Pseudomonas dermatitis/folliculitis associated with pools and hot tubs--Colorado and Maine, 1999-2000.
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During 1999-2000, outbreaks of Pseudomonas aeruginosa dermatitis and otitis externa associated with swimming pool and hot tub use occurred in Colorado and Maine. This report summarizes these outbreaks and provides recommendations for swimming pool and hot tub operation and maintenance, particularly when using offsite monitoring of water disinfectant and pH levels or when cyanuric acid is added to pools as a chlorine stabilizer. (+info)
Telephone care as an adjunct to routine medical follow-up. A negative randomized trial.
(42/802)
CONTEXT: In 1992, a randomized trial at one outpatient clinic demonstrated that making telephone appointments part of routine medical follow-up could save money and reduce hospitalization. OBJECTIVE: To ascertain the effects of telephone care in other clinics. DESIGN: Consenting patients of 20 physicians were randomly assigned to receive telephone care or usual care. SETTING: Veterans Affairs General Medical Clinics in Denver, Colorado, and Sioux Falls, South Dakota. PATIENTS: 512 predominately male elderly veterans (mean age, 68 years) who had a broad range of chronic medical conditions. INTERVENTION: At the intake clinic visit, the recommended revisit interval (e.g., return in 3 months) for telephone care patients was doubled (e.g., return in 6 months) and three intervening telephone appointments were scheduled. Three telephone appointments were also scheduled at all subsequent clinic visits. MAIN OUTCOME MEASURES: Utilization of services and self-reported health status. RESULTS: More than 2000 calls were made during the 2-year study period. Although the revisit interval was longer for telephone care patients after the intake visit (as was expected), it was the same for both telephone care and usual care patients after all subsequent visits, despite the scheduling of three telephone appointments for telephone care patients. The intervention had no effect on self-reported health status, hospital admission, or number of deaths. The intervention also had no effect on the total number of clinic visits, outpatient laboratory tests, or radiologic tests. Telephone care patients had fewer unscheduled visits than did usual care patients (2.0 vs. 2.8 visits/patient; P = 0.01). CONCLUSION: Telephone care had little effect in this study. Instead of providing a way to maintain contact with patients without requiring them to appear in clinic frequently, telephone appointments became simply an additional service. (+info)
Who is at risk for influenza? Using criteria other than age.
(43/802)
PURPOSE: Colorado Access is a safety-net managed care organization that serves the medical and behavioral needs of the medically underserved. Because 75 percent of our population is children, we have had difficulty defining criteria to determine who is at risk for influenza and thus should receive an annual influenza vaccination. Our objective was to create a comprehensive list of diagnostic codes to be used to identify these high-risk individuals, using criteria other than age. METHODOLOGY: A task force of medical experts familiar with diseases and chronic conditions associated with influenza and pneumonia convened to determine criteria other than age that can be used to identify populations recommended to receive an annual influenza vaccination. The task force used previously published criteria, compared them to the Advisory Committee on Immunization Practices (ACIP) recommendations, and developed a single, comprehensive diagnostic-criteria list that correlates with the ACIP recommendations, defined by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification, Fifth Edition) codes, to identify populations recommended to receive an annual influenza vaccination. PRINCIPAL FINDINGS: A comprehensive list of ICD-9 codes that indicate diagnostic criteria to be used to define populations at risk for influenza according to the ACIP recommendation was developed. CONCLUSION: Colorado Access found that having criteria to target groups recommended to receive an annual influenza vaccine facilitates the planning of preventive health programs. These criteria may be beneficial to other health plans and agencies that promote flu vaccination. (+info)
Window shopping: state health reform politics in the 1990s.
(44/802)
Throughout the 1990s states sought politically acceptable policies to reduce the ranks of the uninsured. Visions of comprehensive health reform and universal coverage yielded by mid-decade to more modest measures to repair private health insurance markets, and to these enactments were added several new public programs (state and federal) to expand coverage for lower-income children and, in some cases, adults. Because governments remain ill equipped to counter the power of business, insurers, and providers in conflicts fought on private turf, reform agendas have been more readily set, moved, and cleared in public-sector arenas. Although the number of uninsured rose steadily until 1999, "catalytic federalism"--the accelerating interplay between state and federal reform forces and funds--may be putting the programmatic foundations for broader coverage incrementally into place. (+info)
Genealogical portraits of speciation in montane grasshoppers (genus Melanoplus) from the sky islands of the Rocky Mountains.
(45/802)
Grasshoppers in the genus Melanoplus have undergone a radiation in the 'sky islands' of western North America, with many species originating during the Pleistocene. Despite their recent origins, phylogenetic analyses indicate that all the species exhibit monophyletic or paraphyletic gene trees. The objectives of this study were to determine whether the monophyletic genealogies are the result of a bottleneck at speciation and to investigate the extent to which the different phylogenetic states of eight species (i.e. monophyletic versus paraphyletic gene trees) can be ascribed to the effects of speciation. A coalescent simulation was used to test for a bottleneck at speciation in each species. The effective population sizes and demographic histories of species were compared across taxa to evaluate the possibility that the paraphyly versus monophyly of the species reflects differential rates of lineage loss rather than speciation mode. While coalescent analyses indicate that the monophyly of Melanoplus species might not be indicative of bottlenecks at speciation, the results suggest that the paraphyletic gene trees may reflect the demography of speciation, involving localized divergences in the ancestral species. With respect to different models of Pleistocene divergence, the data do not support a model of founder-effect speciation but are compatible with divergence in allopatric refugia. (+info)
Outbreak of community-acquired pneumonia caused by Mycoplasma pneumoniae--Colorado, 2000.
(46/802)
On May 18, 2000, the Colorado Department of Public Health and Environment (CDPHE) was contacted by a family physician in Moffat County, Colorado (1998 population: 12,700), about a large number (>50) of community-acquired pneumonia cases diagnosed by chest radiograph in a group practice over several months. An investigation by state public health officials and CDC implicated Mycoplasma pneumoniae as the cause of illness. This report summarizes the results of the investigation and underscores the importance of investigating outbreaks of severe unexplained respiratory illness to enable implementation of appropriate treatment and control measures. (+info)
Public health response to 2 clinical cases of blastomycosis in colorado residents.
(47/802)
We summarize the public health response after the identification of 2 cases of pneumonia caused by Blastomyces dermatitidis infection in Colorado residents. The response to these cases emphasizes the need for physicians to add fungal infection to the list of differential diagnoses for patients who have refractory pneumonia, even those who live in areas of nonendemicity. (+info)
Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center.
(48/802)
BACKGROUND: In a one month period, 10 Serratia liquefaciens bloodstream infections and 6 pyrogenic reactions occurred in outpatients at a hemodialysis center. METHODS: We performed a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections or pyrogenic reactions. We reviewed procedures and cultured samples of water, medications, soaps, and hand lotions and swabs from the hands of personnel. RESULTS: We analyzed 208 sessions involving 48 patients. In 12 sessions, patients had S. liquefaciens bloodstream infections, and in 8, patients had pyrogenic reactions without bloodstream infection. Sessions with infections or reactions were associated with higher median doses of epoetin alfa than the 188 other sessions (6500 vs. 4000 U, P=0.03) and were more common during afternoon or evening shifts than morning shifts (P=0.03). Sessions with infections or reactions were associated with doses of epoetin alfa of more than 4000 U (multivariate odds ratio, 4.0; 95 percent confidence interval, 1.3 to 12.3). A review of procedures revealed that preservative-free, single-use vials of epoetin alfa were punctured multiple times, and residual epoetin alfa from multiple vials was pooled and administered to patients. S. liquefaciens was isolated from pooled epoetin alfa, empty vials of epoetin alfa that had been pooled, antibacterial soap, and hand lotion. All the isolates were identical by pulsed-field gel electrophoresis. After the practice of pooling epoetin alfa was discontinued and the contaminated soap and lotion were replaced, no further S. liquefaciens bloodstream infections or pyrogenic reactions occurred at this hemodialysis facility. CONCLUSIONS: Puncturing single-use vials multiple times and pooling preservative-free epoetin alfa caused this outbreak of bloodstream infections in a hemodialysis unit. To prevent similar outbreaks, medical personnel should follow the manufacturer's guidelines for the use of preservative-free medications. (+info)