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INTRODUCTION: Population-based data are limited on how often colorectal cancer (CRC) is identified through screening or surveillance in asymptomatic patients versus diagnostic workup for symptoms. We developed a process for assessing CRC identification methods among Medicare-linked CRC cases from a population-based cancer registry to assess identification methods (screening/surveillance or diagnostic) among Kansas Medicare beneficiaries. METHODS: New CRC cases diagnosed from 2008 through 2010 were identified from the Kansas Cancer Registry and matched to Medicare enrollment and claims files. CRC cases were classified as diagnostic-identified versus screening/surveillance-identified using a claims-based algorithm for determining CRC test indication. Factors associated with screening/surveillance-identified CRC were analyzed using logistic regression. RESULTS: Nineteen percent of CRC cases among Kansas Medicare beneficiaries were screening/surveillance-identified while 81% were diagnostic-identified. Younger age at diagnosis (65 to 74 years) was the only factor associated with having screening/surveillance-identified CRC in multivariable analysis. No association between rural/urban residence and identification method was noted. CONCLUSION: Combining administrative claims data with population-based registry records can offer novel insights into patterns of CRC test use and identification methods among people diagnosed with CRC. These techniques could also be extended to other screen-detectable cancers.
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Colonoscopía/métodos , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/métodos , Medicare Part A/estadística & datos numéricos , Medicare Part B/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Algoritmos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Revisión de Utilización de Seguros/estadística & datos numéricos , Kansas/epidemiología , Modelos Logísticos , Masculino , Tamizaje Masivo/métodos , Análisis Multivariante , Estadificación de Neoplasias , Evaluación de Procesos y Resultados en Atención de Salud , Vigilancia de la Población , Servicios Preventivos de Salud/estadística & datos numéricos , Sistema de Registros , Población Rural/estadística & datos numéricos , Programa de VERF , Factores Socioeconómicos , Estados Unidos , Población Urbana/estadística & datos numéricosRESUMEN
BACKGROUND: Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008. METHODS: We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted. RESULTS: Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source. CONCLUSIONS: Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.
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Capsicum/microbiología , Brotes de Enfermedades , Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella enterica , Solanum lycopersicum/microbiología , Estudios de Casos y Controles , Análisis por Conglomerados , Coriandrum/microbiología , Brotes de Enfermedades/prevención & control , Contaminación de Alimentos/prevención & control , Microbiología de Alimentos , Humanos , Oportunidad Relativa , Restaurantes , Intoxicación Alimentaria por Salmonella/microbiología , Salmonella enterica/clasificación , Salmonella enterica/aislamiento & purificación , Serotipificación , Estados Unidos/epidemiologíaRESUMEN
Hospitalization during pregnancy often produces psychosocial distress for pregnant women. In this study, 3D ultrasound and recreational therapy were compared to the standard treatment for their influence on depressive symptoms and anxiety. In this prospective one-year intervention study, women who were admitted to the hospital for any pregnancy complication, other than psychiatric, were included. A control group, with standard clinical treatment, and two intervention groups, both additionally receiving either 3D ultrasound or recreational therapy, were established. Psychological well-being was assessed at defined times by the PHQ-health-questionnaire. A total of 169/211 women were included: control group n = 79, 3D ultrasound group n = 43, and crochet group n = 83. A higher than estimated underlying depression was seen for all women on admission. The intervention groups showed less depression (p = 0.02762). No difference was seen between the intervention groups (p = 0.23029). Anxiety decreased throughout intervention, but not significantly. On admission, all women showed similar results of underlying depression, indicating that hospitalization itself already causes mild psychological stress. Both interventions decreased depressive symptoms. Intervention with either recreational therapy or 3D ultrasound can prevent the development of mild and major depression and decrease anxiety disorders, and therefore has a positive effect on well-being during hospitalization. These results emphasize the need to implement forms of interventions to improve the well-being of women, as this might improve pregnancy and neonatal outcome.
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OBJECTIVES: We assessed risk factors for 2009 pandemic influenza A (H1N1)-related hospitalization, mechanical ventilation, and death among New Mexico residents. METHODS: We calculated population rate ratios using Poisson regression to analyze risk factors for H1N1-related hospitalization. We performed a cross-sectional analysis of hospitalizations during September 14, 2009 through January 13, 2010, using logistic regression to assess risk factors for mechanical ventilation and death among those hospitalized. RESULTS: During the study period, 926 laboratory-confirmed H1N1-related hospitalizations were identified. H1N1-related hospitalization was significantly higher among American Indians (risk ratio [RR] = 2.6; 95% confidence interval [CI] = 2.2, 3.2), Blacks (RR = 1.7; 95% CI = 1.2, 2.4), and Hispanics (RR = 1.8; 95% CI = 1.5, 2.0) than it was among non-Hispanic Whites, and also was higher among persons of younger age and lower household income. Mechanical ventilation was significantly associated with age 25 years and older, obesity, and lack of or delayed antiviral treatment. Death was significantly associated with male gender, cancer during the previous 12 months, and liver disorder. CONCLUSIONS: This analysis supports recent national efforts to include American Indian/Alaska Native race as a group at high risk for complications of influenza with respect to vaccination and antiviral treatment recommendations.
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Hospitalización/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/etnología , Gripe Humana/mortalidad , Pandemias , Adolescente , Adulto , Factores de Edad , Anciano , Antivirales/administración & dosificación , Índice de Masa Corporal , Niño , Preescolar , Comorbilidad , Estudios Transversales , Etnicidad , Femenino , Humanos , Gripe Humana/tratamiento farmacológico , Masculino , Persona de Mediana Edad , New Mexico/epidemiología , Grupos Raciales , Características de la Residencia , Respiración Artificial , Factores de Riesgo , Índice de Severidad de la Enfermedad , Sexo , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: The emergence and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at a Minneapolis pediatric healthcare facility was investigated. METHODS: Children with MRSA infections from January 1991 to December 2003 were classified as community-associated (CA) or healthcare-associated (HA) using established criteria. Isolates were subtyped using pulsed-field gel electrophoresis and grouped into pulsed-field types (PFTs). Case and isolate characteristics were compared and temporal trends were assessed. RESULTS: The first isolate classified as CA-MRSA in this healthcare facility was identified in 1991. CA-MRSA cases (n = 188) were more likely than HA-MRSA cases (n = 83) to have a skin or soft tissue infection (80% versus 59%) and to belong to a racial or ethnic minority group (82% versus 55%), whereas HA-MRSA cases were younger (median age, 3.4 years versus 4.9 years). The proportion of both CA- and HA-MRSA isolates susceptible to clindamycin and erythromycin declined during the study period. Isolates classified as CA-MRSA were more likely than HA-MRSA isolates to be USA300 (21% versus 11%, P = 0.05) and USA400 (62% versus 31%, P < 0.001) PFTs. Associations between case race/ethnicity and isolate PFT were observed independent of case classification. CONCLUSIONS: CA-MRSA is well established in this pediatric population. Although no discernable changes in CA- or HA-MRSA case characteristics were documented during the study period, significant changes were observed in CA-MRSA isolate characteristics, indicating that this pathogen continues to evolve.
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Infección Hospitalaria/epidemiología , Hospitales Pediátricos , Resistencia a la Meticilina , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/efectos de los fármacos , Adolescente , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/microbiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Infecciones Estafilocócicas/microbiologíaRESUMEN
BACKGROUND: Laboratory testing results are often used to monitor influenza illness in populations, but results may not be representative of illness burden and distribution, especially in populations that are geographically, socioeconomically, and racially/ethnically diverse. OBJECTIVES: Descriptive epidemiology and chi-square analyses using demographic, geographic, and medical condition prevalence comparisons were employed to assess whether a group of individuals with outpatient laboratory-confirmed influenza illness during September-November 2009 represented the burden and distribution of influenza illness in New Mexico (NM). PATIENTS/METHODS: The outpatient group was identified via random selection from those with positive influenza tests at NM laboratories. Comparison groups included those with laboratory-confirmed H1N1-related influenza hospitalization and death identified via prospective active statewide surveillance, those with self-reported influenza-like illness (ILI) identified through random digit dialing, and the NM population. RESULTS: This analysis included 334 individuals with outpatient laboratory-confirmed influenza, 888 individuals with laboratory-confirmed H1N1-related hospitalization, 39 individuals with laboratory-confirmed H1N1-related death, 334 individuals with ILI, and NM population data (N = 2,036,112). The outpatient laboratory-confirmed group had a different distribution of demographic and geographic factors, as well as prevalence of certain medical conditions as compared to the groups of laboratory-confirmed H1N1-related hospitalization and death, the ILI group, and the NM population. CONCLUSIONS: The outpatient laboratory-confirmed group may reflect provider testing practices and potentially healthcare-seeking behavior and access to care, rather than influenza burden and distribution in NM during the H1N1 pandemic.