Epidemiology Commons^™

Task-Based Noise Exposures For Farmers Involved In Grain Production, Michael J. Humann, Wayne T. Sanderson, Kelley J. Donham, Kevin M. Kelly

Epidemiology and Environmental Health Faculty Publications

Few studies have been done examining noise exposures associated with agricultural tasks. This study was conducted to address that research gap by calculating the noise exposures for tasks and equipment associated with grain production and assessing the variability in those exposures. An additional aim of this study was to identify tasks and equipment that could be targeted for intervention strategies as a means toward reducing the total noise exposures of farmers and farm workers. Through the use of personal noise dosimetry and direct observation, over 30,000 one-minute noise exposure measurements and corresponding task and equipment data were collected on 18 …

Cattle-Related Injuries And Farm Management Practices On Kentucky Beef Cattle Farms, Steven R. Browning, Susan C. Westneat, Wayne T. Sanderson, Deborah B. Reed

Epidemiology and Environmental Health Faculty Publications

While working on farms with livestock increases the risk of injury among farm workers in comparison to other commodity farms, few studies have examined the role offarm management practices in association with the risk of cattle-related injury. We examined the farm management practices of Kentucky beef cattle farms in association with self-reported rates of cattle-related injuries among workers. We conducted a mail survey of a random sample of 2,500 members of the Kentucky Cattlemen's Association. Results from 1,149 farm operators who were currently raising beef cattle and provided complete survey response are reported. During the busy season, the principal operator …

Multivitamin Supplementation In Hiv Infected Adults Initiating Antiretroviral Therapy In Uganda: The Protocol For A Randomized Double Blinded Placebo Controlled Efficacy Trial., David Guwatudde, Amara E. Ezeamama, Danstan Bagenda, Rachel Kyeyune, Fred Wabwire-Mangen, Henry Wamani, Ferdinand Mugusi, Donna Spiegelman, Molin Wang, Yukari C. Manabe, Wafaie W. Fawzi

Journal Articles: Epidemiology

BACKGROUND: Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda.

METHODS/DESIGN: We are using a …

Does Place Of Residence Affect Risk Of Suicide? A Spatial Epidemiologic Investigation In Kentucky From 1999 To 2008, Daniel M. Saman, Sabrina Walsh, Anna Borówko, Agricola Odoi

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Approximately 32,000 people take their own lives every year in the United States. In Kentucky, suicide mortality rates have been steadily increasing since 1999. Few studies in the United States have assessed spatial clustering of suicides. The purpose of this study was to identify high-risk clusters of suicide at the county level in Kentucky and assess the characteristics of those suicide cases within the clusters.

METHODS: A spatial epidemiological study was undertaken using suicide data for the period January 1, 1999 to December 31, 2008, obtained from the Kentucky Office of Vital Statistics. Descriptive analyses using Pearson's chi-square test …

A Pilot Online Survey Assessing Risk Factors For Hiv Acquisition In The Navy And Marine Corps, 2005-2010, Shilpa Hakre, Adam W. Armstrong, Robert J. O'Connell, Nelson L. Michael, Paul T. Scott, David Brett-Major

Journal Articles: Epidemiology

The Department of Defense policy Don't Ask, Don't Tell (DADT) ended in September, 2011. The Navy Bloodborne Infection Management Center conducted a post-DADT pilot survey of HIV seroconverters identified when the DADT policy was in effect. Sailors and Marines newly diagnosed as HIV positive from 2005 to 2010 were invited to participate in an online survey. A structured questionnaire elicited risk information about the 3-year period before HIV diagnosis. Respondents reported engaging commonly in same sex sexual activity, having concurrent partners, and poor condom use for anal sex. In this first post-DADT repeal report of self-reported behaviors, male-to-male sexual contact …

Epidemiology Of Contemporary Seroincident Hiv Infection In The Navy And Marine Corps, David Brett-Major, Shilpa Hakre, Neal A. Naito, Adam Armstrong, Eric A. Bower, Nelson L. Michael, Paul T. Scott

Journal Articles: Epidemiology

Human Immunodeficiency Virus (HIV) infection continues at a steady rate among U.S. Sailors and Marines. This study provides the first service-specific description of HIV infection demographics. All Sailors and Marines identified as HIV infected between January 2005 and August 2010 were included. The project compared personnel and epidemiologic data, and tested reposed sera in the Department of Defense Serum Repository. This group comprised 410 Sailors and 86 Marines, predominantly men. HIV infected Marines were more likely to be foreign born than their Navy counterparts, 42% versus 10%, p < 0.001. Approximately half of the patients had deployed including to the wars in Iraq or Afghanistan. Nearly half of each group was infected by the age of 25. Similar to the U.S. epidemic, Black race was over-represented. Unlike national rates, Hispanic Sailors and Marines were not over-represented. Demographics were distinct for those of specific occupational specialties. Certain ship classes carried lower incidences. Clustering of HIV infection risk occurred around deployment. The Navy and Marine Corps have different patterns of HIV infection, which may merit distinct approaches to prevention. The Navy may have unique targets for prevention efforts to include pipeline training and first assignment as well as particular occupational environments.

Malaria And Related Outcomes In Patients With Intestinal Helminths: A Cross-Sectional Study, Abraham Degarege, Mengistu Legesse, Girmay Medhin, Abebe Animut, Berhanu Erko

Journal Articles: Epidemiology

BACKGROUND: The effects of helminth co-infection on malaria in humans remain uncertain. This study aimed to evaluate the nature of association of intestinal helminths with prevalence and clinical outcomes of Plasmodium infection.

METHODS: A cross-sectional study involving 1,065 malaria suspected febrile patients was conducted at Dore Bafeno Health Center, Southern Ethiopia, from December 2010 to February 2011. Plasmodium and intestinal helminth infections were diagnosed using Giemsa-stained blood films and Kato-Katz technique, respectively. Haemoglobin level was determined using a haemocue machine.

RESULTS: Among 1,065 malaria suspected febrile patients, 28.8% were positive for Plasmodium parasites (P. falciparum =13.0%, P. vivax =14.5%, P. …

Characterization Of Street Food Consumption In Palermo: Possible Effects On Health, Silvio Buscemi, Annamaria Barile, Vincenza Maniaci, John A. Batsis

Dartmouth Scholarship

Background: Street Food (SF) consists of out-of-home food consumption and has old, historical roots with complex social-economic and cultural implications. Despite the emergence of modern fast food, traditional SF persists worldwide, but the relationship of SF consumption with overall health, well-being, and obesity is unknown.

Methods: This is an observational, cross-sectional study. The study was performed in Palermo, the largest town of Sicily, Italy. Two groups were identified: consumers of SF (n = 687) and conventional restaurant food (RES) consumers (n = 315). Study subjects answered a questionnaire concerning their health conditions, nutritional preferences, frequency of consumption of SF and …

Medical Encounter Characteristics Of Hiv Seroconverters In The Us Army And Air Force, 2000–2004, Shilpa Hakre, David Brett-Major, Darrell E. Singer, Robert J. O'Connell, Warren B. Sateren, Jose L. Sanchez, Brian K. Agan, Nelson L. Michael, Paul T. Scott

Journal Articles: Epidemiology

BACKGROUND AND METHODS: Active duty US Army and Air Force military personnel undergo mandatory biennial HIV antibody screening. We compared pre- and post-HIV seroconversion health status by conducting a case-control study, which evaluated all medical encounters and sociodemographic factors among incident HIV seroconverters and HIV-negative controls from June 2000 through February 2004.

RESULTS: A total of 274 HIV seroconverters and 6205 HIV-negative personnel were included. In multivariate analysis restricted to male personnel (cases = 261, controls = 5801), single marital status (adjusted odds ratio [AOR] = 14.37), clinical indicators or symptoms within four years of HIV diagnosis (AOR = 6.22), …

Recent Diarrhea Is Associated With Elevated Salivary Igg Responses To Cryptosporidium In Residents Of An Eastern Massachusetts Community, A. I. Egorov, L. M. Montuori Trimble, L. Ascolillo, H. D. Ward, Deborah A. Levy, R. D. Morris, E. N. Naumova, J. K. Griffiths

Journal Articles: Epidemiology

BACKGROUND: Serological data suggest that Cryptosporidium infections are common but underreported. The invasiveness of blood sampling limits the application of serology in epidemiological surveillance. We pilot-tested a non-invasive salivary anti-Cryptosporidium antibody assay in a community survey involving children and adults.

MATERIALS AND METHODS: Families with children were recruited in a Massachusetts community in July; symptoms data were collected at 3 monthly follow-up mail surveys. One saliva sample per person (n = 349) was collected via mail, with the last survey in October. Samples were analyzed for IgG and IgA responses to a recombinant C. hominis gp15 sporozoite protein using a …

Suicides Among Farmers In Three Southeastern States, 1990-1998, Steven R. Browning, Susan C. Westneat, Robert H. Mcknight

Epidemiology and Environmental Health Faculty Publications

Several studies have documented higher rates of suicide among farmers in comparison to other occupational groups, both in the U.S. and internationally. The purpose of this study is to describe the epidemiology of farmer suicides in three southeastern states (Kentucky, North Carolina, and South Carolina) during the nine-year period 1990-1998. Electronic death certificate data were obtained from the National Center for Health Statistics. Over the nine-year period, there were 590 deaths related to suicide (E-codes: 950-959) among farmers (occupation codes: 473, 474, 475, 477, and 479) in the states of Kentucky, North Carolina, and South Carolina. The results of this …

Cutaneous And Presumed Visceral Leishmaniasis In A Soldier Deployed To Afghanistan, James P. Woodrow, Joshua D. Hartzell, Jim Czarnik, David Brett-Major, Glenn Wortmann

Journal Articles: Epidemiology

Leishmaniasis has been frequently diagnosed in US military personnel returning from duty in Southwest Asia. The majority of cases have demonstrated cutaneous disease, although a few cases of visceral disease have been documented. We present the case of an immunocompetent, HIV-negative, US Army soldier who suffered both visceral and cutaneous manifestations of leishmaniasis after returning from deployment in Afghanistan. Overlap of cutaneous and visceral involvement is rare and has not been reported in our cohort. Latent Plasmodium vivax infection may have been an exacerbating cofactor. We discuss this case and present a review of the literature.

A Pilot Randomized, Controlled Trial Of An In-Home Drinking Water Intervention Among Hiv + Persons, John M. Colford, Sona R. Saha, Timothy J. Wade, Catherine C. Wright, Mai Vu, Sandra Charles, Peter Jensen, Alan Hubbard, Deborah A. Levy, Joseph N. S. Eisenberg

Journal Articles: Epidemiology

Although immunocompromised persons may be at increased risk for gastrointestinal illnesses, no trials investigating drinking water treatment and gastrointestinal illness in such patients have been published. Earlier results from San Francisco suggested an association (OR 6.76) between tap water and cryptosporidiosis among HIV + persons. The authors conducted a randomized, triple-blinded intervention trial of home water treatment in San Francisco, California, from April 2000 to May 2001. Fifty HIV-positive patients were randomized to externally identical active (N = 24) or sham (N = 26) treatment devices. The active device contained a filter and UV light; the sham provided no treatment. …

A Randomized, Controlled Trial Of In-Home Drinking Water Intervention To Reduce Gastrointestinal Illness, John M. Colford, Timothy J. Wade, Sukhminder K. Sandhu, Catherine C. Wright, Sherline Lee, Susan Shaw, Kim Fox, Susan Burns, Anne Benker, M. Alan Brookhart, Mark Van Der Laan, Deborah A. Levy

Journal Articles: Epidemiology

Trials have provided conflicting estimates of the risk of gastrointestinal illness attributable to tap water. To estimate this risk in an Iowa community with a well-run water utility with microbiologically challenged source water, the authors of this 2000-2002 study randomly assigned blinded volunteers to use externally identical devices (active device: 227 households with 646 persons; sham device: 229 households with 650 persons) for 6 months (cycle A). Each group then switched to the opposite device for 6 months (cycle B). The active device contained a 1-microm absolute ceramic filter and used ultraviolet light. Episodes of "highly credible gastrointestinal illness," a …

Sars Surveillance During Emergency Public Health Response, United States, March-July 2003, Stephanie J. Schrag, John T. Brooks, Chris Van Beneden, Umesh D. Parashar, Patricia M. Griffin, Larry J. Anderson, William J. Bellini, Robert F. Benson, Dean D. Erdman, Alexander Klimov, Thomas G. Ksiazek, Teresa C. T. Peret, Deborah F. Talkington, W. Lanier Thacker, Maria L. Tondella, Jacquelyn S. Sampson, Allen W. Hightower, Dale F. Nordenberg, Brian D. Plikaytis, Ali S. Khan, Nancy E. Rosenstein, Tracee A. Treadwell, Cynthia G. Whitney, Anthony E. Fiore, Tonji M. Durant, Joseph F. Perz, Annemarie Wasley, Daniel Feikin, Joy L. Herndon, William A. Bower, Barbara W. Klibourn, Deborah A. Levy, Victor G. Coronado, Joanna Buffington, Clare A. Dykewicz, Rima F. Khabbaz, Mary E. Chamberland

Journal Articles: Epidemiology

In response to the emergence of severe acute respiratory syndrome (SARS), the United States established national surveillance using a sensitive case definition incorporating clinical, epidemiologic, and laboratory criteria. Of 1,460 unexplained respiratory illnesses reported by state and local health departments to the Centers for Disease Control and Prevention from March 17 to July 30, 2003, a total of 398 (27%) met clinical and epidemiologic SARS case criteria. Of these, 72 (18%) were probable cases with radiographic evidence of pneumonia. Eight (2%) were laboratory-confirmed SARS-coronavirus (SARS-CoV) infections, 206 (52%) were SARS-CoV negative, and 184 (46%) had undetermined SARS-CoV status because of …

Epidemiologic And Environmental Investigation Of A Recreational Water Outbreak Caused By Two Genotypes Of Cryptosporidium Parvum In Ohio In 2000, Els Mathieu, Deborah A. Levy, Fran Veverka, Mary-Kay Parrish, John Sarisky, Nancy Shapiro, Stephanie Johnston, Thomas Handzel, Allen Hightower, Lihua Xiao, Yeuk-Mui Lee, Steve York, Michael Arrowood, Robin Lee, Jeffrey L. Jones

Journal Articles: Epidemiology

In August 2000, the Ohio Department of Health requested assistance to investigate a cryptosporidiosis outbreak with more than 700 clinical case-patients. An epidemiologic and environmental investigation was conducted. Stool specimens, pool water, and sand filter samples were analyzed. A community-based case-control study showed that the main risk factor was swimming in pool A (odds ratio [OR] = 42, 95% confidence interval [CI] = 12.3-144.9). This was supported by results of polymerase chain reaction (PCR) analysis, which showed the presence of both the human and bovine genotypes of Cryptosporidium parvum in case-patients and samples from the filter of pool A. A …

Did A Severe Flood In The Midwest Cause An Increase In The Incidence Of Gastrointestinal Symptoms?, Timothy J. Wade, Sukhminder K. Sandhu, Deborah A. Levy, Sherline Lee, Mark W. Lechevallier, Louis Katz, John M. Colford

Journal Articles: Epidemiology

Severe flooding occurred in the midwestern United States in 2001. Since November 2000, coincidentally, data on gastrointestinal symptoms had been collected for a drinking water intervention study in a community along the Mississippi River that was affected by the flood. After the flood had subsided, the authors asked these subjects (n = 1,110) about their contact with floodwater. The objectives of this investigation were to determine whether rates of gastrointestinal illness were elevated during the flood and whether contact with floodwater was associated with increased risk of gastrointestinal illness. An increase in the incidence of gastrointestinal symptoms during the flood …

Associations Between Water-Treatment Methods And Diarrhoea In Hiv-Positive Individuals, J. N. S. Eisenberg, T. J. Wade, A. Hubbard, D. I. Abrams, R. J. Leiser, S. Charles, M. Vu, S. Saha, C. C. Wright, Deborah A. Levy, P. Jensen, J. M. Colford

Journal Articles: Epidemiology

This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we …

Risk Factors In Hiv-Associated Diarrhoeal Disease: The Role Of Drinking Water, Medication And Immune Status, J. N. S. Eisenberg, T. J. Wade, S. Charles, M. Vu, A. Hubbard, C. C. Wright, Deborah A. Levy, P. Jensen, J. M. Colford

Journal Articles: Epidemiology

In a cross-sectional survey of 226 HIV-infected men, we examined the occurrence of diarrhoea and its relationship to drinking water consumption patterns, risk behaviours, immune status and medication use. Diarrhoea was reported by 47% of the respondents. Neither drinking boiled nor filtered water was significantly associated with diarrhoea (OR = 0.5 [0.2, 1.6], 1.2 [0.6, 2.5] respectively), whereas those that drank bottled water were at risk for diarrhoea (OR = 3.0 [1.1, 7.8]). Overall, 47% always or often used at least one water treatment. Of the 37% who were very concerned about drinking water, 62% had diarrhoea, 70% always or …

Participant Blinding And Gastrointestinal Illness In A Randomized, Controlled Trial Of An In-Home Drinking Water Intervention, John M. Colford, Judy R. Rees, Timothy J. Wade, Asheena Khalakdina, Joan F. Hilton, Isaac J. Ergas, Susan Burns, Anne Benker, Catherine Ma, Cliff Bowen, Daniel C. Mills, Duc J. Vugia, Dennis D. Juranek, Deborah A. Levy

Journal Articles: Epidemiology

We conducted a randomized, triple-blinded home drinking water intervention trial to determine if a large study could be undertaken while successfully blinding participants. Households were randomized 50:50 to use externally identical active or sham treatment devices. We measured the effectiveness of blinding of participants by using a published blinding index in which values >0.5 indicate successful blinding. The principal health outcome measured was "highly credible gastrointestinal illness" (HCGI). Participants (n=236) from 77 households were successfully blinded to their treatment assignment. At the end of the study, the blinding index was 0.64 (95% confidence interval 0.51-0.78). There were 103 episodes of …

Sulfa Or Sulfone Prophylaxis And Geographic Region Predict Mutations In The Pneumocystis Carinii Dihydropteroate Synthase Gene, Laurence Huang, Charles B. Beard, Jennifer Creasman, Deborah A. Levy, Jeffrey S. Duchin, Sherline Lee, Norman Pieniazek, Jane L. Carter, Carlos Del Rio, David Rimland, Thomas R. Navin

Journal Articles: Epidemiology

To determine factors associated with mutations in the Pneumocystis carinii dihydropteroate synthase (DHPS) gene, a prospective study of human immunodeficiency virus (HIV)-infected patients with confirmed P. carinii pneumonia was conducted in Atlanta, Seattle, and San Francisco. Clinical information was obtained from patient interview and chart abstraction. DHPS genotype was determined from DNA sequencing. Overall, 76 (68.5%) of 111 patients had a mutant DHPS genotype, including 22 (81.5%) of 27 patients from San Francisco. In multivariate analysis, sulfa or sulfone prophylaxis and study site were independent predictors of a mutant genotype. Fourteen (53.8%) of 26 patients who were newly diagnosed with …

Resurgence Of Sleeping Sickness In Tambura County, Sudan, Anne Moore, Michaleen Richer, Mario Enrile, Edward Losio, Jacquelin Roberts, Deborah A. Levy

Journal Articles: Epidemiology

Endemic foci of human African trypanosomiasis are present in southern Sudan. In 1996 and 1997, trypanosomiasis increased sharply in Tambura County. To define the magnitude and geographic distribution of the outbreak, we conducted a prevalence survey using population-based cluster sampling in 16 villages: 1,358 participants answered questions about routine activities and tsetse fly contact and received serologic testing. Seroprevalence in the surveyed area was 19.4% (95% confidence interval = 16.9%, 21.8%). We confirmed infection in 66% of seropositive persons who received one parasitologic examination and in 95% of those who had serial examinations of lymph node fluid and blood. Activities …

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.