Public perceptions of non-pharmaceutical interventions for influenza and mosquito-borne illnesses - a statewide survey in Arizona.

AIMS: We conducted a statewide online survey to understand public knowledge, attitudes, and practices (KAP) related to non-pharmaceutical interventions (NPIs) for mosquito-borne diseases and influenza in Arizona. METHODS: The survey included knowledge of diseases, major health concerns, and sources of health information and KAP of NPIs for influenza and mosquito-borne diseases. Our team worked with Qualtrics®, an online survey company, to recruit a representative sample of 1500 adults in Arizona. RESULTS: Of the 1531 respondents who completed the survey, most indicated that chronic conditions were their primary health concern (48%), with the other half split between infectious diseases (25%) and health effects of environmental conditions (26%). The majority (88%) of respondents indicated that they use the Internet to get their health information. Approximately one in eight people reported not emptying standing water and reducing potential mosquito habitats, despite respondents citing them as being the most effective factors in reducing mosquitoes. Regarding specific diseases, about half of the respondents were concerned about West Nile virus and/or Zika virus. Most (85%) people knew the signs and symptoms of influenza and 63% of people reported being likely to get the influenza shot. Those who did not vaccinate (n = 285) reported concerns that the vaccine would make them sick (41%), was ineffective (37%), or others indicated, 'I don't want to' (37%). CONCLUSIONS: Overall, respondents were most concerned with chronic conditions and received their information from the Internet. Knowledge about mosquito-borne diseases was low. There were high levels of acceptance and self-reported uptake of the influenza vaccine.

Case-case analysis of Campylobacter and Salmonella - using surveillance data for outbreak investigations and monitoring routine risk factors.

Utilising routine surveillance data, this study presents a method for generating a baseline comparison that can be used in future foodborne outbreak investigations following a case-case methodology. Salmonella and Campylobacter cases (2012-2015) from Maricopa County, AZ were compared to determine differences in risk factors, symptoms and demographics. For foods and other risk factors, adjusted odds ratios were developed using Campylobacter as the reference. Comparisons were also made for three major Salmonella subtypes, Typhimurium, Enteritidis and Poona as compared with Campylobacter. Salmonella cases were younger, while Campylobacter cases were more Hispanic and female. Campylobacter cases reported consuming peppers, sprouts, poultry, queso fresco, eggs and raw nuts more and reported contact with animal products, birds, visiting a farm or dairy, owning a pet, a sick pet, swimming in a river, lake or pond, or handling multiple raw meats more. Salmonella cases reported visiting a petting zoo and contact with a reptile more. There were significant variations by Salmonella subtype in both foods and exposures. We recommend departments conduct this analysis to generate a baseline comparison and a running average of relevant odds ratios allowing staff to focus on trace-back of contaminated food items earlier in the outbreak investigation process.

Student outbreak response teams: lessons learned from a decade of collaboration.

OBJECTIVES: Student response teams within colleges of public health effectively address important concerns for two stakeholders. For universities, students learn the fundamentals of field epidemiology and provide popular training and networking opportunities. For health departments, students serve as surge capacity as trained workforce available during outbreak investigations and potentially for routine tasks. STUDY DESIGN: This paper describes the interaction between a student response team and several health departments utilizing specific examples to demonstrate the various roles and activities students can fulfill. Lessons learned from both University team leaders and the various health departments are also included. METHODS: The program evolved over time, beginning with a needs assessment of local health departments and a determination of student training needs, collection, and confidential transmission of data, and interviewing techniques. Over the last decade students have worked on outbreak investigations, case-control studies, program evaluations, and in-field responses. RESULTS: Since 2005, over 200 public health graduate students have contributed more than 1800 h investigating 62 separate disease outbreaks in Arizona. In addition, over the past four years students also worked an additional 2500 h to assist county health departments in routine enteric investigations, specifically for Campylobacter and Salmonella. Best practices and lessons learned found that communication, preplanning and a willingness to collaborate increased the learning opportunities for students and ability for health departments to increase their capacity both during an emergency and for routine work. CONCLUSIONS: Establishment of a student response team (1) trains students in field experiences; (2) creates trained surge capacity for health departments; (3) increases collaboration between schools of public health and state/local health departments; (4) establishes a way to share funding with a local health department; and (5) increases the number of students being placed in health departments for projects, internships, and jobs following graduation.

Assessing risk factors of sporadic Campylobacter infection: a case-control study in Arizona.

Case-control studies of sporadic Campylobacter infections have predominately been conducted in non-Hispanic populations. In Arizona, rates of campylobacteriosis have been historically higher than the national average, with particularly high rates in Hispanics. In 2010, health departments and a state university collaborated to conduct a statewide case-control study to determine whether risk factors differ in an ethnically diverse region of the United States. Statistically significant risk factors in the final multivariate model were: eating cantaloupe [odds ratio (OR) 7·64], handling raw poultry (OR 4·88) and eating queso fresco (OR 7·11). In addition, compared to non-Hispanic/non-travellers, the highest risk group were Hispanic/non-travellers (OR 7·27), and Hispanic/travellers (OR 5·87, not significant). Results of this study suggest Hispanics have higher odds of disease, probably due to differential exposures. In addition to common risk factors, consumption of cantaloupe was identified as a significant risk factor. These results will inform public health officials of the varying risk factors for Campylobacter in this region.

The dicrotic pulse: a common, non-ominous finding after the Ross operation.

We noted a dicrotic pulse in several patients following a Ross operation. Although the etiology of this unique arterial waveform is not completely understood, it has been reported as a sign of low cardiac output and a poor prognosis. We reviewed preoperative echocardiograms and postoperative radial arterial pressure tracings in 33 patients who underwent a Ross procedure between 2000 and 2004. We found a dicrotic pulse to occur commonly (20/33; 61%) following a Ross operation. Moderate to severe preoperative aortic insufficiency was present in 19/20 patients (95%) in whom a dicrotic pulse was noted and in only 3/13 (23%) who did not exhibit a postoperative dicrotic pulse (p<0.001). A dicrotic pulse was not associated with an increased use of vasoactive infusions or longer hospitalization following the Ross operation. The dicrotic pulse should be recognized as a common postoperative finding in Ross patients that does not herald a delayed postoperative convalescence. The mechanism for a dicrotic pulse in these patients is speculative but may result from changes in vascular compliance secondary to chronic aortic insufficiency.