It takes a village: community education predicts paediatric lower-respiratory infection risk better than maternal education.

BACKGROUND: Few studies have evaluated the contribution of community and parental education levels in determining paediatric outcomes, including lower-respiratory infection (LRI), the leading global cause of child mortality. METHODS: The authors evaluated the association between community and maternal educational attainment and LRI risk among Medicaid-enrolled children age <2 years in Alaska, which has one of the highest LRI incidences ever reported. An individual-level database was created by linking Medicaid data to birth certificate files. A community-level database was created by calculating community LRI incidence rates and linking these values to Department of Labor census variables. Multilevel modelling was used to evaluate the independent effects of maternal and community education levels on LRI risk. RESULTS: Statewide outpatient and inpatient LRI incidences were high at 42 and 6 per 100 child-years. When controlling for potential individual and community level confounding variables, a child's risk of outpatient and inpatient LRI was independently predicted in a dose-response manner by the child's mother's educational attainment and the educational attainment of other adults in the child's community. The latter variable had a stronger association and higher community education levels substantially mitigated the risk of poor maternal education. CONCLUSIONS: LRI risk among Alaskan children is affected by the formal education levels of the child's mother and other adults in their community. The mechanisms by which community education might influence LRI risk remain unknown and may include access to medical knowledge or acceptance of scientific versus traditional beliefs.

Passenger behaviors associated with norovirus infection on board a cruise ship--Alaska, May to June 2004.

BACKGROUND: During May 2004, the Vessel Sanitation Program (VSP) investigated an outbreak of norovirus gastroenteritis on board a cruise ship sailing in Alaska waters. The objectives were to identify a common food item source and explore behavioral risk factors for person-to-person transmission among passengers. METHODS: A case was defined as three or more episodes of loose stools within 24 hours or two or fewer episodes of loose stools accompanied by one or more episodes of vomiting. Vomitus and stool samples from affected passengers were tested for norovirus by reverse transcriptase-polymerase chain reaction. Environmental health officers performed an environmental investigation following VSP protocol. Questionnaires about food items consumed and behavioral risk factors were placed in cabin mailboxes (n = 2,018). A case-control study design using multivariable logistic regression tested associations between risk factors and disease. RESULTS: A total of 359 passengers (24.1% of respondents) met the case definition. Four of seven clinical specimens tested positive for norovirus. No significant deficiencies in environmental health practices were identified, and no meal servings were associated with disease. Having a cabin mate sick with diarrhea or vomiting [odds ratio (OR): 3.40; 95% confidence interval (CI) = 1.80-6.44] and using a specific women's toilet that was contaminated with vomit (OR: 5.13; 95% CI = 1.40-18.78) were associated with disease. Washing hands before meals was protective (OR: 0.25; 95% CI = 0.12-0.54) against disease. CONCLUSIONS: Widespread person-to-person norovirus outbreaks can occur on board cruise ships, even with appropriate environmental health practices. Programs to prevent and control norovirus outbreaks on board cruise ships should involve strategies that disrupt person-to-person spread and emphasize hand washing.

Airborne particulate matter from primarily geologic, non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children less than 20 years old enrolled in Medicaid in Anchorage, Alaska.

In Anchorage, Alaska, particulates with aerodynamic diameter < or = 10 micro m (PM(10)) arise primarily from natural, geologic sources, and particulates with aerodynamic diameter < or = 2.5 micro m (PM(2.5)) arise primarily from automobile emissions. The current study used a population-based time-series analysis design to evaluate the effects of daily and weekly PM(10) and PM(2.5) on respiratory health outcomes among children <20 years of age residing in Anchorage enrolled in Medicaid. All generated estimating equations models were adjusted for season, year, weekends, temperature, wind speed, and precipitation. Relative to the days with PM(10) mass concentration < or = 13 micro g/m(3), a significant 9.3% increase (RR: 1.093, 95% CI: 1.004-1.191) in the rate of outpatient visits for asthma occurred during days with PM(10) of 20-33 micro g/m(3). No further dose-response occurred for days with PM(10) > or = 34 micro g/m(3). A significant 18.1% increase (RR: 1.181, 95% CI: 1.010-1.381) in the rate of quick-relief medication prescriptions occurred during days with PM(10) of 34-60 micro g/m(3), and a 28.8% increase (RR: 1.288, 95% CI: 1.026-1.619) occurred during days with PM(10) > or = 61 micro g/m(3). Similar results for outpatient asthma visits and quick-relief medication occurred in weekly models. There were no significant associations with PM(2.5) in either daily or weekly models. These subtle but statistically significant associations suggest that non-industrial, geologic sources of PM(10) may have measurable health effects at levels below current national standards.

Asthma is associated with preterm birth but not with small for gestational age status among a population-based cohort of Medicaid-enrolled children <10 years of age.

BACKGROUND: Few population-based studies have evaluated the association between birth weight or gestation and subsequent clinically significant asthma. METHODS: Birth records of 37 349 Alaska residents <10 years of age who were enrolled in Medicaid for at least 365 days during 1999-2002 were linked to a Medicaid billing file. The occurrence of asthma and lower respiratory infections during the study period was categorised on the basis of standard International Classification of Diseases 9th Revision codes. The association between gestational age or small for gestational age status and asthma outcomes was adjusted for recent history of lower respiratory infection, years of Medicaid enrolment, age at enrolment and a variety of birth-related factors. RESULTS: Among children <5 years of age, the adjusted odds ratio (OR) for developing asthma decreased by 5.5% (95% confidence interval (CI) -0.2 to 10.9) and 7.9% (95% CI 5.2 to 10.4) per additional week of gestational age for children without and with any lower respiratory tract infection, respectively. For children > or =5 years of age, the adjusted OR for developing asthma decreased by 3.4% (95% CI -2.8 to 9.8) and 3.7% (95% CI -2.0 to 9.2) per additional week of gestation for those without and with lower respiratory tract infection, respectively. Among all children with asthma, the adjusted OR for hospitalisation due to asthma decreased by 6.9% (95% CI 2.1 to 11.5) for each additional week of gestational age. Small for gestational age status was not significantly associated with asthma outcomes. CONCLUSIONS: Preterm birth but not small for gestational age status predicted subsequent asthma outcomes. Adverse effects of preterm birth on asthma outcomes persist beyond age 5 years.

Asymptomatic Helicobacter pylori infection and iron deficiency are not associated with decreased growth among Alaska Native children aged 7-11 years.

INTRODUCTION: Alaska Native children have high Helicobacter pylori infection and iron deficiency prevalences, and their average height-for-age is lower than US reference populations. During a clinical trial to determine the impact of H. pylori treatment on iron deficiency, we evaluated the effects of H. pylori infection and treatment on growth. MATERIALS AND METHODS: We measured height and weight for children aged 7-11 years in western Alaska using village-based measuring devices. H. pylori infection was determined by urea breath test and iron deficiency using serum ferritin. Children with H. pylori infection and iron deficiency entered the treatment phase and received iron alone or iron plus triple therapy for H. pylori. Follow-up evaluations occurred at 2, 8, and 14 months. We evaluated the association between baseline H. pylori infection and growth; among children in the treatment phase, we also assessed the effect of H. pylori resolution on growth. RESULTS: At baseline, 566 (87.1%) of 650 children were infected with H. pylori. Neither height and weight, nor body mass index differed by H. pylori infection status. Of 189 children in the treatment phase, 20 (10.6%) were uninfected at all three follow-up periods, and 54 (28.6%) were uninfected for one or two periods. Compared with continuously infected children, children in these two groups had little evidence of improvements in any of the measured growth outcomes. CONCLUSIONS: H. pylori infection is not related to growth among Alaska Native children aged 7-11 years. Growth deficiency should not be considered an indication for H. pylori therapy.

Public health evaluation of cadmium concentrations in liver and kidney of moose (Alces alces) from four areas of Alaska.

Liver and/or kidney samples were collected from 139 hunter-killed moose from four areas of Alaska during 1986. The concentration of cadmium in organ tissue was determined by direct-current plasma atomic emission spectrometry. All results are reported as mug/g wet weight. Concentrations of cadmium in liver ranged from 0.06 microg/g to 9.0 microg/g; in the kidney cortex they ranged from 0.10 microg/g to 65.7 microg/g. Cadmium levels were significantly associated with location and age. The highest geometric mean liver (2.11 microg/g) and kidney cortex (20.2 microg/g) cadmium concentrations were detected in moose harvested near Galena, Alaska. Limited dietary information from Alaska and Canada indicates that the intake of moose liver or kidney does not exceed, in most individuals, the World Health Organization recommendations for weekly cadmium consumption of 400 microg to 500 microg. Additionally, human biomonitoring data from Canada and Alaska indicate exposure to cadmium is low except for individuals who smoke cigarettes. Given the nutritional and cultural value of subsistence foods, the Alaska Division of Public Health continues to support the consumption of moose liver and kidney as part of a well-balanced diet. Human biomonitoring studies are needed in Alaska to determine actual cadmium exposure in populations with a lifelong history of moose liver and kidney consumption.