Asunto(s)
Ilegitimidad/tendencias , Embarazo en Adolescencia , Adolescente , Estudios Transversales , Femenino , Humanos , Recién Nacido , Kentucky , EmbarazoRESUMEN
Neonatal poliomyelitis, which was rare even when poliomyelitis was widespread, has not been reported in the United States since use of live oral poliovirus vaccine (Sabin's vaccine) became widespread. We report a child who became symptomatic with apnea at 18 days of age and who subsequently developed a permanent monoparesis. Serologic and cultural evidence indicated the virus as poliovirus vaccine type. Another infant who received live oral poliovirus vaccine was probably the source of the infecting virus. Recognition that poliovirus infection can still occur in the United States and an understanding of the serologic, cultural, and typing tests required to substantiate this diagnosis are needed so that such patients will be accurately diagnosed.
Asunto(s)
Poliomielitis/diagnóstico , Humanos , Recién Nacido , Masculino , Poliomielitis/prevención & control , Vacuna Antipolio de Virus Inactivados/uso terapéuticoRESUMEN
We conducted a survey of 1,064 out-of-hospital Kentucky births during 1981 to 1983 in order to classify each by planning status (planned or unplanned to occur out of hospital) and attendant. Among the 809 births for which we obtained information, 575 (71.1%) were planned. We examined birth outcome by low birth weight (LBW) and neonatal mortality (NM). Compared with planned births, unplanned births were associated with increased risk of LBW (odds ratio = 6.6; 95% confidence limits [CL], 3.9 to 11.2, adjusted for maternal age). Furthermore, after adjusting for maternal age and parity, LBW births occurred at less than expected frequency among planned births (observed to expected [O:E] ratio = 0.48; 95% CL, 0.29 to 0.73), but at greater than expected frequency among unplanned births (O:E ratio = 2.9; 95% CL, 2.2 to 3.8). A similar, but nonsignificant, trend was seen for NM and NM was much greater in the unplanned group (72.7 per 1,000 live births) than in the planned group (3.5 per 1,000).
Asunto(s)
Parto Obstétrico/métodos , Mortalidad Infantil , Recién Nacido de Bajo Peso , Recién Nacido , Adolescente , Adulto , Escolaridad , Etnicidad , Femenino , Parto Domiciliario , Humanos , Ilegitimidad , Recien Nacido Prematuro , Kentucky , Edad Materna , Partería , Enfermeras y Enfermeros , Médicos , Embarazo , Encuestas y CuestionariosRESUMEN
We identified two random samples of 216 primary care physicians each. In one sample, we made weekly telephone contact for active hepatitis A (HA) surveillance; in the other, we made no such contact (passive surveillance). Appropriate county health departments were notified whenever we identified a HA case by active surveillance. Active surveillance was associated with a 2.8-fold increase in reported HA cases compared to passive surveillance. The estimated benefit: cost ratio active/passive surveillance was 2.5:1.
Asunto(s)
Hepatitis A/epidemiología , Vigilancia de la Población , Administración en Salud Pública/economía , Análisis Costo-Beneficio/métodos , Humanos , Kentucky , Medicina , Médicos de Familia , EspecializaciónRESUMEN
In November 1982, Meade County, Kentucky health officials noted a sudden increase in the incidence of hepatitis A. Using a standardized interview of 73 cases (68 serologically confirmed), and 85 controls (all negative for antibody to hepatitis A virus), the most important risk factor identified was household use of untreated water from a single spring. A dose-response relationship was found for consumption of unboiled spring water. Water samples taken from the spring during the outbreak were contaminated with fecal coliforms.