Patterns of treatment for ductal carcinoma in situ of the breast in Louisiana, 1988-1999

Data from numerous studies show that lumpectomy (breast-conserving therapy) plus radiation therapy provides survival equivalent to that following mastectomy (either modified radical or radical mastectomy) for patients with ductal carcinoma in situ (DCIS). According to the data from the National Cancer Data Base and the Surveillance Epidemiology End Results (SEER) Program, use of lumpectomy among female DCIS patients has increased dramatically over the last decade. This study examined population-based trends in treatment for DCIS among Louisiana women and compared the trends with the SEER data. Our data revealed that the percentage of the DCIS patients who received a lumpectomy increased from 34.3% in 1988-1991 to 53.7% in 1996-1999 in Louisiana (p<0.05) while DCIS patients who received a modified radical mastectomy decreased from 51.7% to 26.1% (p<0.05). Increasing use of lumpectomy was seen across all races, age groups, rural/urban areas, and poverty-level areas. Utilization of lumpectomy was about the same for white and African-American women but varied by age group, rural/urban area, and poverty level. Female DCIS patients residing in rural areas or high poverty level areas were less likely to receive a lumpectomy than those residing in urban or affluent areas. Among the patients who had a lumpectomy, 34.4% received post-lumpectomy radiotherapy in the first study period (1988-1991) and 49.7% in the last study period (1996-1999). In Louisiana, utilization of post-lumpectomy radiotherapy decreased with advancing age. Despite the increase in use of lumpectomy, its utilization remained approximately 10% lower than in the SEER areas throughout the study period. A similar deficit was observed for post-lumpectomy radiation therapy.

Prevalence of overweight, obesity, and associated diseases among outpatients in a public hospital

BACKGROUND

The prevalence of obesity is increasing and may be particularly high among indigent public hospital patients. The purpose of this study was to determine the prevalence of obesity and its associated chronic medical conditions among outpatients at Louisiana State University Health Sciences Center-Shreveport, an urban tertiary health center that serves a mostly black, indigent population.

METHODS

A cross-sectional survey was conducted on 1,507 primary care patients. Age, sex, weight, height, and diagnoses were recorded, and body mass index (BMI) was calculated.

RESULTS

Eighty-one percent of patients were overweight or obese and 75% had one or more obesity-associated conditions. Higher BMI was significantly associated with increased prevalence of obesity-related diseases (P < 0.001) even when adjusted for age and sex.

CONCLUSION

Overweight and obesity rates at this public hospital are alarming and may indicate a problem in public hospitals across the United States. The process and structure of care for overweight and obese patients need to be evaluated, and training for residents needs to address this problem.

Lung cancer mortality among chromate production workers

AIMS

To assess mortality in 1997 among 493 former workers of a US chromate production plant employed for at least one year between 1940 and 1972.

METHODS

Cohort members were followed for mortality to 31 December 1997. Standardised mortality ratios (SMRs) were calculated for selected cause specific categories of death including lung cancer. Lung cancer mortality was investigated further by calculation of SMRs stratified by year of hire, duration of employment, time since hire, and categories of cumulative exposure to Cr(VI).

RESULTS

Including 51 deaths due to lung cancer, 303 deaths occurred. SMRs were significantly increased for all causes combined (SMR = 129), all cancers combined (SMR = 155), and lung cancer (SMR = 241). A trend test showed a strong relation between lung cancer mortality and cumulative hexavalent exposure. Lung cancer mortality was increased for the highest cumulative exposure categories (> or =1.05 to <2.70 mg/m(3)-years, SMR = 365; > or =2.70 to 23 mg/m(3)-years, SMR = 463), but not for the first three exposure groups. Significantly increased SMRs were also found for year of hire before 1960, 20 or more years of exposed employment, and latency of 20 or more years.

CONCLUSIONS

The finding of an increased risk of lung cancer mortality associated with Cr(VI) exposure is consistent with previous reports. Stratified analysis of lung cancer mortality by cumulative exposure suggests a possible threshold effect, as risk is significantly increased only at exposure levels over 1.05 mg/m(3)-years. Though a threshold is consistent with published toxicological evidence, this finding must be interpreted cautiously because the data are also consistent with a linear dose response.

Are physicians equipped to address the obesity epidemic? Knowledge and attitudes of internal medicine residents

BACKGROUND

To analyze whether internists are suited for their role in treating the growing numbers of obese patients, we surveyed residents about their knowledge and attitudes regarding obesity. Previous assessments have not analyzed familiarity with obesity measurement tools or the correlation between knowledge and attitudes.

METHODS

We administered a survey to 87 internal medicine residents in two urban, university-based residency programs.

RESULTS

Almost all respondents understood the medical consequences of obesity, but 60% did not know the minimum BMI for diagnosing obesity, 69% did not recognize waist circumference as a reasonable measure of obesity, and 39% incorrectly reported their own BMI. Although nearly all respondents agreed that treating obesity was important, only 30% reported treatment success. Forty-four percent felt qualified to treat obese patients, and 31% reported treatment to be futile. Knowledge and attitudes were not correlated. Rasch analysis of knowledge and attitude subscales showed satisfactory model fit and item reliability of at least 0.96.

CONCLUSIONS

Despite solid knowledge of the comorbid conditions associated with obesity, residents have a poor grasp of the tools necessary to identify obesity. They also have negative opinions about their skills for treating obese patients. Residency training not only must improve knowledge of obesity measurement tools but also must address physicians' negative attitudes toward obesity treatment.

Cardiovascular risk profile of asymptomatic healthy young adults with increased carotid artery intima-media thickness: the Bogalusa Heart Study

OBJECTIVE

The cardiovascular (CV) risk profile of healthy young adults was studied at the extreme 5th percentiles of carotid intima-medial thickness (IMT) as measured by B-mode ultrasonography in different segments of the carotid artery.

METHODS

Anthropometric variables, blood pressure, laboratory data, family history health habits were collected from 518 individuals (mean age 32 years). Individuals in the top and bottom 5th percentiles of IMT of carotid bulb or bifurcation area (n = 22) and the common carotid (n = 25) segments were examined for presence of risk factors. Univariate analyses compared the two groups, t tests, and chi-square tests were performed.

RESULTS

The common carotid segment top and bottom percentiles of IMT differed with respect to age (p < 0.000), BMI (p < 0.001). In contrast, carotid bulb segment top and bottom percentiles differed with respect to age, (p = 0.001), BMI (p = 0.004), HDL cholesterol (p 0.006), LDL cholesterol (p = 0.023), ECG diagnosis (p = 0.016), smoking status (p = 0.004). The individuals in the top 5th percentile of IMT of the bifurcation area were more obese (BMI > 30), hypertensive (BP > 140/90 or on medications), dyslipidemic (LDL > 130 mg/dl, triglycerides > 150, HDL < 40 mg/dl), and more often had an abnormal ECG, and a history of smoking.

CONCLUSION

The observed deleterious effect of CV risk factors on IMT of the carotid artery, a surrogate measure of coronary atherosclerosis, underscores the risk factor profile history in youth. The prevalence of multiple risk factors among those in the top 5th percentile of IMT was significantly higher with respect to the carotid bulb segment only (p = 0.000), suggesting more sensitivity to the risk factor burden compared with the common carotid segment. These observations have important implications in preventive cardiology.

Street outreach for HIV prevention: effectiveness of a state-wide programme

Street outreach is considered a key HIV prevention strategy in the United States. To determine whether street outreach to prevent HIV infection as practised by state-funded community-based organizations (CBOs) is effective in promoting condom use, we conducted an evaluation using a quasi-experimental design. Twenty-one CBOs involved in street outreach conducted cross-sectional surveys assessing risk behaviour and exposure to outreach activities in 66 intervention and 13 comparison areas in Louisiana over a 2-year period. Surveys were collected from 4950 persons at intervention sites and 1597 persons at comparison sites. After controlling for demographic characteristics and sexual risk factors, persons in intervention sites were more likely to use condoms than persons in comparison sites [odds ratio 1.37 (95% confidence interval 1.20, 1.56; P<0.001)]. Contact with an outreach worker mediated condom use. The mechanism of effect may be related to direct contact with an outreach worker and condom distribution rather than to broader community mobilization.

Lead levels among children who live in public housing

BACKGROUND

Exposure to lead hazards is a serious health concern for inner-city children. In the United States, the greatest contributor to an elevated lead level is lead exposure in the home. There are federal regulations to protect children in public housing developments from exposure to lead paint. The efficacy of these regulations has not been examined.

METHODS

We assessed the association between residence in a public housing development and the risk of an elevated blood lead level among high-risk children in New Orleans. We did so by conducting a case-control study among 7121 children age 6 to 71 months who received a screening blood lead test from New Orleans public health clinics in 1998.

RESULTS

We found elevated blood lead levels for 29% of children who were screened. Children residing in New Orleans housing developments had lead levels no different from those residing in nondevelopment housing when controlling for housing age, and child's sex and age (odds ratio = 0.93; 95% confidence interval = 0.77-1.1).

CONCLUSIONS

Despite legislative efforts, public housing does not appear to protect children from elevated lead levels, calling into question the efficacy of existing regulations.

Awareness of hypertension and dyslipidemia in a semirural population of young adults: the Bogalusa Heart Study

BACKGROUND

To assess the awareness of hypertension and dyslipidemia in a semirural population of young adults.

METHODS

A cohort of 5,707 individuals was surveyed by a questionnaire. The awareness analysis was done on 1,454 subjects screened for cardiovascular risk factors 5 years earlier.

RESULTS

Among the respondents (n = 3,699, 65%), the prevalence of hypertension among blacks and whites was 11% and 7.3% (P < 0.0001), respectively; dyslipidemia, 4.7% and 5.8% (P = 0.27). Results from the screening showed a prevalence of 11.4% in blacks versus 6.0% in whites (P < 0.0001) for hypertension; 14.2% versus 17.9% (P = 0.12) for dyslipidemia. Males had a higher prevalence of dyslipidemia than females (24% vs. 12%, P = 0.001). Five years later, among those informed of their hypertension, males were more likely to be aware of their hypertension than females [odds ratio (95% confidence interval) = 5.0 (1.4-17.5)]. Increasing age [1.04 (1.0-1.1)], positive parental history of coronary heart disease [2.6 (1.5-4.3)], and higher education level [2.1 (1.2-33.6)] were associated with the awareness of dyslipidemia. Awareness of the condition increased the proportion of subjects receiving treatment for hypertension, but did not change the proportion receiving treatment for dyslipidemia.

CONCLUSIONS

These results underscore the need for cardiovascular health education efforts in this population group.

Changing multiple health behaviors: smoking and exercise

BACKGROUND

Previous stage of change research examining health behaviors has tended to examine one behavior at a time. However, one recent study by King et al. (1996) examined the relationship between smoking and exercise across cognitive-behavioral mediators (i.e., decisional balance and self-efficacy) shown to be important in predicting readiness to change. In this study, we seek to replicate the study of King et al. (1996) in a low-income sample, the majority of whom are women, with at least one chronic illness who are attending primary care clinics.

METHODS

Data were obtained from 270 adult outpatients attending four public primary care clinics in Louisiana.

RESULTS

Smoking and exercise stage of change were not related. Significant relationships existed between the cognitive variables of smoking and exercise. No significant differences existed within exercise stage of change on the cognitive variables of smoking, and vice versa, no significant differences were noted within smoking stage of change on the cognitive variables of exercise.

CONCLUSIONS

Smoking and exercise appear to be specific health behaviors that are independent constructs in this particular sample. However, caution should be taken when interpreting the findings since 75% of the sample had at least one chronic illness.

Prevalence of strongyle nematodes in naturally infected ponies of different ages and during different seasons of the year in Louisiana

One hundred and seventeen ponies were surveyed for the seasonal prevalence of strongyloid parasites, particularly cyathostomes, and for host- and age-related differences in these infections. For 56 ponies, all stages of the cyathostome life cycle, both mucosal and luminal, were enumerated. Total numbers of cyathostomes and percentage of developing larvae (DL) encysted in the mucosa remained constant in all 4 seasons of the year, whereas a significant increase in the percentage of adults in the cyathostome population occurred in fall. In yearling ponies, encysted early third-stage larvae constituted a significantly lower percentage of the cyathostome population, and DL and adults formed a significantly higher percentage, compared with those stages in older ponies, 2-5 yr of age. More species of cyathostomes were present in yearling ponies than in older ponies. Significant differences occurred in fecal egg counts at different seasons of the year, even though adult cyathostome and large strongyle numbers remained constant. Twenty-four species of cyathostomes were found year-round, and 2 rare species were found in only 2 or 3 seasons of the year. Prevalences for these 24 species were not significantly different during any season, although 5 species had significant differences in intensity levels of infection in certain seasons of the year. Three species of large strongyle (strongylinae) adults had significant seasonal variations in intensities. These were Strongylus edentatus and S. vulgaris, which occurred in significantly higher numbers in summer and fall, and Triodontophorus brevicauda, which was more numerous in spring and summer. Fourth- and fifth-stage larvae of S. vulgaris recovered from the mesenteric vasculature were significantly more numerous in winter and spring than in other seasons.

Asymptomatic sexually transmitted diseases: the case for screening

BACKGROUND

The United States has the highest prevalence of sexually transmitted diseases in the developed world. Control strategies should address the most frequent reasons why curable sexually transmitted diseases are not treated.

METHODS

We approached 1,631 persons ages 18-29 in various sites and offered them screening for gonorrhea and chlamydial infection and surveys regarding past genitourinary symptoms. For those with past symptoms we abstracted medical records or conducted additional interviews. From these data we estimated the total number of persons who had gonorrhea or chlamydial infections in the previous year, the proportion treated, and the primary reasons for nontreatment.

RESULTS

The prevalence of gonorrhea was 2.3% and that of chlamydial infection was 10.1%. We estimate that 45 and 77% of all cases of gonorrhea and chlamydial infection, respectively, were never symptomatic and that 86 and 95% of untreated cases of gonorrhea and chlamydial infection, respectively, were untreated because they were never symptomatic. The remaining 14 and 5% of untreated cases of gonorrhea and chlamydia, respectively, were not treated because persons did not receive medical care for symptoms.

CONCLUSIONS

The primary reason that gonorrhea and chlamydial infections are untreated is that infected persons never have symptoms. The most effective method to control these sexually transmitted diseases is routine screening at high-volume sites.

Seasonal dynamics of the helminths of bluegill (Lepomis macrochirus) in a subtropical region

Seasonal prevalence and abundance of the helminths of bluegill sunfish in a Louisiana oligohaline bayou were measured by a survey and a field "live-box" experiment. The survey took place from the spring of 1997 to the summer of 1998 and examined fish that were <7 cm. Three trematode species, Phagicola nana (Heterophyidae), Ascocotyle tenuicollis (Heterophyidae), and Posthodiplostomum minimum (Diplostomatidae), and 2 nematode species, Camallanus oxycephalus (Camallanidae) and Spinitectus carolini (Cystidicolidae), were examined. Camallanus oxycephalus was the only helminth that showed a distinct seasonal pattern. Abundance and prevalence peaked in summer, which was likely driven by concerted reproductive cycles of females. The survey data indicated that the other helminths fluctuated over time but did not seem to follow a distinct seasonal pattern. The fluctuations could be attributed to the variable nature of the habitat or to the stochastic events that influence transmission dynamics, particularly isolated events such as tropical storms, which cause dramatic changes in salinity. The live-box experiment successfully measured recruitment of A. tenauicollis and suggested a seasonal component of the distribution of this species, which was possibly caused by temperature-dependent emergence of cercariae from the snail intermediate host.

Management of intracranial aneurysms: factors that influence clinical grade and surgical outcome

BACKGROUND

We report the experience in managing intracranial aneurysms at our medical center.

METHODS

We retrospectively analyzed 297 intracranial aneurysms managed during a 6-year period. Risk factors were analyzed with respect to their influence on outcome after surgery as measured by Glasgow Outcome Scale score.

RESULTS

Fifty-eight patients had multiple aneurysms. Of all aneurysms, 83% were in the anterior circulation, 37% were unruptured, and 59% were larger than 10 mm in size. Good outcomewas achieved in 75% of patients, and another 16% had fair outcomes. The mortality rate was 4%, and significant morbidity occurred in 5% of patients. Significant indicators of poor outcome were worsened clinical grade, posterior aneurysm location, and large aneurysm size.

CONCLUSION

Hypertensive patients, older patients, and patients with posterior circulation aneurysms had poorer neurologic status, which significantly influenced outcome. Larger aneurysms and vertebrobasilar aneurysms were associated with poor outcomes.

Morbidity and mortality of children following motor vehicle crashes

HYPOTHESIS

The use of passenger compartment safety measures has not led to decreases in pediatric morbidity or mortality in our population of patients.

DESIGN

Retrospective review.

SETTING

University, tertiary care, level I trauma center.

PATIENTS

All patients admitted to the Trauma Center at Louisiana State University Health Science Center School of Medicine in Shreveport between July 1, 1991, and December 31, 2000, who were younger than 16 years and involved in a motor vehicle crash.

MAIN OUTCOME MEASURES

Intensive care complications, postoperative complications, and mortality.

RESULTS

We reviewed the experience of all pediatric patients involved in motor vehicle crashes and transported to the Trauma Center at Louisiana State University Health Science Center School of Medicine in Shreveport from July 1, 1991, through December 31, 2000. A total of 191 patients met these criteria. There were 8 deaths, and only 1 of these patients was restrained. There were significantly more injuries in those patients who died compared with those who survived (Modified Injury Severity Score, 29 vs 9; P<.001). We compared the use of restraints in our cohort with the use of restraints in the US pediatric population. Only 20% of our patients were restrained vs 68% of the general pediatric population. This difference was significant (P<.001, chi2) test).

CONCLUSIONS

In our population of patients, death was a relatively infrequent occurrence. All patients who died presented in extremis. No patient died as the result of a complication. The rate of seat belt use in our population of patients was low. The exact reason for why we were unable to detect any survival benefit with seat belt use is unclear and demands further investigation.

Inadequate supervision as a cause of injury deaths among young children in Alaska and Louisiana

OBJECTIVE

Inadequate supervision of children has contributed to injuries. However, the association of inadequate supervision with injury events in children has not been quantified. The purpose of this study was to describe and quantify the role of inadequate supervision of children in injury deaths.

METHODS

Injury deaths among children aged 0 to 6 years in Alaska during 1993 to 1995 and Louisiana during 1994 were classified using 10 child safety standards to assess the role of parent/caregiver supervision in the circumstances of injury death.

RESULTS

The leading categories of injury death for both states combined were motor vehicle injury and fire-related injury. Of the classifiable injury deaths in both states (157 [77%] of 203 deaths), the most commonly violated safety standard was "children should be supervised by a responsible care provider" (64 deaths [41%]). Of these deaths, the caregiver was absent in 38%, and the caregiver increased the danger to the child in 17%. Male injury deaths more typically involved a supervision standard violation. Drowning and pedestrian deaths typically involved a supervision standard violation, whereas asphyxiation, homicide, and occupant motor vehicle injury deaths did not.

CONCLUSION

Alaska and Louisiana child injury deaths were mostly attributed to preventable violations of 10 child safety standards, most commonly the supervision standard. The methods in this report were useful in identifying target populations and causes of death, which can be used to plan and implement interventions to improve supervision of children.

USH1C: a rare cause of USH1 in a non-Acadian population and a founder effect of the Acadian allele

Usher syndrome (USH) is characterized by the associated findings of hearing loss and retinitis pigmentosa (RP), leading to progressive loss of vision. Three forms of USH can be distinguished clinically. In the most severe form, USH1, profound congenital deafness is associated with vestibular dysfunction and RP. To determine the frequency of USH1C mutations as a cause for USH1, 128 probands with Usher syndrome type 1 including seven from Acadian and 121 from non-Acadian populations were systematically screened for mutations in USH1C using a combined single-strand conformational polymorphisms (SSCP)/heteroduplex and sequencing method. All seven Acadian USH1 patients were found to be homozygous for both the 216G>A mutation and the 9-repeat VNTR which characterizes the Acadian allele, confirming previous evidence for a founder effect by haplotype analysis. However, USH1C mutations were identified in only two non-Acadian USH1 probands (1.65%) including one from Pakistan who was homozygous for a 238-239insC mutation and one from Canada was also homozygous for the Acadian allele. The low prevalence of USH1C mutations in the present study suggests that the high prevalence of the 238-239insC in Germany may reflect a founder effect. Comparison of the affected haplotypes in the Canadian patient with the Acadian USH1 patients yielded evidence for a founder effect. Our data suggest that USH1C is a relatively rare form of USH1 in non-Acadian populations and that in addition to the 216G>A Acadian mutation, the 238-239insC mutation appears to be common in some populations.

Partner notification for HIV and syphilis: effects on sexual behaviors and relationship stability

BACKGROUND

Partner notification (PN), originally designed for syphilis control, has been used to control the spread of HIV since 1985. Because HIV infection is noncurable, the benefit of contact tracing and treatment demonstrated for the control of syphilis may not apply to HIV. For HIV, PN must facilitate behavior change that will reduce the spread of the infection. One concern is that HIV PN can promote the breakup of old partnerships and increase the acquisition of new partners, thereby spreading HIV infections.

GOAL

The purpose of this study was to determine the effect of partner notification (PN) on sexual behavior and relationship stability among HIV partnerships, with use of syphilis partnerships for comparison.

STUDY DESIGN

Partnerships were eligible if the index case was interviewed by a disease intervention specialist (DIS) for PN and named at least one sex partner. Partnership information was reported by index cases interviewed at baseline and 3 and 6 months post-PN. Trends in partnership dissolution and acquisition, sexual abstinence, condom use, emotional abuse, and physical violence reported by HIV infection and syphilis index cases were compared.

RESULTS

A total of 157 index cases (76 HIV infection and 81 syphilis) reported 220 partnerships (94 HIV and 126 syphilis). The PN process was completed for 32.7% of partnerships and it was completed more often for partnerships that were classified as main and cohabiting. After PN, 46.8% of partnerships dissolved, 15.9% of cases acquired a new partner, and emotional abuse and physical violence decreased significantly. HIV index cases were somewhat more likely to report using condoms at last sex act and less likely to acquire a new sex partner after PN compared to syphilis index cases. There was no difference post-PN between HIV infection and syphilis partnerships for partnership dissolution, physical violence, emotional abuse and abstention from sex.

CONCLUSION

HIV PN did not appear to cause greater partnership dissolution, new partner acquisition, or violence compared with syphilis PN.

The impact of a staged management approach to diabetes foot care in the Louisiana public hospital system

By the beginning of 1999, a Disease Management Initiative (DMI), consisting of targeted goals for the medical management of diabetes, had been established at all Louisiana State public hospitals. Concurrently, a regional Diabetes Foot Program (DFP) utilizing a staged management approach to foot problems was established in Baton Rouge. This study compares annual rates of hospitalization for diabetes-related foot problems and diabetes-related lower extremity amputations in diabetes patients treated for foot ulceration at the Louisiana public hospitals before and after implementation of DMI and the DFP. Mean diabetes foot-related hospitalization rates were lower in 1999 (1.96 per 100 person-years) compared to 1998 (2.61 per 100 person-years) (p < 0.001). Diabetes-related lower extremity amputation rates were also lower in 1999 (0.72 per 100 person-years) compared to 1998 (1.03 per 100 person-years) (p < 0.001). The reduction in the rate of foot-related hospitalizations was greater (p < 0.001) in patients after DMI and access to the DFP (-44%) compared to the patients after DMI without access to the DFP (-15%). There was no difference in the rate of lower extremity amputations between the patients with access to the DFP compared to the patients without access to the DFP. This study supports the effectiveness of a regional based DFP, providing a staged management approach to foot ulceration, in reducing foot-related hospitalizations, but not lower extremity amputations.

An economic evaluation of a school-based sexually transmitted disease screening program

BACKGROUND

A school-based sexually transmitted disease (STD) screening program was implemented in eight New Orleans public high schools to detect chlamydia and gonorrhea.

GOAL

The goal was to assess the incremental cost-effectiveness of replacing non-school-based screening with the school-based screening program.

STUDY DESIGN

A decision-analysis model was constructed to compare costs and cases of expected pelvic inflammatory disease (PID) in the school-based screening scenario versus a non-school-based screening scenario. Cost-effectiveness was quantified and measured as cost per case of PID prevented.

RESULTS

Under base-case assumptions, at an intervention cost of $86,449, the school screening program prevented an estimated 38 cases of PID, as well as $119,866 in treatment costs for PID and its sequelae, resulting in savings of $1524 per case of PID prevented. Results remained cost-saving over a reasonable range of model parameter estimates.

CONCLUSIONS

The New Orleans school-based chlamydia screening program was cost-effective and cost-saving and could be cost-effective in other settings. School-based screening programs of this type are likely to be a cost-effective use of public funds and can reduce the burden of STDs among adolescents.

Gastrointestinal helminths of ponies in Louisiana: a comparison of species currently prevalent with those present 20 years ago

A survey in Louisiana of gastrointestinal helminths recovered at necropsy from 117 ponies with minimal exposure to anthelmintics between 1989 and 2000 is compared with a survey conducted 20 yr earlier in the same region. An objective of this study was to determine whether species diversity has been affected by the advent and use of the macrocyclic lactone (ML) parasiticides and by the increased anthelmintic pressure on the helminth species infecting the general equine population. Twenty-six cyathostome species and 8 strongyle species were recovered. Two cyathostome species that were not found before, Cylicostephanus asymetricus and C. bidentatus, and 1 species of large strongyle, Oesophagodontus robustus, were added to the list of species found in Louisiana. All cyathostome and large strongyle species found previously were still present. But prevalences and intensities were significantly reduced for almost all large and small strongyle species. Prevalences and intensities of Oxyuris equi adults and larvae were reduced, whereas the prevalence of Parascaris equorum remained constant. The tapeworm Paranoplocephala mamillana was added to the list of parasite species found in Louisiana. Anoplocephala perfoliata remained the most common cestode. This species was found at the same level of intensity but increased slightly in prevalence. Anoplocephala magna was found less frequently than previously. The overall diversity of species remained reatively unchanged. The reasons for the differences in intensity and prevalence of strongyles between these 2 periods are unknown but might be related to the development and use of the broad-spectrum ML anthelmintics in the intervening period, a difference in the population of equids surveyed, different techniques used to identify the parasites, or differences in numbers of parasites identified (or to all).

Evaluation of rotavirus vaccine effectiveness in a pediatric group practice

Vaccines are traditionally tested under the optimal conditions of clinical trials (efficacy). However, their public health impact is better assessed under the real conditions of a clinical practice (effectiveness). The authors aimed to estimate the effectiveness of a rotavirus vaccine (rhesus rotavirus vaccine-tetravalent (RRV-TV)) to prevent rotavirus-related hospitalization among children <or=3 years of age. They reviewed computer records from an urban pediatric practice in New Orleans, Louisiana, comprising 1,413 children born between April 1, 1998, and June 1, 1999, and who would have been eligible to receive RRV-TV. They also reviewed hospital records to determine rotavirus hospitalizations for gastroenteritis during October 1998-June 2001. A total of 1,099 children were enrolled, 513 unvaccinated and 586 vaccinated. The attack rate of rotavirus hospitalization was 0.34 per 100 child-years-0.52 for unvaccinated (no doses) children, 0.20 for partially vaccinated (one or two doses) children, and 0 for fully vaccinated (three doses) children. Protective vaccine effectiveness was 70% (95% confidence interval (CI): -43, 94) among vaccinated children, 61% (95% CI: -86, 92) among partially vaccinated children, and 100% (95% CI: -120, 100) among fully vaccinated children. One episode of rotavirus-associated hospitalization was prevented per 104 infants partially vaccinated and per 64 infants fully vaccinated.

Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa Heart Study

Cardiovascular risk factors begin in childhood and are predictive of cardiovascular risk in adulthood. Observations in the Bogalusa Heart Study have shown an important correlation of clinical risk factors in early life with anatomic changes in the aorta and coronary vessels with atherosclerosis and cardiac and renal changes related to hypertension. These observations have been extended by echo Doppler studies of carotid artery intima media thickness (IMT). A close association of risk factors in young adults, 20-38 years of age, occurs with IMT, and a marked increase is noted as numbers of risk factors increase. More extensive changes seem to occur in the bulb or bifurcation area. This area may be an earlier marker of disease. Observations of risk factors in young individuals and noninvasive studies of structural changes of the cardiovascular system have strong implications for prevention by cardiologists.

St. Louis encephalitis outbreak in Louisiana in 2001

A description of the St. Louis encephalitis (SLE) outbreak in Northeast Louisiana is presented. In the fall of 2001 there were 63 cases of St. Louis encephalitis in Monroe and West Monroe and seven additional cases in the neighboring parishes of Richland, Morehouse and Franklin. All cases had a clinical presentation of encephalitis and were confirmed serologically. Clinically most cases presented with fever, meningitis syndrome with altered mental status. Tremors were common (56% of cases). There were three deaths. Age-group distribution showed a predominance among 45 and older. The epidemic curve based on diagnosis date showed an explosive outbreak starting August 8, 2001, reaching a peak by the second week, and progressively slowing down. The curve showed that by the time the first case was diagnosed, 60% or more of the cases were already infected. Most of the cases come from low socio-economic areas. Houses were often run down, many with screens in disrepair. Backyards were usually large, with heavy brush and many trees. There was an abundance of sources of mosquito larvae, particularly for Culex quinquefasciatus which is the main vector. Mosquito pools confirmed the presence of SLE virus. As soon as the first case was reported, a campaign of health education and increased mosquito adulticiding were implemented.