Development of a Fitness Surveillance System to Track and Evaluate Obesity in North Idaho

BACKGROUND

Internationally 18% of youth are obese. Fitness testing can be used to establish fitness surveillance, which can inform policy and targeted interventions aimed at addressing obesity. The purpose of this study was to estimate the prevalence of overweight, obesity, and low fitness in Idaho school-aged youth through a pilot study.

METHODS

A convenience sample of 13 teachers from 11 north Idaho rural schools collected FitnessGram fitness data: body composition (body mass index [BMI]), aerobic capacity (Progressive Aerobic Cardiovascular Endurance Run [PACER] test), muscular endurance (curl up), strength (pushup), and flexibility (sit and reach).

RESULTS

A total of 761 students (aged 9-18 years) from grades 3&5, 7, and 9 to 12 participated in the study. Approximately 24% of 3&5 and 22% of 7th, and 12% of 9 to 12th-grade students were categorized as Needs Improvement/Health Risk by FitnessGram standards for BMI. Similarly, approximately 25% of 3&5, and 22% of 7 and 9 to 12th-grade students were considered Needs Improvement/Health Risk for PACER.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Results from fitness testing can provide school and public health representatives with a "needs assessment" of student health that can be used to help develop policies and practices to improve student health and wellbeing.

CONCLUSIONS

This study provides a model for statewide annual fitness testing surveillance and reporting within K-12 public school physical education classrooms.

The Impact of the COVID-19 Pandemic on Patient Disparities in Long-Term Opioid Therapy

BACKGROUND

The COVID-19 pandemic disrupted how primary care patients with chronic pain received care. Our study sought to understand how long-term opioid therapy (LtOT) for chronic pain changed over the course of the pandemic overall and for different demographic subgroups.

METHODS

We used data from electronic health records of 64 primary care clinics across Washington state and Idaho to identify patients who had a chronic pain diagnosis and were receiving long-term opioid therapy. We defined 10-month periods in 2019 to 2021 as prepandemic, early pandemic and late pandemic and used generalized estimating equations analysis to compare across these time periods and demographic characteristics.

RESULTS

We found a proportional decrease in LtOT for chronic pain in the early months of the pandemic (OR = 0.94, P = .007) followed by an increase late pandemic (OR = 1.08, P = .002). Comparing late pandemic to prepandemic, identifying as Asian or Black, having fewer comorbidities, or living in an urban area were associated with higher likelihood of being prescribed LtOT.

DISCUSSION

The use of LtOT for chronic pain in primary care has increased from before to after the COVID-19 pandemic with racial/ethnic and geographic disparities. Future research is needed to understand these disparities in LtOT and their effect on patient outcomes.

Effects of Rurality on Distance and Time Traveled to Receive Vaccination Against Mpox-New Mexico and Idaho 2022-2023

ABSTRACT

We compared mpox vaccination access between urban and rural residents who received ≥1 JYNNEOS dose using immunization data in Idaho and New Mexico. Rural residents traveled 5 times farther and 3 times longer than urban residents to receive mpox vaccination. Increasing mpox vaccine availability to health care facilities might increase uptake.

Observed face mask use outside retail chain stores during the COVID-19 pandemic in two cities in the state of Idaho, USA

During the COVID-19 pandemic, public health authorities have encouraged the use of face masks to minimize transmission within the community. To assess mask wear during a COVID-19 surge and guide public health response efforts, including public messaging on mask recommendations, we compared observed mask use in the largest city in each of Idaho's 2 most populous counties, both without a current mask mandate. We recorded mask usage by every third person exiting stores of 5 retail chains in Boise and Nampa during November 8-December 5, 2021. Observations were conducted during three time periods (morning, afternoon, and evening) on weekday and weekend days. A multivariable model with city, retail chain, and city-chain interaction was used to assess mask wear differences by city for each chain. Of 3021 observed persons, 22.0% wore masks. In Boise, 31.3% (430/1376) of observed persons wore masks; in Nampa, 14.3% (236/1645) wore masks. Among all persons wearing masks, > 94% wore masks correctly; cloth and surgical masks were most common. By retail chain, observed individuals at Boise locations were 2.3-5.7 times as likely to wear masks than persons at respective Nampa locations. This study provided a rapid, nonconfrontational assessment of public use of mitigation measures in 2 Idaho cities during a COVID-19 surge.

COVID-19 hospitalizations and deaths predicted by SARS-CoV-2 levels in Boise, Idaho wastewater

The viral load of COVID-19 in untreated wastewater from Idaho's capital city Boise, ID (Ada County) has been used to predict changes in hospital admissions (statewide in Idaho) and deaths (Ada County) using distributed fixed lag modeling and artificial neural networks (ANN). The wastewater viral counts were used to determine the lag time between peaks in wastewater viral counts and COVID-19 hospitalizations as well as deaths (14 and 23 days, respectively). Quantitative measurement of SARS-CoV-2 viral RNA counts in the untreated wastewater was determined three times a week using RT-qPCR over a span of 13 months. To mitigate the effects of PCR inhibitors in wastewater, a series of dilution tests were conducted, and the 1/4 dilution was used to generate the most successful model. Wastewater SARS-CoV-2 viral RNA counts and hospitalization from June 7, 2021 to December 29, 2021 were used as training data to predict hospitalizations; and wastewater SARS-CoV-2 viral RNA counts and deaths from June 7, 2021 to December 20, 2021 were used as training data to predict deaths. These training data were used to make predictive ANN models for future hospitalizations and deaths. To the best of our knowledge, this is the first report of prediction of deaths from COVID-19 based on wastewater SARS-CoV-2 viral RNA counts using machine learning-based multilayered ANN. The applied modeling demonstrates that wastewater surveillance data can be combined with hospitalizations and death data to generate machine learning-based ANN models that predict future COVID-19 hospital admissions and deaths, providing an early warning for medical response teams and healthcare policymakers.

Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit - Idaho, 2021-2022

Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance. CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets. During September 2021-January 2022, an Idaho hospital (hospital A) isolated CP-CRPA from sputum of two patients who stayed in the same intensive care unit (ICU) room (room X), 4 months apart. Both isolates had active-on-imipenem metallo-beta-lactamase (IMP) carbapenemase gene type 84 (blaIMP-84) and were characterized as multilocus sequence type 235 (ST235). A health care-associated infections team from the Idaho Division of Public Health visited hospital A during March 21-22, 2022, to discuss the cluster investigation with hospital A staff members and to collect environmental samples. CP-CRPA ST235 with blaIMP-84 was isolated from swab samples of one sink in room X, suggesting it was the likely environmental source of transmission. Recommended prevention and control measures included application of drain biofilm disinfectant, screening of future patients who stay in room X (e.g., the next 10 occupants) upon reopening, and continuing submission of carbapenem-resistant P. aeruginosa (CRPA) isolates to public health laboratories. Repeat environmental sampling did not detect any CRPA. As of December 2022, no additional CP-CRPA isolates had been reported by hospital A. Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical in the identification of and response to this CP-CRPA cluster in a health care setting.

Household Transmission of SARS-CoV-2 from Humans to Pets, Washington and Idaho, USA

SARS-CoV-2 likely emerged from an animal reservoir. However, the frequency of and risk factors for interspecies transmission remain unclear. We conducted a community-based study in Idaho, USA, of pets in households that had >1 confirmed SARS-CoV-2 infections in humans. Among 119 dogs and 57 cats, clinical signs consistent with SARS-CoV-2 were reported for 20 dogs (21%) and 19 cats (39%). Of 81 dogs and 32 cats sampled, 40% of dogs and 43% of cats were seropositive, and 5% of dogs and 8% of cats were PCR positive. This discordance might be caused by delays in sampling. Respondents commonly reported close human‒animal contact and willingness to take measures to prevent transmission to their pets. Reported preventive measures showed a slightly protective but nonsignificant trend for both illness and seropositivity in pets. Sharing of beds and bowls had slight harmful effects, reaching statistical significance for sharing bowls and seropositivity.

Diversity and Prevalence of Ectoparasites on Poultry from Open Environment Farms in the Western-United States of Washington, Idaho, Oregon, and California

Open-environment poultry farms that allow chickens to forage outdoors are becoming increasingly common throughout the United States and Europe; however, there is little information regarding the diversity and prevalence of ectoparasites in these farming systems. Eight to 25 birds were captured and surveyed for ectoparasites on each of 17 farms across the states of Washington, Idaho, Oregon, and California. Among the farms sampled, six louse species (Phthiraptera: Ischnocera & Amblycera) and two parasitic mite species (Acari: Mesostigmata) were collected and identified: Goniodes gigas (Taschenberg, 1879; Phthiraptera: Menoponidae) on one farm, Menacathus cornutus (Schömmer, 1913; Phthiraptera: Menoponidae) on one farm, Menopon gallinae (Linnaeus, 1758; Phthiraptera: Menoponidae) on six farms, Lipeurus caponis (Linnaeus, 1758; Phthiraptera: Philopteridae) on five farms, Menacanthus stramineus (Nitzsch, 1818; Phthiraptera: Menoponidae) on nine farms, Goniocotes gallinae De Geer (Phthiraptera: Philopteridae) on 11 farms, Dermanyssus gallinae (De Geer, 1778; Mesostigmata: Dermanyssidae) on two farms, and Ornithonyssus sylviarum (Canestrini & Fanzago, 1877; Mesostigmata: Macronyssidae) on one farm. The diversity of ectoparasites on these open environment poultry farms highlights a need for additional research on ectoparasite prevalence and intensity in these poultry farming systems.

Increasing Incidence of Invasive Group A Streptococcus Disease, Idaho, USA, 2008-2019

We investigated invasive group A Streptococcus epidemiology in Idaho, USA, during 2008–2019 using surveillance data, medical record review, and emm (M protein gene) typing results. Incidence increased from 1.04 to 4.76 cases/100,000 persons during 2008–2019. emm 1, 12, 28, 11, and 4 were the most common types, and 2 outbreaks were identified. We examined changes in distribution of clinical syndrome, patient demographics, and risk factors by comparing 2008–2013 baseline with 2014–2019 data. Incidence was higher among all age groups during 2014–2019. Streptococcal toxic shock syndrome increased from 0% to 6.4% of cases (p = 0.02). We identified no differences in distribution of demographic or risk factors between periods. Results indicated that invasive group A Streptococcus is increasing among the general population of Idaho. Ongoing surveillance of state-level invasive group A Streptococcus cases could help identify outbreaks, track regional trends in incidence, and monitor circulating emm types.

COVID-19 Outbreaks in Correctional Facilities with Work-Release Programs - Idaho, July-November 2020

As of April 16, 2021, U.S. correctional and detention facilities reported 399,631 cases of COVID-19 in incarcerated persons, resulting in 2,574 deaths (1). During July 14-November 30, 2020, COVID-19 was diagnosed in 382 persons incarcerated in Idaho correctional facilities with work-release programs. Work-release programs (which place incarcerated persons in community businesses) have social and economic benefits, but might put participants at increased risk for bidirectional transmission of SARS-CoV-2, the virus that causes COVID-19. The Idaho Department of Correction (IDOC) operates 13 state-run correctional facilities, including six low-security facilities dedicated to work-release programs. This report describes COVID-19 outbreaks in five IDOC facilities with work-release programs,* provides the mitigation strategies that IDOC implemented, and describes the collaborative public health response. As of November 30, 2020, 382 outbreak-related COVID-19 cases were identified among incarcerated persons in five Idaho correctional facilities with work-release programs; two outbreaks were linked to food processing plants. Mitigation strategies that helped to control outbreaks in IDOC facilities with work-release programs included isolation of persons with COVID-19, identification and quarantine of close contacts, mass testing of incarcerated persons and staff members, and temporary suspension of work-release programs. Implementation of public health recommendations for correctional and detention facilities with work-release programs, including mass testing and identification of high-risk work sites, can help mitigate SARS-CoV-2 outbreaks. Incarcerated persons participating in work-release should be included in COVID-19 vaccination plans.

Investigation and public health response to a COVID-19 outbreak in a rural resort community-Blaine County, Idaho, 2020

Blaine County, Idaho, a rural area with a renowned resort, experienced a COVID-19 outbreak early in the pandemic. We undertook an epidemiologic investigation to describe the outbreak and guide public health action. Confirmed cases of COVID-19 were identified from reports of SARS-CoV-2-positive laboratory test results to South Central Public Health District. Information on symptoms, hospitalization, recent travel, healthcare worker status, and close contacts was obtained by medical record review and patient interviews. Viral sequence analysis was conducted on a subset of available specimens. During March 13-April 10, 2020, a total of 451 COVID-19 cases among Blaine County residents (1,959 cases per 100,000 population) were reported, with earliest illness onset March 1. The median patient age was 51 years (interquartile range [IQR]: 37-63), 52 (11.5%) were hospitalized, and 5 (1.1%) died. The median duration between specimen collection and a positive laboratory result was 9 days (IQR: 4-10). Forty-four (9.8%) patients reported recent travel and an additional 37 cases occurred in out-of-state residents. Healthcare workers comprised 56 (12.4%) cases; 33 of whom worked at the only hospital in the county, leading to a 15-day disruption of hospital services. Among 562 close contacts monitored by public health authorities, laboratory-confirmed COVID-19 or compatible symptoms were identified in 51 (9.1%). Sequencing results from 34 specimens supported epidemiologic findings indicating travel as a source of SARS-CoV-2, and identified multiple lineages among hospital workers. Community mitigation strategies included school and resort closure, stay-at-home orders, and restrictions on incoming travelers. COVID-19 outbreaks in rural communities can disrupt health services. Lack of local laboratory capacity led to long turnaround times for COVID-19 test results. Rural communities frequented by tourists face unique challenges during the COVID-19 pandemic. Implementing restrictions on incoming travelers and other mitigation strategies helped reduce COVID-19 transmission early in the pandemic.

Cancer among Refugees Resettled to Idaho during 2008-2019: A Proof-of-Concept Study

BACKGROUND

Disparities in cancer burden and outcomes according to socioeconomic characteristics have been extensively characterized for US populations. The cancer experience of refugees, who may share characteristics of other socioeconomically disadvantaged populations and also experience distinct barriers to care, has not been described previously. We conducted a proof-of-concept study evaluating our ability to characterize cancer incidence in refugees resettled to Idaho via a novel linkage of cancer data and administrative data characterizing refugee arrivals to Idaho.

METHODS

In July 2021, the Cancer Data Registry of Idaho probabilistically linked cancer surveillance data and refugee arrival data (2008- 2019 diagnosis and arrival years) collected through the Centers for Disease Control and Prevention's Electronic Disease Notification (EDN) System. We used SEER*Stat to calculate standardized incidence ratios (SIR) for malignant tumors and benign/borderline malignant brain and other nervous system (ONS) tumors using Idaho-specific and Surveillance, Epidemiology, and End Results (SEER) Program referent incidence rates.

RESULTS

60 malignant and 7 benign brain and ONS tumors were diagnosed among 9,499 refugees resettled to Idaho. Refugees had fewer than expected malignant tumors overall (57 observed vs 96.0 expected; SIR, 0.60; 95% CI, 0.45-0.77). An excess of tumors of the esophagus were diagnosed among Southeast Asian refugees (4 observed vs 0.64 expected; SIR, 6.3; 95% CI, 1.7-16.0). We also used EDN data to update country of birth for linked persons.

CONCLUSIONS

Linking EDN refugee data to cancer surveillance data presented unique challenges. However, we used a novel data source to augment cancer data and characterize incidence in refugees, potentially improving our ability to serve this vulnerable population.

US Rural Surgeons Leading During COVID-19: Where Are They Now?

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.

Performance Characteristics of the Abbott Architect SARS-CoV-2 IgG Assay and Seroprevalence in Boise, Idaho

Coronavirus disease 2019 (COVID-19), the novel respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with severe morbidity and mortality. The rollout of diagnostic testing in the United States was slow, leading to numerous cases that were not tested for SARS-CoV-2 in February and March 2020 and necessitating the use of serological testing to determine past infections. Here, we evaluated the Abbott SARS-CoV-2 IgG test for detection of anti-SARS-CoV-2 IgG antibodies by testing 3 distinct patient populations. We tested 1,020 serum specimens collected prior to SARS-CoV-2 circulation in the United States and found one false positive, indicating a specificity of 99.90%. We tested 125 patients who tested reverse transcription-PCR (RT-PCR) positive for SARS-CoV-2 for whom 689 excess serum specimens were available and found that sensitivity reached 100% at day 17 after symptom onset and day 13 after PCR positivity. Alternative index value thresholds for positivity resulted in 100% sensitivity and 100% specificity in this cohort. We tested specimens from 4,856 individuals from Boise, ID, collected over 1 week in April 2020 as part of the Crush the Curve initiative and detected 87 positives for a positivity rate of 1.79%. These data demonstrate excellent analytical performance of the Abbott SARS-CoV-2 IgG test as well as the limited circulation of the virus in the western United States. We expect that the availability of high-quality serological testing will be a key tool in the fight against SARS-CoV-2.

Shifting brucellosis risk in livestock coincides with spreading seroprevalence in elk

Tracking and preventing the spillover of disease from wildlife to livestock can be difficult when rare outbreaks occur across large landscapes. In these cases, broad scale ecological studies could help identify risk factors and patterns of risk to inform management and reduce incidence of disease. Between 2002 and 2014, 21 livestock herds in the Greater Yellowstone Area (GYA) were affected by brucellosis, a bacterial disease caused by Brucella abortus, while no affected herds were detected between 1990 and 2001. Using a Bayesian analysis, we examined several ecological covariates that may be associated with affected livestock herds across the region. We showed that livestock risk has been increasing over time and expanding outward from the historical nexus of brucellosis in wild elk on Wyoming’s feeding grounds where elk are supplementally fed during the winter. Although elk were the presumed source of cattle infections, occurrences of affected livestock herds were only weakly associated with the density of seropositive elk across the GYA. However, the shift in livestock risk did coincide with recent increases in brucellosis seroprevalence in unfed elk populations. As increasing brucellosis in unfed elk likely stemmed from high levels of the disease in fed elk, disease-related costs of feeding elk have probably been incurred across the entire GYA, rather than solely around the feeding grounds. Our results suggest that focused disease mitigation in areas where seroprevalence in unfed elk is high could reduce the spillover of brucellosis to livestock. We also highlight the need to better understand the epidemiology of spillover events with detailed histories of disease testing, calving, and movement of infected livestock. Finally, we recommend using case-control studies to investigate local factors important to livestock risk.

Standardized Infection Surveillance in Long-Term Care Interfacility Comparisons From a Regional Cohort of Facilities

Objectives:

To measure infection rates in a regional cohort of long-term-care facilities (LTCFs) using standard surveillance methods and to analyze different methods for interfacility comparisons.

Setting:

Seventeen LTCFs in Idaho.

Design:

Prospective, active surveillance for LTCF-acquired infections using standard definitions and case-finding methods was conducted from July 2001 to June 2002. All surveillance data were combined and individual facility performance was compared with the aggregate employing a variety of statistical and graphic methods.

Results:

The surveillance data set consisted of 472,019 resident-days of care with 1,717 total infections for a pooled mean rate of 3.64 infections per 1,000 resident-days. Specific infections included respiratory (828; rate, 1.75), skin and soft tissue (520; rate, 1.10), urinary tract (282; rate, 0.60), gastrointestinal (77; rate, 0.16), unexplained febrile illnesses (6; rate, 0.01), and bloodstream (4; rate, 0.01). Initially, methods adopted from the National Nosocomial Infections Surveillance System were used comparing individual rates with pooled means and percentiles of distribution. A more sensitive method appeared to be detecting statistically significant deviations (based on chi-square analysis) of the individual facility rates from the aggregate of all other facilities. One promising method employed statistical process control charts (U charts) adjusted to compare individual rates with aggregate monthly rates, providing simultaneous visual and statistical comparisons. Small multiples graphs were useful in providing images valid for rapid concurrent comparison of all facilities.

Conclusion:

Interfacility comparisons have been demonstrated to be valuable for hospital infection control programs, but have not been studied extensively in LTCFs.

Atlantic salmon, Salmo salar L. are broadly susceptible to isolates representing the North American genogroups of infectious hematopoietic necrosis virus

Beginning in 1992, three epidemic waves of infectious hematopoietic necrosis, often with high mortality, occurred in farmed Atlantic salmon Salmo salar L. on the west coast of North America. We compared the virulence of eleven strains of infectious hematopoietic necrosis virus (IHNV), representing the U, M and L genogroups, in experimental challenges of juvenile Atlantic salmon in freshwater. All strains caused mortality and there was wide variation within genogroups: cumulative mortality for five U-group strains ranged from 20 to 100%, four M-group strains ranged 30-63% and two L-group strains varied from 41 to 81%. Thus, unlike Pacific salmonids, there was no apparent correlation of virulence in a particular host species with virus genogroup. The mortality patterns indicated two different phenotypes in terms of kinetics of disease progression and final per cent mortality, with nine strains having moderate virulence and two strains (from the U and L genogroups) having high virulence. These phenotypes were investigated by histopathology and immunohistochemistry to describe the variation in the course of IHNV disease in Atlantic salmon. The results from this study demonstrate that IHNV may become a major threat to farmed Atlantic salmon in other regions of the world where the virus has been, or may be, introduced.

Two Suspected Worksite or Occupational Cancer Clusters Investigated Using the Cancer Data Registry and Multiple Primary Standardized Incidence Ratios in SEER *Stat-Idaho, 2013-2014

BACKGROUND

Investigations of suspected cancer clusters are resource intensive and rarely identify true clusters: among 428 publicly reported US investigations during 1990-2011, only 1 etiologic cluster was identified. In 2013, the Cancer Data Registry of Idaho (CDRI) was contacted regarding a suspected cancer cluster at a worksite (Cluster A) and among an occupational cohort (Cluster B). We investigated to determine whether these were true clusters.

METHODS

We derived investigation cohorts for Cluster A from facility-provided employee records and for Cluster B from professional licensing records. We used Registry PlusTM Link Plus to conduct probabilistic linkage of cohort members to the CDRI registry and completed matching through manual review by using LexisNexis®, Accurint®, and the Social Security Death Index. We calculated standardized incidence ratios (SIR) using the MP-SIR session type in SEER*Stat and Idaho and US referent populations.

RESULTS

For Cluster A, we identified 34 cancer cases during 9,689 person-years; compared with Idaho and US rates, 95 percent CIs for SIRs included 1.0 for 24 of 24 primary site categories. For Cluster B, we identified 78 cancer cases during 15,154 person-years; compared with Idaho rates, 95 percent CI for SIRs included 1.0 for 23 of 24 primary site categories and was less than 1.0 for lung and bronchus cancers, and compared with US rates, 95 percent CI for SIRs included 1.0 for 22 of 24 primary site categories and was less than 1.0 for lung and bronchus and colorectal cancers.

CONCLUSION

We identified no statistically significant excess in cancer incidence in either cohort. SEER*Stat's MP-SIR is an efficient tool for performing SIR assessments, a Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists-recommended step when investigating suspected cancer clusters.

Spatial and Census Data to Evaluate Obese Persons and their Environment (SCOPE)

OBJECTIVE

To evaluate the built environment and its relationship to BMI for individuals in eastern Idaho.

METHODS

Geospatial analyses were coupled to demographic data of adult individuals. ArcGIS Community Analyst was used to compare demographics relative to median BMI.

RESULTS

For every kilometer increase in distance to prepared food sites, BMI went down by 1.3% and every kilometer increase in distance to green space, BMI went down by 0.8% (p < .001). For every kilometer increase in distance to trails, BMI went up by 1.5%. No other built environment variables had a statistically significant association with BMI.

CONCLUSION

The distance to prepared foods and trails was associated with expected changes in BMI. Conversely, increased distance to green space was associated with a lower BMI.

Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting

PURPOSE

Little is known about the impact of alcohol consumption on warfarin safety, or whether demographic, clinical, or genetic factors modify risk of adverse events. We conducted a case-control study to assess the association between screening positive for moderate/severe alcohol misuse and the risk of major bleeding in a community sample of patients using warfarin.

METHODS

The study sample consisted of 570 adult patients continuously enrolled in Group Heath for at least 2 years and receiving warfarin. The main outcome was major bleeding validated through medical record review. Cases experienced major bleeding, and controls did not experience major bleeding. Exposures were Alcohol Use Disorders Identification Test Consumption Questionnaire (AUDIT-C) scores and report of heavy episodic drinking (≥5 drinks on an occasion). The odds of major bleeding were estimated with multivariate logistic regression models. The overall sample was 55% male, 94% Caucasian, and had a mean age of 70 years.

RESULTS

Among 265 cases and 305 controls, AUDIT-C scores indicative of moderate/severe alcohol misuse and heavy episodic drinking were associated with increased risk of major bleeding (OR = 2.10, 95% CI = 1.08-4.07; and OR = 2.36, 95% CI = 1.24-4.50, respectively). Stratified analyses demonstrated increased alcohol-related major bleeding risk in patients on warfarin for ≥1 year and in those with a low-dose genotype (CYP2C9*2/*3, VKORC1(1173G>A), CYP4F2*1), but not in other sub-groups evaluated.

CONCLUSIONS

Alcohol screening questionnaires, potentially coupled with genetic testing, could have clinical utility in selecting patients for warfarin therapy, as well as refining dosing and monitoring practices.

Outbreak of Hemodialysis Vascular Access Site Infections Related to Malfunctioning Permanent Tunneled Catheters: Making the Case for Active Infection Surveillance

Objective:

To describe an outbreak of infections with permanent cuffed hemodialysis catheters recognized through ongoing surveillance and related to a specific malfunctioning permanent catheter.

Design:

The outbreak was suspected from the results of prospective infection surveillance and confirmed by a retrospective cohort study using medical records for patients receiving dialysis between April 1,1999, and March 31, 2000.

Setting:

Integrated network of six outpatient hemodialysis facilities in southern Idaho and eastern Oregon.

Patients:

Outpatients receiving long-term hemodialysis.

Results:

During the 18 months prior to the outbreak, the overall infection rate was 4.1 infections per 1,000 dialysis sessions with a catheter rate of 8.9 per 1,000 dialysis sessions. During the 7 months of the outbreak, the overall rate increased to 5.8 per 1,000 dialysis sessions, whereas the catheter rate increased to 18.1 per 1,000 dialysis sessions. Reports of malfunctioning “Brand A” catheters prompted discontinuation of their placement. A manufacturer recall occurred in April 2000. During the 14 months after the outbreak, the overall infection rate decreased to 3.3 per 1,000 dialysis sessions and the catheter rate to 10.8 per 1,000 dialysis sessions. A 12-month retrospective cohort study recognized 96 patients with an identifiable catheter brand and 48 infections. Of these, 27 (56%) occurred in patients with Brand A catheters. The relative risk for infection when compared with other catheter brands was 1.96 (95% confidence interval, 1.32 to 2.92; P < .001).

Conclusions:

Ongoing infection surveillance in hemodialysis facilities can identify specific device-related outbreaks of infections and promote interventions to reduce infectious complications and promote patient safety. Surveillance for vascular access site infections is recommended as a routine activity in hemodialysis facilities.

Developing a statewide childhood body mass index surveillance program

BACKGROUND

Several states have implemented childhood obesity surveillance programs supported by legislation. Representatives from Idaho wished to develop a model for childhood obesity surveillance without the support of state legislation, and subsequently report predictors of overweight and obesity in the state.

METHODS

A coalition comprised of the Idaho State Department of Education and 4 universities identified a randomized cluster sample of schools. After obtaining school administrator consent, measurement teams traveled to each school to measure height and weight of students. Sex and race/ethnicity data were also collected.

RESULTS

The collaboration between the universities resulted in a sample of 6735 students from 48 schools and 36 communities. Overall, 29.2% of the youth in the sample were classified as overweight or obese, ranging from 24.0% for grade 1 to 33.8% for grade 5. The prevalence of overweight and obesity across schools was highly variable (31.2 ± 7.58%). Hierarchical logistic regression indicated that sex, age, race/ethnicity, socioeconomic status, and region were all significant predictors of overweight and obesity, whereas school was not.

CONCLUSIONS

This coalition enabled the state of Idaho to successfully estimate the prevalence of overweight and obesity on a representative sample of children from all regions of the state, and subsequently identify populations at greatest risk.

Norovirus outbreak at a wildland fire base camp ignites investigation of restaurant inspection policies

Norovirus outbreaks occur worldwide and have been associated with congregate settings (e.g., military and recreational camps). Investigation of a norovirus outbreak at a wildland fire base camp identified 49 (27%) illnesses among approximately 180 responders. Epidemiologic evidence implicated a restaurant as the infection source. Eight (89%) of nine wildland fire responder groups who ate at the restaurant had ill members; no groups who ate elsewhere reported ill members. An environmental health specialist restaurant inspection identified lack of managerial knowledge to protect against foodborne disease one year after the restaurant's opening; earlier inspection after opening might have led to earlier intervention. States were surveyed to determine existence of any policy or rule for food establishment inspection after opening and inspection timing. Among 18 states, five had no state rule or policy; nine had a policy in place; and four required postopening inspection by rule. Further research is needed to evaluate post-opening inspection efficacy and timing.

Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death?

OBJECTIVE As use of standard depression questionnaires in clinical practice increases, clinicians will frequently encounter patients reporting thoughts of death or suicide. This study examined whether responses to the Patient Health Questionnaire for depression (PHQ-9) predict subsequent suicide attempt or suicide death. METHODS Electronic records from a large integrated health system were used to link PHQ-9 responses from outpatient visits to subsequent suicide attempts and suicide deaths. A total of 84,418 outpatients age ≥13 completed 207,265 questionnaires between 2007 and 2011. Electronic medical records, insurance claims, and death certificate data documented 709 subsequent suicide attempts and 46 suicide deaths in this sample. RESULTS Cumulative risk of suicide attempt over one year increased from .4% among outpatients reporting thoughts of death or self-harm "not at all" to 4% among those reporting thoughts of death or self-harm "nearly every day." After adjustment for age, sex, treatment history, and overall depression severity, responses to item 9 of the PHQ-9 remained a strong predictor of suicide attempt. Cumulative risk of suicide death over one year increased from .03% among those reporting thoughts of death or self-harm ideation "not at all" to .3% among those reporting such thoughts "nearly every day." Response to item 9 remained a moderate predictor of subsequent suicide death after the same factor adjustments. CONCLUSIONS Response to item 9 of the PHQ-9 for depression identified outpatients at increased risk of suicide attempt or death. This excess risk emerged over several days and continued to grow for several months, indicating that suicidal ideation was an enduring vulnerability rather than a short-term crisis.

Assessment of the risk of White Sturgeon to become infected and potential carriers of infectious pancreatic necrosis virus

Little scientific information is available to assess whether White Sturgeon Acipenser transmontanus can become infected and potential carriers of infectious pancreatic necrosis virus (IPNV). To assess this risk, monitoring results of adult and progeny White Sturgeon were examined from waters historically stocked with salmonid fish known to be IPNV carriers. From 1999 through 2004 White Sturgeon from a total of 30 separate families whose parentage came from waters historically stocked with IPNV carrier fish were tested. Duplicate groups of 25 juvenile Snake River White Sturgeon were waterborne exposed to 1.0×10(4) 50% tissue culture infective dose (TCID50)/mL of water for 1 h and an additional group was injected intraperitoneally with 1.0×10(5) TCID50/fish. A negative control group was handled similarly but was not exposed to the virus. No morbidity was detected in any of the treatment groups or the negative control. At 34, 40, 47, and 54 d postexposure to IPNV, virus reisolation was attempted on five fish from each group, and an additional five fish from each group were examined for histological changes consistent with an IPNV infection. At 34 and 40 d postinjection with IPNV, 20% (one of five) of the fish tested positive for the virus per sample interval; however, fish from groups that were waterborne-exposed to IPNV were all negative. At 47 and 54 d after exposure or injection with IPNV an additional five fish from each group were tested at each sample interval and all results were negative. Histological analysis of target tissue obtained from five fish per group at 34 and 54 d postinfection also failed to detect any consistent change associated with an IPNV infection. These results suggest that the risk of White Sturgeon to become infected and develop into potential carriers of IPNV is negligible.

Regional differences and tribal use of American Indian/Alaska Native cancer data in the Pacific Northwest

In the Pacific Northwest, cancer is a leading cause of morbidity and mortality for American Indians and Alaska Natives (AI/AN). Misclassification of AI/AN race in state cancer registries causes cancer burden to be underestimated. Furthermore, local-level data are rarely available to individual tribes for use in health assessment and program planning. We corrected race coding in the cancer registries of Idaho, Oregon, and Washington using probabilistic record linkage to a file derived from patient registration records from Indian Health Service and a large urban clinic. We calculated cancer incidence and mortality measures by state, comparing AI/AN to non-Hispanic White (NHW) race. Record linkages identified a high prevalence of misclassified race. Differences in AI/AN cancer patterns were identified across the three state region. Compared to NHW, AI/AN experienced disproportionate late stage rates of some screen-detectable cancers. The correct classification of race is a crucial factor in cancer surveillance and can reveal regional differences even within a relatively small area. The availability of local-level cancer data can help inform tribes in appropriate intervention efforts.

Lead exposure and poisoning of songbirds using the Coeur d'Alene River Basin, Idaho, USA

Previous studies have found widespread Pb poisoning of waterfowl in the Coeur d'Alene River Basin in northern Idaho, USA, which has been contaminated by mining and smelting activities. We studied the exposure of ground-feeding songbirds to Pb, sampling 204 American robins (Turdus migratorius), song sparrows (Melospiza melodia), and Swainson's thrushes (Catharus ustulatus) throughout the basin. These songbirds had mean blood Pb concentrations (mg/kg, dry weight) of less than 0.19 at a reference area (25 mg Pb/kg soil), 1.09 at moderately contaminated sites (170 to 1300 mg Pb/kg soil), and 2.06 at highly contaminated sites (2000 to 5000 mg Pb/kg soil). Based on guidelines for evaluating blood Pb in birds, 6% of robins from the highly contaminated sites had background concentrations, 24% were subclinically poisoned, 52% were clinically poisoned, and 18% were severely clinically poisoned with Pb. Blood Pb concentrations were lower in song sparrows than in robins and lowest in Swainson's thrushes. More than half of the robins and song sparrows from all contaminated sites and more than half of the Swainson's thrushes from highly contaminated sites showed at least 50% inhibition of the activity of the enzyme δ-aminolevulinic acid dehydratase (ALAD), commonly used as a measure of exposure to Pb. The highest hepatic Pb concentration of 61 mg/kg (dry weight) was detected in a song sparrow. Using Al as a marker for soil in songbird ingesta, we estimated average soil ingestion rates as 20% in robins, 17% in song sparrows, and 0.7% in Swainson's thrushes. Soil Pb in ingesta accounted for almost all of the songbirds' exposure to Pb. Based on these results, it is recommended that ecological risk assessments of ground-feeding songbirds at contaminated sites include soil ingestion as a pathway of exposure to Pb.

Survey of pathogens in hatchery Chinook salmon with different out-migration histories through the Snake and Columbia rivers

The operation of the Federal Columbia River Power System (FCRPS) has negatively affected threatened and endangered salmonid populations in the Pacific Northwest. Barging Snake River spring Chinook salmon Oncorhynchus tshawytscha through the FCRPS is one effort to mitigate the effect of the hydrosystem on juvenile salmon out-migration. However, little is known about the occurrence and transmission of infectious agents in barged juvenile salmon relative to juvenile salmon that remain in-river to navigate to the ocean. We conducted a survey of hatchery-reared spring Chinook salmon at various points along their out-migration path as they left their natal hatcheries and either migrated in-river or were barged through the FCRPS. Salmon kidneys were screened by polymerase chain reaction for nine pathogens and one family of water molds. Eight pathogens were detected; the most prevalent were Renibacterium salmoninarum and infectious hematopoietic necrosis virus. Species in the family Saprolegniaceae were also commonly detected. Pathogen prevalence was significantly greater in fish that were barged through the FCRPS than in fish left to out-migrate in-river. These results suggest that the transmission of infectious agents to susceptible juvenile salmon occurs during the barging process. Therefore, management activities that reduce pathogen exposure during barging may increase the survival of juvenile Chinook salmon after they are released.

A randomized controlled trial of behavioral weight loss treatment versus combined weight loss/depression treatment among women with comorbid obesity and depression

BACKGROUND

Obesity is associated with clinical depression among women. However, depressed women are often excluded from weight loss trials.

PURPOSE

This study examined treatment outcomes among women with comorbid obesity and depression.

METHODS

Two hundred three (203) women were randomized to behavioral weight loss (n = 102) or behavioral weight loss combined with cognitive-behavioral depression management (n = 101).

RESULTS

Average participant age was 52 years; mean baseline body mass index was 39 kg/m(2). Mean Patient Health Questionnaire and Hopkins Symptom Checklist (SCL-20) scores indicated moderate to severe baseline depression. Weight loss and SCL-20 changes did not differ between groups at 6 or 12 months in intent-to-treat analyses (p = 0.26 and 0.55 for weight, p = 0.70 and 0.25 for depressive symptoms).

CONCLUSIONS

Depressed obese women lost weight and demonstrated improved mood in both treatment programs. Future weight loss trials are encouraged to enroll depressed women.

Batrachochytrium dendrobatidis infection dynamics in the Columbia spotted frog Rana luteiventris in north Idaho, USA

The pathogenic chytrid fungus Batrachochytrium dendrobatidis (Bd) is contributing to amphibian declines worldwide. Temperature plays an important role in both pathogen growth and host immune function, but little is known about seasonal dynamics of Bd infection in north temperate regions. Our objective was to increase understanding of Bd disease ecology by investigating patterns of Bd infection of Columbia spotted frogs Rana luteiventris across seasons, age classes, and sexes in north Idaho, USA. We collected skin swabs from 223 R. luteiventris in spring, summer, and fall 2009 at 7 ponds in the Palouse region and quantified Bd zoospores for each sample using quantitative PCR. Across seasons, Bd prevalence of adults was higher in summer than in spring or fall, suggesting that individuals may be clearing low-level infections over the summer. Among age classes, all but one late stage tadpole (Gosner stage 43-45) tested negative for Bd. Conversely, 100% of metamorphs tested positive for Bd and had the highest Bd loads of all age classes, suggesting they may be the most vulnerable age class. Adult R. luteiventris had high infection prevalence (> 60%) in all seasons, indicating that Bd infection is maintained within populations and that adults likely serve as disease reservoirs across seasons. Among adults, we also found weak evidence for females having higher infection prevalence than males. Further laboratory and field studies are needed to determine whether there are individual and population impacts from Bd on R. luteiventris and other amphibians in north Idaho.

Prevalence of chronic obstructive pulmonary disease and tobacco use in veterans at Boise Veterans Affairs Medical Center

BACKGROUND

Although its prevalence is still debated, chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States, and smoking cessation remains the only intervention that can significantly improve the prognosis of COPD.

METHODS

To determine the prevalence of COPD in a typical population seeking care at a Veterans Affairs Medical Center; the impact of smoking, age, and sex on the prevalence of COPD in this population; and how often spirometry is done in patients at risk for COPD, we extracted data from the Veterans Integrated Service Network 20 Consumer Health Information and Performance Sets database, on patients seen at the Boise Veterans Affairs Medical Center between January 1, 1999, and May 30, 2006.

RESULTS

Approximately 8.8% (2,556/28,983) of all patients and 14.1% (1,152/8,149) of smokers were reported to have COPD. The odds of COPD in smokers, after adjusting for age and sex, was 3.18 (95% confidence interval 2.88-3.50) times greater than in nonsmokers. Males were 1.48 times more likely to have COPD than females, and there was an increasing risk of COPD with age. Thirty-nine percent of all veterans and 54% of those with COPD were active smokers. 273 (60%) of the 455 symptomatic smokers without a prior diagnosis of COPD were not evaluated with spirometry.

CONCLUSIONS

The prevalence of COPD in patients at the Boise Veterans Affairs Medical Center was consistent with that in other United States surveys, although the underutilization of screening spirometry in those at risk for COPD may have caused underestimation of the prevalence. Smoking, age, and male sex were identified as significant risk factors for COPD, and the prevalence of active smoking remains high in this population of veterans.

Traumatic brain injury state planning grant: Preparing for change in a rural state

PURPOSE

The overarching purpose of this work was to generate a framework on which to build a traumatic brain injury (TBI) system-support action plan for individuals with a TBI living in a rural state.

METHODS

Four research questions were posed aimed at describing rural service/support needs and service satisfaction among persons with a TBI, as well as rural service/support availability as defined by providers. One hundred and ninety-four providers/agencies and 250 individuals/family members completed one of two versions (provider/agency, individual/family member) of a Needs and Resources Assessment.

RESULTS

Data analyses indicated that the majority of individual respondents lived at an impoverished income level and lived with a TBI for approximately 12 years. Quality of life was perceived as significantly lower after the TBI than before. Employment decreased significantly following a TBI. Reasons for unemployment included a perceived inability to work, problems regarding proper accommodation and/or perceptions regarding being chosen as suitable job candidates.

CONCLUSIONS

Provider data confirmed that many important services are rarely available or specific to TBIs. Basic assistance with employment, cognitive training and occupational therapy were among those most needed. Paradoxically, a high proportion of individuals reported feeling satisfied with most services. Applications of these data along with recommendations for other rural states are described.

Outbreak of cryptosporidiosis associated with a splash park - Idaho, 2007

On August 6, 2007, Idaho's Central District Health Department (CDHD) received a complaint of several ill persons with watery diarrhea consistent with cryptosporidiosis after attendance at a municipal splash park on July 26. Cryptosporidium spp. is a protozoan that causes diarrheal illness and has been implicated previously in recreational water illness outbreaks at splash parks. CDHD and the Idaho Department of Health and Welfare (IDHW) initiated an investigation of illness among municipal park visitors who attended reservation-only gatherings at an onsite pavilion July 23-August 10. The investigation revealed five immunofluorescence assay (IFA)-confirmed and 45 clinically compatible cases of cryptosporidiosis among 154 persons interviewed (32% attack rate). Patients were more likely than non-ill park visitors to have been exposed to water from a splash feature (relative risk [RR] = 6.1) [corrected]. Water samples collected from splash features and an adjacent drinking fountain tested positive for Cryptosporidium hominis. This report summarizes the investigation of the outbreak and highlights the importance of splash park design, operation, access to hygiene facilities, and public education in prevention of waterborne cryptosporidiosis and other infectious agents. Educational efforts and enactment of regulations requiring enhanced disinfection technology, exclusion of persons with diarrhea, adequate hygiene facilities, and preconstruction consultation with health departments might decrease the risk for recreational water illness at splash parks.

Recidivism among child sexual abusers: initial results of a 13-year longitudinal random sample

In the initial analysis of data from a random sample of all those charged with child sexual abuse in Idaho over a 13-year period, only one predictive variable was found that related to recidivism of those convicted. Variables such as ethnicity, relationship, gender, and age differences did not show a significant or even large association with recidivism. The only variable that seemed to show both a significant and almost moderate association to recidivism was the Risk Assessment in the Sex Offender Evaluation reoffense. Comparisons were made to prior research as well as a discussion of implications of the sex offender evaluation for the legal process. Finally, a call for the continued need for further research is discussed.

Strawberry disease lesions in rainbow trout from southern Idaho are associated with DNA from a Rickettsia-like organism

Strawberry disease (SD) in the USA is a skin disorder of unknown etiology that occurs in rainbow trout Oncorhynchus mykiss and is characterized by bright red inflammatory lesions. To identify a candidate bacterial agent responsible for SD, we constructed 16S rDNA libraries from 7 SD lesion samples and 2 apparently healthy skin samples from SD-affected fish. A 16S rDNA sequence highly similar to members of the order Rickettsiales was present in 3 lesion libraries at 1%, 32% and 54% prevalence, but this sequence was not found in either healthy tissue library. Based on phylogenetic analysis, this Rickettsia-like organism (RLO) sequence is most closely related to 16S rDNA sequences of bacteria that may form a novel lineage within the Rickettsiales. We used nested PCR assays to screen 25 SD-affected fish for RLO or Flavobacterium psychrophilum DNA. Sixteen lesion samples were positive for the RLO sequence and 4 of the matched healthy samples were positive resulting in a significant association between SD lesions and presence of RLO DNA. While F. psychrophilum is reportedly associated with 'cold water strawberry disease' in the UK, we found no significant association between SD lesions and the presence of F. psychrophilum DNA. The statistical association between SD lesions and presence of RLO DNA is not proof of etiology, but these data suggest that RLO may play a role in SD in southern Idaho, USA.

Forecasting daily patient volumes in the emergency department

BACKGROUND

Shifts in the supply of and demand for emergency department (ED) resources make the efficient allocation of ED resources increasingly important. Forecasting is a vital activity that guides decision-making in many areas of economic, industrial, and scientific planning, but has gained little traction in the health care industry. There are few studies that explore the use of forecasting methods to predict patient volumes in the ED.

OBJECTIVES

The goals of this study are to explore and evaluate the use of several statistical forecasting methods to predict daily ED patient volumes at three diverse hospital EDs and to compare the accuracy of these methods to the accuracy of a previously proposed forecasting method.

METHODS

Daily patient arrivals at three hospital EDs were collected for the period January 1, 2005, through March 31, 2007. The authors evaluated the use of seasonal autoregressive integrated moving average, time series regression, exponential smoothing, and artificial neural network models to forecast daily patient volumes at each facility. Forecasts were made for horizons ranging from 1 to 30 days in advance. The forecast accuracy achieved by the various forecasting methods was compared to the forecast accuracy achieved when using a benchmark forecasting method already available in the emergency medicine literature.

RESULTS

All time series methods considered in this analysis provided improved in-sample model goodness of fit. However, post-sample analysis revealed that time series regression models that augment linear regression models by accounting for serial autocorrelation offered only small improvements in terms of post-sample forecast accuracy, relative to multiple linear regression models, while seasonal autoregressive integrated moving average, exponential smoothing, and artificial neural network forecasting models did not provide consistently accurate forecasts of daily ED volumes.

CONCLUSIONS

This study confirms the widely held belief that daily demand for ED services is characterized by seasonal and weekly patterns. The authors compared several time series forecasting methods to a benchmark multiple linear regression model. The results suggest that the existing methodology proposed in the literature, multiple linear regression based on calendar variables, is a reasonable approach to forecasting daily patient volumes in the ED. However, the authors conclude that regression-based models that incorporate calendar variables, account for site-specific special-day effects, and allow for residual autocorrelation provide a more appropriate, informative, and consistently accurate approach to forecasting daily ED patient volumes.

Injuries Sustained at Yellowstone National Park Requiring Emergency Medical System Activation

OBJECTIVE

Outdoor-related activity has been on the rise in recent years, and hiking and backpacking are among those activities with the largest growth in participation. As the number of participants with varying experience increases, it is expected that there will be an increase in injuries related to these activities. Little empirical data exist related to outdoor injury types and rates. Our objectives were to determine incidence and frequency of injuries related to outdoor activity and requiring emergency medical system (EMS) activation at a national park.

METHODS

This retrospective study examines injuries within Yellowstone National Park. Subjects were selected from a database containing all EMS calls within Yellowstone National Park from calendar year 2003 through 2004. Data collected included age, gender, type of injury, location, activity at the time of injury, and EMS response.

RESULTS

There were 306 injuries reviewed. The mean age of patients was 40.9 years (SD: 23.0), and the group comprised 49.0% males. Emergency medical system transport was not required in 59.2% of injuries, and of those transported, 58.4% of patients required basic life support only. Of all injuries, 77.4% involved soft tissue, including lacerations. Hiking and walking accounted for 38.0% of all injuries, and 56.0% of those injuries involved the lower extremity. Only 8.8% of the injuries involved fractures and/or dislocations.

CONCLUSIONS

In this study of EMS responses at a national park, the majority of injuries sustained were minor in nature. More than one third of injuries occurred while patients were hiking or walking, and most of those injuries involved the lower extremity. These results will help optimize resource planning in the national park setting.

Modifiable lifestyle factors affecting bone health using calcaneus quantitative ultrasound in adolescent girls

One hundred and fourteen girls were measured for calcaneus QUS (stiffness index score), calcium intake, weight, and total hours spent in physical activity (moderate to high-impact activities and low to no-impact activities). Multiple regression analysis indicated that hours spent in moderate to high-impact activities, current calcium intake, and weight significantly predicted SI.

INTRODUCTION

To determine the influence of modifiable lifestyle factors on adolescent girls' bone health measured by calcaneus quantitative ultrasound (QUS).

METHODS

One hundred and fourteen girls, ages 14-18 (15.97 +/- .7), enrolled in high school physical education classes, were measured for calcaneus QUS (stiffness index score), height, weight, current calcium intake from 2-3 day food records, and estimated total hours spent in physical activity from kindergarten to present. Cumulative physical activity hours were separated into two classifications (according to their estimated strain from ground reaction force): moderate to high-impact activities and low to no-impact activities.

RESULTS

Pearson correlations between stiffness index (SI) and age, height, weight, current calcium intake, and hours spent in moderate to high-impact versus low to no-impact activities indicated a positive relationships between SI and weight (r = .259, p = .005), current calcium intake (r = .286, p = .002), and hours spent in moderate to high-impact activities (r = .451, p < .001). Multiple regression between SI and the above independent variables indicated that collectively, hours spent in moderate to high-impact activities, current calcium intake, and weight (r (2) = .363, p = <.001) significantly predicted SI.

CONCLUSION

Our data indicate that moderate to high-impact activities, current calcium intake, and weight positively influence bone properties of the calcaneus in adolescent girls.

Effect of particulate matter air pollution on hospital admissions and medical visits for lung and heart disease in two southeast Idaho cities

Few, if any, published time series studies have evaluated the effects of particulate matter air exposures by combining hospital admissions with medical visit data for smaller populations. We investigated the relationship between daily particulate matter (<10 microm in aerometric diameter or PM10) exposures with admissions and medical visits (emergency room, urgent care, and family practice) for respiratory and cardiovascular disease in Pocatello and Chubbuck, Idaho (population about 60,000), from November 1994 through March 2000. Within generalized linear models, time, weather, influenza, and day-of-week effects were controlled. In single-pollutant models, respiratory disease admissions and visits increased (7.1-15.4% per 50 microg/m3 PM10) for each age group analyzed, with the highest increases in two groups, children and especially the elderly. Statistical analyses suggest that the results probably did not occur by chance. Sensitivity analyses did not provide strong evidence that the respiratory disease effect estimates were sensitive to reasonable changes in the final degrees of freedom choice for time and weather effects. No strong evidence of confounding by NO2 and SO2 was found from results of multi-pollutant models. Ozone and carbon monoxide data were not available to include multi-pollutant models, but evidence suggests that they were not a problem. Unexpectedly, evidence of an association between PM10 with cardiovascular disease was not found, possibly due to the lifestyles of the mostly Mormon study population. Successful time series analyses can be performed on smaller populations if diverse, centralized databases are available. Hospitals that offer urgent or other primary care services may be a rich source of data for researchers. Using data that potentially represented a wide-range of disease severity, the findings provide evidence that evaluating only hospital admissions or emergency room visit effects may underestimate the overall morbidity due to acute particulate matter exposures. Further work is planned to test this conclusion.

Population-based epidemiologic analysis of acute pyelonephritis

BACKGROUND

Acute pyelonephritis is a potentially severe disease for which there are few population-based studies. We performed a population-based analysis of trends in the incidence, microbial etiology, antimicrobial resistance, and antimicrobial therapy of outpatient and inpatient pyelonephritis.

METHODS

A total of 4887 enrollees of Group Health Cooperative, based in Seattle, Washington, who received an International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis of acute pyelonephritis from 1997 through 2001 were identified using computerized records. Diagnoses were linked to urine culture and antibiotic prescription data. Case patients (n=3236) included subjects who had received an inpatient or culture-confirmed outpatient diagnosis of acute pyelonephritis.

RESULTS

Among the female population, annual rates of outpatient and inpatient pyelonephritis were 12-13 cases per 10,000 population and 3-4 cases per 10,000 population, respectively; among the male population, the rates were 2-3 cases per 10,000 population and 1-2 cases per 10,000 population, respectively. Rates were relatively stable from year to year. Incidence was highest among young women, followed by infants and the elderly population. The ratio of outpatient to inpatient cases was highest among young women (ranging from 5 : 1 to 6 : 1). Escherichia coli caused 80% of cases of acute pyelonephritis in women and 70% of cases in men and was less dominant in older age groups. Among E. coli strains, the rate of ciprofloxacin resistance increased from 0.2% of isolates to 1.5% of isolates (P=.03), and the rate of trimethoprim-sulfamethoxazole resistance decreased from 25% of isolates to 13% of isolates (P<.01) from 1997 to 2001. Among outpatient cases, the rate of fluoroquinolone use increased from 35% to 61%, whereas the rate of trimethoprim-sulfamethoxazole use decreased from 53% to 32% over the 5-year period (P<.01).

CONCLUSIONS

This comprehensive, population-based analysis adds to our limited knowledge of the epidemiology of acute pyelonephritis, especially among outpatients, in whom the majority of cases now occur.

Methamphetamine use by incarcerated women: comorbid mood and anxiety problems

OBJECTIVE

Methamphetamine's (MA) impact on psychiatric functioning is not well understood, especially among women. Efforts to understand MA's impact are complicated by the use of other drugs. The purpose of this study is to untangle the relative contributions of MA versus other drugs on psychiatric symptoms.

METHOD

Incarcerated women (N = 100) completed diagnostic interviews and a symptom measure to establish psychiatric status.

FINDINGS

Nearly all women (83%) had lifetime dependence on > or =1 drugs. The most common drug of dependence was MA (67%), followed by alcohol (32%), cannabis (19%), and cocaine (15%). Over half met lifetime criteria for an affective disorder (53%), and nearly half (46%) met lifetime criteria for an anxiety disorder. Lifetime dependence on MA and a nonstimulant drug was related to current psychiatric symptoms and lifetime mood and anxiety disorder. Lifetime mood and anxiety disorders were generally unrelated to recent MA use.

CONCLUSION

Findings highlight the impact of MA use on psychiatric presentation among women. Results suggest that MA impacts psychiatric symptoms independent of lifetime psychiatric diagnoses. Of note was the high incidence of drug dependence and mood and anxiety disorders among this sample of incarcerated women from a rural state. Findings imply important treatment implications for women in prison settings.

Carbon monoxide poisoning: a new incidence for an old disease

PURPOSE

While carbon monoxide (CO) poisoning is common in the USA, its incidence is uncertain. Fatal poisonings are counted with relative accuracy from death certificate data, but estimates of the more common nonfatal poisonings are either old or limited. This study was performed to estimate the number of emergency department (ED) visits annually in the USA for carbon monoxide poisoning.

BASIC PROCEDURES

ED visit rates in five states (Idaho, Maine, Montana, Utah, and Washington) from three prior studies, each using different methodology, were used to extrapolate independent estimates of national ED visits.

MAIN FINDINGS

After correcting for regional differences in CO poisoning incidence, estimates of national ED visits per year ranging from 32,413 to 56,037 were obtained. Excluding the estimate derived from the Maine rate because it did not include intentional and fire-related poisonings, the national average is 50,558 +/- 4,843 visits per year.

CONCLUSIONS

There are approximately 50,000 ED visits for CO poisoning in the USA annually, 3-5 times the numbers previously estimated. As this disease can result in significant long-term morbidity even when treated, enhanced prevention efforts are warranted.

A devastating outbreak of malignant catarrhal fever in a bison feedlot

In early 2003, an outbreak of malignant catarrhal fever (MCF) occurred in a bison feedlot in southern Idaho. The outbreak resulted in a 51.2% (n = 825) mortality rate among bison, which had been exposed to sheep for 19 days. Diagnosis was made by detection of ovine herpesvirus 2 (sheep-associated MCF virus) DNA in tissues or peripheral blood by polymerase chain reaction (PCR), and by histological examination of tissue lesions. Peak losses occurred between 41 and 55 days postmean exposure time (PME), and reached a maximum of 41 head per day. No known cases of MCF were observed among the 177 head of bison that arrived in the lot 3 1/2 weeks after the departure of the sheep. Of the several thousand head of beef cattle in the lot during the outbreak, only a single case of MCF was identified. This outbreak illustrates the devastating impact the MCF virus can have on bison under certain exposure conditions, the high threat posed by adolescent lambs to susceptible species, the significantly greater susceptibility of bison than beef cattle to MCF, and the lack of horizontal transmission from clinically affected bison to herdmates.