Biomedical subjects

K A Blair

Publications and source records attributed to K A Blair.

10 recordsLinked to original sources

PubMed1998

Surveillance data for waterborne illness detection: an assessment following a massive waterborne outbreak of Cryptosporidium infection.

Following the 1993 Milwaukee cryptosporidiosis outbreak, we examined data from eight sources available during the time of the outbreak. Although there was a remarkable temporal correspondence of surveillance peaks, the most timely data involved use of systems in which personnel with existing close ties to public health programmes perceived the importance of providing information despite workload constraints associated with an outbreak. During the investigation, surveillance systems which could be easily linked with laboratory data, were flexible in adding new variables, and which demonstrated low baseline variability were most useful. Geographically fixed nursing home residents served as an ideal population with nonconfounded exposures. Use of surrogate measurements of morbidity can trigger worthwhile public health responses in advance of laboratory-confirmed diagnosis and help reduce total morbidity associated with an outbreak. This report describes the relative strengths and weaknesses of these surveillance methods for community-wide waterborne illness detection and their application in outbreak decision making.

Bias↗

PubMed1998

Are older women offered adequate health care?

The "graying of America" will have profound effects on the health care delivery system. With shrinking amounts of health care dollars, nurses and primary care providers need to promote health maintenance and disease prevention strategies that will foster healthier aging. This study was designed to examine the health promotion strategies of family practice physicians and residents. The target population was a sample of 201 women age 60 and older. The health maintenance issues were counseling about hormone replacement therapy (HRT), urinary incontinence (UI), and immunizations. The results clearly demonstrated that older women were not adequately immunized or counseled about HRT or UI. Nurses can play a pivotal role in changing these practices. Nurses can serve as advocates for older woman by encouraging them to request these services, or advanced practice nurses can provide these services.

Aged↗

PubMed1997

Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin.

OBJECTIVES: This study estimated the magnitude of cryptosporidiosis-associated mortality in the Milwaukee vicinity for 2 years following a massive waterborne outbreak. METHODS: Death certificates were reviewed. RESULTS: During approximately 2 years before the outbreak, cryptosporidiosis was listed as an underlying or contributing cause of death on the death certificates of four Milwaukee-vicinity residents. In the approximately 2 years after the outbreak, this number was 54, of whom 85% had acquired immunodeficiency syndrome (AIDS) listed as the underlying cause of death. In the first 6 months after the outbreak, the number of death certificates indicating AIDS, but not cryptosporidiosis, as a cause of death was 19 (95% confidence interval = 12.26) higher than preoutbreak trends would have predicted. CONCLUSIONS: Waterborne outbreaks of cryptosporidium infection can result in significant mortality, particularly among immunocompromised populations. Any discussion of policies to ensure safe drinking water must consider the potential fatal consequences of waterborne cryptosporidiosis among immunocompromised populations.

AIDS-Related Opportunistic Infections↗

PubMed1996

Cryptosporidiosis in Wisconsin: a case-control study of post-outbreak transmission.

During March-April 1993, an estimated 403000 residents of the 5-county greater Milwaukee, Wisconsin area developed cryptosporidiosis after drinking contaminated municipal water. Although the number of cases dropped precipitously after the implicated water plant closed on 9 April, cases continued to occur. To investigate risk factors for post-outbreak cryptosporidiosis, 33 Milwaukee-area residents who had laboratory-confirmed Cryptosporidium infection with onset of diarrhoea between 1 May and 27 June 1993 were interviewed by telephone. Of these, 28 (85%) had onset of diarrhoea during May, 12 (36%) had watery diarrhoea during the outbreak, and 5(15%) were HIV-infected. In a neighbourhood-matched case-control study, immunosuppression (matched odds ratio (MOR) not calculable, 95% confidence interval (CI) 3.0, infinity) and having a child less than 5 years old in the household (MOR = 17.0, CI 2.0, 395.0) were independently associated with infection. When persons who had diarrhoea during the outbreak were excluded, immunosuppression remained significantly associated with illness (MOR not calculable, CI 1.6, infinity). Cryptosporidium transmission continued after this massive waterborne outbreak but decreased rapidly within 2 months.

AIDS-Related Opportunistic Infections↗

PubMed1995

Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission.

Contamination of the public water supply in Milwaukee during March and April 1993 resulted in a massive outbreak of cryptosporidium infection. We investigated the clinical and epidemiological features of visitors to the Milwaukee area in whom cryptosporidiosis developed, and we conducted a telephone survey of Milwaukee County households to evaluate the risk of recurrent illness and secondary transmission. Cryptosporidium infection during this outbreak generally seemed more severe than cases described in previous reports of large case series. The risk of secondary transmission within a household was low (5%) when the index case involved an adult. The recurrence of watery diarrhea after apparent recovery was a frequent occurrence among visitors with laboratory-confirmed cryptosporidium infection (39%) and among visitors and Milwaukee County residents with clinical infection (21%). The interval between the initial recovery and the onset of recurrence was prolonged (> or = 5 days) in 6%-8% of persons. This pattern of recurrence and its impact on transmission and our understanding of the pathophysiological mechanisms of cryptosporidium infection merit further investigation.

Adolescent↗

PubMed1994

A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply.

BACKGROUND: Early in the spring of 1993 there was a widespread outbreak of acute watery diarrhea among the residents of Milwaukee. METHODS: We investigated the two Milwaukee water-treatment plants, gathered data from clinical laboratories on the results of tests for enteric pathogens, and examined ice made during the time of the outbreak for cryptosporidium oocysts. We surveyed residents with confirmed cryptosporidium infection and a sample of those with acute watery diarrhea consistent with cryptosporidium infection. To estimate the magnitude of the outbreak, we also conducted a survey using randomly selected telephone numbers in Milwaukee and four surrounding counties. RESULTS: There were marked increases in the turbidity of treated water at the city's southern water-treatment plant from March 23 until April 9, when the plant was shut down. Cryptosporidium oocysts were identified in water from ice made in southern Milwaukee during these weeks. The rates of isolation of other enteric pathogens remained stable, but there was more than a 100-fold increase in the rate of isolation of cryptosporidium. The median duration of illness was 9 days (range, 1 to 55). The median maximal number of stools per day was 12 (range, 1 to 90). Among 285 people surveyed who had laboratory-confirmed cryptosporidiosis, the clinical manifestations included watery diarrhea (in 93 percent), abdominal cramps (in 84 percent), fever (in 57 percent), and vomiting (in 48 percent). We estimate that 403,000 people had watery diarrhea attributable to this outbreak. CONCLUSIONS: This massive outbreak of watery diarrhea was caused by cryptosporidium oocysts that passed through the filtration system of one of the city's water-treatment plants. Water-quality standards and the testing of patients for cryptosporidium were not adequate to detect this outbreak.

Adolescent↗

PubMed1990

Aging: physiological aspects and clinical implications.

Aging is not a new phenomenon, yet the physiology of aging is little understood. Several theories have been formulated to explain the aging process, ranging from immunological to free-radical theories of aging. Although the etiology of aging is important to understand, equally important is the differentiation of normal physiological changes from those associated with disease. The clinician's inability to recognize these differences may result in unnecessary testing, misdiagnoses and mismanagement of the elderly client. In addition, many of the changes associated with aging (e.g., decrease in visual acuity, impaired hearing) are potential hazards. One major role for the health care provider is to anticipate these changes, prepare the elderly client for them, and assist the elderly client in adapting to them. This article summarizes the physiological aspects of aging in the absence of disease and discusses some of the clinical implications related to these changes. Each system is addressed separately, as are the clinical implications related to that system.

Aged↗

PubMed1986

The battered woman: is she a silent victim?

Although hardly a recent phenomenon, the battered woman has still not been a clearly recognizable presence to primary caregivers. Unawareness of actual victims stems from an incomplete understanding of the reality of the "battered wife syndrome," lack of knowledge about the various forms of abuse and the silence of the victims themselves. The victim rarely reports abuse to the primary care provider without being asked. She does, however, present with common psychosomatic complaints, such as choking, gastrointestinal disorders or nervousness. Her injuries may range from bruises to fractures, and the explanation of these injuries is usually inappropriate. Characteristically, the victim of abuse has low self-esteem and anger that has been internalized. These lead to self-destructive behaviors such as alcohol or drug abuse. Many of the victim's behaviors are predictable and best understood in the contexts of learned helplessness, a cycle of violence or anticipatory fear. Recognizing that child abuse and spouse abuse often occur within the same family, the nurse practitioner can play a vital role in halting the cycle of family violence. Early recognition, knowledge of the forms of legal recourse in the community and intervention by the nurse practitioner will have an impact on the morbidity and mortality of this social problem.

Fear↗

PubMed1986

Vitamin supplementation and megadoses.

Almost one-third of American adults regularly take vitamins and supplements. If taken incorrectly or in excess, these vitamins may be a potential health hazard. Vitamins are essential nutrients which, in combination with other nutrients (e.g., fats, carbohydrates and proteins), foster normal metabolism. Vitamins also interact with each other. For example, vitamin C participates in the metabolism of folic acid, and vitamin E facilitates the absorption and storage of vitamin A. Because the biological functions of vitamins are interrelated, a diet poor in vitamins, carbohydrates, fats and proteins is not necessarily enhanced by vitamin supplementation. When vitamins are taken in excess of the Recommended Dietary Allowances or the individual's needs, the vitamins no longer function as vitamins but instead act as drugs, with such pharmacological effects as clinical toxicities and the abnormal utilization of vitamins. There are six categories that require vitamin supplements and, in some cases, megadoses. These will be discussed in detail. In addition, a brief table showing the Recommended Dietary Allowances will be given which the nurse practitioner can use in assessing nutritional needs of the client so that necessary adjustments can be made. Finally, a brief review of the potential risks and benefits of megadoses in normal, healthy adults will be given.

Ascorbic Acid↗

PubMedDate not supplied

Cancer screening of older women : a primary care issue.

PURPOSE: The purpose of this retrospective chart review was to examine whether family practice physicians and residents were screening older women for breast, gynecologic, and colorectal cancers as recommended by the American Cancer Society, the Guide to Clinical Preventive Services, and Healthy People 2000. METHODS: A retrospective chart review of women 60 years and older who were seen at least twice between July 1, 1992, and June 30, 1993, in a midwestern family practice residency program was completed. From the original sample of 660 potential subjects, a systematic random selection of every third chart was identified for review, resulting in a sample of 201. Analysis of the data was performed by descriptive statistics and chi-square tests. A series of multiple regression models using age, number of visits, type and gender of provider, and personal or family history of cancer as predictor variables was performed. RESULTS: Breast cancer screening was offered to approximately 70% of the sample, with only about one third of the older women receiving mammography or clinical breast examination. Recommendations for gynecologic cancer screening were given to 63% of the sample, with less than one third receiving Papanicolaou smears. Recommendations for digital rectal examination, fecal occult blood test, and flexible sigmoidoscopy were 58%, 59%, and 30%, respectively. The percentages of patients who actually received these tests were considerably lower. CLINICAL IMPLICATIONS: Barriers for appropriate cancer screening for older women exist for both the provider and the patient; however, many of these obstacles can be overcome. Improving the resident's exposure to the current recommendations, increasing geriatric content in the training program, and initiating a reminder system may reduce some of the provider barriers. The use of midlevel providers may increase the preventive services offered to older women as well as educate and empower these women to become responsible for their own healthcare. Together, physicians and midlevel providers can become patient advocates through political activism, encouraging legislation that guarantees payment for cancer screening tests. Finally, primary care providers can become actively engaged in research that explores the healthcare concerns of older women.

Aged↗