Lawrence P. Hanrahan

Heat wave morbidity and mortality, Milwaukee, Wis, 1999 vs 1995: an improved response?

OBJECTIVES This study examined whether differences in heat alone, as opposed to public health interventions or other factors, accounted for the reduction in heat-related deaths and paramedic emergency medical service (EMS) runs between 1995 and 1999 during 2 heat waves occurring in Milwaukee, Wis. METHODS Two previously described prediction models were adapted to compare expected and observed heat-related morbidity and mortality in 1999 based on the citys 1995 experience. RESULTS Both models showed that heat-related deaths and EMS runs in 1999 were at least 49% lower than levels predicted by the 1995 relation between heat and heat-related deaths or EMS runs. CONCLUSIONS Reductions in heat-related morbidity and mortality in 1999 were not attributable to differences in heat levels alone. Changes in public health preparedness and response may also have contributed to these reductions.

Decreased Sex Ratio Following Maternal Exposure to Polychlorinated Biphenyls from Contaminated Great Lakes Sport-Caught Fish: A Retrospective Cohort Study.

BackgroundFish from the Great Lakes are contaminated with polychlorinated biphenyls, which have been found to have several adverse reproductive effects. Several environmental contaminants have been found to alter the sex ratio of offspring at birth, but the evidence of such an effect of polychlorinated biphenyls has been inconsistent.MethodsWe examined parental serum polychlorinated biphenyl concentration in relation to the sex ratio of 173 children of mothers and 208 children of fathers from the Great Lakes region of the United States between 1970 and 1995. We calculated odds ratios for a male child using logistic regression and generalized estimating equations with adjustment for the year of birth of the child, maternal and paternal age, the mothers parity at the childs birth, and whether the child had an older brother.ResultsThe adjusted odds ratio for having a male child among mothers in the highest quintile of serum polychlorinated biphenyl concentration was 0.18 (95% CI: 0.06–0.59) compared to mothers in the lowest quintile. Treating exposure as a continuous variable, the adjusted odds ratio for having a male child was 0.54 per unit increase in the natural log of maternal serum polychlorinated biphenyl concentration (95% CI: 0.33–0.89). There was little evidence of an association with paternal exposure. We found no association between either maternal or paternal serum dichlorodiphenyl-dichloroethene concentration and the sex ratio.ConclusionsThese findings suggest that maternal exposure to polychlorinated biphenyls may decrease the sex ratio of offspring. These data add to the growing body of evidence that exposure to particular chemicals can alter the sex ratio at birth.

Formaldehyde vapor in mobile homes: a cross sectional survey of concentrations and irritant effects.

Sixty-five Wisconsin mobile home households volunteered for an assessment of indoor formaldehyde gas. Sixty-one teenage and adult occupants completed health questionnaires. Formaldehyde concentrations ranged from less than 0.10 to 0.80 ppm, with the risk of ocular discomfort showing a positive dose-response relationship.

Estimating Wisconsin Asthma Prevalence Using Clinical Electronic Health Records and Public Health Data

OBJECTIVES We compared a statewide telephone health survey with electronic health record (EHR) data from a large Wisconsin health system to estimate asthma prevalence in Wisconsin. METHODS We developed frequency tables and logistic regression models using Wisconsin Behavioral Risk Factor Surveillance System and University of Wisconsin primary care clinic data. We compared adjusted odds ratios (AORs) from each model. RESULTS Between 2007 and 2009, the EHR database contained 376,000 patients (30,000 with asthma), and 23,000 (1850 with asthma) responded to the Behavioral Risk Factor Surveillance System telephone survey. AORs for asthma were similar in magnitude and direction for the majority of covariates, including gender, age, and race/ethnicity, between survey and EHR models. The EHR data had greater statistical power to detect associations than did survey data, especially in pediatric and ethnic populations, because of larger sample sizes. CONCLUSIONS EHRs can be used to estimate asthma prevalence in Wisconsin adults and children. EHR data may improve public health chronic disease surveillance using high-quality data at the local level to better identify areas of disparity and risk factors and guide education and health care interventions.

Formaldehyde concentrations in Wisconsin mobile homes

Mobile homes utilize a class of prefabricate construction techniques which rely greatly upon the use of particle board and hardwood plywood paneling for structural components. This has resulted In household sources which may emit formaldehyde into the home, since urea-formaldehyde resins are used as the bonding agent in most pressed wood stocks. A series of 137 mobile home households was investigated to determine indoor formaldehyde exposure concentrations. Homes were selected based on the estimated age of the construction components. Homes were studied serially for a nine-month period, with formaldehyde samples obtained on a monthly basis using a modified NIOSH chromotropic acid procedure. Formaldehyde concentrations were found to range from less than 0.10 ppm to 2.84 ppm. The median exposure concentration was 0.39 ppm. Analysis of variance was performed on each home to discern visit and room measurement effects. Eighty-nine percent of the homes exhibited no measurement placement effects, while only 10 p...

Electronic Health Records and Community Health Surveillance of Childhood Obesity

BACKGROUND Childhood obesity remains a public health concern, and tracking local progress may require local surveillance systems. Electronic health record data may provide a cost-effective solution. PURPOSE To demonstrate the feasibility of estimating childhood obesity rates using de-identified electronic health records for the purpose of public health surveillance and health promotion. METHODS Data were extracted from the Public Health Information Exchange (PHINEX) database. PHINEX contains de-identified electronic health records from patients primarily in south central Wisconsin. Data on children and adolescents (aged 2-19 years, 2011-2012, n=93,130) were transformed in a two-step procedure that adjusted for missing data and weighted for a national population distribution. Weighted and adjusted obesity rates were compared to the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in 2014. RESULTS The weighted and adjusted obesity rate was 16.1% (95% CI=15.8, 16.4). Non-Hispanic white children and adolescents (11.8%, 95% CI=11.5, 12.1) had lower obesity rates compared to non-Hispanic black (22.0%, 95% CI=20.7, 23.2) and Hispanic (23.8%, 95% CI=22.4, 25.1) patients. Overall, electronic health record-derived point estimates were comparable to NHANES, revealing disparities from preschool onward. CONCLUSIONS Electronic health records that are weighted and adjusted to account for intrinsic bias may create an opportunity for comparing regional disparities with precision. In PHINEX patients, childhood obesity disparities were measurable from a young age, highlighting the need for early intervention for at-risk children. The electronic health record is a cost-effective, promising tool for local obesity prevention efforts.

Wisconsin's environmental public health tracking network: Information systems design for childhood cancer surveillance

In this article we describe the development of an information system for environmental childhood cancer surveillance. The Wisconsin Cancer Registry annually receives more than 25,000 incident case reports. Approximately 269 cases per year involve children. Over time, there has been considerable community interest in understanding the role the environment plays as a cause of these cancer cases. Wisconsin’s Public Health Information Network (WI-PHIN) is a robust web portal integrating both Health Alert Network and National Electronic Disease Surveillance System components. WI-PHIN is the information technology platform for all public health surveillance programs. Functions include the secure, automated exchange of cancer case data between public health–based and hospital-based cancer registrars; web-based supplemental data entry for environmental exposure confirmation and hypothesis testing; automated data analysis, visualization, and exposure–outcome record linkage; directories of public health and clinical personnel for role-based access control of sensitive surveillance information; public health information dissemination and alerting; and information technology security and critical infrastructure protection. For hypothesis generation, cancer case data are sent electronically to WI-PHIN and populate the integrated data repository. Environmental data are linked and the exposure–disease relationships are explored using statistical tools for ecologic exposure risk assessment. For hypothesis testing, case–control interviews collect exposure histories, including parental employment and residential histories. This information technology approach can thus serve as the basis for building a comprehensive system to assess environmental cancer etiology.

A radiographic survey of public school building maintenance and custodial employees

Analyses of radiographs from a cohort of 457 school maintenance and custodial workers (90 had no employment other than at a school) demonstrated an increased prevalence of abnormalities consistent with asbestos-caused disease. Pleural abnormalities predominated (24 of 29). The abnormalities could not be explained by occupational asbestos exposures which may have occurred prior to school employment. Abnormality prevalence ranged from 1.7% among those with less than 10 years to 37% among those with 30 or more years of public school employment. Laborers and skilled tradesmen with more than 20 years of school employment had a higher prevalence of abnormality (40 and 28%) than the building engineers (14%). In order to ensure that future asbestos exposure and disease risk is minimized in buildings constructed with asbestos-containing materials (ACM), implementation of asbestos hazard identification and abatement must include a rigorous operations and maintenance program. Control of asbestos exposure from in-place ACM is a public health priority.

Roles of Clinician, Patient, and Community Characteristics in the Management of Pediatric Upper Respiratory Tract Infections

PURPOSE Prior studies have evaluated factors predictive of inappropriate antibiotic prescription for upper respiratory tract infections (URIs). Community factors, however, have not been examined. The aim of this study was to evaluate the roles of patient, clinician, and community factors in predicting appropriate management of URIs in children. METHODS We used a novel database exchange, linking electronic health record data with community statistics, to identify all patients aged 3 months to 18 years in whom URI was diagnosed in the period from 2007 to 2012. We followed the Healthcare Effectiveness Data and Information Set (HEDIS) quality measurement titled “Appropriate treatment for children with upper respiratory infection” to determine the rate of appropriate management of URIs. We then stratified data across individual and community characteristics and used multiple logistic regression modeling to identify variables that independently predicted antibiotic prescription. RESULTS Of 20,581 patients, the overall rate for appropriate management for URI was 93.5%. Family medicine clinicians (AOR = 1.5; 95% CI 1.31, 1.71; reference = pediatric clinicians), urgent care clinicians (AOR = 2.23; 95% CI 1.93, 2.57; reference = pediatric clinicians), patients aged 12 to 18 years (AOR = 1.44; 95% CI 1.25, 1.67; reference = age 3 months to 4 years), and patients of white race/ ethnicity (AOR = 1.83; 95% CI 1.41, 2.37; reference = black non-Hispanic) were independently predictive of antibiotic prescription. No community factors were independently predictive of antibiotic prescription. CONCLUSIONS Results correlate with prior studies in which non-pediatric clinicians and white race/ethnicity were predictive of antibiotic prescription, while association with older patient age has not been previously reported. Findings illustrate the promise of linking electronic health records with community data to evaluate health care disparities.

Linking electronic health records with community-level data to understand childhood obesity risk

Environmental and socioeconomic factors should be considered along with individual characteristics when determining risk for childhood obesity.