Investigation of Mycobacterium tuberculosis transmission aboard the U.S.S. Ronald Reagan, 2006.

Pulmonary tuberculosis (TB) was diagnosed in a sailor aboard the U.S.S. Ronald Reagan; an investigation was conducted to determine a screening strategy for 1,172 civilian passengers who were aboard during a temporary guest rider program. Sailors were screened for latent TB infection (LTBI) and TB disease. A case-control study was conducted among sailors to determine factors associated with new LTBI. No secondary TB disease was identified; 13% of close contacts had new LTBI. Factors associated with new LTBI among sailors were having been born outside the United States (adjusted odds ratio = 2.80; 95% confidence interval, 1.55--5.07) and being a carrier air wing member (adjusted odds ratio = 2.89; 95% confidence interval, 1.83--4.58). Among 38 civilian passengers berthed near the patient, 1 (3%) had LTBI. The investigation results indicated that Mycobacterium tuberculosis transmission was minimal and eliminated unnecessary TB screening for 1,134 civilians which saved public health resources.

Addressing disparities in cardiovascular risk through community-based interventions.

Cardiovascular diseases account for a significant portion of deaths and healthcare costs in the United States. Women from ethnic minorities and rural areas carry a disproportionately higher burden of cardiovascular morbidity and mortality. Many factors contribute to this persistent disparity: a comparatively low level of awareness especially among the at-risk populations, increased prevalence of cardiovascular risks linked to the obesity epidemic, and inconsistent levels of screening and treatment of cardiovascular risks. Cultural and social factors that influence lifestyle and behavior also have significant cardiovascular health consequences and contribute to the disparity. Any intervention to address health disparities should include a community-based component that incorporates education at the lay level, as well as the healthcare provider level. We describe a community education initiative to increase awareness and knowledge about heart disease in women and a community-academic collaborative project to improve diabetes and cardiovascular outcome. These programs have been successfully initiated in the Mississippi Delta, a location with some of the highest cardiovascular mortality (especially among the African American women) as well as limited healthcare infrastructure, low socioeconomic levels, and low literacy rates.

Diet and physical activity of U.S. adults with heart disease following preventive advice.

BACKGROUND: The extent to which persons with heart disease have been told to engage in and follow recommended preventive lifestyle actions is unknown. METHODS: Receipt of advice for and levels of reported fruit and vegetable intake and physical activity were analyzed among people with heart disease in 25 states/territories in the 2003 Behavioral Risk Factor Surveillance System, a telephone-based survey of US adults. RESULTS: Overall, 7392 of 113,795 people reported a heart attack or coronary heart disease. Among these, 54.4% of respondents with heart disease were told to eat more fruits and vegetables; 24.7% met recommended 5 servings per day. In multivariable analyses, those told to eat more fruits and vegetables were somewhat more likely than those not advised to meet recommended intake (Odds ratio [OR] 1.30, confidence interval [CI]: 1.10-1.55). Some 53.2% were told to be more physically active; 33.2% met recommended physical activity levels and 30.8% were sedentary. In multivariable analyses, having been told to engage in physical activity was not related to the likelihood of meeting recommended levels (OR: 1.09, 95%; CI: 0.93-1.27). In sub-analyses, receipt of cardiac rehabilitation after heart attack was associated with meeting both dietary (OR: 1.50, CI 1.18-1.92) and activity recommended levels (OR 1.47, CI 1.20-1.82). CONCLUSION: Dietary and physical activity advice and patient actions remain suboptimal. Further efforts to identify effective patient education techniques and barriers to behavior change are needed to improve secondary prevention of heart disease.