RESUMEN
OBJECTIVE: Bread is the largest contributor of Na to the American diet and excess Na consumption contributes to premature death and disability. We sought to determine the Na level at which consumers could detect a difference between reduced-Na bread and bread with typical Na content, and to determine if consumer sensory acceptability and purchase intent differed between reduced-Na bread and bread with typical Na content. DESIGN: Difference testing measured ability to detect differences in control bread and reduced-Na bread using two-alternative forced choice testing. Acceptability was measured using a nine-point hedonic scale and purchase intent was measured using a five-point purchase intent scale. SETTING: Difference and acceptability testing were conducted in Portland, OR, USA in January 2013. SUBJECTS: Eighty-two consumers participated in difference testing and 109 consumers participated in acceptability testing. RESULTS: Consumers did not detect a difference in saltiness between the control bread and the 10 % reduced-Na bread, but did detect a difference between the control bread and bread reduced in Na content by 20 % and 30 %. Na reductions had no effect on consumer acceptability of sensory characteristics, including overall liking, appearance, aroma, flavour, sweetness, salt level and texture, or purchase intent. CONCLUSIONS: Reducing Na levels by up to 30 % in the sandwich bread tested did not affect consumer liking or purchase intent of the product. These results support national recommendations for small, incremental Na reductions in the food supply over time and assure bread manufacturers that sensory characteristics and consumer purchase intent of their products will be preserved after Na reductions occur.
Asunto(s)
Pan/análisis , Comportamiento del Consumidor , Preferencias Alimentarias , Sodio en la Dieta/análisis , Adulto , Conducta de Elección , Estudios de Factibilidad , Femenino , Manipulación de Alimentos , Humanos , Masculino , Persona de Mediana Edad , Oregon , Factores Socioeconómicos , Gusto , Granos Enteros/químicaRESUMEN
Despite the potential for public health strategies to decrease the substantial burden of injuries, injury prevention infrastructure in state health departments is underdeveloped. We sought to describe the legal support for injury prevention activities at state health departments. We searched the Lexis database for state laws providing authority for those activities, and categorized the scope of those laws. Only 10 states have authority that covers the full scope of injury prevention practice; in the others, legal authority is piecemeal, nonspecific, or nonexistent. More comprehensive legal authority could help health departments access data for surveillance, work with partners, address sensitive issues, and garner funding. Efforts should be undertaken to enhance legal support for injury prevention activities across the country.
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Planificación en Salud/legislación & jurisprudencia , Promoción de la Salud/legislación & jurisprudencia , Planes Estatales de Salud/legislación & jurisprudencia , Heridas y Lesiones/prevención & control , Planificación en Salud/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Humanos , Gobierno Estatal , Estados UnidosRESUMEN
Influenza A incidence peaks during winter in temperate regions. The basis for this pronounced seasonality is not understood, nor is it well documented how influenza A transmission principally occurs. Previous studies indicate that relative humidity (RH) affects both influenza virus transmission (IVT) and influenza virus survival (IVS). Here, we reanalyze these data to explore the effects of absolute humidity on IVT and IVS. We find that absolute humidity (AH) constrains both transmission efficiency and IVS much more significantly than RH. In the studies presented, 50% of IVT variability and 90% of IVS variability are explained by AH, whereas, respectively, only 12% and 36% are explained by RH. In temperate regions, both outdoor and indoor AH possess a strong seasonal cycle that minimizes in winter. This seasonal cycle is consistent with a wintertime increase in IVS and IVT and may explain the seasonality of influenza. Thus, differences in AH provide a single, coherent, more physically sound explanation for the observed variability of IVS, IVT and influenza seasonality in temperate regions. This hypothesis can be further tested through future, additional laboratory, epidemiological and modeling studies.
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Humedad , Infecciones por Orthomyxoviridae/transmisión , Orthomyxoviridae/fisiología , Estaciones del AñoRESUMEN
TIPICO is an expert meeting and workshop that aims to provide the most recent evidence in the field of infectious diseases and vaccination. The 10th Interactive Infectious Disease TIPICO workshop took place in Santiago de Compostela, Spain, on November 21-22, 2019. Cutting-edge advances in vaccination against respiratory syncytial virus, Streptococcus pneumoniae, rotavirus, human papillomavirus, Neisseria meningitidis, influenza virus, and Salmonella Typhi were discussed. Furthermore, heterologous vaccine effects were updated, including the use of Bacillus Calmette-Guérin (BCG) vaccine as potential treatment for type 1 diabetes. Finally, the workshop also included presentations and discussion on emergent virus and zoonoses, vaccine resilience, building and sustaining confidence in vaccination, approaches to vaccine decision-making, pros and cons of compulsory vaccination, the latest advances in decoding infectious diseases by RNA gene signatures, and the application of big data approaches.
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Enfermedades Transmisibles , Virus Sincitial Respiratorio Humano , Animales , Vacuna BCG , Humanos , España , VacunaciónRESUMEN
In most countries worldwide, pneumococcal conjugate vaccines have been included in the infant immunization program, resulting in a significant reduction in the burden of pneumococcal disease in children and adults. Shifting serotype distribution due to the indirect effect of infant vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) may continue to increase the gap between 23-valent pneumococcal polysaccharide vaccine (PPSV23) and PCV13 serotype coverage for older adults in the coming years. This clinical study (V110-029; NCT02225587) evaluated the safety and immunogenicity of sequential administration of PCV13 followed approximately 8 weeks later, or approximately 26 weeks later, by PPSV23 in healthy adults ≥50 years of age. Both dosing intervals were generally well tolerated as measured by the nature, frequency, and intensity of reported adverse events (AEs) in both vaccination groups. Serotype-specific opsonophagocytic activity (OPA) geometric mean titers (GMTs) measured 30 days following receipt of PPSV23 in either group and at Week 30 were generally comparable between the 2 groups for 6 serotypes unique to PPSV23 and 12 serotypes shared between PCV13 and PPSV23, regardless of the interval between receipt of PCV13 and PPSV23. In addition, administration of PPSV23 given either 8 weeks or 26 weeks following PCV13 did not negatively impact immune responses induced by PCV13. Furthermore, administration of PPSV23 given either 8 weeks or 26 weeks after PCV13 elicited serotype-specific OPA GMTs to serotypes unique to PPSV23, which could provide earlier protection against pneumococcal disease caused by these serotypes in comparison with the current Advisory Committee on Immunization Practices recommended interval of at least 12 months.
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Infecciones Neumocócicas , Streptococcus pneumoniae , Anciano , Anticuerpos Antibacterianos , Niño , Método Doble Ciego , Voluntarios Sanos , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Vacunas Conjugadas/efectos adversosRESUMEN
Tai chi--moving for better balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the re-aim framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings.
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Accidentes por Caídas/prevención & control , Educación en Salud/métodos , Promoción de la Salud/métodos , Taichi Chuan , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Equilibrio Postural/fisiología , Evaluación de Programas y Proyectos de Salud , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVES: Many of the 2.5 million Americans assaulted annually by intimate partners seek medical care. This project evaluated diagnostic codes indicative of intimate partner violence (IPV) in Oregon hospital and emergency department (ED) records to determine predictive value positive (PVP), sensitivity, and usefulness in routine surveillance. Statewide incidence of care for IPV was calculated and victims and episodes characterized. METHODS: The study was a review of medical records assigned > or = 1 diagnostic codes thought predictive of IPV. Sensitivity was estimated by comparing the number of confirmed victims identified with the number predicted by statewide telephone survey. Patients were aged > or = 12 years, treated in any of 58 EDs or hospitals in Oregon during 2000, and discharged with one of three primary or 12 provisional codes suggestive of IPV. Outcome measures were number of victims detected, PPV and sensitivity of codes for detection of IPV, and description of victims. RESULTS: Of 58 hospitals, 52 (90%) provided records. Case finding using primary codes identified 639 victims, 23% of all estimated female victims seen in EDs or hospitalized statewide. PVP was 94% (639/677). Provisional codes increased sensitivity (51%) but reduced PVP (50%). Highest incidence occurred in women aged 20-39 years, and those who were black. Hospitalizations were highest among women aged > or = 50 years, black people, or those with comorbid illness. CONCLUSIONS: Three diagnostic codes used for case finding detect approximately one-quarter of ED- and hospital-treated victims, complement surveys, and facilitate description of injured victims.
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Mujeres Maltratadas/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Clasificación Internacional de Enfermedades , Tamizaje Masivo , Registros Médicos/clasificación , Vigilancia de la Población/métodos , Maltrato Conyugal/diagnóstico , Adolescente , Adulto , Derecho Penal , Femenino , Control de Formularios y Registros , Humanos , Incidencia , Persona de Mediana Edad , Oregon/epidemiología , Medición de Riesgo , Sensibilidad y Especificidad , Maltrato Conyugal/estadística & datos numéricosRESUMEN
OBJECTIVES: To quantify the risk of pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) in adults aged ≥19 years with underlying medical conditions compared with healthy adults of the same age in Japan. DESIGN: An observational, retrospective, cohort study using two healthcare claims databases in Japan: Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases. PARTICIPANTS: A total of 10.4 million individuals, representing 9.3 million person-years of follow-up, were included in the analysis. Eleven medical conditions as well as PP and IPD were identified by the International Statistical Classification of Diseases and Related Health Problems version 10 diagnostic codes and/or local disease codes used in Japan. PRIMARY OUTCOME MEASURES: Adjusted rate ratios (RRs) for PP and IPD in adults with a medical condition versus adults without any medical condition were calculated using multivariate Poisson regression models with age and/or sex as covariates. RESULTS: In the JMDC and MDV databases, respectively, adults ≥19 years with a medical condition (RRs for PP: 3.3 to 13.4, 1.7 to 5.2; RRs for IPD: 12.6 to 43.3, 4.4 to 7.1), adults with two or more medical conditions (PP: 11.6, 2.8; IPD: 18.7, 5.8) and high-risk adults (PP: 12.9, 1.8; IPD: 29.7, 4.0) were at greater risk of PP and IPD compared with their healthy counterparts. Adults aged 50-64 years with an underlying medical condition (PP rate: 38.6 to 212.1 per 100 000 person-years) had a higher rate of PP than those aged ≥65 years without any condition (PP rate: 13.2 to 93.0 per 100 000 person-years). CONCLUSIONS: Adults of all ages with an underlying medical condition are at greater risk of PP and IPD compared with adults without any medical condition. This risk increases with the number of underlying medical conditions. Our results support extending pneumococcal vaccination to younger adults with an underlying medical condition, especially those aged 50-64 years.
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Enfermedad Crónica , Neumonía Neumocócica/etiología , Adulto , Anciano , Pueblo Asiatico , Bases de Datos Factuales , Femenino , Humanos , Esquemas de Inmunización , Japón , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/etiología , Vacunas Neumococicas , Neumonía Neumocócica/microbiología , Estudios Retrospectivos , Riesgo , Streptococcus pneumoniae , Vacunación , Adulto JovenRESUMEN
OBJECTIVE: In June 2000, Oregon implemented a citizen-initiated ballot measure that grants adult adoptees access to their birth records, which contain their birth parents' identifying information. Because other states are considering similar policy changes, the authors explored whether Oregon's new law is meeting the information needs of adoptees. METHODS: Birth records were abstracted for a 9% (221/2,529) random sample of adoptees who obtained their records from June 20, 2000, to July 20, 2000, to describe the population and the information they obtained. Telephone interviews documented their motivations, expectations, and whether they considered the birth record useful. RESULTS: The mean age of the adoptees was 41 years, 64% were female, and 97% were white. Virtually all received information about their birth mother; however, only one-third received information about their birth father. Of the 221 sampled, 123 (59%) participated in the telephone survey, 12 were ineligible, 84 could not be reached, and 2 refused. The most common motivations for requesting records were to find birth parents (29%) and to obtain medical information (29%). Twenty-nine percent received less information than they expected, with many expecting, but not receiving, birth father information. Thirty-three (47%) of the 70 adoptees who tried to find their birth mother were successful. The records were considered "very" useful by 52% of respondents, "somewhat" or "a little" useful by 42%, and "not at all" useful by 6%. CONCLUSIONS: The results indicate that many adoptees received less information than they expected, and many did not meet their goals of finding birth parents or obtaining medical information. Nonetheless, the majority considered their birth records useful and important.
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Acceso a la Información/legislación & jurisprudencia , Adopción/legislación & jurisprudencia , Certificado de Nacimiento/legislación & jurisprudencia , Comportamiento del Consumidor/estadística & datos numéricos , Padres , Adulto , Confidencialidad , Recolección de Datos , Femenino , Humanos , Difusión de la Información , Masculino , Persona de Mediana Edad , Motivación , Oregon , Relaciones Padres-HijoRESUMEN
OBJECTIVE: In November 1998, Oregon voters passed Ballot Measure 58, which allowed Oregon adoptees > or = 21 years of age access to their original birth records, which are sealed at adoption. The objective of this study was to evaluate the impact of the measure on the Oregon Health Division (since renamed Oregon Health Services) by assessing procedures used and resources needed after implementation of Measure 58. METHODS: Vital records employees were interviewed about processing, storage, and archive retrieval procedures for pre-adoption birth records before, during, and after the implementation of Measure 58 and the effect on their usual workload. Personnel time, space, and fiscal resources used to process requests for pre-adoption records were also calculated. RESULTS: The Oregon Health Division began to receive requests from adoptees immediately following the passage of Measure 58 in November 1998, but due to legal challenges, they could not be processed until May 31, 2000. From June 2, 2000, through October 20, 2000, 12 staff members and two supervisors issued more than 4,700 pre-adoption birth records while also processing their normal workload, which averages more than 135,400 vital record orders annually. Due to the need for retrieval from archives, requests for pre-adoption birth records were estimated to take 75 hours to process vs. 2-3 minutes for standard requests. Each batch of approximately 75 pre-adoption birth records required approximately 12.5 person-hours from vital records staff and 3-4 person-hours from archive personnel; in addition, supervisors spent time responding to incomplete orders, informing the public and the media, and responding to concerns of adoptees, birth parents, and adoptive parents. Fewer than 1% of requests went unfilled. CONCLUSIONS: Implementation of Measure 58 utilized substantial resources of the Oregon Health Division. States contemplating similar legislation should consider increasing personnel and resources, preparing for intense public and media interest, and reorganizing the storage of adoptees' original birth records so they are easily retrieved.
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Acceso a la Información/legislación & jurisprudencia , Adopción/legislación & jurisprudencia , Certificado de Nacimiento/legislación & jurisprudencia , Control de Formularios y Registros/organización & administración , Gestión de la Información/organización & administración , Administración en Salud Pública , Estadísticas Vitales , Adulto , Confidencialidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oregon , Relaciones Padres-Hijo , PadresAsunto(s)
Prescripciones de Medicamentos , Rol del Médico , Derecho a Morir , Adulto , Anciano , Anciano de 80 o más Años , Prescripciones de Medicamentos/historia , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana Edad , Oregon , Pentobarbital , Autonomía Personal , Rol del Médico/historia , Médicos/estadística & datos numéricos , Derecho a Morir/ética , Derecho a Morir/historia , Derecho a Morir/legislación & jurisprudencia , Secobarbital , Estados UnidosRESUMEN
Despite spending an increasing amount on health care and more than every other industrialized country, the U.S. ranks 37th in health outcomes. The implementation of the Patient Protection and Affordable Care Act (ACA) promises to ensure better access to health care for many Americans through expanded public and private insurance coverage, including basic preventive health care. Public health must seize this critical opportunity by taking steps to ensure that prevention, especially primary prevention, is embedded in our health system. This manuscript outlines four areas where public health officials across the U.S. can immediately capitalize on opportunities created by the ACA to ensure that prevention is a key component of health reform: (1) leading the way on community health assessments; (2) linking clinical and community prevention; (3) supporting the development of alternative payment methodologies to pay for prevention; and (4) serving as a community resource for the coordination of care and building the non-traditional health workforce.
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Reembolso de Seguro de Salud , Patient Protection and Affordable Care Act , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/métodos , Continuidad de la Atención al Paciente , Humanos , Evaluación de Necesidades , Oregon , Servicios Preventivos de Salud/organización & administración , Prevención Primaria , Estados UnidosAsunto(s)
Suicidio Asistido/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Esclerosis Amiotrófica Lateral , Recolección de Datos , Etnicidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias , Oregon , Suicidio Asistido/legislación & jurisprudenciaAsunto(s)
Conducta del Adolescente/psicología , Conducta Infantil/psicología , Gobierno Local , Prevención Primaria/organización & administración , Administración en Salud Pública , Servicios de Salud Escolar/organización & administración , Gobierno Estatal , Violencia/prevención & control , Adolescente , Niño , Humanos , Estudios Multicéntricos como Asunto , Proyectos Piloto , Estudiantes/psicología , Estados UnidosRESUMEN
BACKGROUND: This study was designed to develop an evidence- and community based falls prevention program -- Tai Chi: Moving for Better Balance. METHODS: A mixed qualitative and quantitative approach was used to develop a package of materials for program implementation and evaluation. The developmental work was conducted in 2 communities in the Pacific Northwest. Participants included a panel of experts, senior service program managers or activity coordinators, and older adults. Outcome measures involved program feasibility and satisfaction. RESULTS: Through an iterative process, a program package was developed. The package contained an implementation plan and class training materials (ie, instructor's manual, videotape, and user's guidebook). Pilot testing of program materials showed that the content was appropriate for the targeted users (community-living older adults) and providers (local senior service organizations). A feasibility survey indicated interest and support from users and providers for program implementation. A 2-week pilot evaluation showed that the program implementation was feasible and evidenced good class attendance, high participant satisfaction, and interest in continuing Tai Chi. CONCLUSIONS: The package of materials developed in this study provides a solid foundation for larger scale implementation and evaluation of the program in community settings.
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Accidentes por Caídas/prevención & control , Servicios de Salud Comunitaria , Promoción de la Salud , Actividad Motora , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Mercadeo Social , Taichi Chuan , Factores de Edad , Anciano , Anciano de 80 o más Años , Recolección de Datos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Oregon , Proyectos Piloto , Investigación Cualitativa , Estados UnidosAsunto(s)
Gobierno Local , Práctica de Salud Pública/historia , Gobierno Estatal , Acceso a la Información , Atención a la Salud , Práctica Clínica Basada en la Evidencia , Infecciones por VIH/epidemiología , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fumar/epidemiología , Estados UnidosRESUMEN
The unexpected death of a teenager from neurocysticercosis prompted an investigation of this disease in Oregon. We found 89 hospitalizations, 43 newly diagnosed cases, and 6 deaths from 1995 to 2000. At least five cases occurred in persons who had not traveled or lived outside the United States. Enhanced surveillance for neurocysticercosis is warranted.
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Neurocisticercosis/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Resultado Fatal , Femenino , Registros de Hospitales , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neurocisticercosis/patología , Neurocisticercosis/fisiopatología , Oregon/epidemiologíaRESUMEN
OBJECTIVE: Inadequate supervision of children has contributed to injuries. However, the association of inadequate supervision with injury events in children has not been quantified. The purpose of this study was to describe and quantify the role of inadequate supervision of children in injury deaths. METHODS: Injury deaths among children aged 0 to 6 years in Alaska during 1993 to 1995 and Louisiana during 1994 were classified using 10 child safety standards to assess the role of parent/caregiver supervision in the circumstances of injury death. RESULTS: The leading categories of injury death for both states combined were motor vehicle injury and fire-related injury. Of the classifiable injury deaths in both states (157 [77%] of 203 deaths), the most commonly violated safety standard was "children should be supervised by a responsible care provider" (64 deaths [41%]). Of these deaths, the caregiver was absent in 38%, and the caregiver increased the danger to the child in 17%. Male injury deaths more typically involved a supervision standard violation. Drowning and pedestrian deaths typically involved a supervision standard violation, whereas asphyxiation, homicide, and occupant motor vehicle injury deaths did not. CONCLUSION: Alaska and Louisiana child injury deaths were mostly attributed to preventable violations of 10 child safety standards, most commonly the supervision standard. The methods in this report were useful in identifying target populations and causes of death, which can be used to plan and implement interventions to improve supervision of children.