bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-Time Surveillance for Tuberculosis Using Electronic Health Record Data from an Ambulatory Practice in Eastern Massachusetts
Authors: Calderwood Michael S. , Platt Richard , Hou Xuanlin , Malenfant Jessica , Haney Gillian , Kruskal Benjamin , Lazarus Ross , Klompas Michael 
Published: July 2017

Objective. Electronic health records (EHRs) have the potential to improve completeness and timeliness of tuberculosis (TB) surveillance relative to traditional reporting, particularly for culture-negative disease. We report on the development and validation of a TB detection algorithm for EHR data followed by implementation in a live surveillance and reporting system. Methods. We used structured electronic data from an ambulatory practice in eastern Massachusetts to develop a screening algorithm aimed at achieving 100% sensitivity for confirmed active TB with the highest possible positive predictive value (PPV) for physician-suspected disease. We validated the algorithm in 16 years of retrospective electronic data and then implemented it in a realtime EHR-based surveillance system. We assessed PPV and the completeness of case capture relative to conventional reporting in 18 months of prospective surveillance. Results. The final algorithm required a prescription for pyrazinamide, an International Classification of Diseases, Ninth Revision (ICD-9) code for TB and prescriptions for two antituberculous medications, or an ICD-9 code for TB and an order for a TB diagnostic test. During validation, this algorithm had a PPV of 84% (95% confidence interval 78, 88) for physician-suspected disease. One-third of confirmed cases were culture-negative. All false-positives were instances of latent TB. In 18 months of prospective EHR-based surveillance with this algorithm, seven additional cases of physician-suspected active TB were detected, including two patients with culture-negative disease. A review of state health department records revealed no cases missed by the algorithm. Conclusions. Live, prospective TB surveillance using EHR data is feasible and promising.
Effect of School Closure on the Incidence of Influenza among School-Age Children in Arizona
Authors: Wheeler Colleen C. , Erhart Laura M. , Jehn Megan L. 
Published: July 2017

Objective. We assessed the impact of school closures as a viable intervention in the event of an influenza pandemic. Methods. We evaluated the effect of scheduled, two-week winter break school closures during the 2004–2008 school years on the occurrence of influenza among children aged 5–17 years in Arizona. Results. We found a consistent pattern of benefit to school-age children during winter school closures when non-school-age children and adults experienced significant increases in influenza incidence, an increase not seen among school-age children. Quantitative analysis showed that school closures may prevent or delay as much as 42% of potential influenza cases among school-age children. In addition, the ratio of illness in school-age children as compared with adults and non-school-age children decreased significantly from before to during the same school closure periods. Conclusion. This analysis provides evidence to suggest that school-age children may experience a slowing of influenza transmission during winter school closures compared with those not of school age. Federal, state, and local policy makers may consider these findings in their pandemic influenza and public health emergency preparedness planning efforts.
Varicella Seroprevalence in the U.S.: Data from the National Health and Nutrition Examination Survey, 1999–2004
Authors: Reynolds Meredith A. , Kruszon-Moran Deanna , Jumaan Aisha , Schmid D. Scott , McQuillan Geraldine M. 
Published: July 2017

Objective. We estimated the varicella seroprevalence among the U.S. population aged 6–49 years based on retested National Health and Nutrition Examination Survey (NHANES) specimens collected between 1999 and 2004—originally tested using a method unsuitable for detecting vaccine-induced immunity—and compared it with historical estimates. Methods. We performed a confirmatory test suitable for detecting vaccine-induced immunity on all available specimens from 6- to 19-year-olds who originally tested negative ( n=633), and on 297 randomly selected specimens that had tested positive. Retest results superseded original results for determining seroprevalence. We assessed seroprevalence for the entire sample aged 6–49 years ( n=16,050) by participant demographic characteristics and compared it with historical estimates (NHANES 1988–1994). Results. The percentage of false-negative results for the original test was higher for specimens from younger children (6–11 years of age: 27.5%; 12–19 years of age: 13.3%) and for specimens collected most recently (2001–2004: 26.0%; 1999–2000: 12.6%). The age-adjusted rate of varicella seroprevalence for 1999–2004 was 93.6% for 6- to 19-year-olds and 98.0% for adults aged 20–49 years compared with 90.0% and 98.1%, respectively, for 1988–1994. We found an increase in seropositivity between the survey periods, from 93.2% to 97.2% ( p<0.001) among 12- to 19-year-olds. For children, non-Hispanic black ethnicity and younger age were associated with lower seroprevalence in both survey periods. Conclusions. Varicella seroprevalence increased with age among children and was uniformly high in the U.S. adult population between 1999 and 2004. The original testing produced false-negative seroprevalence results among children's specimens collected between 1999 and 2004 from 6- to 19-year-olds.
Comparison of Incidence of Hospital Utilization for Poisoning and other Injury Types
Authors: Spiller Henry A. , Singleton Michael D. 
Published: July 2017

Objectives. We investigated the incidence of hospital utilization for injuries and compared poisoning with other forms of injury. Previous studies have suggested poison control centers reduce health-care costs by decreasing hospital utilization. Methods. We conducted a one-year retrospective study involving patients treated for injuries at acute-care hospitals in Kentucky in 2008. We also compared inpatient discharges with discharges directly from the emergency department (ED) to determine hospitalization rates. The primary data sources were the Kentucky Hospital Billing database and the Kentucky Regional Poison Control Center (KRPCC) database. Results. In 2008, there were 377,642 hospital encounters for injuries in Kentucky. The most common mechanisms of injury were falls, struck by/against, motor vehicle traffic crashes, and overexertion. Three causes of injury were greater than one standard deviation above the mean in percentage of inpatient admissions: poisoning (41.3%), firearms (38.4%), and drowning (22.4%). During this same year, KRPCC reported 46,258 poisonings, with 76.5% of patients managed outside of a health-care facility, 11.4% of patients treated and released from the ED, 7.1% of patients admitted to inpatient care, 2.3% of patients admitted to psychiatric care, and 2.7% lost to follow-up. Conclusions. Three causes of injury had the greatest percentage of patients admitted for inpatient medical care—poisoning, firearms, and drowning—suggesting a high level of severity in these injuries presenting to the ED. We believe availability and use of a poison control center reduced hospital utilization for poisoning primarily by managing a large number of low-severity patients outside of the hospital system.
Use of Hospital Discharge Data to Evaluate Notifiable Disease Reporting to Colorado's Electronic Disease Reporting System
Authors: Boehmer Tegan K. , Patnaik Jennifer L. , Burnite Steven J. , Ghosh Tista S. , Gershman Ken , Vogt Richard L. 
Published: July 2017

Objective. Notifiable disease surveillance systems are critical for communicable disease control, and accurate and timely reporting of hospitalized patients who represent the most severe cases is important. A local health department in metropolitan Denver used inpatient hospital discharge (IHD) data to evaluate the sensitivity, timeliness, and data quality of reporting eight notifiable diseases to the Colorado Electronic Disease Reporting System (CEDRS). Methods. Using IHD data, we detected hospitalized patients admitted from 2003 through 2005 with a discharge diagnosis associated with one of eight notifiable diseases. Initially, we compared all cases identified through IHD diagnoses fields with cases reported to CEDRS. Second, we chose four diseases and conducted medical record review to confirm the IHD diagnoses before comparison with CEDRS cases. Results. Relying on IHD diagnoses only, shigellosis, salmonellosis, and Neisseria meningitidis invasive disease had high sensitivity (≥90%) and timeliness (≥75%); legionellosis, pertussis, and West Nile virus infection were intermediate; and hepatitis A and Haemophilus influenzae ( H. influenzae) invasive disease had low sensitivity (≤25%) and timeliness (≤33%). Medical record review improved the sensitivity to ≥90% and timeliness to ≥80% for H. influenza invasive disease, legionellosis, and pertussis; however, hepatitis A retained suboptimal sensitivity (67%) and timeliness (25%). Conclusions. Hospital discharge data are useful for evaluating notifiable disease surveillance systems. Limitations encountered by using discharge diagnoses alone can be overcome by conducting medical record review. Public health agencies should conduct periodic surveillance system evaluations among hospitalized patients and reinforce notifiable disease reporting among the people responsible for this activity.
Breast and Cervical Cancer Screening Patterns among American Indian Women at IHS Clinics in Montana and Wyoming
Authors: Wilson Robin Taylor , Giroux Jennifer , Kasicky Kathryn Rita , Fatupaito Bethany Hemlock , Wood Eric C. , Crichlow Renee , Rhodes Neil A. Sun , Tingueley Jennifer , Walling Andrea , Langwell Kathryn , Cobb Nathaniel 
Published: July 2017

Objectives. We investigated factors associated with primary and secondary breast and cervical cancer screening among American Indian (AI) women receiving care from the Indian Health Service (IHS) in Montana and Wyoming. Methods. Rates of primary screening (i.e., screening without evidence of a prior abnormal) and secondary screening during a three-year period (2004–2006) were determined in an age- and clinic-stratified random sample of 1,094 women at six IHS units through medical record review. Results. Three-year mammography prevalence rates among AI women aged ≥45 years were 37.7% (95% confidence interval [CI] 34.1, 41.3) for primary and 58.7% (95% CI 43.9, 73.5) for secondary screening. Among women aged ≥18 years, three-year Pap test prevalence rates were 37.8% (95% CI 34.9, 40.6) for primary and 53.2% (95% CI 46.0, 60.4) for secondary screening. Primary mammography screening was positively associated with number of visits and receiving care at an IHS hospital (both p<0.001). Primary Pap test screening was inversely associated with age and positively associated with the number of patient visits (both p<0.001). Secondary mammography screening was inversely associated with driving distance to an IHS facility ( p=0.035). Conclusion. Our results are consistent with other surveys among AI women, which report that Healthy People 2010 goals for breast (90%) and cervical (70%) cancer screening have not been met. Improvements in breast and cervical cancer screening among AI women attending IHS facilities are needed.
Changing Trends in Viral Hepatitis-Associated Hospitalizations in the American Indian/Alaska Native Population, 1995–2007
Authors: Byrd Kathy K. , Redd John T. , Holman Robert C. , Haberling Dana L. , Cheek James E. 
Published: July 2017

Objective. We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care. Methods. We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995–2007 and summary periods 1995–1997 and 2005–2007. Results. Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995–1997 to 0.8 per 100,000 population during 2005–2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45–64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45–64 years, males, and those in the Alaska region. Conclusions. Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment.
Smoke-Free Laws, Gender, and Reduction in Hospitalizations for Acute Myocardial Infarction
Authors: Hahn Ellen J. , Rayens Mary Kay , Burkhart Patricia V. , Moser Debra K. 
Published: July 2017

Objective. We examined gender differences in the incidence of acute myocardial infarction (AMI) after the passage of a smoke-free law in Lexington, Kentucky. The initial legislation had exemptions not covering manufacturing facilities and government buildings, which may have put men at greater risk for AMI. Methods. We examined the effect of Lexington's smoke-free public places law on hospitalizations for AMI (i.e., heart attack) among men and women 40 months prior to and 32 months after enactment of the law. We used the statewide administrative database (Comp Data) for all hospital billing records for the four health-care systems in Lexington-Fayette County. Cases were included in the analysis if ( 1) the patient was ≥35 years of age; ( 2) the patient had a primary discharge diagnosis of AMI, with an International Classification of Diseases, Ninth Revision code in the range of 410.00 to 410.99; and ( 3) the date of service was between January 1, 2001, and December 31, 2006. Results. Among women, AMI hospitalizations declined 23% after the law took effect. The rate of AMI events among men did not change significantly. There was an overrepresentation of women in the hospitality industry and a disproportionate number of men working in manufacturing facilities and government worksites not mandated by the law. Conclusions. We found gender differences in the reduction of AMI hospitalizations following implementation of a smoke-free law that covered only some sectors of the workforce. Enacting smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to female and male workers.
Wild Mushroom Exposures in Florida, 2003–2007
Authors: Kintziger Kristina W. , Mulay Prakash , Watkins Sharon , Schauben Jay , Weisman Richard , Lewis-Younger Cynthia , Blackmore Carina 
Published: July 2017

Objective. Exposure to wild mushrooms can lead to serious illness and death. However, there is little information on the epidemiology of mushroom exposures nationwide, as there is no specific surveillance for this outcome. We described mushroom exposures in Florida using available data sources. Methods. We performed a population-based study of mushroom exposure calls to the Florida Poison Information Center Network (FPICN) and cases of mushroom poisoning reported in hospital inpatient and emergency department (ED) data from 2003 through 2007. Results. There were 1,538 unduplicated mushroom exposures reported during this period, including 1,355 exposure calls and 428 poisoning cases. Most exposures reported to FPICN occurred in children ≤6 years of age (45%) and males (64%), and most were unintentional ingestions (60%). Many exposures resulted in no effect (35%), although 21% reported mild symptoms that resolved rapidly, 23% reported prolonged/systemic (moderate) symptoms, and 1% reported life-threatening effects. Most calls occurred when in or en route to a health-care facility (43%). More than 71% of poisonings identified in hospital records were managed in an ED, and most occurred in young adults 16–25 years of age (49%), children ≤6 years of age (21%), adults >25 years of age (21%), and males (70%). No deaths were reported. Conclusions. Combined, these data were useful for describing mushroom exposures. Most exposures occurred in males and in young children (≤6 years of age) and young adults (16–25 years of age), with 78% resulting in contact with a health-care facility. Education should target parents of young children—especially during summer, when mushrooms are more abundant—and young adults who are likely experimenting with mushrooms for their potential hallucinogenic properties.
Veterinary Public Health Capacity in the United States: Opportunities for Improvement
Authors: Jarman Dwayne W. , Liang Jennifer L. , Luce Richard R. , Wright Jennifer G. , Stennies Gail M. , Bisgard Kristine M. 
Published: July 2017

Objectives. In 2006, the Association of American Veterinary Medical Colleges reported that the shortage (≥1,500) of public health veterinarians is expected to increase tenfold by 2020. In 2008, the Centers for Disease Control and Prevention (CDC) Preventive Medicine Fellows conducted a pilot project among CDC veterinarians to identify national veterinary public health workforce concerns and potential policy strategies. Methods. Fellows surveyed a convenience sample (19/91) of public health veterinarians at CDC to identify veterinary workforce recruitment and retention problems faced by federal agencies; responses were categorized into themes. A focus group (20/91) of staff veterinarians subsequently prioritized the categorized themes from least to most important. Participants identified activities to address the three recruitment concerns with the highest combined weight. Results. Participants identified the following three highest prioritized problems faced by federal agencies when recruiting veterinarians to public health: ( 1) lack of awareness of veterinarians' contributions to public health practice, ( 2) competitive salaries, and ( 3) employment and training opportunities. Similarly, key concerns identified regarding retention of public health practice veterinarians included: ( 1) lack of recognition of veterinary qualifications, ( 2) competitive salaries, and ( 3) seamless integration of veterinary and human public health. Conclusions. Findings identified multiple barriers that can affect recruitment and retention of veterinarians engaged in public health practice. Next steps should include replicating project efforts among a national sample of public health veterinarians. A committed and determined long-term effort might be required to sustain initiatives and policy proposals to increase U.S. veterinary public health capacity.
Identifying the Impact of Social Determinants of Health on Disease Rates Using Correlation Analysis of Area-Based Summary Information
Authors: Song Ruiguang , Hall H. Irene , Harrison Kathleen McDavid , Sharpe Tanya Telfair , Lin Lillian S. , Dean Hazel D. 
Published: July 2017

Objectives. We developed a statistical tool that brings together standard, accessible, and well-understood analytic approaches and uses area-based information and other publicly available data to identify social determinants of health (SDH) that significantly affect the morbidity of a specific disease. Methods. We specified AIDS as the disease of interest and used data from the American Community Survey and the National HIV Surveillance System. Morbidity and socioeconomic variables in the two data systems were linked through geographic areas that can be identified in both systems. Correlation and partial correlation coefficients were used to measure the impact of socioeconomic factors on AIDS diagnosis rates in certain geographic areas. Results. We developed an easily explained approach that can be used by a data analyst with access to publicly available datasets and standard statistical software to identify the impact of SDH. We found that the AIDS diagnosis rate was highly correlated with the distribution of race/ethnicity, population density, and marital status in an area. The impact of poverty, education level, and unemployment depended on other SDH variables. Conclusions. Area-based measures of socioeconomic variables can be used to identify risk factors associated with a disease of interest. When correlation analysis is used to identify risk factors, potential confounding from other variables must be taken into account.
Changing Disparities in Invasive Pneumococcal Disease by Socioeconomic Status and Race/Ethnicity in Connecticut, 1998–2008
Authors: Soto Kristen , Petit Susan , Hadler James L. 
Published: July 2017

Objectives. We compared invasive pneumococcal disease (IPD) incidence by race/ethnicity and neighborhood poverty level and assessed their relative utility to describe disparities in IPD in 1998–1999 and again in 2007–2008, after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Methods. We conducted laboratory surveillance for pneumococcal isolates from sterile body sites and serotyped the isolates. Home address was geocoded to the census-tract level. Census-tract data on the percentage of people below poverty were grouped into three categories. The difference in the magnitude of incidence by race/ethnicity and by census-tract socioeconomic status (SES) (high poverty minus low poverty) was compared for 1998–1999 and 2007–2008 for PCV7 and non-PCV7 serotypes. Results. In 1998–1999, incidence difference (all per 100,000 population) for PCV7 serotypes for black people compared with white people was 14.3 and by poverty level was 13.9. The highest rate was among white people in high-poverty tracts (77.3). By 2007–2008, there were only slight differences between rates for black and white people (0.7) and SES (1.4). In 1998–1999, the incidence difference for non-PCV7 serotypes was 4.7 between black and white people and 6.0 by SES. By 2007–2008, the differences were 11.6 and 11.7, respectively. Among those living in the highest-poverty tracts, white people had the highest rate (42.9). Conclusions. In the absence of vaccine, IPD incidence is higher among people living in higher-poverty census tracts and among black people. Emerging serotypes also follow this trend. Differences in neighborhood poverty levels reveal disparities in rates of IPD as large as those seen by race/ethnicity and could be used to routinely describe disparities and target prevention.