Medicine and Health Sciences Commons^™

In Silico Surveillance: Evaluating Outbreak Detection With Simulation Models, Bryan Lewis, Stephen Eubank, Allyson M. Abrams, Ken Kleinman

Public Health Department Faculty Publication Series

Background

Detecting outbreaks is a crucial task for public health officials, yet gaps remain in the systematic evaluation of outbreak detection protocols. The authors’ objectives were to design, implement, and test a flexible methodology for generating detailed synthetic surveillance data that provides realistic geographical and temporal clustering of cases and use to evaluate outbreak detection protocols.

Methods

A detailed representation of the Boston area was constructed, based on data about individuals, locations, and activity patterns. Influenza-like illness (ILI) transmission was simulated, producing 100 years ofin silico ILI data. Six different surveillance systems were designed and developed using gathered cases …

Correlations Among Adiposity Measures In School-Aged Children, Caroline E. Boeke, Emily Oken, Ken P. Kleinman, Sheryl L. Rifas-Shiman, Elsie M. Taveras, Matthew W. Gillman

Public Health Department Faculty Publication Series

BACKGROUND:

Given that it is not feasible to use dual x-ray absorptiometry (DXA) or other reference methods to measure adiposity in all pediatric clinical and research settings, it is important to identify reasonable alternatives. Therefore, we sought to determine the extent to which other adiposity measures were correlated with DXA fat mass in school-aged children.

METHODS:

In 1110 children aged 6.5-10.9 years in the pre-birth cohort Project Viva, we calculated Spearman correlation coefficients between DXA (n=875) and other adiposity measures including body mass index (BMI), skinfold thickness, circumferences, and bioimpedance. We also computed correlations between lean body mass measures.

RESULTS: …

Childhood Body Mass Index Trajectories: Modeling, Characterizing, Pairwise Correlations And Socio-Demographic Predictors Of Trajectory Characteristics, Xiaozhong Wen, Ken Kleinman, Matthew W. Gillman, Sherly L. Rifas-Shiman, Elsie M. Taveras

Public Health Department Faculty Publication Series

BACKGROUND:

Modeling childhood body mass index (BMI) trajectories, versus estimating change in BMI between specific ages, may improve prediction of later body-size-related outcomes. Prior studies of BMI trajectories are limited by restricted age periods and insufficient use of trajectory information.

METHODS:

Among 3,289 children seen at 81,550 pediatric well-child visits from infancy to 18 years between 1980 and 2008, we fit individual BMI trajectories using mixed effect models with fractional polynomial functions. From each child's fitted trajectory, we estimated age and BMI at infancy peak and adiposity rebound, and velocity and area under curve between 1 week, infancy peak, adiposity …

Estimation Of Newborn Risk For Child Or Adolescent Obesity:Lessons From Longitudinal Birth Cohorts, Anita Morandi, David Meyre, Stephane Lobbens, Ken Kleinman, Marika Kaakinen, Sheryl L. Rifas-Shiman, Vincent Vatin, Stefan Gaget, Anneli Pouta, Anna-Liisa Hartikainen, Jaana Laitinen, Matthew W. Gillman, Marjo-Riitta Jarvelin, Philippe Froguel

Public Health Department Faculty Publication Series

OBJECTIVES:

Prevention of obesity should start as early as possible after birth. We aimed to build clinically useful equations estimating the risk of later obesity in newborns, as a first step towards focused early prevention against the global obesity epidemic.

METHODS:

We analyzed the lifetime Northern Finland Birth Cohort 1986 (NFBC1986) (N = 4,032) to draw predictive equations for childhood and adolescent obesity from traditional risk factors (parental BMI, birth weight, maternal gestational weight gain, behaviour and social indicators), and a genetic score built from 39 BMI/obesity-associated polymorphisms. We performed validation analyses in a retrospective cohort of 1,503 Italian children …

Multicenter Evaluation Of A Novel Surveillance Paradigm For Complications Of Mechanical Ventilation, Michael Klompas, Yosef Khan, Kenneth Kleinman, R.Scott Evans, James F. Lloyd, Kurt Stevenson, Matthew Samore, Richard Platt

Public Health Department Faculty Publication Series

BACKGROUND:

Ventilator-associated pneumonia (VAP) surveillance is time consuming, subjective, inaccurate, and inconsistently predicts outcomes. Shifting surveillance from pneumonia in particular to complications in general might circumvent the VAP definition's subjectivity and inaccuracy, facilitate electronic assessment, make interfacility comparisons more meaningful, and encourage broader prevention strategies. We therefore evaluated a novel surveillance paradigm for ventilator-associated complications (VAC) defined by sustained increases in patients' ventilator settings after a period of stable or decreasing support.

METHODS:

We assessed 600 mechanically ventilated medical and surgical patients from three hospitals. Each hospital contributed 100 randomly selected patients ventilated 2-7 days and 100 patients ventilated >7 …

Colonization With Antibiotic-Susceptible Strains Protects Against Methicillin-Resistant Staphylococcus Aureus But Not Vancomycin-Resistant Enterococci Acquisition: A Nested Case-Control Study, Susan S. Huang, Rupak Datta, Sheryl Rifas-Shiman, Ken Kleinman, Hilary Placzek, Julie D. Lankiewicz, Richard Platt

Public Health Department Faculty Publication Series

INTRODUCTION:

Harboring sensitive strains may prevent acquisition of resistant pathogens by competing for colonization of ecological niches. Competition may be relevant to decolonization strategies that eliminate sensitive strains and may predispose to acquiring resistant strains in high-endemic settings. We evaluated the impact of colonization with methicillin-sensitive Staphylococcus aureus (MSSA) and vancomycin-sensitive enterococci (VSE) on acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), respectively, when controlling for other risk factors.

METHODS:

We conducted a nested case-control study of patients admitted to eight ICUs performing admission and weekly bilateral nares and rectal screening for MRSA and VRE, respectively. Analyses were …

Investigation Of The Correlation Between Odd Oxygen And Secondary Organic Aerosol In Mexico City And Houston, Ezra Wood, M. Canagaratna, S. Herndon, J. Kroll, T. Onasch, C. Kolb, D. Worsnop, W. Knighton, R. Seila, M. Zavala, L. Molina, P. Decarlo, J. Jimenez, A. Weinheimer, D. Knapp, B. Jobson, J. Stutz, W. Kuster, E. Williams

Public Health Department Faculty Publication Series

Many recent models underpredict secondary organic aerosol (SOA) particulate matter (PM) concentrations in polluted regions, indicating serious deficiencies in the models' chemical mechanisms and/or missing SOA precursors. Since tropospheric photochemical ozone production is much better understood, we investigate the correlation of odd-oxygen ([Ox]≡[O3]+[NO2]) and the oxygenated component of organic aerosol (OOA), which is interpreted as a surrogate for SOA. OOA and Ox measured in Mexico City in 2006 and Houston in 2000 were well correlated in air masses where both species were formed on similar timescales (less than 8 h) and not well correlated when their formation timescales or location …

Application Of Quantum Cascade Lasers To High-Precision Atmospheric Trace Gas Measurements, Ezra Wood, J. Barry Mcmanus, Mark Zahniser, David Nelson, Joanne Shorter, Scott Herndon, Rick Wehr

Public Health Department Faculty Publication Series

We review our recent results in development of high-precision laser spectroscopic instrumentation using midinfrared quantum cascade lasers (QCLs). Some of these instruments have been directed at measurements of atmospheric trace gases where a fractional precision of 10−3 or better of ambient concentration may be required. Such high precision is needed in measurements of fluxes of stable atmospheric gases and measurements of isotopic ratios. Instruments that are based on thermoelectrically cooled midinfrared QCLs and thermoelectrically cooled detectors have been demonstrated that meet the requirements of high-precision atmospheric measurements, without the need for cryogens. We also describe the design of and results …

Application Of Positive Matrix Factorization To On-Road Measurements For Source Apportionment Of Diesel- And Gasoline-Powered Vehicle Emissions In Mexico City, D. Thornhill, A. Williams, T. Onasch, Ezra Wood, S. Herndon, C. Kolb, W. Knighton, M. Zavala, L. Molina, L. Marr

Public Health Department Faculty Publication Series

The goal of this research is to quantify diesel- and gasoline-powered motor vehicle emissions within the Mexico City Metropolitan Area (MCMA) using on-road measurements captured by a mobile laboratory combined with positive matrix factorization (PMF) receptor modeling. During the MCMA-2006 ground-based component of the MILAGRO field campaign, the Aerodyne Mobile Laboratory (AML) measured many gaseous and particulate pollutants, including carbon dioxide, carbon monoxide (CO), nitrogen oxides (NOx), benzene, toluene, alkylated aromatics, formaldehyde, acetaldehyde, acetone, ammonia, particle number, fine particulate mass (PM2.5), and black carbon (BC). These serve as inputs to the receptor model, which is able to resolve three factors …

Automated Detection Of Infectious Disease Outbreaks In Hospitals: A Retrospective Cohort Study, Susan S. Huang, Deborah S. Yokoe, John Stelling, Hilary Placzek, Martin Kulldorff, Ken Kleinman, Thomas F. O'Brien, Michael S. Calderwood, Johanna Vostok, Julie Dunn, Richard Platt

Public Health Department Faculty Publication Series

BACKGROUND:

Detection of outbreaks of hospital-acquired infections is often based on simple rules, such as the occurrence of three new cases of a single pathogen in two weeks on the same ward. These rules typically focus on only a few pathogens, and they do not account for the pathogens' underlying prevalence, the normal random variation in rates, and clusters that may occur beyond a single ward, such as those associated with specialty services. Ideally, outbreak detection programs should evaluate many pathogens, using a wide array of data sources.

METHODS AND FINDINGS:

We applied a space-time permutation scan statistic to microbiology …

Short-Term Variation In Near-Highway Air Pollutant Gradients On A Winter Morning, J. Durant, C. Ash, Ezra Wood, S. Herndon, J. Jayne, W. Knighton, M. Canagaratna, J. Trull, D. Brugge, W. Zamore, C. Kolb

Public Health Department Faculty Publication Series

Quantification of exposure to traffic-related air pollutants near highways is hampered by incomplete knowledge of the scales of temporal variation of pollutant gradients. The goal of this study was to characterize short-term temporal variation of vehicular pollutant gradients within 200–400 m of a major highway (>150 000 vehicles/d). Monitoring was done near Interstate 93 in Somerville (Massachusetts) from 06:00 to 11:00 on 16 January 2008 using a mobile monitoring platform equipped with instruments that measured ultrafine and fine particles (6–1000 nm, particle number concentration (PNC)); particle-phase (>30 nm) equation M1, equation M2, and organic compounds; volatile organic compounds …

Use Of Outcomes To Evaluate Surveillance Systems For Bioterrorist Attacks, Kerry A. Mcbrien, Ken P. Kleinman, Allyson M. Abrams, Lisa A. Prosser

Public Health Department Faculty Publication Series

Background

Syndromic surveillance systems can potentially be used to detect a bioterrorist attack earlier than traditional surveillance, by virtue of their near real-time analysis of relevant data. Receiver operator characteristic (ROC) curve analysis using the area under the curve (AUC) as a comparison metric has been recommended as a practical evaluation tool for syndromic surveillance systems, yet traditional ROC curves do not account for timeliness of detection or subsequent time-dependent health outcomes.

Methods

Using a decision-analytic approach, we predicted outcomes, measured in lives, quality adjusted life years (QALYs), and costs, for a series of simulated bioterrorist attacks. We then evaluated …

Evidence That Pneumococcal Serotype Replacement In Massachusetts Following Conjugate Vaccination Is Now Complete, William P. Hanage, Jonathan A. Finkelstein, Susan S. Huang, Stephen I. Pelton, Abbie E. Stevenson, Ken Kleinman, Virginia L. Hinrichsen, Christophe Fraser

Public Health Department Faculty Publication Series

Invasive pneumococcal disease (IPD) has been reduced in the US following conjugate vaccination (PCV7) targeting seven pneumococcal serotypes in 2000. However, increases in IPD due to other serotypes have been observed, in particular 19A. How much this "serotype replacement" will erode the benefits of vaccination and over what timescale is unknown. We used a population genetic approach to test first whether the selective impact of vaccination could be detected in a longitudinal carriage sample, and secondly how long it persisted for following introduction of vaccine in 2000. To detect the selective impact of the vaccine we compared the serotype diversity …

Epidemiology And Risk Factors For Staphylococcus Aureus Colonization In Children In The Post-Pcv7 Era, Grace M. Lee, Susan S. Huang, Sheryl L. Rifas-Shiman, Vriginia L. Hinrichsen, Stephen I. Pelton, Ken Kleinman, William P. Hanage, Marc Lipsitch, Alexander J. Mcadam, Jonathan A. Finkelstein

Public Health Department Faculty Publication Series

BACKGROUND:

The incidence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) has risen dramatically in the U.S., particularly among children. Although Streptococcus pneumoniae colonization has been inversely associated with S. aureus colonization in unvaccinated children, this and other risk factors for S. aureus carriage have not been assessed following widespread use of the heptavalent pneumococcal conjugate vaccine (PCV7). Our objectives were to (1) determine the prevalence of S. aureus and MRSA colonization in young children in the context of widespread use of PCV7; and (2) examine risk factors for S. aureus colonization in the post-PCV7 era, including the absence of vaccine-type S. …

Weight Gain In Pregnancy And Risk Of Maternal Hyperglycemia, Sharon J. Herring, Emily Oken, Sheryl L. Rifas-Shiman, Janet W. Rich-Edwards, Alison M. Stuebe, Ken P. Kleinman, Matthew W. Gillman

Public Health Department Faculty Publication Series

OBJECTIVE:

The purpose of this study was to examine associations of weight gain from prepregnancy to glycemic screening with glucose tolerance status.

STUDY DESIGN:

Main outcomes were failed glycemic screening (1-hour glucose result >or= 140 mg/dL) with either 1 high value on 3-hour oral glucose tolerance testing (impaired glucose tolerance in pregnancy) or >or= 2 high values on 3-hour oral glucose tolerance testing (gestational diabetes mellitus). We performed multinomial logistic regression to determine the odds of these glucose intolerance outcomes by quartile of gestational weight gain among 1960 women in Project Viva.

RESULTS:

Mean gestational weight gain was 10.2 +/- …

Telephone Triage Service Data For Detection Of Influenza-Like Illness, W. Katherine Yih, Kathryn S. Teates, Allyson Abrams, Ken Kleinman, Martin Kulldorff, Robert Pinner, Robert Harmon, Stanley Wang, Richard Platt

Public Health Department Faculty Publication Series

BACKGROUND:

Surveillance for influenza and influenza-like illness (ILI) is important for guiding public health prevention programs to mitigate the morbidity and mortality caused by influenza, including pandemic influenza. Nontraditional sources of data for influenza and ILI surveillance are of interest to public health authorities if their validity can be established.

METHODS/PRINCIPAL FINDINGS:

National telephone triage call data were collected through automated means for purposes of syndromic surveillance. For the 17 states with at least 500,000 inhabitants eligible to use the telephone triage services, call volume for respiratory syndrome was compared to CDC weekly number of influenza isolates and percentage of …

Association Between Umbilical Cord Glucocorticoids And Blood Pressure At Age 3 Years, Susanna Y. Huh, Ruth Andrew, Janet W. Rich-Edwards, Ken P. Kleinman, Jonathan R. Seckl, Matthew W. Gillman

Public Health Department Faculty Publication Series

Background

Animal data show that decreased activity of placental 11-beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2), which potently inactivates glucocorticoids (e.g. cortisol) to inert forms (cortisone), allows increased access of maternal glucocorticoids to the fetus and 'programs' hypertension. Data in humans are limited. We examined in humans the association between venous umbilical cord blood glucocorticoids, a potential marker for placental 11β-HSD2 enzyme activity, and blood pressure at age 3 years.

Methods

Among 286 newborns in Project Viva, a prospective pre-birth cohort study based in eastern Massachusetts, we measured cortisol (F) and cortisone (E) in venous cord blood and …

Assessing The Utility Of Public Health Surveillance Using Specificity, Sensitivity, And Lives Saved, Ken P. Kleinman, Allyson Abrams

Public Health Department Faculty Publication Series

In modern surveillance of public health, data may be reported in a timely fashion, and include spatial data on cases in addition to the time of their occurrence. This has lead to many recent developments in statistical methods to detect events of public health importance. However, there has been relatively little work into methods to identify how to compare such methods. One powerful rationale for performing surveillance is earlier detection of events of public health significance; previous evaluation tools have focused on metrics which include the timeliness of detection in addition to sensitivity and specificity. However, such metrics have not …

Gestational Weight Gain And Child Adiposity At Age 3 Years, Emily Oken, Elsie M. Taveras, Ken P. Kleinman, Janet W. Rich-Edwards, Matthew W. Gillman

Public Health Department Faculty Publication Series

OBJECTIVE

The purpose of this study was to examine the associations of gestational weight gain with child adiposity.

STUDY DESIGN

Using multivariable regression, we studied associations of total gestational weight gain and weight gain according to 1990 Institute of Medicine guidelines with child outcomes among 1044 mother-child pairs in Project Viva.

RESULTS

Greater weight gain was associated with higher child body mass index z-score (0.13 units per 5 kg [95% CI, 0.08, 0.19]), sum of subscapular and triceps skinfold thicknesses (0.26 mm [95% CI, 0.02, 0.51]), and systolic blood pressure (0.60 mm Hg [95% CI, 0.06, 1.13]). Compared with inadequate …

A Satscan Macro Accessory For Cartography (Smac) Package Implemented With Sas Software, Allyson M. Abrams, Ken P. Kleinman

Public Health Department Faculty Publication Series

BACKGROUND:

SaTScan is a software program written to implement the scan statistic; it can be used to find clusters in space and/or time. It must often be run multiple times per day when doing disease surveillance. Running SaTScan frequently via its graphical user interface can be cumbersome, and the output can be difficult to visualize.

RESULTS:

The SaTScan Macro Accessory for Cartography (SMAC) package consists of four SAS macros and was designed as an easier way to run SaTScan multiple times and add graphical output. The package contains individual macros which allow the user to make the necessary input files …

Milk Consumption And The Prepubertal Somatotropic Axis, Janet W. Rich-Edwards, Davaasambuu Ganmaa, Michael N. Pollak, Erika K. Nakamoto, Ken Kleinman, Uush Tserendolgor, Walter C. Willett, A Lindsay Frazier

Public Health Department Faculty Publication Series

Background

Nutrients, hormones and growth factors in dairy foods may stimulate growth hormone (GH), insulin-like growth factor I (IGF-I), and raise the ratio of IGF-I to its binding protein, IGFBP-3. We conducted pilot studies in Mongolia and Massachusetts to test the extent to which milk intake raised somatotropic hormone concentrations in prepubertal children.

Methods

In Ulaanbaatar, we compared plasma levels before and after introducing 710 ml daily whole milk for a month among 46 10–11 year old schoolchildren. In a randomized cross-over study in Boston, we compared plasma hormone levels of 28 6–8 year old girls after one week of …

Evaluating Spatial Surveillance: Detection Of Known Outbreaks In Real Data, Ken Kleinman, Allyson Abrams, W. Katherine Yih, Richard Platt, Martin Kulldorff

Public Health Department Faculty Publication Series

Since the anthrax attacks of October 2001 and the SARS outbreaks of recent years, there has been an increasing interest in developing surveillance systems to aid in the early detection of such illness. Systems have been established which do this is by monitoring primary health-care visits, pharmacy sales, absenteeism records, and other non-traditional sources of data. While many resources have been invested in establishing such systems, relatively little effort has as yet been expended in evaluating their performance.

One way to evaluate a given surveillance system is to compare the signals it generates with known outbreaks identified in other systems. …

Variation In Hepatitis B Immunization Coverage Rates Associated With Provider Practices After The Temporary Suspension Of The Birth Dose, Nancy D. Lin, Ken Kleinman, K Arnold Chan, Xian-Jie Yu, Eric K. France, Feifei Wei, John P. Mullooly, Steven Black, David Shay, Margarette Kolczak, Tracey Lieu, Vaccine Safety Datalink Team

Public Health Department Faculty Publication Series

Background

In 1999, the American Academy of Pediatrics and U.S. Public Health Service recommended suspending the birth dose of hepatitis B vaccine due to concerns about potential mercury exposure. A previous report found that overall national hepatitis B vaccination coverage rates decreased in association with the suspension. It is unknown whether this underimmunization occurred uniformly or was associated with how providers changed their practices for the timing of hepatitis B vaccine doses. We evaluate the impact of the birth dose suspension on underimmunization for the hepatitis B vaccine series among 24-month-olds in five large provider groups and describe provider practices …

Four Different Study Designs To Evaluate Vaccine Safety Were Equally Validated With Contrasting Limitations, Jason M. Glanz, David L. Mcclure, Stanley Xu, Simon J. Hambidge, Martin Lee, Margarette S. Kolczak, Ken Kleinman, John P. Mullooly, Eric K. France

Public Health Department Faculty Publication Series

OBJECTIVE:

We conducted a simulation study to empirically compare four study designs [cohort, case-control, risk-interval, self-controlled case series (SCCS)] used to assess vaccine safety.

STUDY DESIGN AND METHODS:

Using Vaccine Safety Datalink data (a Centers for Disease Control and Prevention-funded project), we simulated 250 case sets of an acute illness within a cohort of vaccinated and unvaccinated children. We constructed the other three study designs from the cohort at three different incident rate ratios (IRRs, 2.00, 3.00, and 4.00), 15 levels of decreasing disease incidence, and two confounding levels (20%, 40%) for both fixed and seasonal confounding. Each of the …

Impact Of The Introduction Of Pneumococcal Conjugate Vaccine On Immunization Coverage Among Infants, Nancy D. Lin, Ken Kleinman, K Arnold Chan, Xian-Jie Yu, Eric K. France, Stanley Xu, Feifei Wei, John Mullooly, Jeanne Santoli, Tracey A. Lieu, Vaccine Safety Datalink Group

Public Health Department Faculty Publication Series

Background

The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life. Surveys have suggested that the addition of PCV has led some immunization providers to move other routine childhood vaccinations to later ages, which could increase the possibility of missing these vaccines. The purpose of this study was to evaluate whether introduction of PCV affected immunization coverage for recommended childhood vaccinations among 13-month olds in four large provider groups.

Methods

In this …

Maternal Fish Consumption, Hair Mercury, And Infant Cognition In A U.S. Cohort., Ken Kleinman, Emily Oken, Robert Wright, David Bellinger, Chitra Amarasiriwardena, Howard Hu, Janet Rich-Edwards, Matthew Gillman

Public Health Department Faculty Publication Series

Fish and other seafood may contain organic mercury but also beneficial nutrients such as n-3 polyunsaturated fatty acids. We endeavored to study whether maternal fish consumption during pregnancy harms or benefits fetal brain development. We examined associations of maternal fish intake during pregnancy and maternal hair mercury at delivery with infant cognition among 135 mother–infant pairs in Project Viva, a prospective U.S. pregnancy and child cohort study. We assessed infant cognition by the percent novelty preference on visual recognition memory (VRM) testing at 6 months of age. Mothers consumed an average of 1.2 fish servings per week during the second …

Longitudinal Study Of Birth Weight And Adult Body Mass Index In Predicting Risk Of Coronary Heart Disease And Stroke In Women, Ken Kleinman, Janet Rich-Edwards, Karin Michels, Meir Stampfer, Joann Manson, Kathryn Rexrode, Eileen Hibert, Walter Willett

Public Health Department Faculty Publication Series

Objectives To determine whether birth weight and adult body size interact to predict coronary heart disease in women, as has been observed for men. To determine whether birth weight and adult body size interact to predict risk of stroke.

Design Longitudinal cohort study.

Setting and participants 66 111 female nurses followed since 1976 who were born of singleton, term pregnancies and reported their birth weight in 1992.

Main outcome measures 1504 events of coronary heart disease (myocardial infarction or sudden cardiac death) and 1164 strokes.

Results For each kilogram of higher birth weight, age adjusted hazard ratios from prospective analysis …

Group Versus Individual Academic Detailing To Improve The Use Of Antihypertensive Medications In Primary Care: A Cluster-Randomized Controlled Trial, Steven R. Simon, Sumit R. Majumdar, Lisa A. Prosser, Susanne Salem-Schatz, Cheryl Warner, Ken Kleinman, Irina Miroshnik, Stephen B. Soumerai

Public Health Department Faculty Publication Series

Purpose

To compare group versus individual academic detailing to increase diuretic or β-blocker use in hypertension.

Methods

We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group detailing (N=227 prescribers), 3 to individual detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group …

A Generalized Linear Mixed Models Approach For Detecting Incident Clusters Of Disease In Small Areas, With An Application To Biological Terrorism, Kenneth Kleinman, Ross Lazarus, Richard Platt

Public Health Department Faculty Publication Series

Since the intentional dissemination of anthrax through the US postal system in the fall of 2001, there has been increased interest in surveillance for detection of biological terrorism. More generally, this could be described as the detection of incident disease clusters. In addition, the advent of affordable and quick geocoding allows for surveillance on a finer spatial scale than has been possible in the past. Surveillance for incident clusters of disease in both time and space is a relatively undeveloped arena of statistical methodology. Surveillance for bioterrorism detection, in particular, raises unique issues with methodological relevance. For example, the bioterrorism …

Maternal Age And Other Predictors Of Newborn Blood Pressure, Matthew Gillman, Janet W. Rich-Edwards, Sheryl L. Rifas-Shiman, Ellice S. Lieberman, Ken Kleinman, Steven Lipshultz

Public Health Department Faculty Publication Series

Objective

To investigate perinatal predictors of newborn blood pressure.

Study design

Among 1059 mothers and their newborn infants participating in Project Viva, a US cohort study of pregnant women and their offspring, we obtained five systolic blood pressure readings on a single occasion in the first few days of life. Using multivariate linear regression models, we examined the extent to which maternal age and other pre- and perinatal factors predicted newborn blood pressure level.

Results

Mean (SD) maternal age was 32.0 (5.2) years, and mean (SD) newborn systolic blood pressure was 72.6 (9.0) mm Hg. A multivariate model showed that …