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Background: Employee health promotion in the elementary school setting can support students' health and academic success. School employees can serve as role models, yet evidence suggests poor health in this population. We identified factors that influence school employee health behaviors to inform subsequent development of employee wellness programs. Methods: Focus groups (10 groups, total N = 62) and interviews (N = 5) were conducted with school employees. Participants were recruited from schools in socioeconomically disadvantaged, racially diverse districts in Massachusetts. We used a socioecological framework to identify multi-level factors that influence employee health behaviors. Factors were characterized as supports (+) or barriers (-) to health-promoting behaviors. Results: Eight themes highlighted the importance of an organizational culture that sustains successful employee wellness programming. Intrapersonal themes included: High Stress (+/-), Desire to Adopt Healthy Behaviors (+), and Sufficient Health Knowledge (+). Interpersonal themes included: Strong Social Network (+) and a Desire to Role Model (+). Organizational themes included: Demanding Job (-), Lack of Wellness Culture (-), and Unhealthy Food (-). Conclusions: Our findings suggest that this population would be receptive to wellness programming. Promising strategies include supporting a dedicated wellness champion and creating recognizable top down wellness support for employees.

This cluster-randomized trial was designed to determine the efficacy of a 6-month exercise-nutritional supplement program (ENP) on physical function and nutritional status for older adults and the feasibility of implementing this program in a senior living setting. Twenty senior-living facilities were randomized to either a 3 day per week group-based ENP led by a trained facility staff member or a health education program (SAP). Participants (N = 121) completed a short physical performance battery, 400-m walk, handgrip strength test, and mini-nutrition assessment. 25-hydroxyvitamin D [25(OH)D], insulin-like growth-factor 1 (IGF-1), and activity level were also measured. The ENP did not significantly improve physical function or nutritional status compared with the SAP. Compared with baseline, participants in the ENP engaged in 39 min less physical activity per week at 6 months. Several facility characteristics hindered implementation of the ENP. This study highlights the complexity of implementing an evidence-based program in a field setting. [ABSTRACT FROM AUTHOR]

Background: Despite advances in surveillance and prevention, pneumonia and influenza (P&I) remain among the leading causes of mortality in the United States. Elderly adults experience the most severe morbidity from influenza-associated diseases, and have the highest rates of seasonal migration within the U.S. compared to other subpopulations. The objective of this study is to assess spatiotemporal patterns in influenza-associated hospitalizations in the elderly, by time, geography, and intensity of P&I. Given the high seasonal migration of individuals to Florida, this state was examined more closely using harmonic regression to assess spatial and temporal patterns of P&I hospitalizations by state of residence. Methods: Data containing all Medicare-eligible hospitalizations in the United States for 1991-2006 with P&I (ICD- 9-CM codes 480-487) were abstracted for the 65+ population. Hospitalizations were classified by state of residence, provider state, and date of admissions, specifically comparing those admitted between October and March to those admitted between April and September. We then compared the hospitalization profile data of Florida residents with that of out-of-state residents by state of primary residence and time of year (in-season or out-of-season). Results: We observed distinct seasonal patterns of nonresident P&I hospitalizations, especially comparing typical winter destination states, such as California, Arizona, Texas, and Florida, to other states. Although most other states generally experienced a higher proportion of non-resident P&I during the summer months (April-September), these states had higher nonresident P&I during the traditional peak influenza season (October-March). Conclusions: This study is among the first to quantify spatiotemporal P&I hospitalization patterns in the elderly, focusing on the change of patterns that are possibly due to seasonal population migration. Understanding migration and influenza-associated disease patterns in this vulnerable population is critical to prepare for and potentially prevent influenza outbreaks in this vulnerable population. [ABSTRACT FROM AUTHOR]

Taste perception is a primary driver of food choices; however, little is known about how perception of all five tastes (sweet, salt, sour, bitter, umami) collectively inform dietary patterns. Our aim was to examine the associations between a multivariable measure of taste perception—taste perception profiles—and empirically derived dietary patterns. The cohort included 367 community-dwelling adults (55–75 years; 55% female; BMI = 32.2 ± 3.6 kg/m2) with metabolic syndrome from PREDIMED-Plus, Valencia. Six taste perception profiles were previously derived via data-driven clustering (Low All, High Bitter, High Umami, Low Bitter and Umami, High All But Bitter, High All But Umami); three dietary patterns were derived via principal component analysis (% variance explained = 20.2). Cross-sectional associations between profiles and tertials of dietary pattern adherence were examined by multinomial logistic regression. Overall, there were several significant differences in dietary pattern adherence between profiles: the vegetables, fruits, and whole grains pattern was significantly more common for the High All But Umami profile (OR range for high vs. low adherence relative to other profiles (1.45–1.99; 95% CI minimum lower, maximum upper bounds: 1.05, 2.74), the non-extra virgin olive oils, sweets, and refined grains pattern tended to be less common for Low All or High Bitter profiles (OR range: 0.54–0.82), while the alcohol, salty foods, and animal fats pattern tended to be less common for Low Bitter and Umami and more common for High All But Bitter profiles (OR range: 0.55–0.75 and 1.11–1.81, respectively). In conclusion, among older adults with metabolic syndrome, taste perception profiles were differentially associated with dietary patterns, suggesting the benefit of integrating taste perception into personalized nutrition guidance. [ABSTRACT FROM AUTHOR]

Background: About 1.4 million Salmonella infections, a common food-borne illness, occur in the U.S. annually; the elderly (aged 65 or above) are most susceptible. In 1997, the USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Points Systems (PR/HACCP) which demands regular Salmonella testing in various establishments processing meat products, such as broiler chickens. Impact evaluations of PR/HACCP on hospitalizations related to Salmonella are lacking. Methods: Hospitalization records of the U.S. elderly in 1991-2004 were obtained from the Centers of Medicare and Medicaid Services. Harmonic regression analyses were performed to evaluate the long-term trends of Salmonella-related hospitalizations in pre- and post-HACCP periods. Seasonal characteristics of the outcome in the nine Census divisions of the contiguous U.S. were also derived and contrasted. Results: Predicted rates decreased in most divisions after 1997, except South Atlantic, East South Central, and West South Central. These three divisions also demonstrated higher overall hospitalization rates, pronounced seasonal patterns, and consistent times to peak at about 32nd to 34th week of the year. Conclusion: The impact of HACCP was geographically different. South Atlantic, East South Central, and West South Central divisions should be targeted in further Salmonella preventive programs. Further research is needed to identify the best program type and timing of implementation. [ABSTRACT FROM AUTHOR]

Background: The effect of calorie restriction (CR) on cognitive function is not well understood, and the impact of the dietary patterns consumed during CR has not been investigated., Objectives: We analyzed the combined association of CR and dietary quality with spatial working memory (SWM) in healthy adults without obesity., Methods: The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial was a 2-y, multisite clinical trial. This trial was registered at clinicaltrials.gov as NCT00427193. Participants were randomized to a 25% reduction in EI (n = 143) or an ad libitum Control (n = 76). The Dietary Inflammatory Index (DII) and the Healthy Eating Index (HEI) captured dietary quality, with a lower DII and higher HEI score indicating a healthier diet. The Cambridge Neuropsychological Test Automated Battery battery was used to assess SWM. Longitudinal associations between each dietary pattern index and SWM for CR and Control were assessed by multivariable negative binomial models that included baseline, 12-mo, and 24-mo visits., Results: Participants were aged 38.1 ± 7.2 y with a BMI of 25.1 ± 1.7 kg/m 2 . A total of 70% of the participants were female. Baseline mean DII and HEI scores were -0.15 (range: -3.77, 4.21) and 59.1 (24.1, 91.0) and did not differ between groups. Improvements in DII and HEI were significantly different between CR and Control over 2 y (both P-interaction = 0.001). In longitudinal analyses, there was no association of either index with SWM. Furthermore, though within-group improvements in SWM were observed at 12 mo, there was no statistically significant difference between CR (SWM errors: 9.0; 95% CI: 1.9, 41.6) and Control (11.7; 95% CI: 2.6, 53.5; P > 0.99), holding DII constant. Comparable results were observed at 24 mo and for the HEI., Conclusions: Dietary quality during CR was not associated with measures of SWM over 2 y in healthy adults without obesity. These results suggest that, in healthy populations, dietary patterns and CR may have a limited impact on working memory. Further research is required to understand the concurrent effect of these nutritional strategies., (Copyright © 2023. Published by Elsevier Inc.)

Background: As suboptimal diet quality remains the leading modifiable contributor to chronic disease risk, it is important to better understand the individual-level drivers of food choices. Recently, a genetic component of food choices was proposed based on variants (SNPs) in genes related to taste perception (taste-related SNPs)., Objectives: This study aimed to determine the cumulative contribution of taste-related SNPs for basic tastes (bitter, sweet, umami, salt, and sour), summarized as "polygenic taste scores," to food group intakes among adults., Methods: Cross-sectional analyses were performed on 6230 Framingham Heart Study participants (mean age ± SD: 50 ± 14 y; 54% female). Polygenic taste scores were derived for tastes with ≥2 related SNPs identified in prior genome-wide association studies, and food group intakes (servings per week [sev/wk]) were tabulated from food frequency questionnaires. Associations were determined via linear mixed-effects models, using false discovery rates and bootstrap resampling to determine statistical significance., Results: Thirty-three taste-related SNPs (9 bitter, 19 sweet, 2 umami, 2 sour, 1 salt) were identified and used to derive polygenic taste scores for bitter, sweet, umami, and sour. Per additional allele for higher bitter perception, whole grain intakes were lower by 0.17 (95% CI: -0.28, -0.06) sev/wk, and for higher umami perception, total and red/orange vegetable intakes were lower by 0.73 (95% CI: -1.12, -0.34) and 0.25 (95% CI: -0.40, -0.10) sev/wk, respectively. Subsequent analyses at the SNP level identified four novel SNP-diet associations-two bitter-related SNPs with whole grains (rs10960174 and rs6782149) and one umami-related SNP with total and red/orange vegetables (rs7691456)-which may have been driving the identified associations., Conclusions: Taste-related genes for bitter and umami were differentially associated with food choices that may impact diet quality. Hence, a benefit could be derived from leveraging knowledge of taste-related genes when developing personalized risk reduction dietary guidance., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Introduction: In response to the opioid overdose crisis, providers were urged to taper and discontinue patients from long-term opioid therapy; however, abrupt discontinuation may lead to poor health outcomes. This study aims to determine abrupt and tapered discontinuation rates and identify the patient and provider characteristics associated with abrupt discontinuation., Methods: Data were from the Massachusetts Prescription Monitoring Program, 2015-2018. Patients discontinued from long-term opioid therapy were included in the analysis. Differences between abrupt and tapered discontinuations were identified with bivariate correlations, and variables independently associated with abrupt discontinuation were identified using multivariable Poisson regression analyses. Data were analyzed during 2019-2021., Results: In total, 277,485 patients experienced 359,320 discontinuations, of which 33.7% (n=120,964) were abrupt. Of all discontinuations, 55.7% were among female patients, and 57.9% were among patients aged >55 years. The ratio of abrupt to tapered discontinuations increased from 1:2.11 in 2015 to 1:1.75 in 2018. In bivariate analysis, prescribers with more patients receiving monthly opioid prescriptions were less likely to abruptly discontinue patients (29.0, IQR=13.9, 55.3 vs 18.8, IQR=5.84, 43.9, p<0.001), as were prescribers who wrote more monthly opioid prescriptions (36.0, IQR=16.8, 70.8 vs 25.4, IQR=7.40, 58.3, p<0.001). Multivariable results indicated that abrupt discontinuation was independently associated with male sex (RR=1.31, 95% CI=1.29, 1.1.32), younger age (RR=0.872, 95% CI=0.869, 0.874), greater distance between patient and prescriber (RR=1.0075, 95% CI=1.0072, 1.0078), and longer long-term opioid therapy duration (RR=1.021, 95% CI=1.021, 1.0122 for every month increase)., Conclusions: Among all long-term opioid therapy discontinuations, abrupt discontinuation is increasing. Evidence-based approaches to managing and tapering long-term opioid therapy are urgently needed., (Copyright © 2021 American Journal of Preventive Medicine. All rights reserved.)

Among school employees, it has been reported that poor physical and mental health, as well as high stress and large workloads, have resulted in high absenteeism and low retention. The consequences of unhealthy behaviors and stress can extend to students, impacting academic achievement and school costs. Our objective was to examine the impact of school employees' physical activity (PA), diet quality and perceived occupational stress on cardiometabolic health, and explore how stress may influence the impact of PA and diet on health. In this cross-sectional study, employees from lower-income Massachusetts schools participated in Wellness Assessments (2015-2016), including measured height, weight, and lipids [total (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C)]. Self-administered surveys were used to collect demographic, stress, PA and 24-hour food intake data. Linear regression models were used to examine the relationship among health behaviors (PA and diet), stress and cardiometabolic health. An interaction between stress and health behaviors was also explored. Seventy-four employees (66% teachers) participated. Overweight/obesity (mean BMI: 25.6 kg/m 2 ), high TC and LDL-C were observed in 47%, 4%, and 34%, respectively, and moderate-to-vigorous PA (MVPA) was low (median: 17 min/day). Positive associations were identified between MVPA and cardiometabolic health, but not diet. The effect of MVPA on BMI was modified by stress (p-for-interaction = 0.001), with higher levels of stress associated with a diminished protective association between MVPA and BMI. Higher levels of PA were associated with more favorable cardiometabolic health, with increasing levels of stress minimizing the beneficial effect of PA on BMI., (© 2020 The Authors.)

Introduction: Opioid overdose deaths quintupled in Massachusetts between 2000 and 2016. Potentially inappropriate opioid prescribing practices (PIP) are associated with increases in overdoses. The purpose of this study was to conduct spatial epidemiological analyses of novel comprehensively linked data to identify overdose and PIP hotspots., Methods: Sixteen administrative datasets, including prescription monitoring, medical claims, vital statistics, and medical examiner data, covering >98% of Massachusetts residents between 2011-2015, were linked in 2017 to better investigate the opioid epidemic. PIP was defined by six measures: ≥100 morphine milligram equivalents (MMEs), co-prescription of benzodiazepines and opioids, cash purchases of opioid prescriptions, opioid prescriptions without a recorded pain diagnosis, and opioid prescriptions through multiple prescribers or pharmacies. Using spatial autocorrelation and cluster analyses, overdose and PIP hotspots were identified among 538 ZIP codes., Results: More than half of the adult population (n = 3,143,817, ages 18 and older) were prescribed opioids. Nearly all ZIP codes showed increasing rates of overdose over time. Overdose clusters were identified in Worcester, Northampton, Lee/Tyringham, Wareham/Bourne, Lynn, and Revere/Chelsea (Getis-Ord Gi*; p < 0.05). Large PIP clusters for ≥100 MMEs and prescription without pain diagnosis were identified in Western Massachusetts; and smaller clusters for multiple prescribers in Nantucket, Berkshire, and Hampden Counties (p < 0.05). Co-prescriptions and cash payment clusters were localized and nearly identical (p < 0.05). Overlap in PIP and overdose clusters was identified in Cape Cod and Berkshire County. However, we also found contradictory patterns in overdose and PIP hotspots., Conclusions: Overdose and PIP hotspots were identified, as well as regions where the two overlapped, and where they diverged. Results indicate that PIP clustering alone does not explain overdose clustering patterns. Our findings can inform public health policy decisions at the local level, which include a focus on PIP and misuse of heroin and fentanyl that aim to curb opioid overdoses., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

The research on how health and health care disparities impact response to and recovery from a disaster, especially among diverse and underserved populations is in great need for a thorough evaluation. The time series analysis utilizing most complete national databases of medical records is an indispensable tool in assessing the destruction and health toll brought about by natural disasters. In this study, we demonstrated such an application by evaluating the impact of Hurricane Katrina in 2005 on cardiovascular disease (CVD), a primary cause of mortality among older adults that can be aggravated by natural disasters. We compared CVD hospitalizations before, during and after Katrina between white and black residents of three most populated parishes in Louisiana: Orleans and Jefferson, which were severely affected by the landfall and subsequent floods, and East Baton Rouge, which hosted many of the evacuees. We abstracted 383,552 CVD hospitalization records for Louisiana's patients aged 65+ in 2005⁻2006 from the database maintained by the Center of Medicare & Medicaid Services. Daily time series of CVD-related hospitalization rates at each study parish were compiled, and the changes were characterized using segmented regression. In Orleans Parish, directly affected by the hurricane, hospitalization rates peaked on the 6th day after landfall with an increase (mean ± SD) from 7.25 ± 2.4 to 18.5 ± 17.3 cases/day per 10,000 adults aged 65+ ( p < 0.001) and returned to pre-landfall level after ~2 months. Disparities in CVD rates between black and white older adults were exacerbated during and following landfall. In Orleans Parish, a week after landfall, the CVD rates increased to 26.3 ± 23.7 and 16.6 ± 11.7 cases/day per 10,000 people ( p < 0.001) for black and white patients, respectively. The abrupt increase in CVDs is likely due to psychosocial and post-traumatic stress caused by the disaster and inadequate response. Inequities in resource allocation and access have to be addressed in disaster preparation and mitigation.

Background: Abscesses commonly occur among people who inject drugs (PWID). However, whether the risks are comparable between males and females, and the impact of sex work on abscess risk is unclear. The goal of this study was to examine the contemporary associations of gender and sex work with the risk of abscesses in PWID., Methods: Combining data from two cross-sectional studies conducted in the Greater Boston Area with people at risk for HIV and hepatitis C virus (HCV), we used the following inclusion criteria: age 18-45 years and report of illicit or non-prescription drug injection within the 30 days prior to the survey. Information on demographics, injection-mediated risks, and sexual behaviors was collected using Audio Computer-Assisted Self-Interview Software. Multivariable logistic regressions were used to model associations., Results: The study sample included 298 people including 30% were female. Females were more likely than men to report sex work (28% vs. 16%, p = .012) and abscess during their lifetime (55% vs. 37% p = .004). Among the females, engaging in sex work increased by >5-fold the odds of reporting abscesses [Adjusted odds ratio 5.42; 95% CI: 1.27, 23.10]. There was no association between sex work and abscesses among men., Discussion: We found a female-specific association between sex work, injection drug use, and abscesses among PWID. Although the cross-sectional designs precluded causal inferences, longitudinal studies could enhance understanding of gender-associated risks for abscesses and inform the development of harm reduction interventions., (Published by Elsevier B.V.)

Rural Ghanaian communities continue using microbiologically contaminated surface water sources due in part to undesirable organoleptic characteristics of groundwater from boreholes. Our objective was to identify thresholds of physical and chemical parameters associated with consumer complaints related to groundwater. Water samples from 94 boreholes in the dry season and 68 boreholes in the rainy season were analyzed for 18 parameters. Interviews of consumers were conducted at each borehole regarding five commonly expressed water quality problems (salty taste, presence of particles, unfavorable scent, oily sheen formation on the water surface, and staining of starchy foods during cooking). Threshold levels of water quality parameters predictive of complaints were determined using the Youden index maximizing the sum of sensitivity and specificity. The probability of complaints at various parameter concentrations was estimated using logistic regression. Exceedances of WHO guidelines were detected for pH, turbidity, chloride, iron, and manganese. Concentrations of total dissolved solids (TDS) above 172mg/L were associated with salty taste complaints. Although the WHO guideline is 1000mg/L, even at half the guideline, the likelihood of salty taste complaint was 75%. Iron concentrations above 0.11, 0.14 and 0.43mg/L (WHO guideline value 0.3mg/L) were associated with complaints of unfavorable scent, oily sheen, and food staining, respectively. Iron and TDS concentrations exhibited strong spatial clustering associated with specific geological formations. Improved groundwater sources in rural African communities that technically meet WHO water quality guidelines may be underutilized in preference of unimproved sources for drinking and domestic uses, compromising human health and sustainability of improved water infrastructure., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Objective: To describe correlates of physical activity (PA) in structured exercise and structured sports sessions among low-income, overweight children participating in a community-based PA program., Methods: A total of 93 children (55% male; 91% Hispanic) aged 8-14 years were included. Participants wore pedometers in a sample of 10 of 59 total sessions offered; mean steps per minute were calculated for structured exercise and sports sessions. Separate multivariable regression models tested associations between steps per minute in exercise and sports sessions and 5 potential correlates: baseline body mass index z-score, aerobic fitness (Progressive Aerobic Cardiorespiratory Endurance Run laps), perceived athletic competence (Harter self-perception profile), sex, and age., Results: Only age (ß = -2.9; P = .02) significantly predicted steps per minute in exercise sessions. Age (ß = -4.3; P = .007), fitness (ß = 0.45; P = .03), and male sex (ß = 8.7; P = .02) significantly predicted steps per minute in sports., Conclusion and Implications: In structured exercise and sports, perceived competence may not influence overweight and obese children's PA. However, girls and older or less fit children may engage less actively, especially in sports., (Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Purpose: Collecting reference values in subpopulations such as infants and children can pose a daunting challenge to gather through epidemiologic studies. The authors propose to evaluate a method the authors refer to as extrapolated norms (e-norms) to derive Stimulated Single Fiber EMG jitter reference values from the laboratory data of pediatric and adult cohorts. Single Fiber EMG studies are considered the gold standard test for evaluation of neuromuscular transmission disorders., Methods: Data that lie in the plateau part of an inverted S curve derived from sorted jitter data were used to calculate descriptive statistics for pediatric and adult e-norms jitter., Results: The e-norms derived jitter was 22 ± 2.83 μs for our pediatric and 21 ± 2.79 μs for our adult cohort. Our adult e-norms values compared favorably with the 22 ± 1.99 μs published jitter range derived from a healthy adult cohort., Conclusions: The e-norms method the authors describe seems to be useful in recovering reference ranges when such values are difficult to obtain, such as in a pediatric subpopulation.

Introduction: Motor unit action potential (MUAP) reference values are usually given per muscle and age group. Our aim was to evaluate the change in MUAP size at different contraction levels using the concentric macro (ConMac) EMG technique., Methods: ConMac needles were used to record the electrode cannula MUAP and measure its amplitude and area during weak, moderate, and strong muscle contractions., Results: MUAP area and amplitude gradually increased from weak to strong contraction levels in all muscles studied. MUAP amplitudes were larger in distal than in proximal muscles, likely because of a higher fiber density distally., Conclusions: MUAP normal values in the literature per muscle do not take into account the contraction level at which they were recorded and can misrepresent the interpretation of normal. Concentric macro EMG is a simple and useful complement to routine EMG studies and yields additional information on MUAP neurophysiology., (Copyright © 2013 Wiley Periodicals, Inc.)

Introduction: Near-infrared spectroscopy (NIRS) is a non-invasive technique used to measure tissue oxygenation. In this study we describe oxyneurography (ONG), a novel application of the NIRS technique in non-invasive surface measurement of oxygenation in ulnar nerve., Methods: NIRS sensors were applied directly over the ulnar epicondylar groove to measure the ulnar nerve ONG index, a ratio of oxygenated over total hemoglobin content. Ulnar motor conduction studies were obtained in all subjects., Results: The ONG index and ulnar motor conduction had a positive linear association. Ulnar motor conduction could be linearly predicted by the ONG index. The ONG index showed a sensitivity of 1.0 and a specificity of 0.852 for the presence of an ulnar neuropathy symptom. During limb ischemia, the ONG index gradually decreased., Conclusions: Oxyneurography can lead to the early detection of a compromise in a nerve's oxygenation status leading to neuropathy., (Copyright © 2011 Wiley Periodicals, Inc.)

Objectives: To assess how influenza vaccination coverage in children is related to pneumonia and influenza (P&I) in older adults and whether sociodemographic factors modify these associations., Design: Approximately 5 million hospitalization records from the Centers for Medicare and Medicaid Services for four influenza years (2002-2006) were abstracted. A single-year age distribution of rates of P&I hospitalization was estimated according to state for each influenza season; an exponential acceleration in the P&I rates with age was observed for each influenza season. State- and season-specific P&I rate accelerations were regressed against the percentage of vaccinated children, older adults, or both using mixed effects models., Setting: U.S. population, 2002 to 2006., Participants: U.S. population aged 65 and older., Measurements: State-level influenza annual vaccination coverage data in children and older adults were obtained from the National Immunization Survey and the Behavioral Risk Factor Surveillance System, respectively., Results: Child influenza vaccination coverage was negatively associated with age acceleration in P&I, whereas influenza vaccination in the older adults themselves was not significantly associated with P&I in older adults., Conclusion: Vaccination of children against influenza may induce herd immunity against influenza for older adults and has the potential to be more beneficial to older adults than the existing policy of preventing influenza by vaccinating older adults themselves., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)

Background: Epidemiologic studies are often confounded by the human and environmental interactions that are complex and dynamic spatio-temporal processes. Hence, it is difficult to discover nuances in the data and generate pertinent hypotheses. Dynamic mapping, a method to simultaneously visualize temporal and spatial information, was introduced to elucidate such complexities. A conceptual framework for dynamic mapping regarding principles and implementation methods was proposed., Methods: The spatio-temporal dynamics of Salmonella infections for 2002 in the U.S. elderly were depicted via dynamic mapping. Hospitalization records were obtained from the Centers of Medicare and Medicaid Services. To visualize the spatial relationship, hospitalization rates were computed and superimposed onto maps of environmental exposure factors including livestock densities and ambient temperatures. To visualize the temporal relationship, the resultant maps were composed into a movie., Results: The dynamic maps revealed that the Salmonella infections peaked at specific spatio-temporal loci: more clusters were observed in the summer months and higher density of such clusters in the South. The peaks were reached when the average temperatures were greater than 83.4 degrees F (28.6 degrees C). Although the relationship of salmonellosis rates and occurrence of temperature anomalies was non-uniform, a strong synchronization was found between high broiler chicken sales and dense clusters of cases in the summer., Conclusions: Dynamic mapping is a practical visual-analytic technique for public health practitioners and has an outstanding potential in providing insights into spatio-temporal processes such as revealing outbreak origins, percolation and travelling waves of the diseases, peak timing of seasonal outbreaks, and persistence of disease clusters.

Objectives: We assessed associations between community-level socioeconomic, demographic, and environmental characteristics, and the presence of two potentially waterborne infectious diseases, cryptosporidiosis and giardiasis, as reported to the Massachusetts Department of Public Health., Methods: We created a series of maps showing the spatial distribution of cryptosporidiosis and giardiasis in Massachusetts (1993-2002) overall and by age, using logistic regression to analyze associations between community-level characteristics and the presence of at least one reported case of each disease. This analysis was repeated for communities with predominantly private water supplies., Result: After adjusting for population size, higher population density and larger than average household sizes were associated with increased odds of reported cases of cryptosporidiosis. Giardiasis was also associated with high population density, but was not associated with household size. In the elderly, income was positively associated with the presence of giardiasis., Discussion: These findings suggest that greater population density and larger household sizes may increase the likelihood of protozoan gastrointestinal infection. The results emphasize the necessity to account for distal factors, such as demographic characteristics, that may ultimately play a role in the transmission or reporting of disease.