Remembering Juan Navia.

Juan Navia died on September 4, 2010. Those who knew him as the director of the University of Alabama's John J. Sparkman Center for International Public Health Education and later the dean of UAB School of Public Health watched him train and shape the next generation of global public health leaders with a kind heart and a firm, but gentle, hand. On this third anniversary of Professor Navia's passing, in response to an invitation from the Journal of Dental Research to write an essay on an educator who influenced the professional trajectories of many people, we have put together an account of some of his contributions and attributes to highlight this remarkable leader's accomplishments in and impact on dental public health and global nutrition.

"A satellite primer on tuberculosis:" a collaboration in distance education.

"A Satellite Primer on Tuberculosis" was offered as a distance-based certificate course on tuberculosis (TB) fundamentals to a national audience of over 5,000 individuals. The course was a collaborative effort of a school of public health, a state health department, and the Centers for Disease Control and Prevention. Instruction was provided through print-based self-study modules that were complemented by live, interactive satellite conferences. Course completers, over 70 percent of whom were nurses and employees of public health departments, scored significantly higher on a course posttest than on a pretest, and the vast majority felt the course provided valuable training.

Age distribution of lymphocytic choriomeningitis virus serum antibody in Birmingham, Alabama: evidence of a decreased risk of infection.

Lymphocytic choriomeningitis virus (LCMV) is an arenavirus that causes human disease ranging from a mild, flu-like illness to meningitis. Infections occur principally in and around the home due to contact with infected mice. Data on the incidence of LCMV infection in the United States are scarce but suggest that the risk of infection may have decreased over the past 30-40 years. To examine this hypothesis, sera from an age-stratified sample of hospital patients in Birmingham, Alabama were tested for LCMV antibody by ELISA. The overall prevalence of LCMV-specific IgG was 3.5% (56 of 1,600). The prevalence of antibody among those < 30 years of age was 0.3% (2 of 600), while the prevalence among those 30 years of age and older was 5.4% (P < 0.0001). Multiple logistic regression was used to identify risk factors for LCMV seropositivity. Age was positively associated (P < 0.0001) and socioeconomic status was negatively associated with a positive antibody test result (P < 0.03). These data are consistent with a decreased incidence of human LCMV infection in Birmingham over the past 30-40 years.

Suicide in Alabama, 1980 to 1989.

Trends of US suicide rates show great variations among demographic groups over time. Although more attention has been directed to the increasing suicide rate among adolescents, persons aged 65 years and older continue to commit suicide at a higher rate than for any other age group. To examine the recent trend of suicide rates and compare the suicide pattern with that at the national level, we conducted a study using suicide data in Alabama from 1980 to 1989. For all age groups in Alabama in the 1980s, male suicide rates exceeded female rates. Of the four major race-sex groups, nonwhite females are an especially low-risk group, experiencing a rate of about 1.5/100,000 at all ages. There have been remarkable increases in suicide rates in the 1980s for males, especially for nonwhite males in Alabama. The results suggest that high-risk groups to be targeted for interventions are men over age 45 (especially white men over age 65), and divorced and widowed men and women.

The risk of bladder calculi in patients with spinal cord injuries.

A nonconcurrent prospective study of bladder calculi included 500 persons treated at the University of Alabama in Birmingham Spinal Cord Injury Care System between 1973 and 1981. Risk factors suspected of contributing to the development of bladder calculi were identified. Logistic regression analysis was used to estimate each risk factor's adjusted odds ratio and to develop a predictive model for bladder stone formation. Bladder calculi were most likely to develop within one year of injury. Patients developing bladder calculi prior to first definitive discharge were most likely to be white and have neurologically complete lesions and Klebsiella infections at admission. Patients developing bladder stones within two years of hospital discharge were most likely to be young and white and have indwelling urethral catheters and either Proteus or multiple-organism infections at discharge. The predictive model was 82% sensitive and 83% specific when applied to a validation sample of patients.

The risk of renal calculi in spinal cord injury patients.

A retrospective epidemiologic study of renal calculi was conducted on 5,915 patients from the National Spinal Cord Injury Data Research Center data base. Various risk factors suspected of contributing to the development of renal calculi were identified. Logistic regression analyses were conducted to estimate the adjusted odds ratio for the formation of renal calculi for each risk factor. Life-table techniques were used to assess the interval of highest renal stone risk after injury. Spinal cord injury patients in whom renal calculi developed were more likely to be male patients with neurologically complete lesions and histories of bladder stones. Renal stones were most likely to develop within 3 months after injury. The estimated cumulative proportion of patients free of renal stones 8 years after injury was 92 per cent. Although it appears that patients at high risk for renal calculi can be identified with a relatively small set of predictor variables, more definitive urological information is needed to improve predictive accuracy before final construction of mathematical predictive models that can be considered appropriate for use in a clinical environment.

Prevalence of spinal cord injury: a reestimation employing life table techniques.

A comparison of frequently cited studies of long-term survival among spinal cord injury victims revealed widely ranging survival rates. When coupled with an estimated incidence rate of 30 cases per million persons at risk, these survival rates correspond to prevalence rates ranging from 486 to 969 per million persons, although 500 per million persons is the figure most often cited. A 30.2-year mean life expectancy for spinal cord injury victims was estimated using previously calculated spinal cord injury relative mortality ratios. The corresponding spinal cord injury prevalence rate was 906 cases per million persons. Based on the incidence rate, an estimated 8.88 beds per million population, or just under 2,000 beds, will be necessary in the United States to care adequately for all patients with newly acquired spinal cord injuries.

Tuberculosis and alcoholism. A partial solution through detection.

Alcoholism and tuberculosis often coexist, and patients with this combination have the most frequent failures of therapy. Several intriguing alternatives to standard outpatient chemotherapy are now available. The brief MAST interview (a shortened version of the Michigan Alcoholism Screening Test) has been demonstrated to be effective in identifying alcoholism in public health clinics for tuberculosis in New Orleans and Birmingham, Ala., with scores indicating populations of alcoholic patients of 25% and 28%, respectively. The test could be administered without interrupting the routine of the clinic. We believe that the problem of inadequate therapy in the alcoholic patient with tuberculosis is significant and widespread and is not being handled well is most places. Identification of the potential problem patient at first contact will be most helpful in choosing candidates for specialized forms of therapy, including short-term and supervised treatment, begun before failure of therapy ensues.

Leptospirosis in zoo workers associated with bears.

Leptospirosis due to Leptospira interrogans serovar icterohaemorrhagiae was diagnosed in two zoo animal keepers. The implicated source of infection was bear cubs that had microscopic agglutination antibody titers to leptospires of the Icterohaemorrhagiae serogroup.

Lymphocytic choriomeningitis from pet hamster exposure: a local public health experience.

Eleven cases of hamster associated lymphocytic choriomeningitis occurred within a space of four months in Jefferson County, Alabama residents. A single Birmingham breeder was the source of the infected hamsters. Ten cases experienced an illness of one to three weeks duration with grippe-like symptoms being most frequent. Complaints of nine cases suggested meningeal involvement, and one was asymptomatic. All patients recovered uneventfully. Frequent hamster contact had occurred in most cases, although three individuals reported infrequent or room exposure to the animals. The holding of hamsters for observation prior to sale, random testing of all breeders' stock, and the distribution of printed information with each hamster sold are suggested as precautions against future outbreaks of this nature.