Mary Jo Trepka

Pulmonary function in children with initial low birth weight

The objective of this analysis was to examine the effect of low birth weight and prematurity on bronchial air‐flow, bronchial reactivity, airway symptoms and asthma diagnosis at school age. A cross‐sectional epidemiologi‐cal study was performed in three small towns in the eastern part of Germany on 2470 school children aged 5–14 (89.1% of eligible children). A 78 item questionnaire to determine risk factors at birth and in early childhood was employed. 7.8% of the children were born before completing 38 gesta‐tional weeks; 6.6% had a birth weight less than 2500 g. Pulmonary function analysis were done by a mobile plethysmography at the school. There were only weak restrictions in lung volume in term low birth weight (LBW) children (100 ml lower TLC, p = 0.107), and flow (257 ml lower PEFR, p=0.108), were low. However, bronchial hyper‐responsiveness indicated by 292 ml lower FEV1.0 after cold air bronchial provocation, was significantly increased compared to term normal birth weight children (p < 0.001). The effect of LBW was less in older children, only slightly stronger in girls and increased in children mechanically ventilated during the postnatal period. Correspondingly, there was a higher prevalence of diagnosed asthma in term LBW children (OR 1.6, 95%‐confidence interval 1.0–2.6), however these were without an increased risk for any allergic sensitization. LBW, therefore, seems to be a risk factor for smaller lungs and hyperreactive airways primarily in term born children, whereas in pre‐term children the immature bronchial system seems to be recover by school age.

The Epidemiology of Atopic Diseases in Germany: An East-West Comparison

This review summarizes studies comparing the epidemiology of asthma, allergic rhinitis, and atopic dermatitis in eastern versus western German populations. These studies clearly revealed that the prevalence of physician-diagnosed allergic rhinitis was higher in western Germany than in eastern Germany. The rate for asthma also tended to be higher in western than in eastern populations, whereas a tendency for less atopic dermatitis was found in western German children. When sensitization rates, as measured by RAST and skin-prick tests, were compared, a clear increase was found in western versus eastern young-adult German populations. This phenomenon may be related to exposure to different allergens, such as those associated with nutritional patterns or pet ownership, as well as to different environmental factors, such as outdoor and indoor pollutants. If lifestyle or environmental factors play a role in developing allergic sensitization, then one would expect the rates of sensitization in eastern and western Germany to converge as the two societies become more similar.

High-Risk Sexual Behavior Among Students of a Minority-Serving University in a Community With a High HIV/AIDS Prevalence

Objective: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. Participants and Methods: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. Results: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. Conclusions: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.

Arsenic burden among children in industrial areas of eastern Germany

The internal burden of arsenic among 5- to 14-year-old eastern German children in the heavily polluted areas of Hettstedt, a region of smelting and copper mining, and Bitterfeld, a center of chemical production and coal mining, was compared with that in a control area (Zerbst) by means of urinary arsenic concentrations in 1992-94. The unadjusted geometric mean among the 950 children was significantly higher in Hettstedt (5.1 micrograms/l; 95% C.I. 4.8-5.5) but not in Bitterfeld (4.3 micrograms/l; 95% C.I. 3.7-4.9) compared with the control area (4.0 micrograms/l; 95% C.I. 3.5-4.5). This difference persisted after adjustment for relevant confounders. Despite these regional differences, recent fish consumption was as strongly associated with urinary arsenic levels (42% increase, 95% C.I. 18-71%). Additionally, although the geometric mean among the children in Hettstedt (4.8 micrograms As/g creatinine; 95% C.I. 4.5-5.1) was higher than that found in an environmental survey of eastern German children (3.60 micrograms As/g creatinine; 95% C.I. 3.06-4.24), it was similar to that found among western German children (4.59 micrograms As/g creatinine; 95% C.I. 4.20-5.02). This suggests that the arsenic contamination in Hettstedt is not substantially increasing the internal burden of arsenic among children above that found in other German children.

Late HIV diagnosis: Differences by rural/urban residence, Florida, 2007-2011.

The purpose of this retrospective cohort study was to identify individual-level demographic and community-level socioeconomic and health care resource factors associated with late diagnosis of HIV in rural and urban areas of Florida. Multilevel modeling was conducted with linked 2007-2011 Florida HIV surveillance, American Community Survey, Area Health Resource File, and state counseling and testing data. Late diagnosis (defined as AIDS diagnosis within 3 months of HIV diagnosis) was more common in rural than urban areas (35.8% vs. 27.4%) (p<0.0001). This difference persisted after controlling for age, sex, race/ethnicity, HIV transmission mode, country of birth, and diagnosis year (adjusted OR 1.39; 95% CI 1.17-1.66). In rural areas, older age and male sex were associated with late HIV diagnosis; zip code-level socioeconomic and county level health care resource variables were not associated with late diagnosis in rural areas. In urban areas only, Hispanic and non-Hispanic black race/ethnicity, foreign birth, and heterosexual mode of transmission were additionally associated with late HIV diagnosis. These findings suggest that, in rural areas, enhanced efforts are needed to target older individuals and men in screening programs and that studies of psychosocial and structural barriers to HIV testing in rural and urban areas be pursued.

Randomized Controlled Trial to Determine the Effectiveness of an Interactive Multimedia Food Safety Education Program for Clients of the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections. OBJECTIVE To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients. DESIGN A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention. SUBJECTS/SETTING Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic. INTERVENTION Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk. MAIN OUTCOME MEASURES Change from pre- to postintervention food safety scores. STATISTICAL ANALYSES PERFORMED A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance. RESULTS Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score. CONCLUSIONS The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Inadequate syphilis screening among women with prenatal care in a community with a high syphilis incidence.

Objectives and Goal: This study was designed to evaluate the extent to which pregnant women in a community with a high syphilis incidence were screened for syphilis according to standard recommendations of twice during prenatal care and at labor and delivery. Study Design: Labor and delivery records from 4 hospitals in Miami–Dade County, Florida, were abstracted to obtain maternal and prenatal care characteristics and syphilis screening practices. Results: Of the 1991 women, records indicated that 1655 (83%) were screened at least once during prenatal care, 220 (11%) were screened twice during prenatal care before delivery, and 184 (9%) were screened twice during prenatal care and at delivery. Attending a private clinic, having more than adequate prenatal care and having private insurance were associated with not being screened at least twice before delivery. Conclusions: Few women were screened according to standard recommendations, and provider or institutional-related factors affected adequacy of screening.

The effect of lead in tap water on blood lead in children in a smelter town

Hettstedt, a city in eastern Germany with a long history of mining and smelting of non-ferrous ores, has multiple lead waste deposits and the remains of a former lead smelter and a copper-silver smelter. As part of a cross-sectional study, an analysis of lead concentrations in drinking water and in blood was undertaken to determine the impact of lead in drinking water on the internal burden of lead in children. The geometric mean of blood lead levels among children 5-14 years old was 35.0 micrograms/l with a 95% confidence interval (C.I.) of 33.4-36.7. The geometric mean of lead in the random tap water samples was 0.5 microgram/l (95% C.I., 0.5-0.6) and 0.7 microgram/l (95% C.I., 0.6-0.8) in the stagnant tap water samples. Blood lead levels were somewhat correlated with the random water measures but not the stagnant water measures (random sample: r = 0.12, P = 0.012; stagnant sample: r = 0.04, P = 0.396). After adjustment for relevant confounders, lead in drinking water (random sample) was not significantly associated with blood lead levels. Factors that were significantly associated with blood lead included gender, the city area of residence, lead in house dust, regular contact with dogs and dirtiness of the child after playing outdoors. Based on this study, lead in domestic tap water contributed little to the lead exposure of children in the lead contaminated region of Hettstedt.

Hepatitis B virus infection risk factors and immunity among sexually transmitted disease clinic clients.

Background and Objectives Hepatitis B virus (HBV) infection is a sexually transmitted infection that can be prevented with hepatitis B vaccination. Goal The goal was to determine prevalence and risk factors for HBV infection and immunity among sexually transmitted disease (STD) clinic clients. Study Design In this cross-sectional study, consenting adult STD clinic clients were interviewed regarding HBV risk factors and vaccination history, and blood was drawn for HBV serologic testing. Results Of the 682 participants, 154 (22.6%) had antibody to hepatitis B core antigen, indicating previous infection, and 64 (9.4%) had only antibody to hepatitis B surface antigen, indicating immunity as a result of hepatitis B vaccination. Only 130 (19.1%) of all participants reported receiving at least one dose of hepatitis B vaccine. Conclusion The majority of clients were susceptible to HBV, were at high risk for HBV infection, and would benefit from hepatitis B vaccination.

Measuring Socioeconomic Inequality in the Incidence of AIDS: Rural–Urban Considerations

Low socioeconomic status (SES) influences the risk of acquiring human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and thus should be considered when analyzing HIV/AIDS surveillance data. Most surveillance systems do not collect individual level SES data but do collect residential ZIP code. We developed SES deprivation indices at the ZIP code tabulation area and assessed their predictive validity for AIDS incidence relative to individual neighborhood-level indicators in Florida using reliability analysis, factor analysis with principal component factorization, and structural equation modeling. For urban areas an index of poverty performed best, although the single factor poverty also performed well. For rural areas no index performed well, but the individual indicators of no access to a car and crowding performed well. In rural areas poverty was not associated with increased AIDS incidence. Users of HIV/AIDS surveillance data should consider urban and rural areas separately when assessing the impact of SES on AIDS incidence.