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PubMed2005

Clinician knowledge and beliefs after statewide program to promote appropriate antimicrobial drug use.

In 1999, Wisconsin initiated an educational campaign for primary care clinicians and the public to promote judicious antimicrobial drug use. We evaluated its impact on clinician knowledge and beliefs; Minnesota served as a control state. Results of pre- (1999) and post- (2002) campaign questionnaires indicated that Wisconsin clinicians perceived a significant decline in the proportion of patients requesting antimicrobial drugs (50% in 1999 to 30% in 2002; p<0.001) and in antimicrobial drug requests from parents for children (25% in 1999 to 20% in 2002; p = 0.004). Wisconsin clinicians were less influenced by nonpredictive clinical findings (purulent nasal discharge [p = 0.044], productive cough [p = 0.010]) in terms of antimicrobial drug prescribing. In 2002, clinicians from both states were less likely to recommend antimicrobial agent treatment for the adult case scenarios of viral respiratory illness. For the comparable pediatric case scenarios, only Wisconsin clinicians improved significantly from 1999 to 2002. Although clinicians in both states improved on several survey responses, greater overall improvement occurred in Wisconsin.

Adult↗
PubMed2000

The proportions of mutagens among chemicals in commerce.

It has been estimated that there are approximately 80,000 chemicals in commerce. Thus, it is not possible to test all these substances for mutagenicity and carcinogenicity; it is possible, however, to test or make estimates from selected subsets of these chemicals. For example, in the U.S. National Toxicology Program (NTP), 35% of the chemicals tested for mutagenicity in Salmonella were positive, as were 52% of the chemicals tested for carcinogenicity in rodents. In contrast, in the U.S. EPA Gene-Tox database, the proportions of chemicals that are Salmonella mutagens is 56%. These and other databases may be biased toward positive responses because they generally have been developed to look at specific structural or use classes of chemicals or chemicals suspected of genetic or carcinogenic activity. To address the question of the proportions of mutagens among all chemicals in commerce, a database of 100 chemicals was created from a random selection of chemicals in commerce. These chemicals were tested for mutagenicity in Salmonella and 22% were mutagenic. The mutagenicity of the 46 highest U.S. production organic chemicals was also compiled; 20% were mutagenic. These values provide a more accurate estimate of the proportions of mutagens among chemicals in commerce than can be derived from published mutagenicity databases.

Commerce↗
PubMed1999

Racial bias in federal nutrition policy, Part I: The public health implications of variations in lactase persistence.

The Dietary Guidelines for Americans from the basis for all federal nutrition programs and incorporate the Food Guide Pyramid, a tool to educate consumers on putting the Guidelines into practice. The Pyramid recommends two to three daily servings of dairy products. However, research has shown that lactase nonpersistence, the loss of enzymes that digest the milk sugar lactose, occurs in a majority of African-, Asian-, Hispanic-, and Native-American individuals. Whites are less likely to develop lactase nonpersistence and less likely to have symptoms when it does occur. Calcium is available in other foods that do not contain lactose. Osteoporosis is less common among African Americans and Mexican Americans than among whites, and there is little evidence that dairy products have an effect on osteoporosis among racial minorities. Evidence suggests that a modification of federal nutrition policies, making dairy-product use optional in light of other calcium sources, may be a helpful public health measure.

Adolescent↗
PubMed2003

Stepping up the pace of discovery: the genomes to life program.

Genome to life (GTL), the U.S Department of Energy Office of Science's systems biology program, focuses on environmental microbiology. Over the next 10 to 20 years, GTL's key goal is to understand the life processes of thousands of microbes and microbial systems in their native environments. This focus demands that we address huge gaps in knowledge, technology, computing, data capture and analysis, and systems-level integration. Distinguishing features include (1) strategies for unprecedented, comprehensive, and high-throughput data collection; (2) advanced computing, mathematics, algorithms, and data-management technologies; (3) a focus on potential microbial capabilities to help solve energy and environmental challenges; and (4) new research and management models that link production-scale systems biology facilities in an accessible environment. This unprecedented opportunity to provide the scientific foundation for solving urgent problems in energy, global climate change, and environmental cleanup demands that we take bold steps to achieve a much faster, more efficient pace of biological discovery.

Biological Science Disciplines↗
PubMed2004

The effect of deinsuring chlorpropamide on the prescribing of oral antihyperglycemics for Nova Scotia Seniors' Pharmacare beneficiaries.

On behalf of the Nova Scotia Seniors' Pharmacare Program, the Drug Evaluation Alliance of Nova Scotia developed a multicomponent intervention plan to facilitate the removal of chlorpropamide as an insured benefit. Chlorpropamide has caused serious hypoglycemia in seniors to a greater extent than some other agents. Pharmacy administrative claims were used to compute monthly use rates for insulin and each oral antihyperglycemic drug from January 1, 2000-December 30, 2002, in an intervention cohort (patients receiving chlorpropamide) and a control cohort (patients receiving an antihyperglycemic agent other than chlorpropamide). Initially, 630 patients were receiving chlorpropamide therapy. By the time chlorpropamide was deinsured, only 10% of the treatment cohort continued receiving chlorpropamide; shortly after deinsurance, no beneficiaries continued receiving the drug. The antihyperglycemics with the greatest increase in prescription were glyburide and gliclazide. The deinsuring of chlorpropamide and the educational strategies that accompanied it resulted in the selection of more appropriate antihyperglycemics for Nova Scotia seniors.

Aged↗
PubMedDate not supplied

[Specialised pediatric pathology service].

Leningrad Regional Children's Bureau of Pathology was established in May 1992. The program of this bureau consisted of: revealing causes of early and late abortions; assessment of ultrasound diagnosis of congenital deficiencies of fetus development and clinical assessment of chronic placental insufficiency; pathogenetic explanation of intrauterine fetuses death; prognosis of neonatal pathology; systemic analysis of dynamics of perinatal, natal and infant mortality; organisation of independant expertise of medical causes of reproductive losses. The following principles in the work of the bureau were established: 1) mass investigation of placentas of newborns; 2) use of urgent pathomorphological diagnosis which allows to present information about placentas not later than 24 hrs after the delivery; 3) complex investigation of placentas with the use of various methods; 4) systemic informational analysis of placental pathology; 5) constant updating of physicians knowledge in the field of practical placentology. Results of mass placentas investigation show a principal pathogenetic role of ascending infection in perinatal mortality in opportunistic pathogenic microflora with the development of inflammatory responses in the system mother-placenta-fetus.

Community Health Services↗
PubMed2006

Oregon Beach Monitoring Program: Bacterial exceedances in marine and freshwater creeks/outfall samples, October 2002-April 2005.

A total of 3086 samples, both marine (2916) and freshwater creeks/outfall samples (170) were collected and analyzed for enterococci during October 2002-April 2005, from 52 designated beaches in Oregon. A total of 3.2% (99/3086) of the samples at 21 beaches exceeded 158 most probable number (MPN)/100 milliliters (mL). The average enterococci levels of these 99 exceedances was 559 MPN/100 mL, with a maximum of 4352 MPN/100 mL (Otter Rock and Ona) and a minimum of 160 MPN/100 mL (Sunset Bay State Park, Bastendorff, and Mill). For marine water, 77/2916 (2.6%) exceeded 158 MPN/100 mL. For freshwater, 22/170 (12.9%) exceeded 158 MPN/100 mL, with a maximum of 587 MPN/100 mL at Sunset Bay. Sixty percent of the marine and 9% of freshwater exceedances occurred during the winter. Seventy-two percent (55/77) of the marine exceedances occurred after rainfall events (0.01-60.0 mm). At Harris and Mill Beaches, cumulative rainfall was highly correlated with bacterial densities, R = 0.7. Rainfall, at both beaches, explained about one-half the variation in log10 bacteria density (R2 = 0.5). Additional monitoring is warranted to further characterize bacterial contamination in Oregon waters.

Bathing Beaches↗
PubMedDate not supplied

[Enteral nutrition at home: National register for the year 2000].

GOAL: Once again, the NADYA-SENPE Working Group analysed the registered data of Home Enteral Nutrition (HEN) in our country, during the year 2000. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Twenty two hospital participated and 2,986 patients, aged 65.1 +/- 19.7 years, were enrolled. Of these patients, 41.2% were diagnosed with neurological diseases and 33.3% with cancer. The mean time on HEN was 6.3 +/- 4.4 months. Oral nutrition was the preferential route (50.8%), followed by nasoenteral tube (30.5%), and in 17.4% ostomy tubes were placed. Polymeric was the formula composition mainly used (83.2%). Patients were followed (70.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included the gastrointestinal (0.25 complications/patient), the mechanical one (0.19 complications/patient), and the metabolic (0.007 complications/patient). Feeding tube need to be replaced 0.3 times/patient/year. The readmission rate, for nutritional problems, was observed in 0.03 patients. At the end of the year, 54.9% of the patients were in the HEN program, and in 30.3% HEN was finish due to different reasons. In 21.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Related to previous years, there is an increment in the number of enrolled patients. Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients were feed with ostomy tube. Finally, due to the few readmission rate and complications, HEN is a safe treatment in our country.

Government Programs↗
PubMed2006

The Inner-City Asthma Intervention: description of a community-based implementation of an evidence-based approach to asthma management.

BACKGROUND: In 2000, the Centers for Disease Control and Prevention funded a 4-year project to implement the Inner-City Asthma Intervention (ICAI)-an asthma treatment and management project based on the protocol developed for the National Cooperative Inner-City Asthma Study (NCICAS) funded by the National Institutes of Health, National Institute of Allergy and Infectious Disease. OBJECTIVE: To describe the ICAI's major components and implementation issues. METHODS: Information contained in this article is based on project activity and management reports, site client tracking and data collection reports, site visit and other program oversight activity, and general subject matter knowledge. The site client tracking data collection process varied among sites during the intervention. Common definitions and processes were developed and implemented as needed. RESULTS: Three of the 24 original sites discontinued participation. The remaining sites enrolled 4,174 children into the intervention. Although the project ended earlier than originally scheduled, 1,035 children completed the entire intervention. Of the 3,139 children who did not complete the entire protocol, 1,355 children and their families completed the core activities or the core activities plus one or more follow-up activities. CONCLUSION: The ICAI project demonstrated that although there were a number of implementation issues to overcome, it is possible to implement effectively a proven National Institutes of Health protocol in the community setting.

Asthma↗
PubMed2000

The electric and magnetic fields research and public information dissemination (EMF-RAPID) program.

In the United States, public concern that exposure to power-line fields was linked to cancer led to the establishment of a Congressionally mandated program, the Electric and Magnetic Fields Research and Public Information Dissemination (EMF-RAPID) Program. A major goal of the program was to "determine whether or not exposures to electric and magnetic fields produced by the generation, transmission, and use of electrical energy affect human health". Between 1994 and 1998, the EMF-RAPID program spent approximately $41 million on biological research. Much of the work funded by the EMF-RAPID program has not yet been published in the peer-reviewed literature. The U.S. National Institute of Environmental Health Sciences (NIEHS) asked that Radiation Research publish this special issue in an attempt to remedy this publication gap. The issue includes reviews of studies that were done to assess the biological plausibility of claims that power-frequency fields caused leukemia and breast cancer. The issue continues with two teratology studies and one immunology study. The section of the issue covering in vitro studies begins with an overview of the efforts NIEHS made to replicate a wide range of reported effects of power-frequency fields and continues with four papers reporting the absence of effects of power-frequency fields on the expression of stress-response genes and oncogenes. Other reports of in vitro studies and studies of mechanisms cover cytotoxicity, gap junction intracellular communication, calcium ion transport across the plasma membrane, and intracellular electric fields.

Animals↗
PubMed2005

Evaluation of lead hazard control treatments in four Massachusetts communities through analysis of blood-lead surveillance data.

This study utilized existing blood-lead surveillance data and records of housing properties treated for lead hazard control (LHC) in order to investigate the effectiveness of LHC treatments performed in four Massachusetts communities (Boston, Cambridge, Malden, and Springfield). This research is part of the US Department of Housing and Urban Development's (HUD) overall program evaluation strategy for assessing the effectiveness of their LHC Grant Program. Childhood blood-lead levels (BLLs) in housing units that were treated through HUD's LHC Grant Program were compared to BLLs in untreated matched control housing units. Data from multiple sources-local housing departments, local tax assessor departments, and the Massachusetts Department of Public Health-were linked to identify similar sets of treated and untreated dwellings. Geometric mean BLLs from before and after treatment were compared for the two sets of housing. Ten years of blood-lead surveillance data for children living in the selected dwellings were analyzed using log-linear mixed models and logistic regression models. Results indicate a 50% decline in BLLs in treated homes, a significantly larger decline than in untreated homes after adjusting for the general downward trend in BLLs observed in the general population for the last several years. Data show that homes that received HUD LHC treatments had children with blood-lead levels that declined twice as fast as in similar untreated homes. These findings show that LHC efforts are successful in reducing children's blood-lead levels.

Child↗
PubMed2005

Criteria and air-toxic emissions from in-use automobiles in the National Low-Emission Vehicle program.

The U.S. Environmental Protection Agency (EPA) implemented a program to identify tailpipe emissions of criteria and air-toxic contaminants from in-use, light-duty low-emission vehicles (LEVs). EPA recruited 25 LEVs in 2002 and measured emissions on a chassis dynamometer using the cold-start urban dynamometer driving schedule of the Federal Test Procedure. The emissions measured included regulated pollutants, particulate matter, speciated hydrocarbon compounds, and carbonyl compounds. The results provided a comparison of emissions from real-world LEVs with emission standards for criteria and air-toxic compounds. Emission measurements indicated that a portion of the in-use fleet tested exceeded standards for the criteria gases. Real-time regulated and speciated hydrocarbon measurements demonstrated that the majority of emissions occurred during the initial phases of the cold-start portion of the urban dynamometer driving schedule. Overall, the study provided updated emission factor data for real-world, in-use operation of LEVs for improved emissions modeling and mobile source inventory development.

Air Pollutants↗
PubMed1999

Efficacy of a preschool breakfast program in reducing refined sugar intake.

The objective of this study was to measure nutritional differences between breakfasts eaten at home and those eaten in a preschool setting, which were prepared and served following the guidelines of the School Breakfast Program (SBP). During the fall semester, baseline data on children's breakfasts were obtained from families of 3- and 4-year-old children attending our laboratory school. Two weeks later, we began providing breakfasts for the children at preschool, before they began their school day. Breakfast menus varied but were always in compliance with SBP guidelines. Six weeks after initiating the SBP, we recorded breakfasts eaten at school, and the entire procedure was repeated during the spring semester. Children's intake of macronutrients from the breakfast meal was altered through participation in the SBP. During each intervention period, the consumption of starch-rich foods and fibre increased while the intake of simple sugars decreased. Protein, fat, and micronutrient intake were not affected. The implementation of the SBP appeared to be an effective way to increase the intake of starch-rich foods and fibre in a low-risk sample of preschool-aged children who regularly are breakfast prior to their participation in this investigation.

Child, Preschool↗
PubMedDate not supplied

[Implementation process evaluation of the Integrated Management Childhood Illness strategy in the Family Health Program, Pernambuco State, Brazil].

This evaluative study attempts to define the contextual determinants of the degree of implementation in the Integrated Management of Childhood Illnesses strategy in Pernambuco State, Brazil. A total of 33 Family Health Program teams were selected from 10 municipalities. In order to define the degree of implementation, the study used a specific score system and the process indicators provided by the strategy. Municipalities were classified as critical, unsatisfactory, and acceptable. All municipalities except for one presented an acceptable degree of implementation in relation to the structure. In relation to process evaluation, two municipalities received one follow-up visit and their scores were unsatisfactory. Four municipalities received two visits, and one was classified as unsatisfactory on the second follow-up visit, while another presented a critical score on the first follow-up visit. Among four municipalities that received three follow-up visits, one was classified as unsatisfactory in the three evaluations. Four municipalities achieved mean unsatisfactory scores, when considering the mean scores acquired in the three follow-up visits. There was no association between the organizational context and degrees of implementation.

Brazil↗
PubMed1998

Impact of a large-scale immunization initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

CONTEXT: Inner-city immunization rates have lagged behind those in other areas of the country. OBJECTIVE: To evaluate the impact of an initiative linking immunization with distribution of food vouchers in the inner city. DESIGN: Retrospective analysis of immunization data gathered in 1996 and 1997. SETTING: Nineteen Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort. PARTICIPANTS: A total of 16581 children 24 months old or younger. INTERVENTIONS: Voucher incentives (varying frequency of food voucher issuance based on immunization status) and assessment of immunization status and referral to immunization provider. MAIN OUTCOME MEASURES: Age-appropriate immunization rates and WIC enrollment rates. RESULTS: During the 15-month period of evaluation, immunization rates increased from 56% to 89% at sites performing voucher incentives. The proportion of children needing voucher incentives declined from 51% to 12%. Sites performing assessment and referral, but not providing voucher incentives, showed no evidence of improvement in immunization coverage. No difference was observed in enrollment rates between sites performing voucher incentives and those that did not. CONCLUSION: Applied in a large-scale, programmatic fashion, voucher incentives in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.

Chicago↗
PubMed2006

Utilization patterns in an asthma intervention.

BACKGROUND: The National Cooperative Inner-City Asthma Study (NCICAS) tested a model of asthma management in which a master's degree-prepared social worker functioned as an asthma counselor. The NCICAS resulted in decreased symptom days and a trend toward fewer emergency department (ED) visits and hospital admissions in the intervention group compared with the control group. OBJECTIVE: To determine whether a real-world implementation would give similar results to the NCICAS. METHODS: Children with moderate or severe persistent asthma were enrolled in a 1-year program, the Inner-City Asthma Intervention (ICAI) program, modeled on the NCICAS. Since the program initially was not designed to be research, data were collected retrospectively. ED and hospital visits were compared 1 year before and after the intervention at 2 of the intervention sites, Children's Mercy Hospital (CMH) and Baystate Medical Center, to determine whether there was a significant change. RESULTS: Data for 93 children from CMH and 77 from Baystate were evaluated. At CMH annual ED visits were 0.38 before, 0.42 during, and 0.41 after the intervention, whereas at Baystate ED visits were 0.09 before, 0.17 during, and 0.15 after the intervention. Mean hospitalizations at CMH increased from 0.06 before to 0.22 during and then decreased to 0.12 after (P > .05), whereas admissions at Baystate increased from 0.03 before to 0.05 during and 0.04 after the intervention. CONCLUSIONS: Asthma self-management interventions can lead to decreases in asthma utilization under controlled circumstances. Further prospective studies are needed to determinewhether the ICAI intervention is effective under real-world conditions.

Allergens↗
PubMed2000

Evaluation of in vitro effects of 50 and 60 Hz magnetic fields in regional EMF exposure facilities.

A weak association between magnetic-field exposure and increased incidences of cancer has been reported. While alterations in cellular processes after in vitro magnetic-field exposures have also been reported to provide plausibility for this association, other laboratories have been unable to repeat the findings. As part of an accelerated electric- and magnetic-field (EMF) research program, the National Institute of Environmental Health Sciences with the Department of Energy identified the replication of the published positive effects as a priority. Regional EMF exposure facilities were established to investigate major in vitro effects from the literature. These included effects on gene expression, intracellular calcium, colony growth in soft agar, and ornithine decarboxylase activity. The laboratories that first reported these effects provided experimental protocols, cell lines, and other relevant experiment details. Regional facility studies included sham/sham exposures (no applied field in either chamber) and were done in a blinded fashion to minimize investigator bias. In nearly all experiments, no effects of magnetic-field exposure were found. The effort provided insight into dealing with the difficulty of replication of subtle effects in complex biological systems. Experimental techniques provided some clues for the differences in experimental results between the regional facility and the original investigator. Studies of subtle effects require extraordinary efforts to confirm that the effect can be attributed to the applied exposure.

Animals↗
PubMed2004

Prevalence of adult binge drinking: a comparison of two national surveys.

BACKGROUND: Binge drinking (defined as five or more drinks on an occasion) causes approximately half of the estimated 85,000 alcohol-related deaths in the United States each year. The Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey, and the National Survey on Drug Use and Health (NSDUH), an in-person survey, provide population-based estimates of binge drinking. Evaluating the concordance of binge drinking estimates from the BRFSS and the NSDUH is important for surveillance and for planning prevention programs. METHODS: In 2003, combined data on binge drinking for 1999 and 2001 from the BRFSS (n =355,371) and the NSDUH (n =87,145) were analyzed for respondents aged >or=18 years. RESULTS: National binge drinking estimates were 14.7% (95% confidence interval [CI]=14.5-15.2) for BRFSS and 21.6% (CI=21.2-22.0) for NSDUH. Although there was good correlation between state-specific binge drinking estimates from the two surveys (Pearson's r =0.82), the BRFSS state estimates were significantly lower (p <0.05) than the NSDUH estimates in 46 states and the District of Columbia. The demographic characteristics of binge drinkers and the wording of the binge question were similar in the two surveys. However, in 1999, NSDUH changed from paper interviews to computer-administered interviews, and incorporated an internal validity check with feedback questions to resolve inconsistent responses. CONCLUSIONS: Estimates of binge drinking from the NSDUH were consistently higher than those from the BRFSS, probably due to differences in survey methodology. Continued efforts to improve binge drinking surveillance are important for preventing this public health problem.

Adult↗