Multi-jurisdictional investigation of interactive fountain-associated cryptosporidiosis and salmonellosis outbreaks.

Interactive water fountains are established sources of gastrointestinal infections yet most health codes fail to regulate their design and operation. This report describes multi-agency, concurrent interactive fountain-associated cryptosporidiosis and salmonellosis outbreak investigations and highlights the need for the adoption of appropriate regulations for interactive fountains.

A prospective study of the relationship between body mass index and cataract extraction among US women and men.

BACKGROUND: Obesity may influence several physiologic processes involved in cataract formation such as oxidative stress, glycosylation and osmotic stress. OBJECTIVE: To examine the association between increased body mass index (BMI) and the incidence of cataract extraction. DESIGN AND SETTING: The Nurses' Health Study and the Health Professionals Follow-up Study, both prospective cohort studies of US women and men. SUBJECTS: A total of 87 682 women and 45 549 men aged 45 y and older who did not have diagnosed cataract or cancer at baseline (1980 for women, 1986 for men). MEASUREMENTS: Cataract extractions occurring between baseline and 1996, confirmed by medical records. RESULTS: During 16 y of follow-up in the women, and 10 y in the men, (1 097 997 person-y), 4430 incident cases were documented. Compared to participants with BMI less than 23 kg/m(2), those with BMI greater than or equal to 30 kg/m(2) had 36% higher risk of any type of cataract (pooled multivariate relative risk (RR), 1.36; 95% CI, 1.23-1.49) after adjusting for smoking, age and lutein/zeaxanthin intake. The association was strongest for posterior subcapsular (PSC) cataract (pooled multivariate RR, 1.99; 95% CI, 1.55-2.55). With adjustment for diabetes, the RR of obesity associated with posterior subcapsular cataract was 1.68 (95% CI, 1.30-2.17). Obesity was not significantly associated with nuclear cataract. CONCLUSION: Obesity increases the risk of developing cataract overall, and of PSC cataract in particular; the etiology of PSC cataract may be mediated at least in part by glucose intolerance and insulin resistance, even in the absence of clinical diabetes.

Trends in prevalence of current smoking, Massachusetts and states without tobacco control programmes, 1990 to 1999.

OBJECTIVE: To assess the effect of a comprehensive tobacco control programme initiated in Massachusetts in 1993, and to compare the 1990 to 1999 trend in smoking prevalence to that in 41 states without tobacco control programmes, controlling for demographic shifts over time. DESIGN: Data from the Behavioral Risk Factor Surveillance System for the years 1990 to 1999 were used to examine changes and trends in prevalence of smoking using multivariate logistic regression models. MAIN OUTCOME MEASURES: Trend in prevalence of current smoking for the years 1990 to 1999. RESULTS: In 1990, the prevalence of current smoking in Massachusetts was 23.5% (95% confidence interval (CI) 21.0% to 26.1%), and 24.2% in the rest of the USA (95% CI 23.7% to 24.7%). By 1999, the prevalence had declined in Massachusetts to 19.4%, and to 23.3% in 41 other US states. Controlling for sex, age, race, and education, there was a greater decline in current smoking between 1990 and 1999 among Massachusetts men than among Massachusetts women, and the decline was greater in Massachusetts than in the rest of the USA for men and for both sexes combined. CONCLUSIONS: These results suggest that the Massachusetts Tobacco Control Program is having a beneficial impact, but suggest a need for additional targeted efforts to achieve similar declines among Massachusetts women.

Receiver operating characteristics curve analysis of cutaneous skin test reactions to predict hay fever and asthma symptoms in the Normative Aging Study.

BACKGROUND: We used receiver operating characteristic (ROC) curves to determine optimal cutoff values and to evaluate the ability of ragweed, mixed grasses, mixed trees, and house-dust antigens to predict symptoms of hay fever and asthma. METHODS: Between 1984 and 1993, 1386 members of the Normative Aging Study cohort had at least one examination that included evaluation of cutaneous hypersensitivity to common aeroallergens by skin prick testing. Standard questionnaires based on the American Thoracic Society DLD-78 questionnaire obtained information on respiratory symptoms, illness, and smoking habits. RESULTS: Ragweed was the best univariate predictor for both hay fever and asthma symptoms: the area under the ROC curve for hay fever was 0.71 (95%) CI 0.67-0.74); for asthma, it was 0.65 (95% CI 0.55-0.75). For hay fever, dichotomizing the average reaction to four antigens at 2 mm gave a sensitivity of 56% and a specificity of 83%; at 3 mm, the sensitivity was 38% and specificity 92%. For asthma, dichotomizing the skin test reaction at 2 mm gave a sensitivity ranging from 30% for reaction to mixed grasses to 56% for the ragweed antigen reaction. CONCLUSIONS: Although in this older population skin test reactivities did not predict current asthma symptoms with high sensitivity, our results support the use of cutoff values of 2 or 3 mm as commonly used in studies of hay fever symptoms.