were approved for use in children and infants between 1987 and 1990. In 1993, the federal government began the Childhood Immunization Initiative (CII), a program to improve the rate of vaccination of children nationwide. Subsequently, the proportion of 19 to 35-month-old children who received three or more doses of Hib vaccine rapidly increased from 28% in 1992 to 90% by 1995, with a concurrent dramatic decline in the incidence of H. influenzae meningitis. We reviewed cases of H. influenzae meningitis reported to the Wisconsin Division of Public Health from 1981 to 1997. The mean annual incidence of H. influenzae meningitis declined 96% from 2.4 cases per 100,000 persons in the pre-vaccination period (1981-1986) to less than 0.1 case per 100,000 persons after Wisconsin had achieved 90% Hib vaccination coverage (1994-1997). H. influenzae meningitis occurrence declined dramatically among all age groups, including 96% among children aged less than 1 year old, 99% among 1-4 and 5-9 year olds, and 46% among persons 10 or more years old. Consistent with national trends, the majority of H. influenzae meningitis cases reported in 1997 was caused by non-type b strains of H. influenzae.

Age Factors↗

PubMed1999

An evaluation of the completeness of tuberculosis case reporting using hospital billing and laboratory data; Wisconsin, 1995.

PURPOSE: The study assesses the completeness of tuberculosis disease (TB) reporting in Wisconsin and evaluates the usefulness of laboratory and hospital discharge data as supplemental case ascertainment sources. METHODS: All 1995 hospital billing records with a discharge diagnosis code of TB (ICD-9 CM 010-018) were retrieved and matched to Wisconsin TB registry records. A hospital discharge summary was obtained for persons not in the registry to verify the TB diagnosis. A list of persons with specimens from which Mycobacterium tuberculosis was isolated in 1995 was requested from all Wisconsin and pertinent out-of-state laboratories and compared with the TB registry. RESULTS: Of the 88 TB cases identified from laboratory lists, one (1.1%) was unreported. Of the 51 TB cases identified from hospital discharge records, one (2.0%) was unreported. The positive predictive values of laboratory and hospital discharge data for a verified TB case were 98.9% and 38.3%, respectively. CONCLUSIONS: In Wisconsin during 1995, nearly all TB cases among hospitalized persons or persons from whom M. tuberculosis was isolated were reported. Most persons having a TB diagnosis code did not have TB.

Adolescent↗

PubMed1999

An increase in sporadic and outbreak-associated Salmonella enteritidis infections in Wisconsin: the role of eggs.

In Wisconsin, reported Salmonella enterica serotype enteritidis (SE) infections during 1997 more than doubled compared with the previous 9 years. A case-control study was conducted to determine risk factors for sporadic infections, and results of outbreak investigations were reviewed. Eating raw eggs (matched odds ratio [MOR]=14.5; 95% confidence interval [CI], 1.7-591.6), eating raw or undercooked eggs (MOR=5.8; 95% CI, 1.3-28.0), eating any eggs (MOR=4.2; 95% CI, 1.2-16.2), and dining at a restaurant (MOR=4.7; 95% CI, 1.4-18.4) were associated with infection in the case-control study. For 3 of the 8 outbreaks, a probable source was identified, in each instance, foods containing eggs. Human infections decreased after eggs were diverted from implicated flocks. This epidemic demonstrates the continuing need for quality assurance on egg farms and enhanced education of consumers and commercial food preparers regarding safe handling of eggs.

Adolescent↗

PubMed1998

The effect of lead in tap water on blood lead in children in a smelter town.

Hettstedt, a city in eastern Germany with a long history of mining and smelting of non-ferrous ores, has multiple lead waste deposits and the remains of a former lead smelter and a copper-silver smelter. As part of a cross-sectional study, an analysis of lead concentrations in drinking water and in blood was undertaken to determine the impact of lead in drinking water on the internal burden of lead in children. The geometric mean of blood lead levels among children 5-14 years old was 35.0 micrograms/l with a 95% confidence interval (C.I.) of 33.4-36.7. The geometric mean of lead in the random tap water samples was 0.5 microgram/l (95% C.I., 0.5-0.6) and 0.7 microgram/l (95% C.I., 0.6-0.8) in the stagnant tap water samples. Blood lead levels were somewhat correlated with the random water measures but not the stagnant water measures (random sample: r = 0.12, P = 0.012; stagnant sample: r = 0.04, P = 0.396). After adjustment for relevant confounders, lead in drinking water (random sample) was not significantly associated with blood lead levels. Factors that were significantly associated with blood lead included gender, the city area of residence, lead in house dust, regular contact with dogs and dirtiness of the child after playing outdoors. Based on this study, lead in domestic tap water contributed little to the lead exposure of children in the lead contaminated region of Hettstedt.

Adolescent↗

PubMed1998

Pulmonary function in children with initial low birth weight.

The objective of this analysis was to examine the effect of low birth weight and prematurity on bronchial air-flow, bronchial reactivity, airway symptoms and asthma diagnosis at school age. A cross-sectional epidemiological study was performed in three small towns in the eastern part of Germany on 2470 school children aged 5-14 (89.1% of eligible children). A 78 item questionnaire to determine risk factors at birth and in early childhood was employed. 7.8% of the children were born before completing 38 gestational weeks; 6.6% had a birth weight less than 2500 g. Pulmonary function analysis were done by a mobile plethysmography at the school. There were only weak restrictions in lung volume in term low birth weight (LBW) children (100 ml lower TLC, p = 0.107), and flow (257 ml lower PEFR, p = 0.108), were low. However, bronchial hyper-responsiveness indicated by 292 ml lower FEV1.0 after cold air bronchial provocation, was significantly increased compared to term normal birth weight children (p < 0.001). The effect of LBW was less in older children, only slightly stronger in girls and increased in children mechanically ventilated during the postnatal period. Correspondingly, there was a higher prevalence of diagnosed asthma in term LBW children (OR 1.6, 95%-confidence interval 1.0-2.6), however these were without an increased risk for any allergic sensitization. LBW, therefore, seems to be a risk factor for smaller lungs and hyperreactive airways primarily in term born children, whereas in preterm children the immature bronchial system seems to be recover by school age.

Adolescent↗

PubMed1997

The internal burden of lead among children in a smelter town--a small area analysis.

Hettstedt, a city in former East Germany with a history of mining and smelting of nonferrous ores, has multiple lead waste deposits and the remains of a former lead and copper-silver smelter. A small-area analysis of lead concentrations in blood and in household dust was undertaken in a cross-sectional study to determine if children living near the sources had particularly high burdens of lead. The overall geometric mean of the region was 38.0 micrograms Pb/liter blood with a 95% confidence interval (CI) of 36.5-39.5. The burden of lead among children living in the region containing the lead tailings piles and adjacent smelters was almost twice as high (77.4 micrograms Pb/liter blood; 95% CI 65.0-92.0). It decreased in the areas farther northeast from the smelter. Lead levels in the children residing in areas southwest of the smelters were not appreciably elevated. The same pattern was found in house dust lead concentrations. This analysis helped target areas where follow-up is needed and found that not only distance from lead sources, but also meteorological factors played an important role in lead exposure.

Adolescent↗

PubMed1996

Arsenic burden among children in industrial areas of eastern Germany.

The internal burden of arsenic among 5- to 14-year-old eastern German children in the heavily polluted areas of Hettstedt, a region of smelting and copper mining, and Bitterfeld, a center of chemical production and coal mining, was compared with that in a control area (Zerbst) by means of urinary arsenic concentrations in 1992-94. The unadjusted geometric mean among the 950 children was significantly higher in Hettstedt (5.1 micrograms/l; 95% C.I. 4.8-5.5) but not in Bitterfeld (4.3 micrograms/l; 95% C.I. 3.7-4.9) compared with the control area (4.0 micrograms/l; 95% C.I. 3.5-4.5). This difference persisted after adjustment for relevant confounders. Despite these regional differences, recent fish consumption was as strongly associated with urinary arsenic levels (42% increase, 95% C.I. 18-71%). Additionally, although the geometric mean among the children in Hettstedt (4.8 micrograms As/g creatinine; 95% C.I. 4.5-5.1) was higher than that found in an environmental survey of eastern German children (3.60 micrograms As/g creatinine; 95% C.I. 3.06-4.24), it was similar to that found among western German children (4.59 micrograms As/g creatinine; 95% C.I. 4.20-5.02). This suggests that the arsenic contamination in Hettstedt is not substantially increasing the internal burden of arsenic among children above that found in other German children.

Adolescent↗

PubMedDate not supplied

Factors affecting internal mercury burdens among eastern German children.

Internal burdens of mercury were evaluated among 5- to 14-y-old eastern German children in the heavily polluted areas of Bitterfeld, a center of chemical production and coal mining, and Hettstedt, a region of nonferrous metal smelting and mining. We compared blood and urine mercury concentrations in these children with mercury burdens in children who lived in a control area. The unadjusted geometric means of mercury levels in the total group were 0.25 microg/l (95% confidence interval = 0.24, 0.27) in blood and 0.36 microg mercury/g creatinine (95% confidence interval = 0.33, 0.39) in urine. Mercury levels in blood and urine were not significantly higher in children who occupied the two polluted areas, compared with children in the control area. The most significant factor that affected urinary mercury levels was the number of dental amalgam fillings; 27% of the variance in the regression model was explained by the presence of these fillings.

Adolescent↗

PubMedDate not supplied

The epidemiology of atopic diseases in Germany: an east-west comparison.

This review summarizes studies comparing the epidemiology of asthma, allergic rhinitis, and atopic dermatitis in eastern versus western German populations. These studies clearly revealed that the prevalence of physician-diagnosed allergic rhinitis was higher in western Germany than in eastern Germany. The rate for asthma also tended to be higher in western than in eastern populations, whereas a tendency for less atopic dermatitis was found in western German children. When sensitization rates, as measured by RAST and skin-prick tests, were compared, a clear increase was found in western versus eastern young-adult German populations. This phenomenon may be related to exposure to different allergens, such as those associated with nutritional patterns or pet ownership, as well as to different environmental factors, such as outdoor and indoor pollutants. If lifestyle or environmental factors play a role in developing allergic sensitization, then one would expect the rates of sensitization in eastern and western Germany to converge as the two societies become more similar.

Adolescent↗

PubMedDate not supplied

Extent of undiagnosed HIV infection in hospitalized patients: assessment by linkage of seroprevalence and surveillance methods.

Routine screening of hospitalized patients for human immunodeficiency virus (HIV) infection has been suggested as a method to identify undiagnosed HIV infection. To evaluate HIV seroprevalence and rates and risk factors for undiagnosed HIV infection among inpatients at an urban hospital, we linked a blinded HIV seroprevalence survey with data from a health care systemwide HIV surveillance registry. Consecutive nonobstetric adult inpatients admitted over four months had remnant samples of serum and plasma obtained and demographic and clinical data abstracted from hospital registration and outpatient encounter billing files. After linkage with the HIV registry, patient data were assigned a study code, individual identifiers were removed, and specimens were tested for HIV-1 antibody. Of 2,825 eligible patients, 155 (5.5%) were HIV-seropositive: 139 (90%) with known infection and 16 (10%) with previously undiagnosed infection. Of those with previously undiagnosed infection, eight (5%) were newly diagnosed during hospitalization and eight (5%) remained undetected following hospitalization. For HIV-seropositive patients, previously undiagnosed infection was significantly more common among those with no use of the health care system in the past year than those with recent outpatient or inpatient visits (41.7% versus 4.6%, odds ratio [OR] = 14.9, 95% confidence intervals [CI] = 4.7, 47.1). Despite a relatively high hospital HIV seroprevalence, the rate of undiagnosed infection was low, suggesting that the percentage of the HIV epidemic remaining "undetected" may be smaller in some settings than suggested by previous studies of hospitalized patients. Linkage of surveillance data to blinded seroprevalence studies can be of value in estimating this "undetected" percentage and in evaluating the potential yield of routine HIV testing programs. Medical Subject Headings (MeSH): HIV infection, risk factors, HIV seroprevalence, inpatients, HIV screening, population surveillance.

Adolescent↗