Effectiveness of Cleaning and Health Education in Reducing Childhood Lead Poisoning Among Children Residing Near Superfund Sites in Missouri

In this study, the authors evaluated whether a combination of tailored education, lead dust removal by trained cleaning specialists, and family follow-up visits would be more effective than conventional health educational programs in reducing elevated blood lead levels in children living in or near lead mining hazardous waste sites. The authors randomized children between 6 and 72 mo of age with blood lead levels between 10 and 20 microg/dl into 3 groups: standard care, tailored newsletters, or tailored newsletters and specialized cleaning. The authors obtained questionnaires, blood lead levels, and environmental lead samples during initiation and compared them with the same items obtained at 3, 6, and 9 mo follow-up. They used a linear mixed effect model to evaluate the intervention effect. Blood lead levels decreased overall 1.54 microg/dl (12.1%) during the study. The authors found that tailored newsletters and specialized cleaning produced the greatest decline in blood lead levels, but no statistical differences were found among the methodologies. The small decline observed in blood lead levels reduced levels to below 10 microg/dl for 40% of the children.

Are rates of psychiatric disorders in the homeless population changing?

OBJECTIVES

We examined the prevalence of psychiatric illness among 3 homeless populations in St. Louis, Mo, in approximately 1980, 1990, and 2000. The 3 studies were conducted with the same systemic research methodology.

METHODS

We compared selected demographics and lifetime substance abuse and dependence and other mental illness among the 3 populations.

RESULTS

Among the homeless populations we studied, the prevalence of mood and substance use disorders dramatically increased, and the number of minorities within these populations has increased.

CONCLUSIONS

The prevalence of psychiatric illness, including substance abuse and dependence, is not static in the homeless population. Service systems need to be aware of potential prevalence changes and the impact of these changes on service needs.

The Emergence of Neisseria gonorrhoeae With Decreased Susceptibility to Azithromycin in Kansas City, Missouri, 1999 to 2000

BACKGROUND AND OBJECTIVES

We describe the first cluster of persons with Neisseria gonorrhoeae with decreased susceptibility to azithromycin (AziDS; minimum inhibitory concentration >/=1.0 microg/mL) in the United States. GOAL The goal of this study was to identify risk factors for AziDS N. gonorrhoeae and to describe isolate microbiology.

STUDY DESIGN

Persons with AziDS N. gonorrhoeae (cases) were identified in Kansas City, Missouri, through the Gonococcal Isolate Surveillance Project (GISP) in 1999 and expanded surveillance, January 2000 to June 2001. A case-control study using 1999 GISP participants was conducted; control subjects had azithromycin-susceptible N. gonorrhoeae.

RESULTS

Thirty-three persons with AziDS N. gonorrhoeae were identified. Case patients were older than control patients (median age, 33 years vs. 23 years; P <0.001). Fifty percent of cases and 13% of control subjects had a history of sex with a female commercial sex worker (odds ratio, 7.0; 95% confidence interval, 1.3-36.0); 50% of cases and 4% of control subjects met sex partners on street A (P <0.01). AziDS N. gonorrhoeae isolates were phenotypically and genotypically similar and contained an mtrR gene mutation.

CONCLUSIONS

With few treatment options remaining, surveillance for antimicrobial-resistant N. gonorrhoeae is increasingly important, especially among persons at high risk.

The association of sexual dysfunction and substance use among a community epidemiological sample

This study examines the prevalence of DSM-III sexual dysfunctions and their association with comorbid drug and alcohol use in a community epidemiologic sample. The data for these analyses are based on the Epidemiological Catchment Area Project, a multistage probability study of the incidence and prevalence of psychiatric disorders in the general population conducted in 1981-83. Only the sample of 3,004 adult community residents in the St. Louis area was queried on DSM-III sexual dysfunctions of inhibited orgasm, functional dyspareunia (painful sex), inhibited sexual excitement (i.e., lack of erection/arousal), and inhibited sexual desire. There was a prevalence rate of 11% for inhibited orgasm, 13% for painful sex, 5% for inhibited sexual excitement, 7% for inhibited sexual desire, and 26% for any of these sexual dysfunctions (14% for men and 33% for women). The prevalence of qualifying lifetime substance use among the population was 37%, with males meeting more drug and alcohol use criteria than females. After controlling for demographics, health status variables, and psychiatric comorbidity (depression disorder, generalized anxiety disorder, antisocial personality disorder, and residual disorders), inhibited orgasm was associated with marijuana and alcohol use. Painful sex was associated with illicit drug use and marijuana use. Inhibited sexual excitement was more likely among illicit drug users. Inhibited sexual desire was not associated with drug or alcohol use.

Predominance of Ehrlichia ewingii in Missouri dogs

To investigate the species distribution of Ehrlichia present in Missouri dogs, we tested 78 dogs suspected of having acute ehrlichiosis and 10 healthy dogs. Blood from each dog was screened with a broad-range 16S rRNA gene PCR assay that detects known pathogenic species of Ehrlichia and ANAPLASMA: The species was determined by using species-specific PCR assays and nucleotide sequencing. Ehrlichia antibody testing was performed by using an indirect immunofluorescence assay with Ehrlichia chaffeensis as the antigenic substrate. The broad-range assay detected Ehrlichia or Anaplasma DNA in 20 (26%) of the symptomatic dogs and 2 (20%) of the asymptomatic dogs. E. ewingii accounted for 20 (91%), and E. chaffeensis accounted for 1 (5%) of the positives. Anaplasma phagocytophilum DNA was detected in one dog, and the sequences of regions of the 16S rRNA gene and the groESL operon amplified from the blood of this dog matched the published sequences of this organism. Antibodies reactive with E. chaffeensis were detected in 14 (67%) of the 21 PCR-positive dogs and in 12 (19%) of the 64 PCR-negative dogs. Combining the results of PCR and serology indicated that 33 (39%) of 85 evaluable dogs had evidence of past or current Ehrlichia infection. We conclude that E. ewingii is the predominant etiologic agent of canine ehrlichiosis in the areas of Missouri included in this survey. E. canis, a widely recognized agent of canine ehrlichiosis, was not detected in any animal. The finding of E. ewingii in asymptomatic dogs suggests that dogs could be a reservoir for this Ehrlichia species.

Effect of Do-Not-Resuscitate Orders on Hospitalization of Nursing Home Residents Evaluated for Lower Respiratory Infections

OBJECTIVES

To determine resident and facility characteristics associated with do-not-resuscitate (DNR) orders and to test the effect of DNR orders on hospitalization of acutely ill nursing home (NH) residents with lower respiratory tract infections (LRIs).

DESIGN

Prospective cohort.

SETTING

Thirty-six NHs (almost 4,000 residents) in central and eastern Missouri in the Missouri Lower Respiratory Infection study.

PARTICIPANTS

NH residents with a LRI (n=1031).

MEASUREMENTS

Data were obtained from new Minimum Data Set evaluations, resident examination, and chart review. Associations between resident, physician, and facility characteristics and the presence of a DNR order and hospitalization within 30 days from evaluation for an LRI were analyzed.

RESULTS

Sixty percent of subjects had a DNR order, and 2% had a do-not-hospitalize order. Resident characteristics associated with a DNR order included older age, white race, having a surrogate decision-maker, NH residence for longer than 3 years, and more-impaired cognition. Residents with DNR orders were more likely to live in facilities with more licensed beds, a lower proportion of Medicaid recipients, and a higher prevalence of influenza vaccination. After controlling for potential confounders, residents with a DNR order before the acute illness episode were significantly less likely to be hospitalized (adjusted odds ratio=0.69, 95% confidence interval=0.49-0.97).

CONCLUSION

DNR orders independently reduce the risk of hospitalization for LRI and may function as a marker for undocumented care limitations or as a mandate to limit care (unrelated to resuscitation) in NH residents with LRI.

Reliability of self-reported age of substance involvement onset

The authors investigated the reliability of self-reported age of onset (AO) for alcohol, tobacco (cigarette), and illicit drug involvement. Participants were 410 young adults taking part in an 11-year longitudinal study. A moderate degree of reliability was found for the 3 substances. Despite this level of stability, results illustrate a tendency for reported AOs to increase over time. The trend is more salient for participants who reported younger AOs at the initial assessment. Findings also indicate that, for alcohol and tobacco, more individuals were classified as early onset based on Year 1 compared with Year 11 reports. Despite these systematic changes, at least for alcohol and illicit drugs, age at which onset was assessed did not moderate the association between AO and substance-related outcomes.

Blastomycosis in Missouri: epidemiology and risk factors for endemic disease

Between 1992 and 1999, 93 cases of blastomycosis, including 25 laboratory confirmed cases, were identified in Missouri (annual incidence, 0.2/100,000 population). Mississippi County in southeastern Missouri had the highest incidence (12/100,000) with a much higher rate among blacks than whites in this county (43.21/100,000). The mortality rate, 44% was also higher among blacks. To determine risk factors for endemic blastomycosis, a case-control study was conducted among southeastern Missouri residents. Independent risk factors for blastomycosis were black race and a prior history of pneumonia. No environmental exposures or socioeconomic factors were significantly associated with increased risk. The increased risk among blacks may possibly be related to genetic factors, but further studies are needed to clarify this. However, heightened awareness of the disease and a better understanding of the risk factors are important and may lead to earlier diagnosis and start of treatment, possibly improving outcome.

Generalizing the alcohol outlet-assaultive violence link: evidence from a U.S. midwestern city

This study assessed the geographic association between rates of assaultive violence and alcohol-outlet density in Kansas City, Missouri. Data were obtained for sociodemographic factors, alcohol-outlet density, and rates of assaultive violence across 89 inner-city census tracts in Kansas City, Missouri. Hierarchical regression analysis indicated that sociodemographic variables predicted 61% (R2 = 0.61) of the variance in assaultive violence, but that an additional 9% (R2 = 0.09) of the variability in assaultive violence was explained by the density of alcohol outlets. Alcohol-outlet density contributed significantly to the explained variance of the regression model and was associated with higher rates of assaultive violence in this midwestern city.

Mortality in workers in poultry slaughtering/processing plants: the Missouri poultry cohort study

BACKGROUND

Subjects who work in poultry slaughtering and processing plants have one of the highest human exposures to viruses that cause cancer in chickens and turkeys. It is not known whether these viruses cause cancer in humans also. Epidemiological studies investigating this issue are scarce.

AIMS AND METHODS

Mortality was studied during the period 1969-90 in a cohort of 7700 subjects who worked in poultry slaughtering and processing plants and were members of a local poultry union in the State of Missouri.

RESULTS AND CONCLUSIONS

Statistically significant excess risks of non-malignant respiratory diseases, accidents, and symptoms, senility, and ill-defined conditions, and increased but not statistically significant excesses for some cancers were observed in particular race/sex groups. Most of these results were based on small numbers of deaths, and in many cases were evident only in particular subgroups of the cohort. Because of this and the multiple comparisons made, chance could not be ruled out in explaining the findings. Furthermore, the cohort is young, with only 6% deceased at the end of follow up. Further follow up of this cohort is required before a reliable assessment of the potential risk associated with these viruses can be made.

The pyramid of injury

STUDY OBJECTIVE

Although much is known about injury-related deaths from the use of external cause of injury codes (ecodes) on death certificates, the contribution of nonfatal injury is unknown, with most information based on estimates from national surveys. Some states mandate ecoding of charts for hospitalized patients, but few require ecode assignment for emergency department (ED) records. Missouri and Nebraska mandated ecoding of ED records in 1993 and 1994, respectively, allowing for a more complete description of injuries in those states. We describe fatal and nonfatal injury frequencies in Missouri and Nebraska by using ecodes, with graphic representation in the form of injury pyramids.

METHODS

Ecode frequencies for 1996 to 1998 for all injury causes in Missouri and Nebraska were reported directly from their respective health departments. The ecode frequencies were grouped according to the Centers for Disease Control and Prevention's ecode matrix for presenting injury and mortality data.

RESULTS

During the study period, 13,052 deaths, 131,210 hospitalizations, and 1,914,140 ED visits occurred as the result of injury. The most frequent lethal injuries were unintentional motor vehicle crashes (32.3% of total deaths), self-inflicted gunshot wound (13.2%), unintentional falls (11.3%), gunshot wound from an assault (7.7%), and unintentional poisoning (4.3%). The leading causes of injury-related hospitalization were unintentional falls (47.8% of total hospitalizations), unintentional motor vehicle crashes (15.5%), self-inflicted poisoning (6.5%), and overexertion or strenuous movements (2.4%). Of 1.9 million ED injury visits, unintentional falls accounted for 24.3%, unintentionally being struck by an object or person for 14.6%, unintentional motor vehicle crashes for 11.4%, unintentionally being cut or pierced for 10.7%, and overexertion or strenuous movements for 8.5%.

CONCLUSION

Ecoding in Missouri and Nebraska provides a comprehensive data retrieval system that allows for a graphic depiction of the burden of injury derived from real patient encounters within specific geographic regions.

Periodontal Referral Patterns, 1980 Versus 2000: A Preliminary Study

BACKGROUND

A review of the periodontal literature offers little information concerning trends in referral patterns of patients for periodontal therapy. Over the last 2 decades, there has been a significant increase in the knowledge base concerning inflammatory periodontal disease. It might be assumed that the collective advances in knowledge have impacted periodontal referral patterns. Thus, the purpose of this study was to examine the differences in periodontal referral patterns in the same offices separated by a 20-year interval (i.e., 1980 and 2000).

METHODS

A retrospective chart analysis was conducted on a total of 782 patient charts from three conveniently selected periodontal practices. Charts were randomly selected from two time periods: 1980-1981 and 2000-2001. The following information was obtained from each patient record: gender, age at time of initial examination, tobacco smoking status at time of initial examination, periodontal case type, number of missing teeth at initial examination (not including third molars), and number of teeth scheduled for extraction per periodontal treatment plan. Descriptive data were analyzed using frequency distributions, measures of central tendency, and measures of dispersion. Non-parametric statistics were used to examine the relationship of disease severity as a function of site, time period, and patient age.

RESULTS

The following trends were noted: 1) an increase in the average age of patients at the time of the initial examination; 2) a decrease in the percentage of patients using tobacco at the time of the initial interview; 3) an increase in the percentage of periodontal Case Type IV patients with a concomitant decrease in the number of periodontal Case Type II patients; 4) an increase in the average number of missing teeth per patient at the initial examination; and 5) an increase in the average number of teeth scheduled for extraction per periodontal treatment plan.

CONCLUSIONS

Characteristics of patients referred in 1980 compared to those referred in the year 2000 indicate that, although fewer patients used tobacco, there were several noteworthy trends. At referral, patients exhibited a greater loss of teeth, had more severe disease, and required extraction of a greater number of teeth in 2000 compared to 1980. Possible reasons for these trends are discussed.

Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance

STUDY DESIGN

Radiographic analysis, outcomes analysis (pain scale, Oswestry, SRS-24), and accumulation of complications. Outcomes and complications collected prospectively. Radiographic analysis performed retrospectively.

OBJECTIVES

To assess the benefits and stress complications of pedicle subtraction osteotomies for patients with fixed sagittal imbalance.

SUMMARY OF BACKGROUND DATA

Few reports on pedicle subtraction osteotomies exist in the peer-review literature for conditions other than trauma and ankylosing spondylitis.

MATERIALS AND METHODS

Thirty-three consecutive patients with sagittal imbalance treated with lumbar pedicle subtraction osteotomy at one institution (minimum 2-year follow-up) were analyzed. Complications were also analyzed for the entire group of consecutive pedicle subtraction osteotomies done at our institution to date (n = 66).

RESULTS

For the 33 patients with minimum 2-year follow-up, there were significant improvements in the overall Oswestry score (P 0.0001) and pain score (P = 0.0001). Most patients reported improvement in pain and self-image and reported overall satisfaction based on ultimate SRS-24 questionnaire. There was one pseudarthrosis in the lumbar spine through an area of pedicle subtraction osteotomy (area of previous laminectomy and nonunion), and six patients had thoracic pseudarthroses (levels other than the osteotomy level) and one patient had a pseudarthrosis at L5-S1. Two patients had acute angular kyphosis at the thoracolumbar junction at the proximal end of the construct. Five patients who experienced transient neurologic deficits resolved their deficits after central canal enlargement.

CONCLUSIONS

The clinical result with pedicle subtraction osteotomy is reduced with pseudarthrosis in the thoracic or lumbar spine and subsequent breakdown adjacent to the fusion. For patients with a degenerative sagittal imbalance etiology the results were worse and the complications were higher. Central canal enlargement is critical.

Alcohol and tobacco use disorders in a general population: short-term and long-term associations from the St. Louis epidemiological catchment area study

BACKGROUND

Although research using clinical and convenience samples has shown alcohol use disorders (AUD) to be highly comorbid with tobacco dependence (TD), little work has examined this association prospectively using population-based data. The AUD-TD association was prospectively examined using data from the St. Louis Epidemiological Catchment Area (ECA) Study and its 1-year follow-up as well as from a 16-year follow-up on a subsample of ECA data.

METHOD

Respondents were 3004 (2564, 85%, at Wave 2) participants in the St. Louis household ECA sample, including 444 participants at Year 16 follow-up. At baseline, the sample was predominately White (58%; 38% Black), female (60%), and 44.3 years. Past-year AUD and TD were diagnosed at all waves according to DSM-III criteria.

RESULTS

AUDs and TDs were cross-sectionally associated at Years 1, 2, and 16. Controlling for demographics, Year 1 TD prospectively predicted Year 2 AUD, and Year 1 AUD prospectively predicted Year 16 TD. We found evidence for prediction of onset and persistence of both AUD and TD at short-term but not long-term follow-up. Prospective findings were reduced and no longer reached significance when concurrent diagnoses at follow-up were included in the regression models.

CONCLUSIONS

We observed short-term and long-term associations between AUD and TD. These associations were mediated through concurrent diagnoses with the other substance use disorder.

Semen quality in relation to biomarkers of pesticide exposure

We previously reported reduced sperm concentration and motility in fertile men in a U.S. agrarian area (Columbia, MO) relative to men from U.S. urban centers (Minneapolis, MN; Los Angeles, CA; New York, NY). In the present study we address the hypothesis that pesticides currently used in agriculture in the Midwest contributed to these differences in semen quality. We selected men in whom all semen parameters (concentration, percentage sperm with normal morphology, and percentage motile sperm) were low (cases) and men in whom all semen parameters were within normal limits (controls) within Missouri and Minnesota (sample sizes of 50 and 36, respectively) and measured metabolites of eight current-use pesticides in urine samples provided at the time of semen collection. All pesticide analyses were conducted blind with respect to center and case-control status. Pesticide metabolite levels were elevated in Missouri cases, compared with controls, for the herbicides alachlor and atrazine and for the insecticide diazinon [2-isopropoxy-4-methyl-pyrimidinol (IMPY)]; for Wilcoxon rank test, p = 0.0007, 0.012, and 0.0004 for alachlor, atrazine, and IMPY, respectively. Men from Missouri with high levels of alachlor or IMPY were significantly more likely to be cases than were men with low levels [odds ratios (ORs) = 30.0 and 16.7 for alachlor and IMPY, respectively], as were men with atrazine levels higher than the limit of detection (OR = 11.3). The herbicides 2,4-D (2,4-dichlorophenoxyacetic acid) and metolachlor were also associated with poor semen quality in some analyses, whereas acetochlor levels were lower in cases than in controls (p = 0.04). No significant associations were seen for any pesticides within Minnesota, where levels of agricultural pesticides were low, or for the insect repellent DEET (N,N-diethyl-m-toluamide) or the malathion metabolite malathion dicarboxylic acid. These associations between current-use pesticides and reduced semen quality suggest that agricultural chemicals may have contributed to the reduction in semen quality in fertile men from mid-Missouri we reported previously.

Development and Initial Validation of the Hangover Symptoms Scale: Prevalence and Correlates of Hangover Symptoms in College Students

BACKGROUND

Despite its ubiquity, hangover has received remarkably little systematic attention in alcohol research. This may be due in part to the lack of a standard measure of hangover symptoms that cleanly taps the physiologic and subjective effects commonly experienced the morning after drinking. In the present study, we developed and evaluated a new scale, the Hangover Symptoms Scale (HSS), to potentially fill this void.

METHODS

Participants were 1230 currently drinking college students (62% women, 91% Caucasian). They were administered a self-report inventory in which they reported the frequency of occurrence of 13 different hangover symptoms during the past 12 months. Participants also reported their history of alcohol involvement, alcohol-related problems, and family history of alcohol-related problems.

RESULTS

On average, participants experienced 5 out of 13 different hangover symptoms in the past year; the three most common symptoms were feeling extremely thirsty/dehydrated, feeling more tired than usual, and headache. Higher scores on the HSS were significantly positively associated with the frequency of drinking and getting drunk and the typical quantity of alcohol consumed when drinking, a personal history of alcohol-related problems, and a family history of alcohol-related problems. After controlling for sex differences in alcohol involvement, women had higher scores on the HSS than men.

CONCLUSIONS

The HSS appears to capture a reasonably valid set of adjectives describing common hangover effects. It is hoped that the availability of a brief, valid hangover assessment such as the HSS will encourage further study of hangover's frequency, correlates, and consequences. Future research is needed to explore the performance of a re-worded HSS in laboratory settings, which may help bridge the gap between laboratory and survey investigations of hangover.

Clinical significance of rapid (accelerated) gastric emptying

PURPOSE

The purpose of this study was to determine the significance and frequency of rapid gastric emptying (RGE) in clinical practice and to examine its relationship to age, gender, and presenting symptoms.

METHODS

The review included 750 patients who underwent scintigraphic gastric emptying studies (GES) within the past 11 years. In 80 patients with RGE, the mean gastric emptying time (GET) in female and male patients was compared with study gender differences. Similarly, the mean GET in young and old patients was compared with study age differences. The presenting symptoms and conditions indicating GES were noted.

RESULTS

RGE was found in 80 of 750 study patients (10.7%). RGE was equally common in both sexes. Younger patients (mean age, 34.3 +/- 9.5 years) and older patients (mean age, 67.3 +/- 11.6 years) had similar mean GETs. Most patients with RGE presented with symptoms that mimicked gastroparesis.

CONCLUSIONS

RGE has no relationship to age or gender. RGE may be representative of early dumping syndrome in most patients. GES help make a clear distinction between early dumping syndrome and gastroparesis, which can present with similar symptoms.

Direct costs and patterns of injuries among residential carpenters, 1995-2000

Workers' compensation records for residential contractors were combined with hours worked provided by the union to examine injury rates and costs among union carpenters between 1995 and 2000. Brief text descriptions were reviewed to describe more costly injuries. Costs per hour worked decreased over 6 years, largely because of declines in rates and mean costs for falls from elevations. Higher costs were associated with injuries from falls, raising framed walls, setting steel I-beams, and pneumatic nail guns. Prevention priorities should include fall protection; methods to safely set steel beams, raise and brace framed walls; and steps to prevent injuries from pneumatic tools. Cost data provide an important measure that is useful in focusing prevention; combined with even limited descriptions of injuries target areas for intervention can be identified based on frequency or severity.

Falls in residential carpentry and drywall installation: findings from active injury surveillance with union carpenters

Active injury surveillance was conducted with a large, unionized workforce of residential and drywall carpenters over a 3-year period. Injured carpenters were interviewed by trained carpenter investigators and sites were visited where falls occurred. Qualitative information was collected on exposures, risk perception, training, and mentoring. Falls accounted for 20% of injuries. Same-level falls were often related to weather, carrying objects-sometimes with an obstructed view-housekeeping, terrain of the lot, and speed of work. Falls from height occurred from a variety of work surfaces and involved ladders, scaffolding, roofs, work on other unsecured surfaces, unprotected openings, speed, and weather conditions. Recognized fall protection strategies, such as guardrails, toe boards, tying off to appropriate anchors, and guarding openings, would have prevented many of these falls; these practices were not the norm on many sites.

Update: multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003

CDC and state and local health departments continue to investigate cases of monkeypox among persons in the United States who had contact with wild or exotic mammalian pets or with persons with monkeypox. This report updates results of the epidemiologic investigation, provides information on the use of smallpox vaccine during the outbreak, and summarizes the animal tracing activities to identify the origin and subsequent distribution of infected animals.

Update: multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003

CDC and state and local health departments continue to investigate cases of monkeypox among persons who had contact with wild or exotic mammalian pets or persons with monkeypox. This report updates epidemiologic, laboratory, and smallpox vaccine use data for U.S. cases, and summarizes the laboratory-based evidence implicating imported African rodents as the probable source of the outbreak.

The role of epidemiology in chronic disease prevention and health promotion programs

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiologic capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.

Impact of prophylaxis with cytogam alone on the incidence of CMV viremia in CMV-seropositive lung transplant recipients

BACKGROUND

Cytomegalovirus (CMV) infection remains a serious problem after lung transplantation. The purpose of this study was to evaluate the efficacy of CytoGam, a CMV hyperimmune globulin (CMV-IGIV), as CMV prophylaxis after lung transplantation.

METHODS

This prospective, randomized, open-label study compared prophylaxis with CMV-IGIV and no prophylaxis in 44 CMV-seropositive lung transplant recipients. The primary end-point was development of CMV viremia during the first year after transplantation.

RESULTS

Cytomegalovirus viremia was detected in 13 of 22 recipients without prophylaxis and in 16 of 22 recipients with CMV-IGIV prophylaxis (p = 0.19). Cytomegalovirus pneumonitis developed in 8 controls vs in 11 CMV-IGIV recipients (p = 0.54). We found no significant difference between the groups in the incidence of positive shell vial assays (6.8% +/- 6.5% without vs 11.2% +/- 10.1% with prophylaxis, p = 0.09) or in the attack rate of CMV pneumonitis (0.41 +/- 0.59 episodes/patient without vs 0.86 +/- 0.99 episodes/patient with prophylaxis, p = 0.07). Similarly, no difference was apparent in the time to onset of CMV viremia, to detection of CMV DNA in peripheral blood leukocytes by polymerase chain reaction, or to development of CMV pneumonitis. The incidence of acute rejection and bronchiolitis obliterans syndrome and the survival rate during the first post-transplant year did not differ between the groups.

CONCLUSIONS

Prophylaxis with CMV-IGIV alone did not decrease CMV viremia or pneumonitis, did not decrease the incidence of acute rejection or bronchiolitis obliterans syndrome, and did not affect 1-year survival of CMV-seropositive lung transplant recipients at our center.