RESUMEN
INTRODUCTION: Untreated dental caries (UC), although preventable, is the most prevalent disease in the United States. UC diminishes quality of life and lowers productivity for millions of Americans and is notably higher among lower-income compared to higher-income persons. OBJECTIVE: This study examines changes in disparities by income in past-year dental use (DU) and UC in 4 life stages (2-5, 6-19, 20-64, and ≥65 y) between 1999-2004 and 2011-2016. We also examined changes in dental safety net policies during this time. METHODS: We obtained data on dependent variables, UC and DU, from cross-sectional, nationally representative surveys for 1999-2004 and 2011-2016. We used multivariable regression models with 3 main-effect explanatory variables: income (<200% or ≥200% federal poverty level), life stage, and survey period (1999-2004 or 2011-2016) and sociodemographic variables. We included 2-way interaction terms among main-effect variables to test whether disparities had changed over time in each life stage and a 3-way term to test changes in disparities differed across life stages. RESULTS: Model-adjusted disparities in DU decreased for both preschool-age and school-age children, and disparities in UC decreased for school-age children. Changes in DU and UC disparities were not detectable for working-age adults and increased for retirement-age adults. Changes in DU and UC among preschool and school-age children were not significantly different from one another and were significantly different from changes among retirement-age adults. Compared to working-age adults, changes in disparities for DU and UC were significantly different for school-age children, and changes in DU were significantly different for preschool-age children. Between surveys, the dental safety net was expanded for youth but remained largely unchanged for adults. CONCLUSIONS: Expanding the dental safety net for youth could have contributed to increased access to dental care among children relative to adults and contributed to the decrease in disparities in DU and UC among youth. KNOWLEDGE TRANSFER STATEMENT: Between 1999-2004 and 2011-2016, the dental safety net was expanded for youth but remained largely unchanged for adults. Using national survey data to compare changes in disparities in past-year dental use and untreated dental caries by income between adults and youth sheds light on the potential impact of expanding the dental safety net.
Asunto(s)
Caries Dental , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Caries Dental/epidemiología , Susceptibilidad a Caries Dentarias , Humanos , Encuestas Nutricionales , Prevalencia , Calidad de Vida , Estados Unidos/epidemiologíaRESUMEN
Studies estimating the human health impact of the foodborne disease often include estimates of the number of gastroenteritis hospitalisations. The aims of this study were to examine the degree to which hospital discharge data underreport hospitalisations due to bacterial gastroenteritis and to estimate the frequency of stool sample submission among patients presenting with gastroenteritis. Using linked laboratory and hospital discharge data from a healthcare organisation and its affiliated hospital, we examined the International Classification of Disease (ICD-9-CM) diagnosis codes assigned to hospitalised adults with culture-confirmed Campylobacter, Salmonella, or Escherichia coli O157 infections and determined the frequency of stool sample submission. Among 138 hospitalised patients with culture-confirmed infections, 43% of Campylobacter patients, 56% of Salmonella patients and 35% of E. coli O157 patients had that pathogen-specific code listed on the discharge record. Among patients without their infection listed as a diagnosis, 65% were assigned a nonspecific gastroenteritis code. Submitting a specimen for culture ⩾3 days before discharge was significantly associated with having the pathogen-specific diagnosis listed. Of 6181 patients assigned a nonspecific gastroenteritis code, 69% had submitted a stool sample for bacterial culture. This study can be used to understand differences and adjust for the underreporting and underdiagnosed of Campylobacter, Salmonella and E. coli O157 in hospital discharge and surveillance data, respectively.
Asunto(s)
Infecciones por Campylobacter/epidemiología , Infecciones por Escherichia coli/epidemiología , Enfermedades Transmitidas por los Alimentos/epidemiología , Gastroenteritis/epidemiología , Hospitalización/estadística & datos numéricos , Vigilancia de la Población/métodos , Infecciones por Salmonella/epidemiología , Campylobacter/fisiología , Infecciones por Campylobacter/microbiología , Infecciones por Escherichia coli/microbiología , Escherichia coli O157/fisiología , Enfermedades Transmitidas por los Alimentos/microbiología , Gastroenteritis/microbiología , Salmonella/fisiología , Infecciones por Salmonella/microbiología , Wisconsin/epidemiologíaRESUMEN
Listeria monocytogenes is a foodborne pathogen that can cause bacteraemia, meningitis, and complications during pregnancy. In July 2012, molecular subtyping identified indistinguishable L. monocytogenes isolates from six patients and two samples of different cut and repackaged cheeses. A multistate outbreak investigation was initiated. Initial analyses identified an association between eating soft cheese and outbreak-related illness (odds ratio 17·3, 95% confidence interval 2·0-825·7) but no common brand. Cheese inventory data from locations where patients bought cheese and an additional location where repackaged cheese yielded the outbreak strain were compared to identify cheeses for microbiological sampling. Intact packages of imported ricotta salata yielded the outbreak strain. Fourteen jurisdictions reported 22 cases from March-October 2012, including four deaths and a fetal loss. Six patients ultimately reported eating ricotta salata; another reported eating cheese likely cut with equipment also used for contaminated ricotta salata, and nine more reported eating other cheeses that might also have been cross-contaminated. An FDA import alert and US and international recalls followed. Epidemiology-directed microbiological testing of suspect cheeses helped identify the outbreak source. Cross-contamination of cheese highlights the importance of using validated disinfectant protocols and routine cleaning and sanitizing after cutting each block or wheel.
Asunto(s)
Queso/microbiología , Brotes de Enfermedades , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos/epidemiología , Listeria monocytogenes/aislamiento & purificación , Listeriosis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Enfermedades Transmitidas por los Alimentos/microbiología , Enfermedades Transmitidas por los Alimentos/mortalidad , Humanos , Listeria monocytogenes/clasificación , Listeriosis/microbiología , Listeriosis/mortalidad , Masculino , Persona de Mediana Edad , Embarazo , Estados Unidos/epidemiologíaRESUMEN
To design effective food safety programmes we need to estimate how many sporadic foodborne illnesses are caused by specific food sources based on case-control studies. Logistic regression has substantive limitations for analysing structured questionnaire data with numerous exposures and missing values. We adapted random forest to analyse data of a case-control study of Salmonella enterica serotype Enteritidis illness for source attribution. For estimation of summary population attributable fractions (PAFs) of exposures grouped into transmission routes, we devised a counterfactual estimator to predict reductions in illness associated with removing grouped exposures. For the purpose of comparison, we fitted the data using logistic regression models with stepwise forward and backward variable selection. Our results show that the forward and backward variable selection of logistic regression models were not consistent for parameter estimation, with different significant exposures identified. By contrast, the random forest model produced estimated PAFs of grouped exposures consistent in rank order with results obtained from outbreak data, with egg-related exposures having the highest estimated PAF (22·1%, 95% confidence interval 8·5-31·8). Random forest might be structurally more coherent and efficient than logistic regression models for attributing Salmonella illnesses to sources involving many causal pathways.
Asunto(s)
Árboles de Decisión , Intoxicación Alimentaria por Salmonella/epidemiología , Intoxicación Alimentaria por Salmonella/microbiología , Salmonella enteritidis/aislamiento & purificación , Animales , Estudios de Casos y Controles , Brotes de Enfermedades , Microbiología de Alimentos , Humanos , Modelos Logísticos , Valor Predictivo de las Pruebas , Factores de Riesgo , Serogrupo , Estados Unidos/epidemiologíaRESUMEN
We explored the overall impact of foodborne disease caused by seven leading foodborne pathogens in the United States using the disability adjusted life year (DALY). We defined health states for each pathogen (acute illness and sequelae) and estimated the average annual incidence of each health state using data from public health surveillance and previously published estimates from studies in the United States, Canada and Europe. These pathogens caused about 112 000 DALYs annually due to foodborne illnesses acquired in the United States. Non-typhoidal Salmonella (32 900) and Toxoplasma (32 700) caused the most DALYs, followed by Campylobacter (22 500), norovirus (9900), Listeria monocytogenes (8800), Clostridium perfringens (4000), and Escherichia coli O157 (1200). These estimates can be used to prioritize food safety interventions. Future estimates of the burden of foodborne disease in DALYs would be improved by addressing important data gaps and by the development and validation of US-specific disability weights for foodborne diseases.
Asunto(s)
Costo de Enfermedad , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos/epidemiología , Años de Vida Ajustados por Calidad de Vida , Infecciones por Caliciviridae/epidemiología , Infecciones por Campylobacter/epidemiología , Infecciones por Clostridium/epidemiología , Infecciones por Escherichia coli/epidemiología , Inocuidad de los Alimentos , Enfermedades Transmitidas por los Alimentos/microbiología , Enfermedades Transmitidas por los Alimentos/mortalidad , Humanos , Incidencia , Listeriosis/epidemiología , Vigilancia de la Población , Intoxicación Alimentaria por Salmonella/epidemiología , Toxoplasmosis/epidemiología , Estados Unidos/epidemiologíaRESUMEN
US public health laboratories began reporting Escherichia coli O157 isolates to CDC in 1996. We describe temporal and geographical patterns of isolates reported from 1996 to 2011 and demographics of persons whose specimens yielded isolates. We calculated annual E. coli O157 isolation rates/100 000 persons by patient's state of residence, county of residence, age, and sex using census data. The average annual isolation rate was 0·84. The average isolation rate in northern states (1·52) was higher than in southern states (0·43). Counties with ⩾76% rural population had a lower isolation rate (0·67) than counties with ⩽25%, 26-50%, and 51-75% rural populations (0·81, 0·92, and 0·81, respectively). The highest isolation rate (3·19) was in children aged 1-4 years. Infections were seasonal with 49% of isolates collected during July to September. Research into reasons for higher incidence in northern states and for seasonality could guide strategies to prevent illnesses.
Asunto(s)
Infecciones por Escherichia coli/epidemiología , Escherichia coli O157 , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estaciones del Año , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Non-typhoidal Salmonella is estimated to be the most common bacterial cause of foodborne illness in the United States, causing an estimated one million domestically acquired foodborne illnesses annually. Recent, large outbreaks have highlighted the importance of ground beef as an important source of multidrug-resistant Salmonella. We analysed the epidemiology of salmonellosis outbreaks that were attributed to beef in the United States reported to the Centers for Disease Control and Prevention (CDC) from 1973 to 2011. During 1973-2011, of the 1965 outbreaks of Salmonella where a food vehicle was implicated, 96 were attributed to beef, accounting for 3684 illnesses. We observed a shift in the type of beef implicated in salmonellosis outbreaks, from roast to ground beef. Delicatessen-style roast beef cooked in commercial processing establishments was the predominant type during the 1970s and early 1980s; regulations on cooking and processing essentially eliminated this problem by 1987. Ground beef emerged as an important vehicle in the 2000s; it was implicated in 17 (45%) of the 38 beef-attributed outbreaks reported during 2002-2011. Although this emergence was likely due in part to increased participation in CDC's PulseNet, which was established in 1996, and proactive decisions by the United States Department of Agriculture's Food Safety and Inspection Service, stronger measures are needed to decrease contamination of ground beef with Salmonella.
Asunto(s)
Brotes de Enfermedades , Carne/microbiología , Intoxicación Alimentaria por Salmonella/epidemiología , Adulto , Anciano , Animales , Bovinos , Centers for Disease Control and Prevention, U.S. , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Intoxicación Alimentaria por Salmonella/microbiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
We describe multiple-aetiology infections involving non-O157 Shiga toxin-producing Escherichia coli (STEC) identified through laboratory-based surveillance in nine FoodNet sites from 2001 to 2010. A multiple-aetiology infection (MEI) was defined as isolation of non-O157 STEC and laboratory evidence of any of the other nine pathogens under surveillance or isolation of >1 non-O157 STEC serogroup from the same person within a 7-day period. We compared exposures of patients with MEI during 2001-2010 with those of patients with single-aetiology non-O157 STEC infections (SEI) during 2008-2009 and with those of the FoodNet population from a survey conducted during 2006-2007. In total, 1870 non-O157 STEC infections were reported; 68 (3.6%) were MEI; 60 included pathogens other than non-O157 STEC; and eight involved >1 serogroup of non-O157 STEC. Of the 68 MEI, 21 (31%) were part of six outbreaks. STEC O111 was isolated in 44% of all MEI. Of patients with MEI, 50% had contact with farm animals compared with 29% (P < 0.01) of persons with SEI; this difference was driven by infections involving STEC O111. More patients with non-outbreak-associated MEI reported drinking well water (62%) than respondents in a population survey (19%) (P < 0.01). Drinking well water and having contact with animals may be important exposures for MEI, especially those involving STEC O111.
Asunto(s)
Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/etiología , Escherichia coli Shiga-Toxigénica , Zoonosis/etiología , Zoonosis/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Animales Domésticos/microbiología , Infecciones por Campylobacter/etiología , Niño , Preescolar , Criptosporidiosis/etiología , Escherichia coli O157/aislamiento & purificación , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Factores de Riesgo , Infecciones por Salmonella/etiología , Toxina Shiga/aislamiento & purificación , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Estados Unidos/epidemiología , Adulto Joven , Zoonosis/epidemiologíaRESUMEN
Non-O157 Shiga toxin-producing Escherichia coli (STEC) infections are increasingly detected, but sources are not well established. We summarize outbreaks to 2010 in the USA. Single-aetiology outbreaks were defined as ⩾2 epidemiologically linked culture-confirmed non-O157 STEC infections; multiple-aetiology outbreaks also had laboratory evidence of ⩾2 infections caused by another enteric pathogen. Twenty-six states reported 46 outbreaks with 1727 illnesses and 144 hospitalizations. Of 38 single-aetiology outbreaks, 66% were caused by STEC O111 (n = 14) or O26 (n = 11), and 84% were transmitted through food (n = 17) or person-to-person spread (n = 15); food vehicles included dairy products, produce, and meats; childcare centres were the most common setting for person-to-person spread. Of single-aetiology outbreaks, a greater percentage of persons infected by Shiga toxin 2-positive strains had haemolytic uraemic syndrome compared with persons infected by Shiga toxin 1-only positive strains (7% vs. 0·8%). Compared with single-aetiology outbreaks, multiple-aetiology outbreaks were more frequently transmitted through water or animal contact.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/aislamiento & purificación , Toxina Shiga I/aislamiento & purificación , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Infecciones por Escherichia coli/diagnóstico , Femenino , Humanos , Incidencia , Masculino , Sistema de Registros , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiologíaRESUMEN
Common sources of shiga toxin-producing Escherichia coli (STEC) O157 infection have been identified by investigating outbreaks and by case-control studies of sporadic infections. We conducted an analysis to attribute STEC O157 infections ascertained in 1996 and 1999 by the Foodborne Diseases Active Surveillance Network (FoodNet) to sources. Multivariable models from two case-control studies conducted in FoodNet and outbreak investigations that occurred during the study years were used to calculate the annual number of infections attributable to six sources. Using the results of the outbreak investigations alone, 27% and 15% of infections were attributed to a source in 1996 and 1999, respectively. Combining information from both data sources, 65% of infections in 1996 and 34% of infections in 1999 were attributed. The results suggest that methods to incorporate data from multiple surveillance systems and over several years are needed to improve estimation of the number of illnesses attributable to exposure sources.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Métodos Epidemiológicos , Infecciones/etiología , Estudios de Casos y Controles , Interpretación Estadística de Datos , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/etiología , Enfermedades Transmitidas por los Alimentos/epidemiología , Enfermedades Transmitidas por los Alimentos/etiología , Humanos , Infecciones/epidemiología , Vigilancia de la Población , Escherichia coli Shiga-Toxigénica , Estados Unidos/epidemiologíaRESUMEN
We investigated an outbreak of 396 Salmonella enterica serotype I 4,5,12:i:- infections to determine the source. After 7 weeks of extensive hypothesis-generation interviews, no refined hypothesis was formed. Nevertheless, a case-control study was initiated. Subsequently, an iterative hypothesis-generation approach used by a single interviewing team identified brand A not-ready-to-eat frozen pot pies as a likely vehicle. The case-control study, modified to assess this new hypothesis, along with product testing indicated that the turkey variety of pot pies was responsible. Review of product labels identified inconsistent language regarding preparation, and the cooking instructions included undefined microwave wattage categories. Surveys found that most patients did not follow the product's cooking instructions and did not know their oven's wattage. The manufacturer voluntarily recalled pot pies and improved the product's cooking instructions. This investigation highlights the value of careful hypothesis-generation and the risks posed by frozen not-ready-to-eat microwavable foods.
Asunto(s)
Culinaria , Brotes de Enfermedades , Etiquetado de Alimentos , Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella enterica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Recolección de Datos , Femenino , Inocuidad de los Alimentos , Alimentos Congelados , Humanos , Lactante , Masculino , Persona de Mediana Edad , Salud Pública/métodos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self- and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for all adults aged 20+ years and for adults aged 40+ years. Twenty studies were included in the final body of evidence. Among studies published after/during 1980, any fluoride (self- and professionally applied or water fluoridation) annually averted 0.29 (95%CI: 0.16-0.42) carious coronal and 0.22 (95%CI: 0.08-0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95%CI: 19%-34%). These findings suggest that fluoride prevents caries among adults of all ages.
Asunto(s)
Caries Dental/prevención & control , Fluoruros/uso terapéutico , Adulto , Factores de Edad , Fluoruración , Fluoruros/administración & dosificación , HumanosRESUMEN
Argentina has a high incidence of hemolytic uremic syndrome (HUS); 12.2 cases per 100,000 children younger than 5 years old were reported in 2002. Shiga toxin (Stx)-producing Escherichia coli (STEC) is the primary etiologic agent of HUS, and STEC O157 is the predominant serogroup isolated. The main objective of the present work was to establish the phenotypic and genotypic characteristics of the STEC strains in general isolated from Argentine children during a prospective study and the clonal relatedness of STEC O157:H7 strains using subtyping techniques. One hundred and three STEC strains isolated from 99 children were included. The phenotypic and genotypic features were established, and a polymerase chain reaction-restriction fragment length polymorphism (PCRRFLP) was performed to determine stx2 variants. The clonal relatedness of E. coli O157 isolates was established by phage typing and pulsed-field gel electrophoresis (PFGE). The 103 STEC strains belonged to 18 different serotypes, and 59% were of serotype O157:H7. Stx2 was identified in 90.3%, and stx1 in 9.7%. Among the 61 STEC O157 strains, 93.4% harbored the stx2/stx2vh-a genes; PT4 (39.3%) and PT2 (29.5%) were the predominant phage types. Using PFGE with the enzyme XbaI, a total of 41 patterns with at least 80% similarity were identified, and seven clusters with identical profiles were established. Some of the clusters were further split by PFGE using BlnI as the second enzyme. Isolates with indistinguishable PFGE patterns were with one exception also indistinguishable by phage typing and stx genotyping. These findings confirmed that some isolates were genetically related. However, no epidemiological linkages were identified. STEC strains with different genotypes and belonging to diverse serotypes were isolated in Argentina. Some STEC O157 strains could not be distinguished by applying subtyping techniques such as PFGE and phage typing.
Asunto(s)
ADN Bacteriano/análisis , Diarrea/microbiología , Infecciones por Escherichia coli/microbiología , Escherichia coli O157/clasificación , Síndrome Hemolítico-Urémico/microbiología , Toxinas Shiga/biosíntesis , Argentina/epidemiología , Tipificación de Bacteriófagos , Preescolar , Análisis por Conglomerados , Diarrea/epidemiología , Brotes de Enfermedades , Electroforesis en Gel de Campo Pulsado , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/aislamiento & purificación , Escherichia coli O157/metabolismo , Genotipo , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Lactante , Recién Nacido , Fenotipo , Polimorfismo de Longitud del Fragmento de Restricción , Estudios Prospectivos , Serotipificación , Toxinas Shiga/aislamiento & purificaciónRESUMEN
To characterize the extent and severity of coronal caries among older US adults and document their need for prevention interventions, we systematically reviewed studies on coronal caries incidence, increment, and attack rate. We abstracted six studies and calculated summary measures using a random-effects model (95% confidence interval [95%CI]). We tested for heterogeneity and identified associated factors by examining the correlation between outcome measures and baseline population risk and study characteristics. We re-calculated summary measures after adjusting outcomes that netted out examiner reversals. Incidence and increment varied significantly by study. Adjusting studies for netting out examiner reversals reduced heterogeneity significantly. Annual attack rate among adjusted North American studies was 1.4 surfaces per 100 surfaces (95%CI = 1.0-1.9), or approximately 1 new carious surface per person per year. These rates are equal to or higher than those in children and indicate a need for caries-prevention services.
Asunto(s)
Cuidado Dental para Ancianos , Caries Dental/epidemiología , Anciano , Australia/epidemiología , Canadá/epidemiología , Índice CPO , Caries Dental/prevención & control , Humanos , Incidencia , Persona de Mediana Edad , Modelos Estadísticos , Suecia/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Although older adults are keeping their teeth longer, no national data are available on new caries in this age group. To characterize the extent of caries among older adults, we systematically reviewed studies on root caries incidence, increment, attack rate, and annual total (root + coronal) caries increment. We used a random-effects model to estimate annual summary measures and their 95% confidence intervals (CI) and tested for heterogeneity. For the 9 studies reporting root caries incidence, the summary measure equaled 23.7% (CI = 17.1-30.2%). For the 9 studies reporting root caries increment, the summary measure was 0.47 surfaces (CI = 0.34-0.61). For the 7 studies reporting total caries increment, the summary measure equaled 1.31 surfaces (95% CI = 1.01-1.61 surfaces). Because of heterogeneity, summary measures should be interpreted with caution. This research suggests, however, that older adults experience high rates of new caries and could benefit from caries-prevention programs.
Asunto(s)
Caries Radicular/epidemiología , Distribución por Edad , Anciano , Distribución de Chi-Cuadrado , Caries Dental/epidemiología , Predicción , Humanos , Incidencia , Persona de Mediana Edad , Modelos Estadísticos , Evaluación de Resultado en la Atención de Salud , Caries Radicular/prevención & control , Estados Unidos/epidemiologíaRESUMEN
Diarrheal diseases are a leading cause of childhood morbidity and mortality in Latin America. Most studies have focused on infants but not on older children. We enrolled 505 children (age, 12-59 months) with diarrhea and age-matched controls in a case-control study in Sao Paulo, Brazil. Independent risk factors for diarrhea included another household member with diarrhea (matched odds ratio [mOR], 8.1; attributable fraction [AF], 0.17; P<.001) and consumption of homemade juice (mOR, 1.8; AF, 0.10; P=.01); protective factors included boiling of the baby bottle or nipple (mOR, 0.60; AF, 0.19; P=.026), childcare at home (mOR, 0.58; AF, 0.12; P=.004), and piped sewage (mOR, 0.58; AF, 0.05; P=.047). Hand washing by the caretaker after helping the child defecate protected against Shigella infection (mOR, 0.35; P<.05). Preparation of rice, beans, or soup in the morning and serving it to children after noon were associated with enterotoxigenic Escherichia coli infection (mOR, 8.0; P<.05). In these poor households, 28% of cases of diarrhea in 1-4-year-old children was attributable to easily modifiable exposures.
Asunto(s)
Diarrea Infantil/epidemiología , Diarrea/epidemiología , Infecciones por Adenovirus Humanos/epidemiología , Infecciones por Adenovirus Humanos/prevención & control , Anciano , Brasil/epidemiología , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/prevención & control , Estudios de Casos y Controles , Preescolar , Diarrea/microbiología , Diarrea/prevención & control , Diarrea/virología , Diarrea Infantil/microbiología , Diarrea Infantil/prevención & control , Diarrea Infantil/virología , Disentería Bacilar/epidemiología , Disentería Bacilar/prevención & control , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/prevención & control , Heces/microbiología , Heces/virología , Femenino , Humanos , Lactante , Masculino , Selección de Paciente , Valor Predictivo de las Pruebas , Factores de Riesgo , Infecciones por Rotavirus/epidemiología , Infecciones por Rotavirus/prevención & control , Distribución por Sexo , Shigella/aislamiento & purificación , Shigella/patogenicidad , Especificidad de la EspecieRESUMEN
We analyzed the cost-effectiveness of 3 sealant delivery strategies: Seal all (SA), seal children assessed to be at risk by screening (TARGET), and seal none (SN). We assumed a nine-year analytic horizon, a 3% discount rate, and zero screening costs. Estimates for sealant costs ($27.00) and restoration costs ($73.77), annual caries increment (0.0624 surfaces), sealant failure rate (20% in yr 1 and 3% thereafter), annual amalgam failure rate (4.6%), and sensitivity (0.635) and specificity (0.795) of screening were obtained from published studies. Under baseline assumptions, TARGET dominated (cost less and reduced caries) SA and SN. If annual caries increment exceeded 0.095 surfaces, SA dominated TARGET, and if increment exceeded 0.05 surfaces, TARGET dominated SN. If sealant costs decreased to $6.00 (reported cost for school programs), TARGET dominated SN for caries increments exceeding 0.007 surfaces, and SA dominated TARGET for caries increments exceeding 0.034 surfaces.
Asunto(s)
Selladores de Fosas y Fisuras/economía , Niño , Análisis Costo-Beneficio , Índice CPO , Atención a la Salud/economía , Amalgama Dental/economía , Caries Dental/economía , Caries Dental/prevención & control , Susceptibilidad a Caries Dentarias , Fracaso de la Restauración Dental/economía , Restauración Dental Permanente/economía , Costos de los Medicamentos , Estudios de Seguimiento , Humanos , Tamizaje Masivo/economía , Modelos Económicos , Selladores de Fosas y Fisuras/uso terapéutico , Medición de Riesgo , Servicios de Odontología Escolar/economía , Sensibilidad y Especificidad , Estados UnidosRESUMEN
In 1992, a large outbreak of bloody diarrhea caused by Escherichia coli O157 infections occurred in southern Africa. In Swaziland, 40,912 physician visits for diarrhea in persons ages >5 years were reported during October through November 1992. This was a sevenfold increase over the same period during 1990-91. The attack rate was 42% among 778 residents we surveyed. Female gender and consuming beef and untreated water were significant risks for illness. E. coli O157:NM was recovered from seven affected foci in Swaziland and South Africa; 27 of 31 patient and environmental isolates had indistinguishable pulsed-field gel electrophoresis patterns. Compared with previous years, a fivefold increase in cattle deaths occurred in October 1992. The first heavy rains fell that same month (36 mm), following 3 months of drought. Drought, carriage of E. coli O157 by cattle, and heavy rains with contamination of surface water appear to be important factors contributing to this outbreak.
Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Diarrea/epidemiología , Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157/aislamiento & purificación , África Austral/epidemiología , Animales , Bovinos , Enfermedades de los Bovinos/epidemiología , Enfermedades de los Bovinos/microbiología , Preescolar , Enfermedades Transmisibles Emergentes/microbiología , Diarrea/microbiología , Infecciones por Escherichia coli/microbiología , Escherichia coli O157/clasificación , Escherichia coli O157/genética , Humanos , Lactante , Vigilancia de la Población , Factores de RiesgoRESUMEN
A multistate outbreak of Escherichia coli O157:H7 infections occurred in the United States in June and July 1997. Two concurrent outbreaks were investigated through independent case-control studies in Michigan and Virginia and by subtyping isolates with pulsed-field gel electrophoresis (PFGE). Isolates from 85 persons were indistinguishable by PFGE. Alfalfa sprouts were the only exposure associated with E. coli O157:H7 infection in both Michigan and Virginia. Seeds used for sprouting were traced back to one common lot harvested in Idaho. New subtyping tools such as PFGE used in this investigation are essential to link isolated infections to a single outbreak.
Asunto(s)
Brotes de Enfermedades , Infecciones por Escherichia coli/epidemiología , Escherichia coli O157 , Microbiología de Alimentos , Medicago sativa/microbiología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , ADN Bacteriano/análisis , Electroforesis en Gel de Campo Pulsado/métodos , Infecciones por Escherichia coli/microbiología , Escherichia coli O157/clasificación , Escherichia coli O157/genética , Escherichia coli O157/aislamiento & purificación , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Michigan/epidemiología , Persona de Mediana Edad , Semillas , Estados Unidos/epidemiología , Virginia/epidemiologíaRESUMEN
The frequency of Shiga toxin-producing Escherichia coli (STEC) serotypes associated with postdiarrheal hemolytic uremic syndrome (HUS) cases among children and adults in the United States and the proportion with IgM or IgG lipopolysaccharide antibodies to E. coli O157 were determined by use of a nationwide sample from January 1987 through December 1991. Among 83 patients, STEC were isolated from 30 (43%) of 70 whose stool cultures yielded bacterial growth (25 E. coli O157 isolates and 5 non-O157 STEC isolates). Fifty-three (80%) of 66 patients with serum samples had positive O157 lipopolysaccharide antibody titers. Of the 83 patients, 60 (72%) had evidence of STEC infection, including 6 of 8 adults whose illnesses also met criteria for thrombotic thrombocytopenic purpura. Data from a subset of patients suggest that E. coli O157 was the cause of > or = 80% of the STEC infections. All 3 women who were postpartum had evidence of E. coli O157 infection. STEC infection should be considered the likely cause for all persons with postdiarrheal HUS.