Janet C. Mohle-Boetani

Body size, reproductive factors, and breast cancer survival☆

Mortality rates among 838 white female breast cancer patients were examined for relationships to personal characteristics assessed at time of diagnosis. These included weight and body mass index, oral contraceptive use, and prior menstrual and reproductive events. Multivariate analyses were used to determine the importance of these characteristics in predicting death rates specific for age and extent of disease at time of diagnosis. Weight was associated with poor prognosis among premenopausal patients, but not among postmenopausal patients. Premenopausal women weighing more than 140 lbs at diagnosis had death rates 1.7 times those of lighter women (P = 0.04). This effect was not explained by differences in the distribution of disease stage between the two groups. Body mass index was positively associated with mortality in both premenopausal and postmenopausal patients. In the entire group, the death rate ratio was 1.4 (P = 0.02) for obese (body mass index greater than 30.4 X 10(-3) lbs/in.2) vs lean women. Among premenopausal patients, parous women had higher mortality rates than nulliparous women (death rate ratio = 2.0, P = 0.06). Although the data were sparse, death rates were higher for women having a full-term pregnancy within 2 years of diagnosis than for premenopausal women with earlier pregnancies. Oral contraceptive use, age at menarche, age at first full term birth, and age at menopause were unrelated to mortality.

Occupational coccidioidomycosis in California: outbreak investigation, respirator recommendations, and surveillance findings.

Objective: To describe the investigation of a 2007 occupational coccidioidomycosis outbreak in California, recommend prevention measures, and assess statewide disease burden. Methods: We evaluated the worksite, observed work practices, interviewed the workers and employer, reviewed medical records, provided prevention recommendations including risk-based respirator selection, and analyzed statewide workers compensation claims. Results: Ten of 12 workers developed acute pulmonary coccidioidomycosis; none used respiratory protection. We recommended engineering, work practice, and administrative controls, powered air-purifying respirator use, and medical care. Occupational coccidioidomycosis incidence nearly quadrupled in California from 2000 to 2006, with the highest rates in construction and agricultural workers. Conclusions: Construction workers are at risk for occupational coccidioidomycosis. The high attack rate in this outbreak was due to lack of awareness, rainfall patterns, soil disruption, and failure to use appropriate controls. Multiple risk-based measures are needed to control occupational coccidioidomycosis in endemic areas.

Rates and risk factors for Coccidioidomycosis among prison inmates, California, USA, 2011.

African American ethnicity is a risk factor for primary and disseminated disease in this population.

Awareness and Environmental Exposures Related to Coccidioidomycosis Among Inmates at Two California Prisons, 2013:

Coccidioidomycosis (Valley fever) is a major cause of illness in inmates in some California prisons. This article discusses an investigation conducted at two prisons to describe potential environmental exposures. The study did not identify modifiable risk factors; limiting the type or duration of outdoor activity in these prisons may not decrease coccidioidomycosis morbidity.

1729Preventing Coccidioidomycosis (Valley Fever) at Highly Endemic Prisons in California: Estimating the Effect of a Screening Skin Test to Identify Immune Inmates

Prisons in California: Estimating the Effect of a Screening Skin Test to Identify Immune Inmates Anne Purfield, PhD; Gordana Derado, PhD; Janet Mohle-Boetani, MD, MPH; Charlotte Wheeler, MD MPH; Benjamin Park, MD; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Atlanta, GA; Centers for Disease Control and Prevention, Atlanta, GA; California Correctional Health Care Services, Elk Grove, CA

Risk Stratification With Coccidioidal Skin Test to Prevent Valley Fever Among Inmates, California, 2015

Two California state prisons (A and B) have very high rates of coccidioidomycosis (Valley Fever). The prison health care service sought to improve their prevention strategy by risk stratification with a newly available spherulin-based Coccidioides delayed-type hypersensitivity test. Of the 36,789 voluntarily screened inmates, 4.7% experienced adverse reactions. A positive test (8.6% of those tested) was independently associated with (1) incarceration at prisons A and B, (2) admission to prison from a Coccidioides-endemic county, (3) length of stay at prisons A and B, and (4) increasing age. These findings suggest that the test is safe and performing well at risk stratification; the prison system now restricts inmates with negative tests from prisons A and B. This novel use of the test might benefit other coccidioidomycosis prevention programs.

Increased Coccidioidomycosis Among Inmates at a California Prison: Initial Investigation in 2005 to 2006

Since 2005, coccidioidomycosis has increased among inmates at a California prison. Our initial investigation found an incidence of 3,323 cases/100,000 persons. Black race, age ≥41 years, and residence on Yard C were significantly associated with coccidioidomycosis (p < .05). Inmates at this prison have continued to be at risk for coccidioidomycosis.