bluuebunny/crossref_metadata_2025 huggingface dataset:
Alleged B. Anthracis Exposure Claims in a Workers' Compensation Setting
Authors: Jewell Gregory , Dunning Kari , Lockey James E.
Published: January 2017

Objectives.

Workers' compensation insurance in some states may not provide coverage for medical evaluation costs of workplace exposures related to potential bioterrorism acts if there is no diagnosed illness or disease. Personal insurance also may not provide coverage for these exposures occurring at the workplace. Governmental entities, insurers, and employers need to consider how to address such situations and the associated costs. The objective of this study was to examine characteristics of workers and total costs associated with workers' compensation claims alleging potential exposure to the bioterrorism organism B. anthracis.

Methods.

We examined 192 claims referred for review to the Ohio Bureau of Workers' Compensation (OBWC) from October 10, 2001, through December 20, 2004.

Results.

Although some cases came from out-of-state areas where B. anthracis exposure was known to exist, no Ohio claim was associated with true B. anthracis exposure or B. anthracis-related illness. Of the 155 eligible claims, 126 included medical costs averaging $219 and ranging from $24 to $3,126. There was no difference in mean cost for government and non-government employees ( p=0.202 Wilcoxon).

Conclusions.

The number of claims and associated medical costs for evaluation and treatment of potential workplace exposure to B. anthracis were relatively small. These results can be attributed to several factors, including no documented B. anthracis exposures and disease in Ohio and prompt transmission of recommended diagnostic and prophylactic treatment protocols to physicians. How employers, insurers, and jurisdictions address payment for evaluation and treatment of potential or documented exposures resulting from a potential terrorism-related event should be addressed proactively.
Measles Immunization Coverage Determined by Serology and Immunization Record from Children in Two Chicago Communities
Authors: Watson John T. , Ramirez Enrique , Evens Anne , Bellini William J. , Johnson Hope , Morita Julie
Published: January 2017

Objectives.

We compared the prevalence of measles immunization determined by serology with the prevalence of measles immunization determined by immunization records, and identified factors predictive of measles immunization among a sample of children from two Chicago communities.

Methods.

We collected demographic information and blood specimens from a sample of children aged 12–71 months in two Chicago communities at risk for low measles immunization coverage levels. We collected immunization information from provider records, parent-held records, and the statewide immunization registry. We compared evidence of immunization determined by serology with evidence of immunization from these three sources of immunization records.

Results.

The sample of children from the two communities had serologic measles immunity levels of 85% and 90%. Significantly fewer children had evidence of immunization by record in both communities (45% and 63%, respectively).

Conclusions.

Immunization coverage levels determined using immunization records were significantly lower than immunization coverage determined using serology. A fully populated immunization registry used by all immunization providers could prevent the problems of record loss and scatter.
The Use of AAP-Recommended Disciplinary Practice Guidelines among African American Caregivers of Children in Head Start Programs
Authors: Horn Ivor B. , Lewin Amy , Turner-Musa Jocelyn , Edwards Mark C. , Joseph Jill G.
Published: January 2017

Objective.

The American Academy of Pediatrics (AAP) recommends that parents not use harsh disciplinary practices. Previous studies have characterized the disciplinary practices of African American parents as harsh, with reliance on more aggressive techniques not currently recommended by the AAP. However, recent research has indicated more disciplinary practice diversity among African Americans. This study describes factors associated with the use of AAP-recommended disciplinary practices among lower-income African American caregivers of children in Head Start.

Methods.

Subjects were caregivers of children at three Head Start sites. Participants were eligible for inclusion if the biological mother, biological father, or target child was identified as African American. Using consensus methods, responses to the Parental Discipline Methods Interview (PDMI) were described as consistent or inconsistent with AAP guidelines regarding use of negative disciplinary practices (e.g., spanking, yelling). Caregivers avoiding any of these inconsistent methods were referred to as “adherent.”

Results.

“Adherent” caregivers were older (32.5 years vs. 30.4 years) and had more education (86.0% vs. 75.4% high school graduates). They were also less likely to report that their child had behavioral problems (12.9% vs. 25.2%) or deficient social skills (1.7% vs. 8.0%).

Conclusions.

Lower-income African American caregivers were more likely to use disciplinary practices consistent with AAP guidelines if they had higher levels of education and were living in an urban setting. Caregivers describing their child as having fewer behavior problems, better social skills, or themselves as less stressed were also more likely to be “adherent.”
Do the Same Houses Poison Many Children? An Investigation of Lead Poisoning in Rochester, New York, 1993–2004
Authors: Korfmacher Katrina Smith , Kuholski Kate
Published: January 2017

Objectives.

In several cities, researchers have found that a discrete number of properties owned by a small number of owners house multiple lead poisoned children over time. The purpose of this study was to determine whether or not a small number of properties were implicated in the poisoning of multiple children in Rochester, New York, between 1993 and 2004.

Methods.

We analyzed the patterns of ownership and repeated positive environmental investigations (i.e., documented lead hazards) in homes of lead poisoned children using county health department data during a 12-year period.

Results.

A small percentage (14.8%) of properties in which the health department found a lead hazard had previously documented lead hazards. When a second positive investigation occurred, the average elapsed time between investigations was a little less than three years. Only four property owners owned more than two properties that had multiple positive investigations.

Conclusions.

In some cities, a small number of properties or property owners provide housing for a large percentage of lead poisoned children. However, this situation is not universal. In Rochester, a relatively small percentage of homes that housed a child with an elevated blood lead level have a history of housing lead poisoned children. In cities like Rochester, lead hazard reduction resources should focus on high-risk housing stock determined by factors such as age, value, and condition, rather than on those with a prior record of housing lead poisoned children.
Using Social Network Analysis to Understand Missouri's System of Public Health Emergency Planners
Authors: Harris Jenine K. , Clements Bruce
Published: January 2017

Objectives.

Effective response to large-scale public health threats requires well-coordinated efforts among individuals and agencies. While guidance is available to help states put emergency planning programs into place, little has been done to evaluate the human infrastructure that facilitates successful implementation of these programs. This study examined the human infrastructure of the Missouri public health emergency planning system in 2006.

Methods.

The Center for Emergency Response and Terrorism (CERT) at the Missouri Department of Health and Senior Services has responsibility for planning, guiding, and funding statewide emergency response activities. Thirty-two public health emergency planners working primarily in county health departments contract with CERT to support statewide preparedness. We surveyed the planners to determine whom they communicate with, work with, seek expertise from, and exchange guidance with regarding emergency preparedness in Missouri.

Results.

Most planners communicated regularly with planners in their region but seldom with planners outside their region. Planners also reported working with an average of 12 local entities (e.g., emergency management, hospitals/clinics). Planners identified the following leaders in Missouri's public health emergency preparedness system: local public health emergency planners, state epidemiologists, the state vaccine and grant coordinator, regional public health emergency planners, State Emergency Management Agency area coordinators, the state Strategic National Stockpile coordinator, and Federal Bureau of Investigation Weapons of Mass Destruction coordinators. Generally, planners listed few federal-level or private-sector individuals in their emergency preparedness networks.

Conclusions.

While Missouri public health emergency planners maintain large and varied emergency preparedness networks, there are opportunities for strengthening existing ties and seeking additional connections.
Validity of Self-Reported Varicella Disease History in Pregnant Women Attending Prenatal Clinics
Authors: Watson Barbara , Civen Rachel , Reynolds Meredith , Heath Karl , Perella Dana , Carbajal Tina , Mascola Laurene , Jumaan Aisha , Zimmerman Laura , James Abike , Quashi Carlene , Schmid Scott
Published: January 2017

Objective.

The purpose of this study was to assess the validity of self-reported history for varicella disease relative to serological evidence of varicella immunity in pregnant women attending antenatal care at clinics located in two diverse geographical locations in the U.S. (Antelope Valley, California, and Philadelphia) with high varicella vaccination coverage.

Methods.

Pregnant women attending prenatal care appointments who needed blood drawn as part of their routine care were eligible to participate. Self-reported varicella disease history was obtained via questionnaire. Varicella serostatus was determined using a whole-cell enzyme-linked immunosorbent assay to test for varicella zoster virus-specific immunoglobulin G (VZV IgG) antibodies.

Results.

Of the 309 study participants from Antelope Valley and the 528 participants from Philadelphia who self-reported having had chickenpox disease, 308 (99.7%; 95% confidence interval [CI]: 98.2, 100) and 517 (97.9%; 95% CI: 96.3, 99.0), respectively, had serological evidence of immunity to varicella. Only 6.8% (95% CI: 3.9, 11.0) and 17.4% (95% CI: 13.1, 22.5) of women who self-reported having a negative or uncertain varicella disease history in Antelope Valley and Philadelphia, respectively, were seronegative for varicella antibodies.

Conclusion.

Despite the dramatic changes in the epidemiology of varicella that have occurred since 1995 due to the introduction and subsequent widespread use of the varicella vaccine, self-reported history of varicella continues to be a strong predictor of VZV IgG antibodies in pregnant women. Negative or uncertain history remains poorly predictive of negative serostatus.
Increasing Safe Syringe Collection Sites in New York State
Authors: Klein Susan J. , Candelas Alma R. , Cooper Jay G. , Badillo Wesley E. , Tesoriero James M. , Battles Haven B. , Plavin Hope A.
Published: January 2017

This article describes expansion of options for safe syringe collection in New York State (NYS) in conjunction with efforts to enhance and expand access to hypodermic needles and syringes. Together with activities to educate the public and providers about the dangers of improperly disposed of syringes, the goals were to ( 1) develop community-based collection sites for individuals to safely dispose of used syringes and ( 2) improve accessibility of existing health-care facility-based collection sites. During the period of 2002 to 2006, 79 community-based collection sites were created. These sites collected an estimated 2.6 million used syringes during 2006. Significant increases in availability and use of health-care facility-based collection sites was also documented. Efforts to promote safe disposal in NYS are ongoing, informed by these findings.
Regional Public Health Emergency Preparedness: The Experience of Massachusetts Region 4b
Authors: Grieb John , Clark Mary E.
Published: January 2017

Historically, local public health in Massachusetts has been largely decentralized, with each town responsible for providing local public health services. After 9/11, the Massachusetts Department of Public Health (MDPH) began to plan for bioterrorism and other possible public health emergencies and found that having 351 separate departments made emergency planning difficult and dispersing of funds a challenge. To facilitate this process, MDPH created seven emergency preparedness regions and asked local public health departments to engage in joint planning. This article describes the formation of Region 4b and how the region came together to work on emergency preparedness issues. It also examines the organizational, financial, and planning challenges associated with organizing these towns as a unified entity.
Regionalization in Local Public Health Systems: Public Health Preparedness in the Washington Metropolitan Area
Authors: Stoto Michael A. , Morse Lindsey
Published: January 2017

The Washington metropolitan area was closely examined to understand how these regional preparedness structures have been organized, implemented, and governed, as well as to assess the likely impact of such regional structures on public health preparedness and public health systems more generally. It was found that no single formal regional structure for the public health system exists in the Washington metropolitan area, although the region is designated by the Department of Homeland Security as the National Capital Region (NCR). In fact, the vast majority of preparedness planning and response activities in this area are the result of voluntary self-organization through both governmental and nongovernmental organizations. Some interviewed felt that this was an optimal arrangement, as personal relationships prove crucial in responding to a public health emergency and an informal response is often more timely than a formal response. The biggest challenge for public health preparedness in the NCR is incorporating all federal government agencies in the area in NCR preparedness planning.
Using Google Earth as an Innovative Tool for Community Mapping
Authors: Lefer Theodore B. , Anderson Matthew R. , Fornari Alice , Lambert Anastasia , Fletcher Jason , Baquero Maria
Published: January 2017

Maps are used to track diseases and illustrate the social context of health problems. However, commercial mapping software requires special training. This article illustrates how nonspecialists used Google Earth™, a free program, to create community maps.

The Bronx, New York, is characterized by high levels of obesity and diabetes. Residents and medical students measured the variety and quality of food and exercise sources around a residency training clinic and a student-run free clinic, using Google Earth to create maps with minimal assistance. Locations were identified using street addresses or simply by pointing to them on a map. Maps can be shared via e-mail, viewed online with Google Earth or Google Maps, and the data can be incorporated into other mapping software.
Maternal Obesity and Risk of Infant Death Based on Florida Birth Records for 2004
Authors: Thompson Daniel R. , Clark Cheryl L. , Wood Betsy , Zeni Mary Beth
Published: January 2017

Objective.

The purpose of this study was to assess the relationship between pre-pregnancy maternal obesity and risk of infant death.

Methods.

In March 2004, maternal height and pre-pregnancy weight were added to the data collected on the Florida birth certificate. Using birth records linked to infant deaths, these data were used to assess the relationship between pre-pregnancy maternal obesity, as measured by body mass index, and infant death.

Results.

Pre-pregnancy maternal obesity was associated with increased odds of infant death. The increased risk was found with and without adjustments for maternal race, marital status, age, education, trimester prenatal care began, first birth, and tobacco use.

Conclusion.

There is a substantial and significant association between prepregnancy maternal obesity and infant death.
Incorporating Youth-Led Community Participatory Research into School Health Center Programs and Policies
Authors: Soleimanpour Samira , Brindis Claire , Geierstanger Sara , Kandawalla Spenta , Kurlaender Tamar
Published: January 2017

Training adolescents as student researchers is a strategy that can improve the delivery of care at school-based health centers (SBHCs) and significantly shift school health policies impacting students. From 2003 to 2006, the University of California, San Francisco, in partnership with Youth In Focus, implemented a participatory student research project to enhance the existing evaluation of the Alameda County SBHC Coalition and its participating clinic members, and to help develop and implement school health policies. Providing opportunities and training that enabled youth to identify and research the health needs of their peers, as well as advocate for improvements in SBHCs based on their research findings, represents an exciting youth development strategy. This article describes the role the youth played, how their adult partners supported their work, and the impact that their efforts had on the SBHCs and school health programming and policies in the areas of condom accessibility and mental health services.
Access and Utilization Patterns of School-Based Health Centers at Urban and Rural Elementary and Middle Schools
Authors: Wade Terrance J. , Mansour Mona E. , Guo Jeff J. , Huentelman Tracy , Line Kristin , Keller Kathryn N.
Published: January 2017

Objective.

We examined patterns of enrollment, use, and frequency of use in school-based health centers (SBHCs), as well as the referral, diagnosis, and disposition of SBHC visits among newly implemented SBHCs.

Methods.

Four rural and four urban school districts implementing SBHCs were examined from 2000 to 2003. Total school enrollment for students was 13,046. SBHC enrollment and medical encounter data were tracked using a Web-based medical database. Descriptive analyses were conducted to evaluate primary care access and utilization patterns.

Results.

A total of 7,460 (57.2%) students were enrolled in their SBHCs, of which 4,426 used the SBHC at least once for a total of 14,050 visits. SBHC enrollment was greater in urban districts but rate of utilization was higher in rural districts. Black students, students with public or no health insurance, and students with asthma or attention deficit disorder had higher enrollment and utilization. Rural parents referred more children to SBHCs than urban parents. Teachers referred more students who were black, had asthma, had no public or health insurance, or had acute-type health issues. Total visits increased during the three years, with the largest increase in mental health services. Students who were younger, white, attended rural schools, had public or health insurance, or had infections were more likely to be sent home. Those with chronic conditions and visits for mental health were more likely to be returned to class.

Conclusion.

Utilization patterns suggest improved access to needed health care for disadvantaged children. SBHCs are an important part of the safety net for the populations they are intended to serve.
Planning and Sustaining a School-Based Health Center: Cost and Revenue Findings from Oregon
Authors: Nystrom Robert J. , Prata Adriana
Published: January 2017

Objective.

Research concerning school-based health center (SBHC) costs and revenues is limited. This article discusses Oregon's SBHC State Program Office methodology and findings regarding costs and revenues for planning and operating Oregon SBHCs.

Methods.

A variety of data sources and case studies conducted in five Oregon SBHC systems were used to calculate startup and annual operations costs. All Oregon SBHCs completed a survey providing 2005–2006 revenue data. Revenue data were further linked to 2005–2006 client utilization data, such as the number and age of unduplicated clients, public and private insurance status, and medical sponsor type.

Results.

Startup costs for Oregon SBHCs depended largely on the status of available space. Median, minimum, and maximum annual operations costs were calculated for core, intermediate, and expanded models of service delivery, and depended mostly on provider hours and types. Centers with federally qualified health center medical sponsors rely heavily on revenue from billing public insurance programs. Billing revenue depends on the percent of uninsured visits. School socioeconomic indicators such as the percent of students eligible for free and reduced lunch may be good indicators for the percent of student clients with public insurance.

Conclusions.

The methodology employed may encourage other state SBHC agencies or organizations to adopt research designs to collect and analyze cost and revenue data. On a practical level, the findings provide state and local policy makers and communities planning SBHCs with preliminary estimates for the costs of startup and annual operations, and some understanding of income sources and billing revenue projections.
Impact of School-Based Health Centers on Students with Mental Health Problems
Authors: Guo Jeff J. , Wade Terrance J. , Keller Kathryn N.
Published: January 2017

Objectives.

School-based health centers (SBHCs) play an increasingly major role in providing mental health services for students. This study evaluated the impact of SBHCs on mental health-care services and psychosocial health-related quality of life (HRQOL).

Methods.

Four SBHC intervention and two matched non-SBHC school districts were examined from 1997 to 2003. The SBHC intervention began in 2000. Data included child and parent pediatric HRQOL and Ohio Medicaid claims. A longitudinal quasi-experimental time-series repeated measures design was used for this study, involving analysis of covariance to assess health costs and regression analyses for HRQOL scores.

Results.

After the SBHC program, proportions of students accessing mental health-care services for urban and rural SBHC intervention schools increased 5.6% (χ2=39.361, p<0.0001) and 5.9% (χ2=5.545, p<0.0001), respectively, compared with increases of 2.6% (χ2=2.670, p=0.1023) and 0.2% (χ2=0.006, p=0.9361) for urban and rural non-SBHC schools, respectively. Using data from 109 students with mental health problems based on Medicaid claims, the study found SBHC students had significantly lower total health-care costs (F=5.524, p=0.005) and lower costs of mental health services (F=4.820, p=0.010) compared with non-SBHC students. While improvements over time in HRQOL for SBHC students compared with non-SBHC students and students from non-SBHC schools were observed, only some were statistically significant.

Conclusions.

SBHC programs increase the proportion of students who receive mental health services and may improve pediatric HRQOL. SBHC students with mental health problems had lower total Medicaid reimbursements compared with non-SBHC students.
Process Evaluation of an In-School Anti-Tobacco Media Campaign in Louisiana
Authors: Hong Traci , Johnson Carolyn C. , Myers Leann , Boris Neil , Brewer Dixye , Webber Larry S.
Published: January 2017

Objectives.

In light of challenges imposed by the changing media landscape and decreasing classroom time available for health interventions, new approaches are needed to disseminate anti-tobacco messages to adolescents. This study reported process evaluation of an in-school three-year anti-tobacco media campaign conducted in 10 schools in Louisiana.

Methods.

Over three years, 10 schools received an in-school anti-tobacco media campaign. The media campaign was one intervention component of the Acadiana Coalition of Teens against Tobacco. Campaign measures were tracked over the campaign's three-year duration. The campaign and evaluation were designed to target the students as they progressed through high school. The number of students who completed the surveys were 1,823 in Year 1, 1,552 in Year 2, and 1,390 in Year 3. Schools eligible for participation were publicly funded schools with no magnet or special populations and within a two-hour driving distance of the New Orleans study office.

Results.

In a self-report survey (Year 1, n=1,823; Year 2, n=1,552; Year 3, n=1,390), more than 75% and 50% of students reported being exposed to posters and public service announcements, respectively. Recognition of campaign theme was more than 80%. Almost half of respondents reported that the posters were interesting, one-third reported that the posters prevented them from smoking, and 10% reported that the posters encouraged them to cease smoking. Stock media posters had a significantly higher affective reaction than the customized media posters.

Conclusion.

Findings suggest that in-school media programs are useful and should be considered as a viable approach to health education for adolescents.
Using Gaming Simulation to Evaluate Bioterrorism and Emergency Readiness Education
Authors: Olson Debra K. , Scheller Amy , Larson Susan , Lindeke Linda , Edwardson Sandra
Published: January 2017

Objective.

We performed an outcome evaluation of the impact of public health preparedness training as a group comparison posttest design to determine the differences in the way individuals who had participated in training performed in a simulated emergency.

Methods.

The Experimental Group 1 included students who had graduated from or were currently enrolled in the bioterrorism and emergency readiness (BT/ER) curriculum at the University of Minnesota School of Public Health. The comparison groups included individuals who had access to the Internet and were aware of the 2006 online simulation Disaster in Franklin County: A Public Health Simulation. The evaluation process employed surveys and the gaming simulation as sources for primary data.

Results.

Participants in the BT/ER curriculum ( p=0.0001) and other participants completing at least 45 hours of training in the past year ( p=0.0001) demonstrated higher effectiveness scores (accuracy of chosen responses within the simulation) than participants who did not report significant amounts of training.

Conclusions.

This evaluation research demonstrated that training is significantly associated with better performance in a simulated emergency using gaming technology.
Emergency Department Visits for Antiviral Adverse Events during the 2009 H1N1 Influenza Pandemic
Authors: Lovegrove Maribeth C. , Shehab Nadine , Hales Craig M. , Poneleit Kathy , Crane Elizabeth , Budnitz Daniel S.
Published: January 2017

The 2009 pandemic influenza A (H1N1) outbreak was associated with an increased use of antiviral agents and highlighted the role of population-based monitoring for related adverse drug events (ADEs). An ongoing, nationally representative emergency department-based surveillance system was used to identify and characterize ADEs during the pandemic. Active surveillance for ADEs successfully provided timely, population-based data during the pandemic. Increases in antiviral ADEs paralleled increases in prescribing. Type and severity of ADEs were similar across all seasons.
Cancer-Related Disparities and Opportunities for Intervention in Northern Plains American Indian Communities
Authors: Watanabe-Galloway Shinobu , Flom Nicole , Xu Liyan , Duran (Rosebud Sioux) Tinka , Frerichs Leah , Kennedy Favian , Smith Corey B. , Jaiyeola Adeola O.
Published: January 2017

Objectives.

We examined behavioral trends associated with cancer risk and cancer screening use from 1997 through 2006 among American Indians/Alaska Natives (AI/ANs) in the Northern Plains region (North Dakota, South Dakota, Nebraska, and Iowa) of the United States. We also examined disparities between that population and non-Hispanic white (NHW) people in the Northern Plains and AI/ANs in other regions.

Methods.

We analyzed Behavioral Risk Factor Surveillance System data from the Centers for Disease Control and Prevention for 1997–2000 and 2003–2006. We used age-adjusted Wald Chi-square tests to test the difference between these two periods for AI/ANs and the difference between AI/ANs and NHW people during 2003–2006.

Results.

There was no statistically significant improvement among AI/ANs in the Northern Plains region for behaviors associated with cancer risk or cancer screening use, and there was a significant increase in the obesity rate. The prevalence of binge drinking, obesity, and smoking among AI/ANs in the Northern Plains was significantly higher than among NHW people in the same region and among AI/AN populations in other regions. Although the percentage of cancer screening use was similar for all three groups, the use of sigmoidoscopy/colonoscopy was significantly lower among the Northern Plains AI/ANs than among NHW people.

Conclusion.

These results indicate a need for increased efforts to close the gaps in cancer health disparities between AI/ANs and the general population. Future efforts should focus not only on individual-level changes, but also on system-level changes to build infrastructure to promote healthy living and to increase access to cancer screening.
Who are California's Late HIV Testers? An Analysis of State AIDS Surveillance Data, 2000–2006
Authors: Tang Janet J. , Levy Vivian , Hernandez Maria Teresa
Published: January 2017

Objectives.

Late HIV testing leads to preventable, severe clinical and public health outcomes. California, lacking a mature HIV surveillance system, has been excluded from documented analyses of late HIV testers in the United States. We identified factors associated with late HIV testing in the California AIDS surveillance data to inform programs of HIV testing and access to treatment.

Methods.

We analyzed data from California AIDS cases diagnosed between 2000 and 2006 and reported through November 1, 2007. Late testers were people diagnosed with HIV within 12 months before their AIDS diagnosis. We identified factors significantly associated with late HIV testing using multivariable logistic regression.

Results.

Among 28,382 AIDS cases, 61.2% were late HIV testers. Late testing was significantly associated with those ≥35 years of age, heterosexual contact or unknown/other reported transmission risk, and being born outside of the U.S. When further classified by country of birth, people born in Mexico were most likely to be HIV late testers who progressed to AIDS.

Conclusions.

Our findings support wider implementation of opt-out HIV testing and HIV testing based in emergency departments. Services for HIV testing and treatment should be inclusive of all populations, but especially targeted to populations that may have more limited access.
Age as an Independent Risk Factor for Intensive Care Unit Admission or Death Due to 2009 Pandemic Influenza A(H1N1) Virus Infection
Authors: Nickel Katelin B. , Marsden-Haug Nicola , Lofy Kathryn H. , Turnberg Wayne L. , Rietberg Krista , Lloyd Jennifer K. , Marfin Anthony A.
Published: January 2017

Objective.

This study evaluated risk factors for intensive care unit (ICU) admission or death among people hospitalized with 2009 pandemic influenza A (pH1N1) virus infection.

Methods.

We based analyses on data collected in Washington State from April 27 to September 18, 2009, on deceased or hospitalized people with laboratory-confirmed pH1N1 infection reported by health-care providers and hospitals as part of enhanced public health surveillance. We used bivariate analyses and multivariable logistic regression to identify risk factors associated with ICU admission or death due to pH1N1.

Results.

We identified 123 patients admitted to the hospital but not an ICU and 61 patients who were admitted to an ICU or died. Independent of high-risk medical conditions, both older age and delayed time to hospital admission were identified as risk factors for ICU admission or death due to pH1N1. Specifically, the odds of ICU admission or death were 4.44 times greater among adults aged 18–49 years (95% confidence interval [CI] 1.97, 10.02) and 5.93 times greater among adults aged 50–64 years (95% CI 2.24, 15.65) compared with pediatric patients <18 years of age. Likewise, hospitalized cases admitted more than two days after illness onset had 2.17 times higher odds of ICU admission or death than those admitted within two days of illness onset (95% CI 1.10,4.25).

Conclusion.

Although certain medical conditions clearly influence the need for hospitalization among people infected with pH1N1 virus, older age and delayed time to admission each played an independent role in the progression to ICU admission or death among hospitalized patients.
Health Impact in New York City during the Northeastern Blackout of 2003
Authors: Lin Shao , Fletcher Barbara A. , Luo Ming , Chinery Robert , Hwang Syni-An
Published: January 2017

Objective.

This study assessed the health effects of the 2003 Northeastern blackout, the largest one in history, on mortality and hospital admissions due to respiratory, cardiovascular, and renal diseases in New York City (NYC), and compared the disease patterns and sociodemographic profiles of cases during the blackout with those on control days.

Method.

We investigated the effects of the blackout on health using incidence rate ratios to compare the disease on blackout days (August 14 and 15, 2003) with those on normal and comparably hot days (controls). Normal days were defined as summer days (June-August) between the 25th and 75th percentiles of maximum temperature during 1991–2004. Comparably hot days were days with maximum temperatures in the same range as that of the blackout days. We evaluated the interactive effects of demographics and the blackout using a case-only design.

Results.

We found that mortality and respiratory hospital admissions in NYC increased significantly (two- to eightfold) during the blackout, but cardiovascular and renal hospitalizations did not. The most striking increases occurred among elderly, female, and chronic bronchitis admissions. We identified stronger effects during the blackout than on comparably hot days. In contrast to the pattern observed for comparably hot days, higher socioeconomic status groups were more likely to be hospitalized during the blackout.

Conclusions.

This study suggests that power outages may have important health impacts, even stronger than the effects of heat alone. The findings provide some direction for future emergency planning and public health preparedness.
Increasing Inner-City Adult Influenza Vaccination Rates: A Randomized Controlled Trial
Authors: Humiston Sharon G. , Bennett Nancy M. , Long Christine , Eberly Shirley , Arvelo Lourdes , Stankaitis Joseph , Szilagyi Peter G.
Published: January 2017

Objectives.

In a population of seniors served by urban primary care centers, we evaluated the effect of the practice-based intervention on influenza immunization rates and disparities in vaccination rates by race/ethnicity and insurance status.

Methods.

A randomized controlled trial during 2003–2004 tested patient tracking/recall/outreach and provider prompts on improving influenza immunization rates. Patients aged ≥65 years in six large inner-city primary care practices were randomly allocated to study or control group. Influenza immunization coverage was measured prior to enrollment and on the end date.

Results.

At study end, immunization rates were greater for the intervention group than for the control group (64% vs. 22%, p<0.0001). When controlling for other factors, the intervention group was more than six times as likely to receive influenza vaccine. The intervention was effective across gender, race/ethnicity, age, and insurance subgroups. Among the intervention group, 3.5% of African Americans and 3.2% of white people refused influenza immunization.

Conclusions.

Patient tracking/recall/outreach and provider prompts were intensive but successful approaches to increasing seasonal influenza immunization rates among this group of inner-city seniors.
Assessing the Relationship between Seasonal and H1N1 Influenza Vaccination Status in Michigan Children, 2009–2010
Authors: Boulton Matthew L. , Grossman Alyse M. , Potter Rachel , Vranesich Patricia A. , Clayton Joshua
Published: January 2017

Objectives.

To examine the relationship between the outcome of vaccination for H1N1 influenza and receipt of seasonal influenza vaccine in Michigan children during the 2009–2010 season, we examined the influenza vaccination status of all Michigan residents aged six months to 18 years who were enrolled in the Michigan Care Improvement Registry.

Methods.

We calculated descriptive statistics for dichotomous and categorical variables, including numbers of children vaccinated with either influenza A (H1N1) monovalent vaccine and/or seasonal influenza vaccine, gender, race/ethnicity, provider type, moved-or-gone-elsewhere (MOGE) status, and vaccine type. We used logistic regression, adjusting for potential confounders and effect modifiers (age and MOGE status), to calculate odds ratios associated with H1N1 vaccine status (vaccinated vs. unvaccinated).

Results.

Michigan children who were vaccinated for seasonal influenza from August 1, 2009, to February 27, 2010, were 6.26 (95% confidence interval 6.18, 6.34) times as likely as children who were unvaccinated for seasonal influenza to be vaccinated with H1N1 2009 monovalent vaccine. Private health-care providers administered 91% of the seasonal influenza vaccine and 59% of the H1N1 vaccine.

Conclusions.

Increasing seasonal influenza vaccination campaign efforts could also benefit pandemic influenza vaccination efforts. Special educational outreach to parents regarding the importance of influenza vaccination for all children, regardless of age, may be needed. Stocking and offering traditional seasonal vaccine with pandemic-specific vaccine may aid in increasing immunization uptake. Efforts should be made to ensure that private providers are supplied with adequate pandemic vaccine as part of preparedness planning.
The Swiss National Vaccination Coverage Survey, 2005–2007
Authors: Lang Phung , Zimmermann Hanspeter , Piller Ursula , Steffen Robert , Hatz Christoph
Published: January 2017

Objectives.

We described the results from the Swiss National Vaccination Coverage Survey (SNVCS) 2005–2007, a survey designed to monitor immunization coverage of children and adolescents residing in Switzerland in each canton within a three-year period.

Methods.

The SNVCS is a cross-sectional survey using a two-stage sampling design targeting children aged 2, 8, and 16 years. Families of selected children were contacted by mail and telephone. Coverage was determined via vaccination cards or vaccination summary forms.

Results.

A total of 25 out of 26 cantons participated in the survey, with 8,286 respondents for children aged 24–35 months, 10,314 respondents for children aged 8 years, and 9,301 respondents for teenagers aged 16 years. Compared with data from 1999–2003, coverage estimates for toddlers remained unchanged for diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b vaccines at three doses, but increased five percentage points to 86%–87% for measles-mumps-rubella at one dose and was 71% at two doses. Coverage for measles, mumps, and rubella were 89%–90% at one dose and 75% at two doses for 8-year-olds, and 94% and 76% for the two dosages, respectively, for 16-year-olds. Linguistic region and nationality were highly correlated with being vaccinated against measles for the two younger age groups.

Conclusion.

Despite the increase in vaccine coverage, measles vaccination is still low, and the World Health Organization goal to eliminate measles by 2010 was not achieved in Switzerland. More efforts are needed by the cantons and the central government to increase vaccination coverage.
Vaccination Coverage among U.S. Children Aged 19–35 Months Entitled by the Vaccines for Children Program, 2009
Authors: Smith Philip J. , Lindley Megan C. , Rodewald Lance E.
Published: January 2017

Objectives.

Following the measles outbreaks of the late 1980s and early 1990s, vaccination coverage was found to be low nationally, and there were pockets of underimmunized children primarily in inner cities. We described the percentage and demographics of children who were entitled to the Vaccines for Children (VFC) program in 2009 and evaluated whether Healthy People 2010 (HP 2010) vaccination coverage objectives of 90% were achieved among these children.

Methods.

We analyzed data from 16,967 children aged 19–35 months sampled by the National Immunization Survey in 2009. VFC-entitled children included children who were ( 1) on Medicaid, ( 2) not covered by health insurance, ( 3) of American Indian/Alaska Native race/ethnicity, or ( 4) covered by private health insurance that did not pay all of the costs of vaccines, but who were vaccinated at a Federally Qualified Health Center or a Rural Health Center.

Results.

An estimated 49.7% of all children aged 19–35 months were entitled to VFC vaccines. Compared with children who did not qualify for VFC, the VFC-entitled children were significantly more likely to be Hispanic or non-Hispanic black; to have a mother who was widowed, divorced, separated, or never married; and to live in a household with an annual income below the federal poverty level. Mothers of VFC-entitled children were significantly less likely to have some college experience or to be college graduates. Of nine vaccines analyzed, two vaccines—polio at 91.7% and hepatitis B at 92.2%—achieved the HP 2010 90% coverage objective for VFC-entitled children, and four others, including measles-mumps-rubella at 88.8%, achieved greater than 80% coverage.

Conclusions.

Today, children with demographic characteristics like those of children who were at the epicenter of the measles outbreaks two decades ago are entitled to VFC vaccines at no cost, and have achieved high vaccination coverage levels.
Vaccination Coverage among U.S. Adolescents Aged 13–17 Years Eligible for the Vaccines for Children Program, 2009
Authors: Lindley Megan C. , Smith Philip J. , Rodewald Lance E.
Published: January 2017

Objectives.

We compared ( 1) characteristics of adolescents who are and are not entitled to receive free vaccines from the Vaccines for Children (VFC) program and ( 2) vaccination coverage with meningococcal conjugate (MCV4), quadrivalent human papillomavirus (HPV4), and tetanus-diphtheria-acellular pertussis (Tdap) vaccines among VFC-eligible and non-VFC-eligible adolescents.

Methods.

We analyzed data from the 2009 National Immunization Survey-Teen, a nationally representative, random-digit-dialed survey of households with adolescents aged 13–17 years ( n=20,066). Differences in sociodemographic characteristics and provider-reported vaccination coverage were evaluated using t-tests.

Results.

Overall, 32.1% (±1.2%) of adolescents were VFC-eligible. VFC-eligible adolescents were significantly less likely than non-VFC-eligible adolescents to be white and to live in suburban areas, and more likely to live in poverty and to have younger and less educated mothers. Nationally, coverage among non-VFC-eligible adolescents was 57.1% (±1.5%) for ≥1 dose of Tdap, 55.4% (±1.5%) for ≥1 dose of MCV4, and 43.2% (±2.2%) for ≥1 dose of HPV4. Coverage among VFC-eligible adolescents was 52.5% (±2.4%) for ≥1 dose of Tdap, 50.1% (±2.4%) for ≥1 dose of MCV4, and 46.6% (±3.5%) for ≥1 dose of HPV4. Only 27.5% (±1.8%) of non-VFC-eligible adolescents and 25.0% (±2.9%) of VFC-eligible adolescents received ≥3 doses of HPV4. Vaccination coverage was significantly higher among non-VFC-eligible adolescents for Tdap and MCV4, but not for one-dose or three-dose HPV4.

Conclusions.

Coverage with some recommended vaccines is lower among VFC-eligible adolescents compared with non-VFC-eligible adolescents. Continued monitoring of adolescent vaccination rates, particularly among VFC-eligible populations, is needed to ensure that all adolescents receive all routinely recommended vaccines.
Obesity among Chronically Homeless Adults: Is it a Problem?
Authors: Tsai Jack , Rosenheck Robert A.
Published: January 2017

Objective.

We examined rates of obesity and associated characteristics in the chronically homeless population to explore how a range of factors, including sociodemographics, housing, food source, physical and mental health, and health service use, were related to being overweight or obese.

Methods.

We conducted multivariate regression analyses on a community sample of 436 chronically homeless adults across 11 U.S. cities to examine the prevalence of obesity.

Results.

The majority (57%) of chronically homeless adults were overweight or obese Chronically homeless adults who were female or Hispanic appeared to be at particular risk for obesity There were few differences on physical and mental health by weight group Although overweight and obese chronically homeless adults were more likely to discuss exercise with a health-care provider, they reported engaging in less exercise than those who were underweight or normal weight.

Conclusion.

these findings underscore the need for greater attention to obesity in chronically homeless adults and demonstrate a food insecurity-obesity paradox or poverty-obesity link.
Uptake of Meningococcal Vaccine in Arizona Schoolchildren after Implementation of School-Entry Immunization Requirements
Authors: Simpson Jennifer E. , Hills Rebecca A. , Allwes Deborah , Rasmussen Lisa
Published: January 2017

Objectives.

Meningitis and bacteremia due to Neisseria meningitidis are rare but potentially deadly diseases that can be prevented with immunization Beginning in 2008, Arizona school immunization requirements were amended to include immunization of children aged 11 years or older with meningococcal vaccine before entering the sixth grade We describe patterns in meningococcal vaccine uptake surrounding these school-entry requirement changes in Arizona.

Methods.

We used immunization records from the Arizona State Immunization Information System (ASIIS) to compare immunization rates in 11- and 12-year-olds We used principal component analysis and hierarchical cluster analysis to identify and analyze demographic variables reported by the 2010 U.S. Census.

Results.

Adolescent meningococcal immunization rates in Arizona increased after implementation of statewide school-entry immunization requirements The increase in meningococcal vaccination rates among 11- and 12-year-olds from 2007 to 2008 was statistically significant ( p<0.0001) All demographic groups had significantly higher odds of on-schedule vaccination after the school-entry requirement change (odds ratio range = 5.57 to 12.81, p<0.0001) County demographic factors that were associated with lower odds of on-schedule vaccination included higher poverty, more children younger than 18 years of age, fewer high school graduates, and a higher proportion of Native Americans.

Conclusions.

This analysis suggests that implementation of school immunization requirements resulted in increased meningococcal vaccination rates in Arizona, with degree of response varying by demographic profile. ASIIS was useful for assessing changes in immunization rates over time Further study is required to identify methods to control for population overestimates in registry data.