Southern extension of the range of human babesiosis in the eastern United States.
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We sought evidence of babesiosis in three residents of New Jersey who were suspected of local acquisition of Babesia microti infection. We tested serial blood samples from these residents for B. microti antibodies and amplifiable DNA by using immunofluorescent antibody and PCR techniques. All three residents experienced symptoms suggestive of acute babesiosis. The sera of each of the patients reacted against babesial antigen at a titer fourfold or higher in sequentially collected blood samples. PCR-amplifiable DNA, characteristic of B. microti, was detected in their blood. These data suggest that human B. microti infections were acquired recently in New Jersey, extending the range of this piroplasmosis in the northeastern United States. (+info)
Influence of an interventional program on resource use and cost in pediatric asthma.
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OBJECTIVE: Asthma is the most common chronic condition of childhood, for which morbidity, mortality, and cost are increasing. This study was performed to determine whether patient education and assignment to a primary care provider improve outcomes and cost in the management of pediatric asthma. STUDY DESIGN: A prospective pilot study of 61 patients was conducted with a retrospective review. Data were obtained from health and pharmacy records. PATIENTS AND METHODS: Sixty-one unassigned pediatric asthma patients who were noted to be frequent users of emergency department services and who had no primary care provider were identified. This cohort received asthma education and was assigned a provider trained in the national asthma guidelines. Hospital admissions, Emergency Department and clinic visits, use of beta 2 agonists and anti-inflammatory drugs, number of chest radiographs, and continuity of care were recorded for a mean of 58.1 months before and 11.2 months after the intervention. A cost analysis was done. RESULTS: All measured parameters showed favorable changes after intervention, with the decrease in the number of prescriptions of monthly inhaled anti-inflammatory drugs and chest radiographs ordered being statistically significant (P = 0.007 and P = 0.040, respectively). Monthly admissions, Emergency Department visits, and clinic visits declined after intervention when evaluated after 22.8 months of follow up. Annual resource savings after intervention was estimated to be $4845.29 per patient for this military hospital. CONCLUSIONS: A combined intervention consisting of provider and patient education and assignment to a primary care provider was associated with improved care and economic outcomes in this group. (+info)
Impact of nativity and race on "Stroke Belt" mortality.
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The southeastern region of the United States has been recognized for 6 decades as an area of excess cerebrovascular mortality rates. While the reasons for the disease variation remain an enigma, South Carolina has consistently been the forerunner of the "Stroke Belt." To determine the effects of nativity (birthplace) on stroke mortality rates in South Carolina, proportional mortality ratios (PMRs) were calculated for stroke deaths in South Carolina during 1980-1996 according to birthplace and stratified by gender, race, age, and educational status. The analyses revealed a graded risk of stroke by birthplace, with the highest PMRs (95% CI) among individuals born in South Carolina (104.8 [103.4 to 106.3]), intermediate PMRs in those born in the Southeast other than South Carolina (92.5 [90.2 to 94.9]), and lowest PMRs for those born outside the Southeast (77.4 [74.9 to 80.1]). The lower stroke PMRs for individuals born outside the Southeast were more striking in blacks (51.8 [45.2 to 59.3]) than in whites (84.9 [82.0 to 88.0]) and for men (73.3 [69.5 to 77.3]) than women (83.5 [79.9 to 87.3]). The findings, particularly in blacks, were not explainable by gender, differences in age, and/or markers of educational and socioeconomic status. These findings suggest that nativity is a significant risk marker for the geographic variation in stroke mortality. Moreover, the regional disparities for nativity and subsequent stroke mortality appear to be greater in blacks than in whites and for men than for women. An understanding of factors linking birthplace to risk for cerebrovascular mortality could facilitate efforts directed at stroke prevention. (+info)
High prevalence of complement component C6 deficiency among African-Americans in the south-eastern USA.
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Complement component C6 is a part of the membrane attack complex that forms a pore-like structure in cell membranes following complement activation. Deficiency of terminal complement components including C6 predisposes individuals to infection with Neisseriae. Using polymerase chain reaction/single-strand conformation polymorphism analysis followed by DNA sequencing, we screened genomic DNA from 200 randomly chosen blacks and an equal number from whites for three loss-of-function C6 mutations. Ten blacks and two whites were found to be heterozygous for one of the mutations. Two of the mutations, 1195delC and 1936delG, were found exclusively in black individuals. A third previously undescribed mutation, 878delA, was found at equal frequency among the two groups. The difference between the two groups was significant (P = 0.027), indicating that C6 deficiency due to these three mutations is more common among blacks than whites in the local area, principally Jefferson County, Alabama. In addition, three previously undescribed point mutations, two of which result in amino acid substitutions, were identified within exon 6. A review of the county health department records over the past 6 years revealed a higher incidence of meningococcal meningitis in blacks due to serogroups Y and W-135 which paralleled the difference in the estimated prevalence of C6 deficiency. Among black residents of the county (n = 235 598) there were 15 cases of meningitis due to these two serogroups, compared with two cases in the white population (n = 422 604) (P = 0.002). We conclude that C6 deficiency is more common among blacks than whites in the south-eastern United States, with a frequency approaching 1 in 1600 black individuals. (+info)
Testing for hereditary breast and ovarian cancer in the southeastern United States.
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OBJECTIVES: To detail characterization of mutations and uncharacterized variants in the breast cancer susceptibility genes BRCA1 and BRCA2, as observed in a population of breast cancer patients from the southeastern United States, and to examine baseline characteristics of women referred for counseling and testing and provide a preliminary look at how counseling and testing affected intentions toward prophylactic surgery. BACKGROUND: Mutations in the BRCA1 and BRCA2 genes give rise to a dramatically increased risk of developing breast or ovarian cancer or both. There are many reports about special populations in which deleterious mutations are present at a high frequency. It is useful to study these genes in more heterogeneous populations, reflecting different geographic regions. Interest in preventive surgery for gene carriers is high in women and their surgeons. METHODS: Women were recruited through a prospective clinical trial of counseling and free genetic testing. BRCA1 and BRCA2 were screened for mutations using standard techniques, and results were given to participants. Baseline questionnaires determined interest in preventive surgery at the beginning of the study. Follow-up questionnaires for those who completed testing surveyed interest in prophylactic surgery after counseling and receiving test results. RESULTS: Of 213 women who completed counseling and testing, 44 (20.6%) had 29 separate mutations; there were 11 Jewish women carrying three founder mutations. Twenty-eight women (13.1%) had uncharacterized variants in BRCA1 or BRCA2; nine were not previously reported. Women overestimated their chances of possessing a deleterious gene mutation compared to a statistical estimate of carrier risk. A number of women changed their intentions toward preventive surgery after genetic counseling and testing. CONCLUSIONS: Hereditary breast cancer due to mutations in BRCA1 and BRCA2 was a heterogeneous syndrome in the southeastern United States. Most mutations were seen just once, and uncharacterized variants were common and of uncertain clinical significance. In general, positive test results tended to reinforce intentions toward prophylactic surgery. In contrast, women not interested in surgery at the time of entry tended to remain reluctant after testing and counseling. (+info)
Genetic relatedness of Salmonella isolates from nondomestic birds in Southeastern United States.
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Salmonella infections have been implicated in large-scale die-offs of wild birds in the United States. Although we know quite a bit about the epidemiology of Salmonella infection among domestic fowl, we know little about the incidence, epidemiology, and genetic relatedness of salmonellae in nondomestic birds. To gain further insight into salmonellae in these hosts, 22 Salmonella isolates from diseased nondomestic birds were screened for the presence of virulence and antibiotic resistance-associated genes and compared genetically using pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA analysis. Of the 22 Salmonella isolates examined, 15 were positive for the invasion gene invA and the virulence plasmid-associated genes spvC and pef. Most (15 of 22) were generally sensitive to antibiotics. However, two Salmonella isolates from pet birds were identified as Salmonella enterica serovar Typhimurium DT104. Despite the general susceptibility of these Salmonella isolates to most antimicrobial agents, antibiotic resistance-associated genes intI1, merA, and aadA1 were identified in a number of these isolates. Five distinct XbaI and nine distinct BlnI DNA patterns were observed for the 22 Salmonella isolates typed by PFGE. PFGE analysis determined that Salmonella isolates from passerines in Georgia and Wyoming were genetically related. (+info)
Surveillance for possible estuary-associated syndrome--six states, 1998-1999.
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Pfiesteria piscicida (Pp) is an alga that has been associated with fish kills in estuaries (where fresh water mixes with salty seawater) along the eastern seaboard and possibly with human health effects. Since June 1, 1998, surveillance for possible estuary-associated syndrome (PEAS), including possible Pp-related human illness, has been conducted in Delaware, Florida, Maryland, North Carolina, South Carolina, and Virginia. This report summarizes passive surveillance for PEAS during June 1, 1998-December 31, 1999, which indicated no persons had illnesses that met PEAS criteria. (+info)
Forage systems for production of stocker steers in the upper south.
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The southern states produce large numbers of beef calves that are generally weaned and sold in autumn. Keeping calves in this region beyond weaning to graze high-quality forages through a stocker cattle phase could improve profitability. Autumn-weaned Angus crossbred steers were allocated by breeding and weight to four forage systems that began in mid-November and continued through mid-October as follows: System 1, tall fescue (Festuca arundinacea Schreb.) and Kentucky bluegrass (Poa pratensis L.)-white clover (Trifolium repens L.); System 2, tall fescue, caucasian bluestem (Bothriochloa caucasica [Trin.] C. E. Hubbard) and tall fescue-red clover (Trifolium pratense L.); System 3, orchardgrass-alfalfa and bluegrass-white clover; and System 4, rye (Secale cereale L.), soybeans (Glycine max)-foxtail millet (Setaria italica), and bluegrass-white clover. All steers were supplemented with hay or silage previously cut from their respective systems when forage for grazing was limited. System 2 which used stockpiled tall fescue for winter grazing and caucasian bluestem for summer forage plus fescuered clover for hay and grazing in a three-paddock system, resulted in greater (P < .01) gain per hectare and per steer, more grazing days, and reduced stored forage requirements and produced more surplus feed than the other systems tested. Gains per hectare for Systems 1 through 4 were 454, 554, 472, and 487 kg (SE = 18), respectively. Harvested forage from Systems 1, 2, and 3 met needs for stored forages but System 4 required additional "purchased" hay. Stored forage was fed for 61, 38, 112, or 104 d for Systems 1 through 4, respectively. Within the physio-climatic region of this experiment, a simple three-paddock system based on cool- and warm-season perennial forages could improve beef production per unit of land area while reducing inputs of labor and equipment. (+info)