Toxic anterior segment syndrome after cataract surgery--Maine, 2006.
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Toxic anterior segment syndrome (TASS), an acute, noninfectious inflammation of the anterior segment of the eye, is a complication of anterior segment eye surgery; cataract extraction is the most common form of this type of surgery. Various contaminants, usually from surgical equipment or supplies, have been implicated as causes of TASS. The syndrome typically develops within 24 hours after surgery and is characterized by corneal edema and accumulation of white cells in the anterior chamber of the eye. Although most cases of TASS can be treated successfully with topical steroids, topical nonsteroidal antiinflammatory agents, or both, the inflammatory response associated with TASS can cause serious damage to intraocular tissues, resulting in vision loss. In October 2006, the Maine Department of Health and Human Services (MDHHS) received a report of a cluster of TASS cases among outpatients who had undergone cataract surgery at a hospital in Maine. MDHHS and CDC investigated the cluster and worked with the treating ophthalmologist and the hospital to prevent additional cases. This report describes the results of that investigation and the subsequent prevention measures implemented. Although the specific cause of the outbreak was not identified, no additional cases were reported after two series of changes were made to the materials and equipment used for surgery. Prevention of TASS requires careful attention to solutions, medications, and ophthalmic devices and to cleaning and sterilization of surgical equipment because of the numerous potential causes of the condition. (+info)
Confronting trade-offs in health care: Harvard Pilgrim Health Care's organizational ethics program.
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Patients, providers, and policy leaders need a new moral compass to guide them in the turbulent U.S. health care system. Task forces have proposed excellent ethical codes, but these have been seen as too abstract to provide guidance at the front lines. Harvard Pilgrim Health Care's ten-year experience with an organizational ethics program suggests ways in which health care organizations can strengthen transparency, consumer focus, and overall ethical performance and contribute to the national health policy dialogue. (+info)
On November 15, 2006, the Maine Department of Health and Human Services (MDHHS) was notified of a case of salmonellosis (a nationally notifiable disease) in an employee of a facility that produced poultry vaccine. When a second case of salmonellosis in another employee at the same facility was reported on November 25, MDHHS began an outbreak investigation. Results of that investigation suggested that 21 employees of the facility became ill during a 1-month period from exposure to a strain of Salmonella serotype Enteritidis (SE) that was used in vaccine production. Infection was thought to have resulted from environmental contamination after the spill of a liquid containing a high concentration of SE. As a result, MDHHS recommended that the facility improve its infection-control procedures to better protect workers. This outbreak highlights occupational risks that can be associated with the manufacture of veterinary biologics involving human pathogens. (+info)
Use of the 16S-23S rDNA internal transcribed spacer of Roseovarius crassostreae for epizootiological studies of juvenile oyster disease (JOD).
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Juvenile oyster disease (JOD) in Crassostrea virginica is caused by the marine bacterium Roseovarius crassostreae. Although the 16S rRNA genes of the bacterial isolates exhibit little variation, 2 genetic signatures (GSI and GSII) may be discerned by Ava I digestion of the 16S-23S internal transcribed spacer (ITS). In this study we analyzed isolates from JOD epizootics throughout the northeastern USA (including affected adults for the first time) to better understand how oyster populations encounter and become affected by the pathogen. Isolates from a given epizootic usually had the same ITS signature; however, the involvement of both genetic signatures was occasionally detected, even within the same oyster. Sequencing was used to localize the variable Ava I site to a 100 bp region of low sequence identity, and detection of additional base changes resulted in the identification of 11 distinct genotypes. One genotype was found only in Martha's Vineyard, Massachusetts, USA and persisted in JOD survivors. Two genotypes were associated with Maine epizootics, and both were believed to be unique to that region until 2004, when one was detected in Martha's Vineyard among oysters that had survived colonization by the local genotype. Apparent competition between those 2 genotypes was also detected among a population of juveniles. Five genotypes were found only in New York, and the other 3 were isolated from both New York and from around Cape Cod, Massachusetts. Relationships between the geographic occurrence and phylogenetic relatedness of genotypes were compared with regional current patterns to identify possible mechanisms controlling their distribution. (+info)
Neuropsychological function in children with blood lead levels <10 microg/dL.
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Clear adverse effects of blood lead levels >or=10 microg/dL have been documented in children. Given that the majority of US children have levels below 10 microg/dL, clarification of adverse effects below this cutoff value is needed. Our study evaluated the associations between blood lead levels <10 microg/dL and a broad spectrum of children's cognitive abilities. Data were analyzed from 534 children aged 6-10, enrolled in the New England Children's Amalgam Trial (NECAT) from the urban area of Boston, Massachusetts and rural Farmington, Maine. Adjusting for covariates (age, race, socioeconomic status, and primary caregiver IQ), children with 5-10 microg/dL had 5.0 (S.D. 2.3) points lower IQ scores compared to children with blood lead levels of 1-2 microg/dL (p=0.03). Verbal IQ was more negatively affected than performance IQ, with the most prominent decrement occurring in children's vocabulary. Wechsler Individual Achievement Test scores were strongly negatively associated with blood lead levels of 5-10 microg/dL. In adjusted analyses, children with levels of 5-10 microg/dL scored 7.8 (S.D. 2.4) and 6.9 (S.D. 2.2) points lower on reading and math composite scores, respectively, compared to children with levels of 1-2 microg/dL (p<0.01). Finally, levels of 5-10 microg/dL were associated with decreased attention and working memory. Other than associations of lead exposure with achievement, which even persisted after adjustment for child IQ, the most pronounced deficits were in the areas of spatial attention and executive function. Overall, our analyses support prior research that children's blood levels <10 microg/dL are related to compromised cognition and highlight that these may especially be related to academic achievement. (+info)
Increasing reach of quitline services in a US state with comprehensive tobacco treatment.
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OBJECTIVE: The population reach of tobacco quitlines is an important measure of treatment seeking and penetration of services. Maine offers an opportunity to examine temporal changes in quitline reach and referral sources in the context of a comprehensive tobacco treatment programme. The impact of a $1.00 cigarette tax increase is also examined. METHODS: This is a descriptive analysis of Maine Tobacco Helpline call volume September 2001 to December 2006. Annual reach was estimated using a cross sectional state surveillance survey. Weekly call volume was examined during 2005, a year of marked changes in tobacco taxes and quitline resources. Referral patterns were analysed yearly. RESULTS: Maine's Tobacco Helpline observed more than a threefold increase in population reach during a four year interval, from 1.9% to over 6% per year. Calls increased substantially in 2005, concurrent with added hours of operation and a rise in the cigarette tax. Over time, callers increasingly reported hearing about the quitline from health professionals, from 10% in 2001 to 38% in 2006. CONCLUSIONS: Tobacco treatment programmes offering free nicotine therapy and professional medical education can drive quitline utilisation over time. Call volume can also be affected by quitline operational and policy changes that promote the reduction of tobacco use. (+info)
Online GIS services for mapping and sharing disease information.
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Emergency medical services data for cardiovascular disease surveillance, program planning, and evaluation in Maine.
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Rapid access to medical treatment is a key determinant of outcomes for cardiovascular events. Emergency medical services (EMS) play an important role in delivering early treatment for acute cardiovascular events. Attention has increased on the potential for EMS data to contribute to our understanding of prehospital treatment. Maine recently began to explore the possible role of EMS data in cardiovascular disease surveillance and cardiovascular health program planning and evaluation. We describe the Maine EMS data system, discuss findings on ease of data use and data quality, provide a sample of findings, and share how we plan to use EMS data for program planning and evaluation of community-level interventions and to partner with EMS provider organizations to improve treatment. Our objective is to increase understanding of the promise and limitations of using EMS data for cardiovascular disease surveillance and program planning and evaluation. (+info)