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Biomedical subjects

R L Vogt

Publications and source records attributed to R L Vogt.

At least 19 recordsLinked to original sources
PubMed1996

Mortality of Kauai residents in the 12-month period following Hurricane Iniki.

On September 11, 1992, Hurricane Iniki struck Kauai leaving all residents without electricity and telephone services and damaging 70% of the homes. This study examined the hypothesis that Hurricane Iniki increased the mortality of Kauai residents by comparing mortality data for the 5 years preceding Hurricane Iniki with mortality data for the 12 months immediately following. Although the overall mortality rate was increased in the post-Iniki period, the only significant increase was in the rate of diabetes mellitus-related deaths (relative risk = 2.61, 95% confidence interval 1.44-4.74). Hurricane Iniki did not appear to significantly increase the risk of dying of Kauai residents in the 12 months immediately following the disaster.

Adolescent↗
PubMed1996

Tuberculosis screening for immigrants and refugees. Diagnostic outcomes in the state of Hawaii.

The effectiveness of the required overseas tuberculosis (TB) screening for immigrants and refugees to the United States has not been evaluated since new guidelines were introduced in 1991. Using data from the Hawaii State TB register for 1992-1993, patient records, and data from the U.S. government notifications of suspect TB among aliens, we determined the percentage of persons either classified as having active TB (B1), inactive TB (B2), or considered "normal" overseas, who were evaluated and subsequently diagnosed with active TB within 1 yr of arrival in the United States. Of the 124 TB cases among immigrants and refugees evaluated within 1 yr of arrival, 78 (63%) had been classified overseas as B1, 17 (14%) as B2, and 29 (23%) as "normal." The proportion of TB cases diagnosed after arrival in the United States was 14.0% for B1s and 2.1% for B2s. This proportion decreased with increasing age. A positive skin test was a strong predictor (OR: 10.7; 95% CI: 1.4-80.1) of culture-confirmed TB. These data document that immigrants and refugees with B1 and B2 TB status have a high prevalence of active TB. They should be promptly evaluated after arrival in the United States to determine the need for curative or preventive therapy.

Adolescent↗
PubMed1993

Investigation of an outbreak of "humidifier fever" in a print shop.

An outbreak of "humidifier fever" affected 16 (57%) of 28 workers in a print shop. The most common symptoms were myalgia, chills or subjective fever, and cough. Illness began 5-13 hours after entering the workplace, and lasted 2-24 hours. A humidifier in use the day of the outbreak was found to be contaminated with fungi, amebae, and Gram-negative bacteria. The risk of illness was highest for those who had been on the job 3 months before the outbreak, a time when the humidifier was in constant use. Serologic studies of print shop workers showed positive reactions to extracts of organisms isolated from the humidifier, but could neither distinguish ill from well workers, nor identify causative organisms. The presence of endotoxin-producing bacteria and the clinical syndrome are consistent with an organic dust toxic syndrome. Previous exposure appeared to be the major risk factor for illness.

Acute Disease↗
PubMed1993

Use of multiple molecular subtyping techniques to investigate a Legionnaires' disease outbreak due to identical strains at two tourist lodges.

A multistate outbreak of Legionnaires' disease occurred among nine tour groups of senior citizens returning from stays at one of two lodges in a Vermont resort in October 1987. Interviews and serologic studies of 383 (85%) of the tour members revealed 17 individuals (attack rate, 4.4%) with radiologically documented pneumonia and laboratory evidence of legionellosis. A survey of tour groups staying at four nearby lodges and of Vermont-area medical facilities revealed no additional cases. Environmental investigation of common tour stops revealed no likely aerosol source of Legionella infection outside the lodges. Legionella pneumophila serogroup 1 was isolated from water sources at both implicated lodges, and the monoclonal antibody subtype matched those of the isolates from six patients from whom clinical isolates were obtained. The cultures reacted with monoclonal antibodies MAB1, MAB2, 33G2, and 144C2 to yield a 1,2,5,7 or a Benidorm 030E pattern. The strains were also identical by alloenzyme electrophoresis and DNA ribotyping techniques. The epidemiologic and laboratory data suggest that concurrent outbreaks occurred following exposures to the same L. pneumophila serogroup 1 strain at two separate lodges. Multiple molecular subtyping techniques can provide essential information for epidemiologic investigations of Legionnaires' disease.

Adult↗
PubMed1991

Effects of elemental mercury exposure at a thermometer plant.

This study compares 84 mercury-exposed workers at a thermometer manufacturing facility with 79 unexposed workers for evidence of chronic mercury toxicity. Personal breathing-zone air concentrations of mercury ranged from 25.6 to 270.6 micrograms/m3 for thermometer workers. Urinary mercury levels in the study population ranged from 1.3 to 344.5 micrograms/g creatinine, with eight (10%) participants exceeding 150 micrograms/g creatinine and three workers exceeding 300 micrograms/g creatinine, which indicates increased absorption of mercury among the thermometer workers. All urine mercury levels in the comparison group were compatible with normal background levels in unexposed adults (less than 10 micrograms/g creatinine). Thermometer plant workers reported more symptoms than did controls; in general, these differences were not statistically significant and could not be specifically associated with mercury exposure. Static tremor, abnormal Romberg test, dysdiadochokinesia, and difficulty with heel-to-toe gait were more prevalent among thermometer workers than control workers, which could not be associated with recent mercury exposure; there was some suggestion of an association with chronic exposure. There were no intergroup differences for the standard clinical tests of renal function except for a significantly higher mean specific gravity among the thermometer workers. A positive correlation was found, however, between urinary N-acetyl-b-D-glucosaminidase (NAG) and urinary mercury. There was no consistent evidence for intergroup differences in proximal renal tubule function, as measured by urinary beta 2-microglobulin (B2M) or retinol binding protein (RBP).

Adult↗
PubMed1991

The use of hospital discharge data for public health surveillance of Guillain-Barré syndrome.

The sensitivity of passive reporting of Guillain-Barré syndrome (GBS) to the Vermont Department of Health from 1980 to 1985 was compared to that of computerized hospital discharge abstract data. Written hospital discharge summaries were reviewed for clinical data to validate the computerized abstracts. In all, 51 definite and probable cases of GBS were identified from hospital data during a period when only 4 cases (8%) had been reported to the health department through passive physician reporting. Based on the hospital data, the incidence of this syndrome in Vermont was 1.6/100,000 population/year. The incidence rate for males was 1.5 times that for females. No geographical or seasonal clustering of cases was found. These epidemiological features are consistent with previously published data on the syndrome and suggest that the incidence has not changed significantly in the past 10 years. Incidence rates for GBS based on passively reported cases markedly underestimate the true incidence rate. Although limited by the lack of timeliness for public health surveillance, computerized hospital discharge data are readily available in many states and may be more sensitive in detecting cases, compared to passive surveillance. They may be a useful tool for establishing baseline rates and examining long-term trends for selected acute diseases like GBS for which there are well-established diagnostic criteria and that usually result in hospitalization.

Adult↗
PubMed1990

Increased morbidity in surgical patients undergoing secondary (incidental) cholecystectomy.

Using computerized hospital discharge abstracts for all Vermont residents hospitalized during 1983 and 1984, we examined the question of whether increased morbidity occurs in patients undergoing secondary (incidental) cholecystectomy. Among a cohort of 4183 patients undergoing a primary surgical procedure in which secondary cholecystectomy might have been considered. 69 patients had a secondary cholecystectomy. The surgical wound infection rate was 8.7% in the secondary cholecystectomy group compared to 2.4% in the rest of the cohort (relative risk, 3.7, 95% C.I. 1.7, 8.1). Other postoperative complications occurred in 10.1% of those undergoing secondary cholecystectomy compared to 4.1% in those who did not (relative risk, 2.5, 95% C.I. 1.2, 5.1). The adjusted relative risk for wound infection was 3.3 (95% C.I. 1.4,8.0) and for other surgical complications was 1.7 (95% C.I. 0.8, 3.8). Postoperative length of hospital stay was longer for the secondary cholecystectomy group (mean, 13.8 days) than in the comparison group (mean 8.9 days, p = 0.001). These data suggest that patients undergoing a secondary cholecystectomy may have an increased risk of surgical wound infection and possibly other surgical complications.

Adolescent↗
PubMed1989

Epidemiologic surveillance for endemic Giardia lamblia infection in Vermont. The roles of waterborne and person-to-person transmission.

The authors studied 1,211 laboratory-confirmed, non-outbreak-related cases of giardiasis in Vermont residents reported through Vermont's laboratory-based active surveillance system between 1983 and 1986. Giardiasis was the most common reportable disease in the state, with an average annual incidence rate of 45.9 cases per 100,000 population per year. This rate is higher than that in other states reporting giardiasis incidence. Morbidity from giardiasis was also significant in that 30% of cases reported symptoms lasting four or more weeks. Waterborne transmission was suggested to be an important cause of non-outbreak-related cases because rates of infection were highest in persons receiving nonfiltered municipal or nonmunicipal residential drinking water. Rates were also higher at higher elevations, where water supplies may be difficult to protect from contamination. In addition, the pattern of age-specific incidence rates and the high estimated incidence of infection in children attending day care suggested that person-to-person transmission also played a role in causing non-outbreak-related cases. Routine surveillance data can serve to indicate likely important routes of transmission of giardiasis in the community.

Adolescent↗
PubMed1989

Elevated levels of immunoglobulin A to Giardia lamblia during a waterborne outbreak of gastroenteritis.

During an outbreak of diarrheal illness among residents of a trailer park in rural Vermont, 37 (30%) of 122 residents met the case definition of outbreak-related giardiasis. Convalescent-phase sera from 24 residents and 20 nonresident control subjects were tested by enzyme-linked immunosorbent assay for immunoglobulin G (IgG), IgM, and IgA antibodies to Giardia lamblia. Residents showed higher levels of parasite-specific antibody than did nonresident controls for IgG and IgA but not IgM. Nine residents with giardiasis had a higher median level of G. lamblia-specific IgA but not IgG or IgM than 15 healthy residents (0.61 versus 0.16 optical density units; P = 0.004). Moreover, parasite-specific IgA levels were higher in those consuming tap water than in those who did not (0.31 versus 0.08 optical density units; P = 0.03) and increased with increasing water consumption. Levels of serum antibody to G. lamblia, particularly IgA, may be useful in determining exposure to G. lamblia-contaminated water and illness from G. lamblia during waterborne outbreaks of diarrheal illness.

Adult↗
PubMed1988

Characterization of an outbreak of Clostridium perfringens food poisoning by quantitative fecal culture and fecal enterotoxin measurement.

Published criteria for implicating Clostridium perfringens as the cause of food-poisoning outbreaks include finding a median fecal C. perfringens spore count of greater than 10(6)/g among specimens from ill persons. We investigated a food-poisoning outbreak with the epidemiologic characteristics of C. perfringens-related disease in a nursing home in which the median fecal spore count for ill patients (2.5 X 10(7)/g) was similar to that for well patients (4.0 X 10(6)/g), making the etiology of the outbreak uncertain. All ill and well patients tested had eaten turkey, the implicated food item. C. perfringens enterotoxin was detected by reverse passive latex agglutination in fecal specimens from six of six ill and none of four well patients who had eaten turkey (P = 0.005), suggesting that this organism had caused the outbreak. This investigation suggests that detection of fecal C. perfringens enterotoxin is a specific way to identify this organism as the causative agent in food-poisoning outbreaks.

Aged↗
PubMed1988

Investigation of possible health effects of community exposure to fermenting wood chips.

We conducted a case-control study of emergency room (ER) patients to evaluate whether asthma is caused by living near a wood-chip fueled power plant that released wood-chip fermentation products. Only eight (29 per cent) of 28 asthma patients seen in the ER during an 11-week period lived within 1.5 miles of the plant compared with 18 (34 per cent) of 54 control patients matched for severity of diagnosis and seen during the same period (Mantel-Haenszel odds ratio controlling for age = 0.96).

Adult↗
PubMed1987

Risk factors for secondary transmission in households after a common-source outbreak of Norwalk gastroenteritis.

In November 1984, a foodborne outbreak of Norwalk gastroenteritis occurred in a K-12 public school in northern Vermont. The outbreak offered an opportunity to systematically study in detail secondary transmission rates in households. Eating salad at Tuesday's school-sponsored Thanksgiving Banquet was associated with illness among students and staff members (p less than 0.025). Seven of 11 serum pairs from ill persons showed a fourfold or greater rise in antibody titer to Norwalk virus compared with one of nine controls (p = 0.028). The study of secondary household transmission revealed that households with persons with primary illness were 5.5 times more likely to experience secondary illness than households with well school children or adults. As the number of individuals with primary illness in the household increased, the secondary illness rates increased. Pre-school children were twice as likely as adults to develop secondary illness.

Adult↗