Radon and lung cancer: a cost-effectiveness analysis.

OBJECTIVES: This study examined the cost-effectiveness of general and targeted strategies for residential radon testing and mitigation in the United States. METHODS: A decision-tree model was used to perform a cost-effectiveness analysis of preventing radon-associated deaths from lung cancer. RESULTS: For a radon threshold of 4 pCi/L, the estimated costs to prevent 1 lung cancer death are about $3 million (154 lung cancer deaths prevented), or $480,000 per life-year saved, based on universal radon screening and mitigation, and about $2 million (104 lung cancer deaths prevented), or $330,000 per life-year saved, if testing and mitigation are confined to geographic areas at high risk for radon exposure. For mitigation undertaken after a single screening test and after a second confirmatory test, the estimated costs are about $920,000 and $520,000, respectively, to prevent a lung cancer death with universal screening and $130,000 and $80,000 per life-year for high risk screening. The numbers of preventable lung cancer deaths are 811 and 527 for universal and targeted approaches, respectively. CONCLUSIONS: These data suggest possible alternatives to current recommendations.

Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971-1974 and 1988-1994)

Iodine deficiency in a population causes increased prevalence of goiter and, more importantly, may increase the risk for intellectual deficiency in that population. The National Health and Nutrition Examination Surveys [NHANES I (1971-1974) and (NHANES III (1988-1994)] measured urinary iodine (UI) concentrations. UI concentrations are an indicator of the adequacy of iodine intake for a population. The median UI concentrations in iodine-sufficient populations should be greater than 10 microg/dL, and no more than 20% of the population should have UI concentrations less than 5 microg/dL. Median UI concentrations from both NHANES I and NHANES III indicate adequate iodine intake for the overall U.S. population, but the median concentration decreased more than 50% between 1971-1974 (32.0+/-0.6 microg/dL) and 1988-1994 (14.5+/-0.3 microg/dL). Low UI concentrations (<5 microg/dL) were found in 11.7% of the 1988-1994 population, a 4.5-fold increase over the proportion in the 1971-1974 population. The percentage of people excreting low concentrations of iodine (UI, <5 microg/dL) increased in all age groups. In pregnant women, 6.7%, and in women of child-bearing age, 14.9% had UI concentrations below 5 microg/dL. The findings in 1988-1994, although not indicative of iodine deficiency in the overall U.S. population, define a trend that must be monitored.

Knowledge about indoor radon in the United States: 1990 National Health Interview Survey.

The Year 2000 objectives for environmental health include radon testing in 40% of residences overall and in 50% of residences that house a smoker, former smoker, or a child. Baseline data about radon and radon testing were determined by questions included in the 1990 Health Promotion and Disease Prevention supplement for the National Health Interview Survey. Minorities and individuals with low income or minimal education were significantly less likely to have heard of indoor radon than were whites and those with more education or income. In this survey, only 3%-5% of residences had been tested for radon. A substantial increase above the rate of testing noted for 1990 will be needed to achieve the Year 2000 objectives for indoor radon.

Radon awareness and testing behavior: findings from the Behavioral Risk Factor Surveillance System, 1989-1992.

Radon is considered an important environmental risk factor for lung cancer. Previous studies have shown that relatively few homes have been tested for radon. Results from the Behavioral Risk Factor Surveillance System from 1989--1992 show significant interstate and demographic variation in levels of radon awareness and home testing. There was evidence that levels of radon awareness and testing homes for radon have increased from 1989 through 1992. Although these trends in the data are encouraging, the data also suggest that continued education and other interventions may be necessary to reach the Public Health Service's testing and mitigating objectives for residential radon.

Characteristics of pet populations and households in the Purdue Comparative Oncology Program catchment area, 1988.

A 1-stage, random-digit dial telephone survey was conducted to obtain information on characteristics of pet populations and pet-owning households in 1988 in Marion and Tippecanoe Counties, Indiana. Interviews for 653 out of 731 eligible households were completed (response rate, 88%). Approximately half of the households in each county owned a pet. Of these, 35% owned at least 1 dog, and 23% owned at least 1 cat. Households with pets were more likely to be larger and have a higher median income score than were households without pets. Households with children between 6 and 17 years old were more likely to own pets than were households with no children; however, no difference in pet ownership proportions was determined for households with children < or = 5 years old, compared with households without children. For dogs, younger dogs and male dogs were less likely to have been neutered than older dogs and female dogs. Older cats were more likely to have been neutered than younger cats, with neutering percentages of > 90% for cats in the oldest age group. Approximately 20% of dogs and 40% of cats had not been seen by a veterinarian in the 12 months preceding the interview.

Pet populations in the catchment area of the Purdue Comparative Oncology Program.

Using a 1-stage random-digit dial telephone survey, we estimated the number of pet dogs and cats and cancer case ascertainment in the principal catchment area of an animal tumor registry in Indiana, the Purdue Comparative Oncology Program (PCOP). These findings will assist in the estimation of pet cancer incidence rates for the PCOP. The estimated canine and feline populations for Marion County were 144,039 (95% confidence interval, 121,555 to 166,523) and 94,998 (74,384 to 115,648), respectively. For Tippecanoe County (excluding university housing residences), the estimated canine population was 18,000 (14,445 to 21,555), whereas the estimated feline population was 17,165 (12,569 to 21,761). The estimated cancer case ascertainment was 88.3% (dogs, 92.5%; cats, 83.0%) with no statistically significant difference in the estimated ascertainment by county of residence or by species of pet. The amount that owners report themselves willing to pay for treatment of cancer in dogs or cats, however, differed in counties polled. This method's appropriateness for estimating pet populations in general and the validity of the data gathered were supported by response rate of 88.0% and by concurrence with census data for household characteristics previously documented to be associated with pet dog and cat ownership.

Surveillance of major causes of hospitalization among the elderly, 1988.

Medicare records represent a potential resource for surveillance data on hospitalizations among the elderly. Several features make these data useful for describing hospitalization patterns: a) Medicare covers hospitalization expenses for approximately 95% of the U.S. population greater than or equal to 65 years, and these data are considered to represent accurately the hospitalization patterns of this group; b) The comprehensive nature of the information about the beneficiary population provides public health researchers with data to generate accurate rates for well-defined demographic and geographic subgroups; c) Because data for all covered hospitalizations have been included in the file since 1984, stable estimates for even relatively rare conditions can be generated for any years since then; d) A unique personal identifier on each record permits the differentiation of first from subsequent hospitalizations, thereby permitting public health researchers to generate both counts and rates of hospitalizations by person and by event; and e) Temporal trends in hospitalization can be generated for 1980 through 1988, because data are available in machine-readable form. This report presents surveillance data for elderly persons hospitalized in 1988 for several diseases of public health importance. In 1988, approximately 9.1 million hospitalizations covered by Medicare occurred among persons greater than or equal to 65 years. For major disease categories, the rates of persons discharged ranged from 7,448/100,000 for circulatory diseases to 274/100,000 for blood diseases. For the 49 discrete diseases and conditions studied, rates varied widely by gender, race, and age. Conditions also varied widely in the mean number of discharges per person and in the probability that the condition would be recorded as the principal diagnosis.

Mild parkinsonism in persons exposed to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP).

MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) produces moderate to severe parkinsonism in humans, but has not been reported to cause a syndrome similar to early Parkinson's disease. We now report 22 cases of mild parkinsonism resulting from exposure to MPTP.

Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source.

Investigation of a recent outbreak of nosocomial legionnaires' disease--initially thought to be due to the documented presence of Legionella pneumophila in the hospital potable water--showed that aerosols from one or more cooling towers were the actual source of infection. From June 27 to Aug 25, 1983, nosocomial legionnaires' disease developed in 15 persons at a hospital in Rhode Island. Twelve (80%) of 15 case-patients occupied rooms in building 1, unit B, compared with eight (28%) of 29 control patients (odds ratio = 10.8; 95% confidence interval = 1.4 to 85.6). Subsequent investigation demonstrated that water in a cooling tower located 100 ft upwind of unit B was heavily contaminated with L pneumophila, serogroup 1, subgroup 1, 2, 4, 5. The same strain was isolated from nine of the patients and from the make-up water for the tower. Active surveillance during the ten months following decontamination of the cooling tower identified no additional cases of nosocomial legionnaires' disease, although the hospital potable water had not been treated. While recommendations have been made for controlling nosocomial legionnaires' disease by heating or hyperchlorination of hospital potable water, this outbreak demonstrates the importance of an adequate epidemiologic-environmental investigation in choosing the appropriate control strategy.

Staphylococcus aureus isolates from patients with nonmenstrual toxic shock syndrome. Evidence for additional toxins.

Although toxic shock syndrome toxin-1 (TSST-1) has been proposed as the toxin responsible for toxic shock syndrome, its role in this disease has not been proved. To study this question, we examined Staphylococcus aureus strains isolated from normally sterile sites in patients with nonmenstrual toxic shock syndrome for the presence of TSST-1 production. Only 20 (62.5%) of 32 produced TSST-1, compared with 41 (93%) of 44 vaginal isolates from patients with menstrual toxic shock syndrome. Of strains of S aureus from patients with nonmenstrual toxic shock syndrome, TSST-1-negative isolates were more likely to be associated with a fatal outcome and to not be phage group 1 than TSST-1-positive isolates. Seven of the TSST-1-negative strains were evaluated in a rabbit subcutaneous chamber model of toxic shock syndrome. Fifteen (60%) of 25 rabbits developed a toxic shock syndrome-like illness and nine died. Clinical signs and histopathologic findings in the rabbits were similar to those seen in rabbits inoculated with TSST-1-positive S aureus isolates. These results suggest that other, as yet unrecognized, toxins play a role in toxic shock syndrome, and that TSST-1 production may not be essential to the pathogenesis of toxic shock syndrome.

Outbreaks of group A streptococcal abscesses following diphtheria-tetanus toxoid-pertussis vaccination.

Two outbreaks of group A streptococcal abscesses following receipt of diphtheria-tetanus toxoid-pertussis (DTP) vaccine from different manufacturers were reported to the Centers for Disease Control (CDC) in 1982. The clustering of the immunization times of cases, the isolation of the same serotype of Streptococcus from all cases in each outbreak, and the absence of reported abscesses associated with receipt of the same lots of vaccine in other regions of the country, suggest that each outbreak was probably caused by contamination of a single 15-dose vial of vaccine. The preservative thimerosal was present within acceptable limits in unopened vials from the same lot of DTP vaccine in each outbreak. Challenge studies indicate that a strain of Streptococcus from one of the patients can survive up to 15 days in DTP vaccine at 4 degrees C. Contamination of vials during manufacturing would have required survival of streptococci for a minimum of 8 months. Preservatives in multidose vaccine vials do not prevent short-term bacterial contamination. Options to prevent further clusters of streptococcal abscesses are discussed. The only feasible and cost-effective preventive measure now available is careful attention to sterile technique when administering vaccine from multidose vials.