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Biomedical subjects

Ali Mokdad

Publications and source records attributed to Ali Mokdad.

At least 19 recordsLinked to original sources
PubMed2007

Employment status and frequent mental distress among adults with disabilities.

BACKGROUND: It has been postulated that poor mental health can lead to disability and disability can lead to unemployment. However, the association between poor mental health and employment status among adults with disabilities has not been well characterized in population-based studies. AIM: To examine the association between employment status and frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days) among adults with disabilities. METHODS: Cross-sectional data were analysed for 47,377 community-dwelling US adults aged 25-64 years with disabilities that participated in the 2001 and 2003 Behavioural Risk Factor Surveillance System. Logistic regression analysis was applied. RESULTS: Among adults with disabilities, the unadjusted prevalence of FMD was 18% (SE 0.4) among those employed, 40% (SE 1.3) among those unemployed and 44% (SE 0.8) among those unable to work. After adjustments were made for age, sex and race/ethnicity, the results indicated that adults with disabilities who were unemployed or unable to work were significantly more likely than those employed to have FMD (adjusted prevalence: 39 and 45%, respectively, versus 18%; P < 0.001). These associations persisted after further adjusting for education, marital status, health risk behaviours, body mass index, health care coverage and self-rated general health (34 and 36%, respectively, versus 19%; P < 0.001). CONCLUSION: These findings demonstrate the need for research and development of public health interventions to reduce the toll of mental distress among all adults with disabilities.

Adult↗
PubMed2006

Ribostral: an RNA 3D alignment analyzer and viewer based on basepair isostericities.

UNLABELLED: RNA atomic resolution structures have revealed the existance of different families of basepair interactions, each of which with its own isosteric sub-families. Ribostral (Ribonucleic Structural Aligner) is a user-friendly framework for analyzing, evaluating and viewing RNA sequence alignments with at least one available atomic resolution structure. It is the first of its kind that makes direct and easy- to-understand superposition of the isostericity matrices of basepairs observed in the structure onto sequence alignments, easily indicating allowed and unallowed substitutions at each BP position. Potential mistakes in the alignments can then be corrected using other sequence editing software. Ribostral has been developed and tested under Windows XP, and is capable of running on any PC or MAC platform with MATLAB 7.1 (SP3) or higher installed version. A stand-alone version is also available for the PC platform. AVAILABILITY: http://rna.bgsu.edu/ribostral.

Algorithms↗
PubMed2006

Structural and evolutionary classification of G/U wobble basepairs in the ribosome.

We present a comprehensive structural, evolutionary and molecular dynamics (MD) study of the G/U wobble basepairs in the ribosome based on high-resolution crystal structures, including the recent Escherichia coli structure. These basepairs are classified according to their tertiary interactions, and sequence conservation at their positions is determined. G/U basepairs participating in tertiary interactions are more conserved than those lacking any interactions. Specific interactions occurring in the G/U shallow groove pocket--like packing interactions (P-interactions) and some phosphate backbone interactions (phosphate-in-pocket interactions)--lead to higher G/U conservation than others. Two salient cases of unique phylogenetic compensation are discovered. First, a P-interaction is conserved through a series of compensatory mutations involving all four participating nucleotides to preserve or restore the G/U in the optimal orientation. Second, a G/U basepair forming a P-interaction and another one forming a phosphate-in-pocket interaction are replaced by GNRA loops that maintain similar tertiary contacts. MD simulations were carried out on eight P-interactions. The specific GU/CG signature of this interaction observed in structure and sequence analysis was rationalized, and can now be used for improving sequence alignments.

Base Pairing↗
PubMed2006

Associations of physical activity and body mass index with activities of daily living in older adults.

Research reports about the associations of leisure-time physical activity (LPA) and Body Mass Index (BMI) with activities of daily living (ADL)- or instrumental activities of daily living (IADL)-dependent disability in older adults are inconclusive. Data were obtained from the 2000 Missouri Older Adult Needs Assessment Survey. Logistic regression was used to examine the associations of LPA and BMI with ADL- or IADL-dependent disability, while controlling for factors known to be associated with LPA, BMI, ADL and IADL. ADL- or IADL-dependency decreased with LPA and increased with BMI regardless of each other's level, presence of functional limitation, education, gender, race-ethnicity, and health care coverage. Physically active individuals were less likely than inactive ones to be ADL- or IADL-dependent. BMI was modestly associated with ADL- or IADL-dependency and this relationship was confounded by LPA. If confirmed by well designed longitudinal studies, LPA and BMI independent associations with ADL- or IADL-dependent disability lends supports to a strategy for improving older adult quality of life through improved physical activity. Etiological studies on the associations between risk factors and quality of life outcomes in older adults should consider the joint confounding effect of LPA and BMI.

Activities of Daily Living↗
PubMed2005

Surveillance for certain health behaviors among states and selected local areas--Behavioral Risk Factor Surveillance System, United States, 2003.

PROBLEM: Data on health risk behaviors (e.g., cigarette smoking, binge drinking, and physical inactivity) for chronic diseases and use of preventive practices (e.g., influenza and pneumococcal vaccination for adults aged > or =65 years and cholesterol screening) are essential for developing effective health education and intervention programs and policies to prevent morbidity and mortality from chronic diseases. Continuous monitoring of these behaviors and practices at the state, city, and county levels can help public health programs in evaluating progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2003 are presented for states, selected metropolitan and micropolitan statistical areas (MMSAs), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS during 2003. Within these states and territories, 105 MMSAs and 153 counties that reported data for at least 500 respondents or a minimum sample size of 19 per weighting class were included in the analyses. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. Twelve states, 39 MMSAs, and 65 counties achieved the HP 2010 objective to reduce the proportion of adults who engage in no leisure-time physical activity to 20%. Twenty states, 41 MMSAs, and 63 counties achieved the HP 2010 goal of 50% of adults engaging in moderate physical activity for at least 30 minutes per day. The HP 2010 goal of 30% of adults who engage in vigorous physical activity was achieved by 17 states, 33 MMSAs, and 57 counties. Two states, one MMSA, and one county achieved the HP 2010 current cigarette smoking goal of 12% prevalence. One county achieved the HP 2010 binge drinking goal of 6% prevalence among adults. One MMSA and eight counties achieved the HP 2010 goal of 15% for obesity prevalence. The HP 2010 goal for influenza and pneumococcal vaccination coverage of 90% was not achieved by any state, MMSA, or county. No state, MMSA, or county achieved the HP 2010 objective of 17% prevalence of high cholesterol among adults. INTERPRETATION: The findings in this report indicate substantial variation in health risk behaviors and use of preventative services among adults at state and local levels, indicating a need for appropriate public health interventions and continued efforts to evaluate public health programs and policies and health-care-related efforts designed to reduce morbidity and mortality. PUBLIC HEALTH ACTION: Data from BRFSS are useful for assessing national health objectives, for identifying and characterizing at risk populations, and for designing and evaluating health promotion and disease prevention programs and policies. The 2003 BRFSS data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and provides information for measuring progress towards achieving disease prevention and health promotion goals at state and local levels.

Behavioral Risk Factor Surveillance System↗
PubMed2005

Report from the CDC. Changes in selected chronic disease-related risks and health conditions for nonpregnant women 18-44 years old BRFSS.

We examined changes in the prevalence of selected chronic disease-related indicators among women aged 18-44 years using the Behavioral Risk Factor Surveillance System (BRFSS) data for two time periods, 1991-1992 and 2000-2001. We examined alcohol use, cigarette smoking, leisure time physical activity, body mass index (BMI), having had Pap smear screening, and having been diagnosed with hypertension, diabetes, high cholesterol, and asthma. We created a multicondition index by combining multiple chronic disease-related conditions. Younger women, <25 years of age, reported a higher prevalence of cigarette smoking and binge drinking. Black women and women with lower educational levels had a higher prevalence of obesity, and higher proportions were diagnosed with hypertension and diabetes. About 35% of the women had been diagnosed with at least one chronic disease-related condition. More than 10% of black women reported being diagnosed with two chronic disease-related conditions, compared with 7% in white women and 8% in Hispanic women. The BRFSS data can be used for monitoring the prevalence of multiple chronic disease-related behaviors and conditions.

Adult↗
PubMed2004

Frequent mental distress status among adults with arthritis age 45 years and older, 2001.

OBJECTIVE: To identify characteristics and behaviors among persons with arthritis through evaluation of self-perceived mental health status. METHODS: Data were analyzed for adults with arthritis age 45 years or older from the 2001 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults living in the United States. RESULTS: The prevalence of frequent mental distress (FMD; > or =14 self-reported mentally unhealthy days in the past 30 days) among persons with arthritis was 13.4%. Among persons with arthritis, those with FMD as compared with those without FMD were more likely to be underweight and obese than normal weight; they also were more likely to be insufficiently active or inactive than following recommended physical activity guidelines. In addition, those with arthritis and FMD were more likely to report disability and impaired physical and general health than were those with arthritis but without FMD. CONCLUSION: Physicians should encourage their patients with arthritis and mental distress to participate in educational and behavioral interventions shown to have both physical and psychological benefits.

Affective Symptoms↗
PubMed2004

Surveillance for certain health behaviors among selected local areas--United States, Behavioral Risk Factor Surveillance System, 2002.

PROBLEM: Monitoring risk behaviors for chronic diseases and participation in preventive practices are important for developing effective health education and intervention programs to prevent morbidity and mortality. Therefore, continual monitoring of these behaviors and practices at the state, city, and county levels can assist public health programs in evaluating and monitoring progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2002 are presented for states, selected metropolitan, and micropolitan statistical areas (MMSA), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an on-going, state-based, telephone survey of the civilian, noninstitutionalized population aged >18 years. All 50 states, the District of Columbia (DC), Guam, the Virgin Islands, and the Commonwealth of Puerto Rico participated in BRFSS during 2002. Metropolitan and MMSA and their counties with >500 respondents or a minimum sample size of 19 per weighting class were included in the analyses for a total of 98 MMSA and 146 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state, county, and MMSA. Obesity ranged from 27.6% in West Virginia, 29.4% in Charleston, West Virginia, and 32.0% in Florence County, South Carolina, to 16.5% in Colorado, 12.8% in Bethesda-Frederick-Gaithersburg, Maryland, and 11.8% in Washington County, Rhode Island. No leisuretime physical activity ranged from 33.6% in Tennessee, 36.8% in Miami-Miami Beach-Kendall, Florida, and 36.8% in Miami-Dade County, Florida to 15.0% in Washington, 13.8% in Seattle-Bellevue-Everett Washington, and 11.4% in King County, Washington. Cigarette smoking ranged from 32.6% in Kentucky, 32.8% in Youngstown-Warren- Boardman, Ohio-Pennsylvania, and 31.1% in Jefferson County, Kentucky to 16.4% in California, 13.8% in Ogden- Clearfield, Utah, and 10.9% in Davis County, Utah. Binge drinking ranged from 24.9% in Wisconsin, 26.1% in Fargo, North Dakota-Minnesota, and 25.1% Cass County, North Dakota, to 7.9% in Kentucky, 8.2% in Greensboro- High Point, North Carolina, and 6.6% in Henderson County, North Carolina. At risk for heavy drinking ranged from 8.7% in Arizona, 9.5% in Lebanon, New Hampshire-Vermont, and 11.3% in Richland County, South Carolina, to 2.8% in Utah, 1.9% in Ogden-Clearfield, Utah, and 1.7% in King County, New York. Adults who were told they had diabetes ranged from 10.2% in West Virginia, 11.1% in Charleston, West Virginia, and 11.1% in Richland, South Carolina, to 3.5% in Alaska, 2.7% in Anchorage, Alaska, and 2.4% in Weber County, Utah. Percentage of adults aged>50 years who were ever screened for colorectal cancer ranged from 64.8% in Minnesota, 67.9% in Minneapolis-St. Paul-Bloomington Minnesota-Wisconsin, and 73.6% in Ramsey County, Minnesota, to 39.2% in Hawaii, 30.7% in Kahului-Wailuku, Hawaii, and 30.7% in Maui County, Hawaii. Persons aged >65 years who had received pneumococcal vaccine ranged from 72.5% in North Dakota, 74.8% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 73.1% in Milwaukee County, Wisconsin, to 47.9% in DC, 47.5% in New York-Wayne-White Plains, New York, New Jersey, and 47.9% in DC County, DC. Older adults who had received influenza vaccine ranged from 76.6% in Minnesota, 80.0% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 76.3% in Middlesex County, Massachusetts, to 57.0% in Florida, 55.8% in Houston-Baytown-Sugar Land, Texas, and 56.2% in Cook County, Illinois. INTERPRETATION: BRFSS data indicate substantial variation in high-risk behaviors, participation in preventive healthcare services, and screening among U.S. adults at states and selected local areas, indicating a need for continued efforts to evaluate public health programs or policies designed to reduce morbidity and mortality. PUBLIC HEALTH ACTIONS: Data from BRFSS are useful in developing and guiding public health programs and policies. Therefore, states, selected MMSA, and their counties can use BRFSS data as a tool to prevent premature morbidity and mortality among adult population and to assess progress toward national health objectives. The data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and serve as a baseline for future surveillance at the local level in the United States.

Adult↗
PubMed2004

Trends in alcohol use and binge drinking, 1985-1999: results of a multi-state survey.

BACKGROUND: Alcohol abuse is a major public health problem in the United States. Binge drinking and drinking among youth are of special concern. The purpose of this study is to examine trends in alcohol use and binge drinking and correlates of the behaviors with a focus on drinking among persons 18 to 20 years of age. METHODS: Data are from telephone interviews of 449,110 adults aged > or =18 years residing in the 19 states that participated in the Behavioral Risk Factor Surveillance System (BRFSS) from 1985 to 1999. The percentages reporting current alcohol use and binge use (> or =5 drinks per occasion) were calculated by year, age, gender, race, and level of education. Data were analyzed in 2003. RESULTS: From 1985 to 1999, the prevalence of current alcohol use dropped 7.3%, and binge drinking dropped 3.3%. Among all age groups, most of the decline occurred before 1990. The greatest decline in both current (12.6%) and binge use (7.3%) occurred in the 18- to 20-year-old group. Between 1997 and 1999, however, respondents in this age group reported increases in these behaviors. Throughout the survey period, the proportion of current users who binge changed very little and remained highest among persons aged 18-20 years (52.1%). CONCLUSIONS: Alcohol use leveled off in the 1990s, but may be increasing, especially among persons 18-20 years of age. Those who drink are about as likely to report binge drinking as were drinkers 15 years ago.

Adolescent↗
PubMed2004

Prevalence of adult binge drinking: a comparison of two national surveys.

BACKGROUND: Binge drinking (defined as five or more drinks on an occasion) causes approximately half of the estimated 85,000 alcohol-related deaths in the United States each year. The Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey, and the National Survey on Drug Use and Health (NSDUH), an in-person survey, provide population-based estimates of binge drinking. Evaluating the concordance of binge drinking estimates from the BRFSS and the NSDUH is important for surveillance and for planning prevention programs. METHODS: In 2003, combined data on binge drinking for 1999 and 2001 from the BRFSS (n =355,371) and the NSDUH (n =87,145) were analyzed for respondents aged >or=18 years. RESULTS: National binge drinking estimates were 14.7% (95% confidence interval [CI]=14.5-15.2) for BRFSS and 21.6% (CI=21.2-22.0) for NSDUH. Although there was good correlation between state-specific binge drinking estimates from the two surveys (Pearson's r =0.82), the BRFSS state estimates were significantly lower (p <0.05) than the NSDUH estimates in 46 states and the District of Columbia. The demographic characteristics of binge drinkers and the wording of the binge question were similar in the two surveys. However, in 1999, NSDUH changed from paper interviews to computer-administered interviews, and incorporated an internal validity check with feedback questions to resolve inconsistent responses. CONCLUSIONS: Estimates of binge drinking from the NSDUH were consistently higher than those from the BRFSS, probably due to differences in survey methodology. Continued efforts to improve binge drinking surveillance are important for preventing this public health problem.

Adult↗
PubMed2004

Characteristics of people aged 45 years or older with heart disease by frequent mental distress status, 2001.

BACKGROUND: Depression commonly occurs after nonfatal cardiac events and is associated with adverse health outcomes. METHODS: In 2001, the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized adults, administered cardiovascular health questions to 19 states and DC. Among those aged > or = 45 years, we examined the association of frequent mental distress (FMD) (> or = 14 self-reported mentally unhealthy days in the past 30 days) with modifiable adverse behaviors (smoking, physical inactivity, and obesity) and health care coverage. RESULTS: The prevalence of FMD among adults with heart disease was 14.8%. Age-adjusted odds ratios indicated that adults with heart disease and FMD were more likely to smoke, to be physically inactive, to be obese, and to be without health care coverage than persons without FMD. Although frequent mental distress was associated with only one adverse health behavior (physical inactivity) after fully adjusting when these health behaviors were considered separately, we observed a twofold increased likelihood for the presence of multiple adverse health behaviors among those with FMD as compared to those without FMD. CONCLUSIONS: Medical counseling on lifestyle changes after cardiac events is accepted as a key part of rehabilitation; however, the mental well-being of patients may also need to be monitored, as it may be a mediating factor in achieving healthy lifestyle goals.

Aged↗
PubMed2004

Mental and physical distress and high-risk behaviors among reproductive-age women.

OBJECTIVE: To examine the prevalence of mental and physical distress indicators among women of reproductive age and the association of these indicators with cigarette smoking and alcohol use, by pregnancy status. METHODS: The Behavioral Risk Factor Surveillance System data for several years were aggregated across states and weighted for this analysis. Seven measures of self-reported mental and physical distress and general health were examined along with demographic variables. RESULTS: Overall, 6.7% (95% confidence interval [CI] 6.5-6.9) of women reported frequent physical distress, 12.3% (95% CI 12.0-12.6) reported frequent mental distress, 9.9% (95% CI 9.4-10.4) reported frequent depression, 18.4% (95% CI 17.8-19.1) reported feeling anxious, and 34.3% (95% CI 33.5-35.1) reported that they frequently did not get enough rest. At the time of the survey 4.6% of the women were pregnant. Pregnant women were less likely than nonpregnant women to report frequent mental distress. Although there was attenuation of cigarette smoking and alcohol use during pregnancy, those with mental and physical distress were more likely to consume cigarettes and alcohol than were those without such experiences. CONCLUSION: High proportions of reproductive-age women report frequent mental and physical distress. Women experiencing mental and physical distress were more likely to report consuming cigarettes and alcohol than women without such experiences.

Adolescent↗
PubMed2003

Unique tertiary and neighbor interactions determine conservation patterns of Cis Watson-Crick A/G base-pairs.

X-ray, phylogenetic and quantum chemical analysis of molecular interactions and conservation patterns of cis Watson-Crick (W.C.) A/G base-pairs in 16S rRNA, 23S rRNA and other molecules was carried out. In these base-pairs, the A and G nucleotides interact with their W.C. edges with glycosidic bonds oriented cis relative to each other. The base-pair is stabilised by two hydrogen bonds, the C1'-C1' distance is enlarged and the G(N2) amino group is left unpaired. Quantum chemical calculations show that, in the absence of other interactions, the unpaired amino group is substantially non-planar due to its partial sp(3) pyramidalization, while the whole base-pair is internally propeller twisted and very flexible. The unique molecular properties of the cis W.C. A/G base-pairs make them distinct from other base-pairs. They occur mostly at the ends of canonical helices, where they serve as interfaces between the helix and other motifs. The cis W.C. A/G base-pairs play crucial roles in natural RNA structures with salient sequence conservation patterns. The key contribution to conservation is provided by the unpaired G(N2) amino group that is involved in a wide range of tertiary and neighbor contacts in the crystal structures. Many of them are oriented out of the plane of the guanine base and utilize the partial sp(3) pyramidalization of the G(N2). There is a lack of A/G to G/A covariation, which, except for the G(N2) position, would be entirely isosteric. On the contrary, there is a rather frequent occurrence of G/A to G/U covariation, as the G/U wobble base-pair has an unpaired amino group in the same position as the cis W.C. G/A base-pair. The cis W.C. A/G base-pairs are not conserved when there is no tertiary or neighbor interaction. Obtaining the proper picture of the interactions and phylogenetic patterns of the cis W.C. A/G base-pairs requires a detailed analysis of the relation between the molecular structures and the energetics of interactions at a level of single H-bonds and contacts.

Base Pairing↗
PubMed2003

Binge drinking among US adults.

CONTEXT: Binge drinking (consuming > or =5 alcoholic drinks on 1 occasion) generally results in acute impairment and has numerous adverse health consequences. Reports indicate that binge drinking may be increasing in the United States. OBJECTIVES: To quantify episodes of binge drinking among US adults in 1993-2001, to characterize adults who engage in binge drinking, and to describe state and regional differences in binge drinking. DESIGN, SETTING, AND PARTICIPANTS: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey of adults aged 18 years or older that is conducted annually in all states. The sample size ranged from 102 263 in 1993 to 212 510 in 2001. MAIN OUTCOME MEASURES: Binge-drinking prevalence, episodes, and episodes per person per year. RESULTS: Between 1993 and 2001, the total number of binge-drinking episodes among US adults increased from approximately 1.2 billion to 1.5 billion; during this time, binge-drinking episodes per person per year increased by 17% (from 6.3 to 7.4, P for trend =.03). Between 1995 and 2001, binge-drinking episodes per person per year increased by 35% (P for trend =.005). Men accounted for 81% of binge-drinking episodes in the study years. Although rates of binge-drinking episodes were highest among those aged 18 to 25 years, 69% of binge-drinking episodes during the study period occurred among those aged 26 years or older. Overall, 47% of binge-drinking episodes occurred among otherwise moderate (ie, non-heavy) drinkers, and 73% of all binge drinkers were moderate drinkers. Binge drinkers were 14 times more likely to drive while impaired by alcohol compared with non-binge drinkers. There were substantial state and regional differences in per capita binge-drinking episodes. CONCLUSIONS: Binge drinking is common among most strata of US adults, including among those aged 26 years or older. Per capita binge-drinking episodes have increased, particularly since 1995. Binge drinking is strongly associated with alcohol-impaired driving. Effective interventions to prevent the mortality and morbidity associated with binge drinking should be widely adopted, including screening patients for alcohol abuse in accordance with national guidelines.

Adult↗
PubMed2003

Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey.

OBJECTIVE: To address key gaps in the annual monitoring of breastfeeding prevalence in the United States, 3 breastfeeding questions concerning the initiation, duration, and exclusivity of breastfeeding were added to the rotating modules of the National Immunization Survey (NIS) beginning in the third quarter of 2001. The present study examines the current prevalence of breastfeeding in the United States using NIS data from this initial quarter. METHODS: The NIS is a random-digit-dialing survey of households with children aged 19 to 35 months, followed by a mail survey of the eligible children's vaccination providers to validate the child's vaccination information. In the third quarter of 2001, a randomly selected subset of households interviewed in the NIS (N = 896) were asked questions about breastfeeding. RESULTS: Almost two thirds (65.1%) of children had ever been breastfed. At 6 and 12 months, 27.0% and 12.3%, respectively, were receiving some breast milk. Non-Hispanic blacks had the lowest rates of breastfeeding initiation and continuation. Exclusive breastfeeding rates were low in the United States with only 7.9% at 6 months. CONCLUSIONS: Although breastfeeding initiation is near the national goal of 75%, breastfeeding continuation lags behind the national goals of 50% and 25% at 6 and 12 months, respectively. Strenuous public health efforts are needed to improve breastfeeding practices among blacks.

Black or African American↗
PubMedDate not supplied

The first oral rotavirus vaccine, 1998-1999: estimates of uptake from the National Immunization Survey.

OBJECTIVE: On August 31, 1998, the rhesus-human reassortant rotavirus vaccine (RRV-TV) was licensed for use in the U.S. During the next nine months, 15 cases of intussusception were reported among infants who received the vaccine. Case-control and cohort studies showed a significantly increased risk of developing intussusception within one week of receiving the vaccine; subsequent ecologic studies did not. In this study, the authors used data on RRV-TV vaccination rates from the National Immunization Survey (NIS) to estimate state and national RRV-TV uptake rates and factors associated with receiving RRV-TV. These estimates are a key component in evaluating published ecologic studies designed to investigate the relationship between receipt of the vaccine and intussusception. METHODS: The authors analyzed NIS data for children ages 19 to 35 months who were eligible to receive RRV-TV between September 1998 and July 1999. The authors estimated vaccine coverage and the number of doses administered by state, NIS sampling quarter, and birth cohort, and analyzed demographic and socioeconomic variables to evaluate their relationship with receiving RRV-TV. RESULTS: It was estimated that approximately 1 million doses of RRV-TV were administered to 504,585 (+/-61,854) children, 13.4% (+/-1.6%) of children who were eligible. The estimated number of doses administered and the vaccination coverage rate varied greatly from state to state. Children living in households with higher socioeconomic conditions were more likely to receive the vaccine. CONCLUSION: Ecologic studies had a limited ability to detect a significant increase in the population incidence rate of intussusception that could be attributed to RRV-TV because populations in these studies consisted primarily of children who did not receive the vaccine. The example from RRV-TV demonstrates some of the challenges of assessing the magnitude of the association between a vaccine and an uncommon or rare adverse event.

Administration, Oral↗
PubMedDate not supplied

Prioritization MICA: a Web-based application to prioritize public health resources.

Although setting priorities is an important step in making public health policy, the benefit of using epidemiology to prioritize scarce public health resources has not been fully recognized. This situation is mostly due to the complexity of proposed models for setting priorities. We describe a public health priority setting model, Missouri Information for Community Assessment Priority Setting Model (Priority MICA), which uses epidemiologic measures available in most surveillance systems across the United States. Priority MICA uses data from birth and death certificates, hospital discharges, emergency departments, risk factors from the Behavioral Risk Factors Surveillance System, and eight epidemiologic measures to construct six priority criteria: size (the number of emergency department visits, hospitalizations, and deaths), severity (number of deaths of people younger than 65), urgency (trends in deaths and hospital morbidity), preventability (evidence-based score), community support (score of social support for preventive action), and racial-disparity (race comparison through death and morbidity rate ratio). Priority MICA is part of a Web-based interactive tool that makes available data from a wide variety of surveillance systems (http://www.dhss.mo.gov/MICA). The top 10 priority diseases determined by Priority MICA were compared to a more traditional method of ranking diseases by mortality rates. Using the additional criteria in Priority MICA identified four more priority diseases than were identified using just mortality while the ranking of the other six priority diseases differed between methods.

Health Care Rationing↗