Bioterrorism alleging use of anthrax and interim guidelines for management--United States, 1998.
From October 30 through December 23, 1998, CDC received reports of a series of bioterroristic threats of anthrax exposure. Letters alleged to contain anthrax were sent to health clinics on October 30, 1998, in Indiana, Kentucky, and Tennessee. During December 17-23 in California, a letter alleged to contain anthrax was sent to a private business, and three telephone threats of anthrax contamination of ventilation systems were made to private and public buildings. All threats were hoaxes and are under investigation by the Federal Bureau of Investigation (FBI) and local law enforcement officials. The public health implications of these threats were investigated to assist in developing national public health guidelines for responding to bioterrorism. This report summarizes the findings of these investigations and provides interim guidance for public health authorities on bioterrorism related to anthrax. (+info)
Correlates of physical activity in a sample of older adults with type 2 diabetes.
OBJECTIVE: Physical activity is integral to the management of type 2 diabetes. Unfortunately, the majority of adults with type 2 diabetes do not regularly engage in physical activity. The purpose of this study was to assess physical activity behavior and its correlates (i.e., physical activity knowledge, barriers, and performance and outcome expectations) in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: A subgroup of 260 adults with type 2 diabetes was identified from a larger stratified random sample of adults aged > or = 55 years. Participants completed an interviewer-administered survey designed from focus group findings and social learning theory. RESULTS: The majority of the respondents (54.6%) reported 0 min of weekly physical activity. This was especially true of older female respondents. Performance expectation scores were lower among respondents who were in the oldest age-group, namely, white women. Physical activity knowledge varied by age-group, and barriers to physical activity were prevalent in all groups. The following are significant correlates of reported weekly physical activity: younger age, more education, fewer motivational barriers, and greater perceived health and performance expectations. CONCLUSIONS: Given the importance of physical activity to diabetes management, the low prevalence of physical activity found in this and other studies should raise concerns among clinicians. Future research to identify predictors of physical activity is needed to guide clinicians in the promotion of physical activity. (+info)
Reduced utilization and cost of primary care clinic visits resulting from self-care education for patients with osteoarthritis of the knee.
OBJECTIVE: To determine the extent to which the cost of an effective self-care intervention for primary care patients with knee osteoarthritis (OA) was offset by savings resulting from reduced utilization of ambulatory medical services. METHODS: In an attention-controlled clinical trial, 211 patients with knee OA from the general medicine clinic of a municipal hospital were assigned arbitrarily to conditions of self-care education (group E) or attention control (group AC). Group E (n = 105) received individualized instruction and followup emphasizing nonpharmacologic management of joint pain. Group AC (n = 106) received a standard public education presentation and attention-controlling followup. A comprehensive clinical database provided data concerning utilization and cost of health services during the following year. RESULTS: Only 25 subjects (12%) were lost to followup. The 94 subjects remaining in group E made 528 primary care visits during the year following intervention, compared with 616 visits by the 92 patients remaining in group AC (median visits 5 versus 6, respectively; P < 0.05). Fewer visits translated directly into reduced clinic costs in group E, relative to controls (median costs [1996 dollars] $229 versus $305, respectively; P < 0.05). However, self-care education had no significant effects on utilization and costs of outpatient pharmacy, laboratory, or radiology services over the ensuing year. The cost per patient to deliver the self-care intervention was estimated to be $58.70. CONCLUSION: Eighty percent of the cost of delivering effective self-care education to the knee OA patients in this study was offset within 1 year by the reduced frequency and costs of primary care visits. For >50% of patients receiving the intervention, the savings associated with fewer primary care visits exceeded the cost of self-care education. (+info)
The impact of after-school peer contact on early adolescent externalizing problems is moderated by parental monitoring, perceived neighborhood safety, and prior adjustment.
Unsupervised peer contact in the after-school hours was examined as a risk factor in the development of externalizing problems in a longitudinal sample of early adolescents. Parental monitoring, neighborhood safety, and adolescents' preexisting behavioral problems were considered as possible moderators of the risk relation. Interviews with mothers provided information on monitoring, neighborhood safety, and demographics. Early adolescent (ages 12-13 years) after-school time use was assessed via a telephone interview in grade 6 (N = 438); amount of time spent with peers when no adult was present was tabulated. Teacher ratings of externalizing behavior problems were collected in grades 6 and 7. Unsupervised peer contact, lack of neighborhood safety, and low monitoring incrementally predicted grade 7 externalizing problems, after controlling for family background factors and grade 6 problems. The greatest risk was for those unsupervised adolescents living in low-monitoring homes and comparatively unsafe neighborhoods. The significant relation between unsupervised peer contact and problem behavior in grade 7 held only for those adolescents who already were high in problem behavior in grade 6. These findings point to the need to consider individual, family, and neighborhood factors in evaluating risks associated with young adolescents' after-school care experiences. (+info)
Is a third-trimester antibody screen in Rh+ women necessary?
OBJECTIVE: To determine the need for routine third-trimester antibody screening in Rh+ women. STUDY DESIGN: An analytic case-control study. METHODS: We identified Rh+ pregnant women who had received prenatal care and retrospectively analyzed their laboratory data. Patients were grouped into those with a positive third-trimester antibody screen (cases) and those with a negative third-trimester screen (controls). Because entry into a group was decided by the investigators, it could not be randomized. We reviewed the maternal medical records for antibody identification and final pregnancy outcome. We also reviewed the neonatal medical records for evidence of direct Coombs-positive cord blood, anemia, need for transfusion or phototherapy, other medical complications, and death. RESULTS: Using a computerized laboratory database from 2 teaching hospitals, we identified 10,581 obstetric patients who underwent routine first- and third-trimester antibody screening between 1988 and 1997. Of these, 1233 patients were Rh- and 9348 were Rh+. Among the Rh+ patients, 178 (1.9%) had 1 or more atypical antibodies at the first-trimester screen, and 53 (0.6%) had a positive third-trimester antibody screen despite a negative first-trimester screen. Although 6 of these 53 patients (0.06% of the study population) had clinically relevant antibodies for hemolytic disease of the new-born, no significant neonatal sequelae occurred among these 6 patients. CONCLUSION: Based on the patient and hospital records studied, a repeat third-trimester antibody screen for Rh+ patients is clinically and economically unjustified. Eliminating this laboratory test from clinical practice will not adversely affect pregnancy outcomes and will decrease the costs of prenatal care. (+info)
Increasing paintball related eye trauma reported to a state eye injury registry.
OBJECTIVES: To evaluate an apparent increase in documented trauma from paintball related eye injuries reported to the Eye Injury Registry of Indiana. METHODS: A retrospective review of cases reported to the database is reported, with representative case histories. RESULTS: No injuries from paintball were reported during the period June 1992 to June 1996. Over the next two years 11 injuries were reported, representing 4% of all ocular trauma reports over this period. Visual outcome is poor in many of these eyes and more than one half present with posterior segment ocular injury. CONCLUSIONS: Severe ocular trauma results from impacts from paintball pellets, and the occurrence of injuries appears to be increasing due to growth in popularity of this war game. Diligent use of eye protection by all participants is necessary to prevent a continuing rise in ocular trauma prevalence from this activity. (+info)
Olestra consumption is not associated with macular pigment optical density in a cross-sectional volunteer sample in Indianapolis.
The associations between the intake of the fat-substitute olestra and the concentrations of macular carotenoid pigments and serum lutein and zeaxanthin were investigated in a volunteer cross-sectional sample in Indianapolis. The study was conducted in January through March, 1998 after olestra-containing savory snacks had been sold in central Indiana for a year. Volunteers (n = 280) aged 18-50 y were recruited to make a single clinic visit during which macular pigment optical density (MPOD) was determined by psychophysical flicker photometry, serum was obtained for determination of lutein and zeaxanthin concentration, usual intake of olestra, carotenoids and nutrients were assessed by 1-y food frequency questionnaire, and health habits including smoking, physical characteristics such as eye color, demographics and medical history were determined by questionnaire. Intake of olestra at least one time per month for the past year was reported by 81:280 subjects and their mean, median and 90(th) percentile intakes were 1.09, 0.34 and 2.43 g olestra/d, respectively. Mean macular pigment optical density was not significantly different between olestra consumers and nonconsumers (0.213 +/- 0.014 vs. 0.211 +/- 0.010) nor was serum lutein and zeaxanthin concentration (0.361 +/- 0.017 vs. 0.375 +/- 0. 013 micromol/L) or intake (1242 +/- 103 mg/d vs. 1042 +/- 58 mg/d) in one-way or two-way ANOVA. Olestra intake was not associated with MPOD or serum lutein and zeaxanthin before or after correction for significant covariates of MPOD. Thus, olestra intake over the past year in a cross-sectional volunteer sample in Indianapolis was not associated with MPOD. (+info)
A community outbreak of hepatitis A in a religious community in Indiana: failure of immune serum globulin to prevent the spread of infection.
An outbreak of hepatitis A occurred in a religious community in Indiana, USA. Sixty-nine cases were ascertained among the 4466 residents over a year, and the highest attack rate was in children. The management of the outbreak included the widespread use of prophylactic immune serum globulin (ISG). Despite this, further cases occurred. To guide further ISG administration, a survey was undertaken to ascertain what proportion remained susceptible to HAV infection. From a random sample of 600 people in the affected community 440 saliva specimens (73%) were obtained. Of these, 12.5% were found to be immune (95% confidence intervals from 9-16%). No changes were made to the ISG administration policy. There was no evidence to suggest that administration of ISG had any effect on the duration of the outbreak. There was a low rate of symptomatic infection among young children (less than 10 years); as ISG does not prevent the spread of the virus its use is not recommended in future outbreak situations. (+info)