Blastomycosis in urban southeastern Wisconsin.

PURPOSE: A previous study revealed a non-random distribution of blastomycosis cases by home site in urban Milwaukee County. This study was conducted to determine the proportion of cases with likely exposures solely in urban areas. METHODS: Records of 68 urban southeastern Wisconsin individuals, including 45 residents of Milwaukee, 19 from suburban Milwaukee County, and 4 from outside Milwaukee County, diagnosed with blastomycosis between January 2002 and July 2007 were studied using medical record reviews, case reports, and telephone interviews. Geographic Information Systems (GIS) proximity analysis was then used to compare the distance between case and control home sites to environmental risk factors. RESULTS: Of patients reporting their exposure history, 41 of 49 (84%) participated in outdoor work or leisure activities, and 12 of 47 (26%) engaged in fishing, hunting, camping, or hiking. Of the urban cases, 64 occurred among Milwaukee County residents; of those, 25 of 49 (51%) denied traveling, which suggests local urban exposure, and 8 of 11 (73%) specifically recalled urban waterway exposure prior to diagnosis. The 45 Milwaukee cases were concentrated on the north side of town and were closer to inland waterways than a random sample of 6528 controls (median 690 versus 1170 meters; P=0.003), but not closer to parks. CONCLUSION: Southeastern Wisconsin residents may acquire blastomycosis solely in their local urban area, sometimes without specific outdoor exposures. Proximity to inland waterways is associated with blastomycosis cases in urban areas, similar to rural areas of Wisconsin. Clinicians should include blastomycosis in appropriate differential diagnoses of symptomatic individuals, even in urban residents without travel history or history of significant outdoor exposures.

Geographic analysis of diagnosis of Attention-Deficit/Hyperactivity Disorder in children: Eastern Wisconsin, USA.

OBJECTIVE: To perform a novel geographic analysis of Attention-Deficit/ Hyperactivity Disorder (ADHD) diagnosis in Midwest United States. METHOD: Primary care children age 5-17 with ADHD diagnosis (N = 6833; 13.5%) were compared to those receiving well child care without ADHD diagnosis (N = 43,630) in a Wisconsin integrated medical system. Street addresses, demographic, and block group level U.S. Census 2000 data were mapped and analyzed using ArcGIS, CrimeStat III, and SaTScan. Lead levels from a State database were linked to 2,837 subjects. Univariate analysis was done by chi-square test or Mann-Whitney U test, multivariate analysis by logistic regression. RESULTS: ADHD cases were 74% male (p = 0.0001), and more frequently diagnosed in White children (17.3%) than Blacks (10.6%), Hispanics (9.4%), or Asians (3.7%; all p values < 0.001). Overall, male gender, white race, lower block group median household income and population density, and greater distance to nearest park and airport were more predictive of ADHD (p values < 0.001). In urban Milwaukee County (865 cases/10,493 controls) male gender, white race, suburban residence, and younger age were more predictive of ADHD (p values < 0.01). Among children with ADHD diagnosis and linked lifetime lead values, those with a maximum level of 10 microg/dl or more differed significantly from controls (9.3% vs. 5.6%; p = 0.003); elevated lead remained a significant predictor of ADHD diagnosis in multivariate analysis. CONCLUSIONS: Further studies are needed to determine if geographic distribution of ADHD diagnosis can be partially explained by differential efficiency of referral for diagnosis by school districts, by race/ethnicity, and/or built environment.