Diphtheria-tetanus toxoids-pertussis vaccination and sudden infant deaths in Tennessee.
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OBJECTIVES: To determine risk factors for carriage of drug-resistant Streptococcus pneumoniae to understand better the factors promoting spread of these isolates. STUDY DESIGN: We obtained medical and demographic information and nasopharyngeal swab specimens from 216 children less than 6 years old with upper respiratory tract infections, seeking medical care at five Memphis, Tenn, study sites. We evaluated risk factors for carriage of penicillin-nonsusceptible S. pneumoniae (NSSP) among 100 children with S. pneumoniae isolates. Patterns of antimicrobial prescription were recorded for enrolled children. RESULTS: Independent risk factors for carriage of NSSP included an increased number of antimicrobial treatment courses during the previous 3 months and white race. Day care attendance approached statistical significance (p = 0.07). Most children with upper respiratory tract infection received a prescription for antimicrobial drugs. These prescriptions were more common for white children than for black children. CONCLUSIONS: Increased use of antimicrobial drugs enhances the risk of carriage of NSSP. This may contribute to the higher risk among white children of NSSP infection; however, after control for antimicrobial use, white children were still at an increased risk of infection with NSSP, possibly through greater exposure to resistant strains.
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A 12-month field study was conducted consecutively from June 2003 to May 2004 to quantify temporal variations of dissolved gaseous mercury (DGM) concentrations in Cane Creek Lake, a southern reservoir lake (Cookeville, TN). Diurnal changes of DGM concentrations in two periods (morning increase vs afternoon decrease with an around-noon peak) were observed, and the changes closely followed daily solar radiation variation trends. The diurnal patterns prevailed in the late spring and summer, but became vague in the late fall and winter. The monthly mean DGM concentrations peaked at 40.8 pg L(-1) in July and reached the lowest at 14.2 pg L(-1) in December and 21.9 pg L(-1) in January; this DGM concentration change closely followed the monthly mean solar radiation variation trend. The increase of the lake DGM concentration from January to July and its decrease from July to December mirror the typical daily rhythm of DGM concentration variations in the two periods. This finding supports the following hypothesis: The natural phenomenon of daily oscillation of freshwater DGM concentrations that follows diurnal solar radiation variation would manifest on a seasonal scale. High DGM concentrations were found in the spring and summer and low in the fall and winter (seasonal mean: 34.2, 37.5, 20.0, 24.4 pg L(-1), respectively). This seems to suggest an annual occurrence of two periods of the seasonal DGM level fluctuation (spring and summer high vs fall and winter low DGM levels). Linear relationships of the monthly mean DGM concentrations were found with the monthly mean global solar radiation (R2 = 0.82, P < 0.05) and UVA radiation (R2 = 0.84, P < 0.05). Linear relationships of the seasonal mean DGM concentrations were also found with the seasonal mean global solar radiation (R2 = 0.85, P = 0.08) and UVA radiation (R2 = 0.93, P < 0.05).
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Ground water that was used as a source of potable water by residents of a small community became contaminated by leachate from a 300,000 barrel pesticide waste dump. An environmental health survey of the residents and an apparent control group was conducted to determine if any adverse health effects resulting from exposure to the toxic compounds, many of which were hepatotoxins, could be detected. The survey utilized a health questionnaire, a clinical examination, and a biochemical screening. The latter included analysis of serum for liver and kidney function parameters, determination of hepatitis A and B serology, and bile acid determinations on fasting and postprandial serum and urine specimens. Air and water from representative homes and urine from study participants were analyzed for selected organic compounds. The biochemical screening was conducted on two occasions 2 months apart. The initial hepatic profile testing revealed elevated concentrations of the serum enzymes, alkaline phosphatase and serum glutamic oxaloacetic transaminase, in residents who had used the contaminated water. During follow-up testing of these same persons 2 months later, these values were significantly reduced, as were postprandial serum concentrations of the bile acid of cholyglycine. Six individuals in the exposed group had slight hepatomegaly compared to one individual in the intermediate exposure group and none in the controls. Concentrations of carbon tetrachloride were as high as 18,700 microgram/L in the well water samples. The biochemical and clinical observations are suggestive of a transitory liver injury probably related to exposure to the contaminated drinking water.
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Forced-air heating and air conditioning (HAC) systems caused an average and maximum increase in air infiltration rates of 1.8- and 4.3-fold, respectively, during brief whole-house studies of tracer gas decay in 39 occupied houses. An average increase in air infiltration rate of 0.33 +/- 0.37 h-1 corresponded to an incremental air leak of 240 m3/h, based on approximate house volume. More detailed tracer gas decay studies were performed in basement, kitchen and bedroom locations of six homes with low air infiltration rates (i.e., less than 0.25 h-1). The HAC mixed the indoor air efficiently between measurement sites. HAC operation also caused 1.1- to 3.6-fold increases in air infiltration rates, corresponding to absolute increases of 0.02 to 0.1 h-1. In an unoccupied research house, three-fold increases in average air infiltration rate with HAC operation (i.e., from 0.13 to 0.36 h-1) were reduced to two-fold (i.e., from 0.10 to 0.18 h-1) by sealing the external HAC unit and crawlspace ductwork system. This sealing also resulted in a 30 percent reduction in crawlspace-to-indoor transport rates with the HAC turned on. Blower door tests indicated a less than 20 percent reduction in house leakage area.
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