A summary of health outcomes: multistate foodborne disease outbreaks in the U.S., 1998-2007.

Multistate foodborne disease outbreaks (FBDOs) pose a particular threat to public health. The study described in this article sought to describe the incidence and health outcomes of multistate FBDOs in the U.S. from 1998 to 2007. The Centers for Disease Control and Prevention's (CDC's) OutbreakNet Foodborne Outbreak online database was used to analyze FBDOs reported to and confirmed by CDC between 1998 and 2007. Univariate analysis and ANOVA were used to examine outcomes of illnesses, hospitalizations, and deaths. Over 100 multistate FBDOs occurred between 1998 and 2007, with a slight increase over time. Average illnesses, hospitalizations, and deaths were 74.075 (SD = 106.24), 14.11 (SD = 23.23), and 0.826 (SD = 2.88), respectively. Vectors most often identified as the cause of the FBDOs were Salmonella (n = 57) and E. coli (n = 30), making up 81% of all multistate outbreaks. Policy makers and health officials need to reconsider the means by which industry and government coordinate response to outbreaks--particularly across jurisdictions--to ensure an efficient and seamless system of response, particularly in the case of multistate outbreaks.

Impact of chronic constipation on health-related quality of life, work productivity, and healthcare resource use: an analysis of the National Health and Wellness Survey.

BACKGROUND: There has been limited research addressing the effects of constipation on work productivity and healthcare resource use. AIMS: To assess the effect of chronic constipation on health outcomes and healthcare resource use. METHODS: Using data from the 2007 National Health and Wellness Survey (NHWS), chronic constipation patients (n = 1,430) were propensity score-matched to controls (n = 1,430) on demographic and clinical characteristics. Differences between groups in health-related quality of life (SF-12v2), work productivity and activity impairment, and resource use in the last 6 months were examined. Mediation analyses were conducted in order to determine whether the relationship between constipation and resource use was caused by a reduction in health status. RESULTS: Chronic constipation patients reported significantly lower levels of health-related quality of life (physical component summary score: 39.57 vs. 43.73; mental component summary score: 43.19 vs. 47.86, all P-values < 0.01) and significantly higher levels of loss of work productivity and activity impairment (absenteeism: 9.08% vs. 5.20%; presenteeism: 29.52% vs. 19.09%; overall work impairment: 33.65% vs. 21.56%; activity impairment: 46.58% vs. 33.90%, all P-values < 0.01) compared to the matched controls. Chronic constipation patients also reported significantly more provider (7.73 vs. 5.63) and emergency room visits (0.52 vs. 0.30) in the past 6 months (all P-values < 0.01). Mediation analyses suggested that increased resource use among chronic constipation patients were partially a result of reduced health status. CONCLUSIONS: Compared to matched controls, chronic constipation patients reported greater economic and humanistic burden. Alleviating the humanistic burden associated with constipation may have economic benefits.

Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life.

AIMS: The study's aim was to quantify prevalence of tolerability issues among patients with T2DM currently treated with OADs and to assess its association with treatment adherence, satisfaction and health-related quality of life (HRQL). METHODS: Data were collected from the 2006-2008 US National Health and Wellness Survey and the Ailment Panel of Lightspeed Online Research, an internet-based questionnaire. Participants (N=2074) self-reported a diagnosis of T2DM, were >18 years of age and currently taking >1 OADs but not insulin, and spoke English. RESULTS: The majority (71.7%) experienced at least 1 tolerability issue in the past 2 weeks; 49.7% experienced >2. Tolerability issues included signs/symptoms of hypoglycemia (57.2%), constipation/diarrhea (28%), headaches (25.6%), weight gain (22.9%) and water retention (21.0%). There was a significant association between the number of tolerability issues and both the likelihood of non-adherence (r=0.20, p<0.01) and reduced treatment satisfaction (r=-0.42, p<0.01). Each additional tolerability issue was associated with 28% greater likelihood of medication non-adherence. Constipation/diarrhea (b=-0.02, p<0.01) and symptoms of hypoglycemia (b=-0.08, p<0.01) were significantly associated with lower HRQL scores. CONCLUSIONS: Optimizing OAD therapy of T2DM by improving tolerability may increase patient satisfaction, medication adherence and HRQL, and may increase the likelihood of attaining treatment goals.