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Few studies have investigated the impacts of established invasive birds on the native threatened avifauna. However, measuring the levels of mortality in native birds from exotic birds can help with management decisions on whether or not such introduced species need to be controlled. The black robin Petroica traversi is an endangered bird endemic to the Chatham Islands of New Zealand. Black robins build cup-like nests either within tree cavities ('cavity' nests) or in the sub-canopy vegetation ('open' nests). Nest predation, most likely by the invasive European starling Sturnus vulgaris, was the largest cause of nest failure in the main population of the black robin on Rangatira Island. Nest predation rate over five breeding seasons was 20.6% in comparison with 7.74% of nests failing because of severe weather events (the second largest cause for nest failure). Cavity nests experienced a significantly higher rate of predation (36.33%) than open nests (10.82%). The greater frequency of open nests (63.5% out of 244 nests monitored) may be a result of higher selection pressure by starlings on cavity nests. Nest height also influenced predation, with predation risk increasing from 4.88% for nests below 1 m to 31.89% for nests above 3 m. Overall, predation on black robin nests decreased chick production in the population by 15.6% annually. For a population of only 220-240 birds, this loss may be limiting continued population growth and we recommend that efforts be made to reduce predation through either the culling of starlings or the installation of nest boxes at the low heights avoided by starlings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study assessed the prevalence of self-reported hearing loss (HL) and work-related noise-induced hearing loss (NIHL) in Michigan. METHODS: Questions related to HL and NIHL were added to the 2003 Behavioral Risk Factor Surveillance System in Michigan, a national telephone survey-based surveillance system of health conditions among adults. RESULTS: An estimated 19% reported HL; the proportion with HL increased steeply with age. Among those with HL, 29.9% reported that their HL was related to noise at work. Associations were found between HL/NIHL and current cigarette smoking and elevated cholesterol. CONCLUSIONS: Self-reported HL is common in Michigan. Almost 30% of this loss was attributed to noise exposure at work, a preventable condition. Prevalence estimates from this study were higher than previously published estimates. Better surveillance and prevention programs are recommended. [ABSTRACT FROM AUTHOR]

AIM: To compare alternative survey methods for estimating (a) levels of at risk alcohol consumption and (b) total volume of alcohol consumed per capita in comparison with estimates from sales data and to investigate reasons for under-reporting. SETTING: The homes of respondents who were eligible and willing to participate. PARTICIPANTS: A total of 21,674 Australians aged 14 years and older. DESIGN: A 2001 national household survey of drug use, experiences and attitudes with weights applied for age, sex, geographic location and day of week of interview. MEASURES: Self-completion questionnaire using quantity-frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption 'yesterday': one in standard drinks, another with empirically based estimates of drink size and strength. RESULTS: The highest estimate of age 14 + per capita consumption of 7.00 l of alcohol derived from recall of consumption 'yesterday' or 76.8% of the official estimate. The lowest was QF with 49.8%. When amount consumed 'yesterday' was recalled in standard drinks this estimate was 5.27 l. GF questions yielded higher estimates than did QF questions both for total volume (5.25 versus 4.54 l) and also for the proportion of the population at risk of long-term alcohol-related harm (10.6%versus 8.1%). With the detailed 'yesterday' method 61% of all consumption was on high risk drinking days. CONCLUSIONS: Questions about typical quantities of alcohol consumed can lead to underestimates, as do questions about drinking 'standard drinks' of alcohol. Recent recall methods encourage fuller reporting of volumes plus more accurate estimates of unrecorded consumption and the proportion of total alcohol consumption that places drinkers at risk of harm. However, they do not capture longer-term drinking patterns. It is recommended that both recent recall and measures of longer-term drinking patterns are included in national surveys. [ABSTRACT FROM AUTHOR]

Problem/Condition: Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. WRA includes new-onset asthma caused by workplace exposure to sensitizers or irritants and preexisting asthma exacerbated by workplace exposures. Reporting Period: This report reviews cases of WRA identified by state health departments from January 1, 1993, through December 31, 1995, as well as follow-up investigations of cases and associated workplaces conducted through June 30, 1998. Description of the Systems: State-based surveillance and intervention programs for WRA are conducted in California, Massachusetts, Michigan, and New Jersey as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR) cooperative agreement program, initiated by CDC's National Institute for Occupational Safety and Health (NIOSH). Results: From 1993 through 1995, a total of 1,101 cases of WRA were identified by SENSOR surveillance staff members in California, Massachusetts, Michigan, and New Jersey. Of these 1,101 cases, 19.1% were classified as work-aggravated asthma, and 80.9% were classified as new-onset asthma. Objective evidence substantiating asthma work-relatedness was documented in the medical records of 3.4% of WRA cases identified in the two states (Michigan and New Jersey) where medical records are routinely reviewed for this information. Indoor air pollutants, dusts, cleaning materials, lubricants (e.g., metalworking fluids), and diisocyanates were among the most frequently reported causes of WRA. In addition, a well-recognized cause of occupational asthma - natural rubber latex - was identified in a new setting, the health-care industry. The most common industries associated with WRA cases included transportation equipment manufacturing (19.3%), health services (14.2%), and educational services (8.7%). Air sampling for agents known to induce occupational asthma was performed in Michigan for comparison with established federal time-weighted average exposure limits. Sixteen (13.4%) of 119 workplaces tested had airborne concentrations exceeding NIOSH recommended exposure limits (RELs); 11 (9.1%) of 121 workplaces had concentrations exceeding permissible exposure limits (PELs) of the Michigan Occupational Safety and Health Act (MIOSHA) program.* Interpretation: The surveillance data findings confirm well-recognized causes of asthma and have identified new putative causes (e.g., cleaning materials and metal-working fluids). Because the surveillance program depends on physicians' recognizing asthma work-relatedness and reporting diagnosed cases, the data are considered an underestimate of the magnitude of the WRA problem. The data also indicate that physicians are not commonly performing objective physiologic tests to substantiate a WRA diagnosis. Workplace findings suggest a need to evaluate existing exposure standards for specific agents known to induce occupational asthma (e.g., diisocyanates). Case-based surveillance can help improve the recognition, control, and prevention of WRA. The SENSOR model also provides a mechanism for workers and physicians to request workplace investigations aimed at primary prevention for other workers. Public Health Action: NIOSH and state health department representatives are working to establish a long-term agenda for state-based surveillance of work-related conditions and hazards. The results from the SENSOR WRA programs described in this report support inclusion of WRA as a priority condition warranting surveillance at the state level. [ABSTRACT FROM AUTHOR]

Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 ., (© 2024. The Author(s).)

Objectives: This paper aims to apply a novel demographic technique to update - and extend to sub-national regions - estimates of the lifetime probability of admission to residential aged care., Methods: Making optimal use of Australian data sources on aged care usage, mortality and population, this study adopts a two-population life table approach to produce an updated set of national probability estimates and first-time regional estimates., Results: The probability of admission generally increases with age: nationally, lifetime probability at age 65 is 50% for women and 37% for men, rising to 55% and 46%, respectively, at age 85. This general pattern varied somewhat across regions., Discussion: The regional results point to inequities in the uptake of care, thereby informing providers, governments, aged care advocates and anyone interested in equity of access., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval., Methods: Transthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides., Results: 160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69-82) and a median heart rate of 100 beats per minute (IQR 86-112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e' (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (p<0.001): 35.4 s to measure E/e' (95% CI 33.1 to 37.8) compared with 44.7 s for 5-beat (95% CI 41.8 to 47.5) and 98.1 s for 10-beat (95% CI 91.7 to 104.4) analyses. Using a single index-beat did not compromise the association of LVEF, GLS or E/e' with natriuretic peptide levels., Conclusions: Compared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF., Competing Interests: Competing interests: KVB reports she was the research fellow for the RATE-AF trial funded by a National Institute for Health Research (NIHR) Career Development Fellowship awarded to DK. SG: none directly relevant to this work; funding through the BigData@Heart Innovative Medicines Initiative (grant no 116074). GL: none directly relevant to this work; consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi Sankyo; and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim and Daiichi Sankyo; no fees are directly received personally. PK reports grants from NIHR, European Union and British Heart Foundation, during the conduct of the study; grants and non-financial support from the European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK) and German Centre for Heart Research, from several drug and device companies active in atrial fibrillation, and has received honoraria from several such companies, outside the submitted work; in addition, PK is listed as inventor on two patents held by the University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). JC: none directly relevant to this work; reports grants and personal fees from Bayer, Boehringer Ingelheim, Daiichi Sankyo and Pfizer/BMS; and personal fees from Medtronic, Boston Scientific and Abbott. KR reports grants from NIHR Oxford Biomedical Research Centre, University of Oxford; grants from UKRI’s Global Challenge Research Fund (ESRC), PEAK Urban Programme Grant Ref: ES/P011055/1; grants from the British Heart Foundation (grant numbers: FS/19/36/34346 and PG/18/65/33872); grants from Oxford Martin School, University of Oxford, during the conduct of the study; and personal fees from PLOS Medicine and from BMJ Heart, outside the submitted work. DK reports grants from the National Institute for Health Research (NIHR CDF-2015-08-074 and NIHR HTA-130280), the British Heart Foundation (PG/17/55/33087 and AA/18/2/34218), the European Society of Cardiology supported by educational grants from Boehringer Ingelheim/BMS-Pfizer Alliance/Bayer/Daiichi Sankyo/Boston Scientific, the NIHR/University of Oxford Biomedical Research Centre and British Heart Foundation/University of Birmingham Accelerator Award (STEEER-AF NCT04396418), EU/EFPIA Innovative Medicines Initiative (BigData@Heart 116074) and IRCCS San Raffaele/Menarini (Beta-blockers in Heart Failure Collaborative Group NCT0083244), in addition to personal fees from Bayer (Advisory Board), AtriCure (Speaker fees), Amomed (Advisory Board), Protherics Medicines Development (Advisory Board) and Myokardia (Advisory Board), all outside the submitted work., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Objective This paper tests the hypothesis that increases in recorded dependency levels of permanent residential aged care clients are associated with reduced length of stay and higher turnover. A secondary objective is to compare the Aged Care Funding Instrument with its predecessor, the Resident Classification Scale, on a common schema. Methods Administrative data for all Commonwealth-subsidised residential aged care services in Australia from 2008-09 to 2018-19 were obtained from the National Aged Care Data Clearinghouse. More than 750000 episodes of permanent residential aged care were analysed. The categories from the two rating systems were mapped to a six-level schema, primarily based on the dollar value of the categories at the time of transition. Results There was a strong trend towards higher dependency ratings across admissions, residents, and separations. However, contrary to expectation, measures of system activity showed a slowing of the system: length of stay increased and turnover decreased. Conclusions The mapping of dependency rating schemes to a common rating enables the analysis of long-term trends in residential care dynamics. There is no evidence that the marked increases in reported dependency ratings led to accelerated system activity, consistent with an earlier study. This analysis forms a solid base for ongoing analysis of care appraisals in the context of a possible new rating scheme. It highlights the interplay between policy changes and provider behaviour, and the need for robust data to monitor care appraisals and system dynamics. What is known about the topic? Residential aged care subsidies are determined by care needs in relation to assessed dependency levels, using the Aged Care Funding Instrument since 2008, and before that, the Resident Classification Scale. Between 2008-09 and 2018-19, there was considerable growth in residents classified at more dependent levels, and this would be expected to result in greater turnover in the system. What does this paper add? This paper maps the rating schemes to a simplified, common rating that enables the analysis of long-term trends in residential care dynamics. It shows that the system is slowing, contrary to the trends expected if residents were more frail as the reported ratings imply. The paper examines possible explanations of these trends, and addresses policy implications. What are the implications for practitioners? In the context of a potential new client-dependency classification, this study shows the importance of robust measures of the dynamics of the system-and the underlying data-vis -à -vis the means by which client dependency is assessed.

Importance: There is little evidence to support selection of heart rate control therapy in patients with permanent atrial fibrillation, in particular those with coexisting heart failure., Objective: To compare low-dose digoxin with bisoprolol (a β-blocker)., Design, Setting, and Participants: Randomized, open-label, blinded end-point clinical trial including 160 patients aged 60 years or older with permanent atrial fibrillation (defined as no plan to restore sinus rhythm) and dyspnea classified as New York Heart Association class II or higher. Patients were recruited from 3 hospitals and primary care practices in England from 2016 through 2018; last follow-up occurred in October 2019., Interventions: Digoxin (n = 80; dose range, 62.5-250 μg/d; mean dose, 161 μg/d) or bisoprolol (n = 80; dose range, 1.25-15 mg/d; mean dose, 3.2 mg/d)., Main Outcomes and Measures: The primary end point was patient-reported quality of life using the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) at 6 months (higher scores are better; range, 0-100), with a minimal clinically important difference of 0.5 SD. There were 17 secondary end points (including resting heart rate, modified European Heart Rhythm Association [EHRA] symptom classification, and N-terminal pro-brain natriuretic peptide [NT-proBNP] level) at 6 months, 20 end points at 12 months, and adverse event (AE) reporting., Results: Among 160 patients (mean age, 76 [SD, 8] years; 74 [46%] women; mean baseline heart rate, 100/min [SD, 18/min]), 145 (91%) completed the trial and 150 (94%) were included in the analysis for the primary outcome. There was no significant difference in the primary outcome of normalized SF-36 PCS at 6 months (mean, 31.9 [SD, 11.7] for digoxin vs 29.7 [11.4] for bisoprolol; adjusted mean difference, 1.4 [95% CI, -1.1 to 3.8]; P = .28). Of the 17 secondary outcomes at 6 months, there were no significant between-group differences for 16 outcomes, including resting heart rate (a mean of 76.9/min [SD, 12.1/min] with digoxin vs a mean of 74.8/min [SD, 11.6/min] with bisoprolol; difference, 1.5/min [95% CI, -2.0 to 5.1/min]; P = .40). The modified EHRA class was significantly different between groups at 6 months; 53% of patients in the digoxin group reported a 2-class improvement vs 9% of patients in the bisoprolol group (adjusted odds ratio, 10.3 [95% CI, 4.0 to 26.6]; P < .001). At 12 months, 8 of 20 outcomes were significantly different (all favoring digoxin), with a median NT-proBNP level of 960 pg/mL (interquartile range, 626 to 1531 pg/mL) in the digoxin group vs 1250 pg/mL (interquartile range, 847 to 1890 pg/mL) in the bisoprolol group (ratio of geometric means, 0.77 [95% CI, 0.64 to 0.92]; P = .005). Adverse events were less common with digoxin; 20 patients (25%) in the digoxin group had at least 1 AE vs 51 patients (64%) in the bisoprolol group (P < .001). There were 29 treatment-related AEs and 16 serious AEs in the digoxin group vs 142 and 37, respectively, in the bisoprolol group., Conclusions and Relevance: Among patients with permanent atrial fibrillation and symptoms of heart failure treated with low-dose digoxin or bisoprolol, there was no statistically significant difference in quality of life at 6 months. These findings support potentially basing decisions about treatment on other end points., Trial Registration: ClinicalTrials.gov Identifier: NCT02391337 and clinicaltrialsregister.eu Identifier: 2015-005043-13.

Aims: To establish the extent and impact of symptoms in patients with atrial fibrillation (AF), the importance of different aspects of quality of life (QoL), and how we should assess wellbeing., Methods: Focus groups of patients with symptomatic permanent AF in a trial of heart rate control; the RATE-AF trial randomised 160 patients aged ≥60 years with permanent AF and at least NYHA class II dyspnoea to either digoxin or beta-blockers. Patient and public representatives led the focus groups and performed all data acquisition and analysis, using thematic approaches to interpret patient views about QoL and its measurement., Results: Substantial impairment of health-related QoL was noted in 160 trial patients, with impact on all domains apart from mental health. Eight women and 11 men aged 61-87 years participated in the focus groups. Common themes were a lack of information from healthcare professionals about AF, a lack of focus on QoL in consultations, and a sense of frustration, isolation, and reduced confidence. There was marked variability in symptoms in individual patients, with some describing severe impact on activities of daily living, and profound interaction with comorbidities such as arthritis. Day-to-day variation in QoL and difficulty in attributing symptom burden to AF or other comorbidities led to challenges in questionnaire completion. Consensus was reached that collecting both general and AF-specific QoL would be useful in routine practice, along with participation in peer support, which was empowering for the patients., Conclusions: The impact of comorbidities is poorly appreciated in the context of AF, with considerable variability in QoL that requires both generic and AF-specific assessment. Improvement in QoL should direct the appraisal, and reappraisal, of treatment decisions for patients with permanent AF., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

TiO2 nanoparticles are successively functionalized with [Mn(κ2N1,N2-ttpy)(CO)3Br] as catalyst and [Ru(bpy)3]2+ as photosensitizer to yield RuII/TiO2/MnI. Under continuous irradiation at 470 nm and in the presence of a sacrificial electron donor, this triad reduces CO2 to HCOOH (TONmax = 27) with 100% selectivity.

With this 2016 Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, CDC is publishing official statistics for the occurrence of nationally notifiable noninfectious conditions and disease outbreaks for the second time in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases and Conditions (1). As was the case for the 2015 Summary of Notifiable Noninfectious Conditions and Disease Outbreaks (2), this joint publication is the result of a request by the Council of State and Territorial Epidemiologists (CSTE) to provide readers with information on all nationally notifiable conditions and disease outbreaks in a single publication.

Aim: To understand how older Australians used Federal Government-funded aged care services in the eight years before their death., Method: The Australian Institute of Health and Welfare's Pathways in Aged Care (PIAC) database was used to examine individual patterns of aged care service use between 2002 and 2011 for the 116 481 people who died in 2010-2011 aged 65 or over., Results: About 80% of Australians who died in 2010-2011 aged 65 or over had used aged care services in the eight years prior to their death. Most (84%) entered the system through a community-based programme (particularly Home and Community Care (HACC) and, to a much smaller degree, community packaged aged care programmes), with only 1 in 10 people first using permanent residential aged care. The most common pattern of age care service use was HACC only. Other common patterns of care use were HACC followed by permanent residential aged care, and permanent residential care only. In all, people used aged care programmes in more than 1500 combinations., Conclusion: The comprehensive PIAC database allows research into patterns of use of aged care services that can inform decision-making by clients, carers, providers and funders of the services., (© 2015 AJA Inc.)

Introduction: Approximately 1.2 million persons in Oakland County, Michigan (USA) reside less than 50 miles from the Fermi Nuclear Power Plant, Unit 2, but information is limited regarding how residents might react during a radiation emergency. Community Assessment for Public Health Emergency Response (CASPER) survey methodology has been used in disaster and non disaster settings to collect reliable and accurate population-based public health information, but it has not been used to assess household-level emergency preparedness for a radiation emergency. To improve emergency preparedness plans in Oakland County, including how residents might respond during a radiation emergency, Oakland County Health Division (OCHD), with assistance from the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Community Health (MDCH), conducted a CASPER survey., Methods: During September 2012, a 2-stage cluster sampling design was used to select 210 representative households in Oakland County. By using in-person surveys, the proportion of households with essential needs and supplies, how residents might respond to public health authorities' instructions, and their main source for obtaining information during a radiation emergency were assessed. Data were weighted to account for the complex sampling design., Results: Of the goal of 210 households, 192 (91.4%) surveys were completed: 64.7% and 85.4% of respondents indicated having 3-day supplies of water and of non perishable food, respectively; 62.8% had a 7-day supply of prescription medication for each person who needed it. Additionally, 64.2% had a working carbon monoxide detector; 67.1% had a first-aid kit; and 52% had an alternative heat source. In response to instructions from public health officials during a radiation emergency, 93.3% of all respondents would report to a radiation screening center; 96% would evacuate; and 91.8% would shelter-in-place. During a radiation emergency, 55.8% of respondents indicated their main information source would be television, 18.4% radio, and 13.6% the Internet. The most trusted source for information would be the local public health department (36.5%), local news (23%), a physician (11.2%), and family members (11.1%). Including completed and incomplete interviews, refusals, and non respondents, 517 total households were contacted., Conclusions: CASPER data regarding how residents might react during a radiation emergency provided objective and quantifiable information that will be used to develop Oakland County's radiation emergency preparedness plans. Survey information demonstrates the feasibility and usefulness of CASPER methodology for radiation emergency preparedness planning.

Background: This report used employment and public health surveillance data in Michigan to characterize work-related race/ethnic health disparities., Methods: U.S. Census data were used to calculate the percent by race/Hispanic ethnicity in occupational groups ranked by three measures for potential work-related health risks. Disparities by race/ethnicity were generated from occupational health surveillance data., Results: Blacks and Hispanics were over-represented in lower wage-higher manual-labor occupations and in highest risk occupations. Blacks were at greater risk of silicosis, work-related asthma, and work-related burns than whites, and Hispanics had higher rates of work-related acute fatal injuries and pesticide injury than non-Hispanics., Conclusions: Michigan employment data indicated that blacks and Hispanics were overly represented in lower paid and more hazardous jobs. Occupational health surveillance data confirmed disparate risks for some illnesses and injuries. This approach can be used in other states to bring awareness to policy makers and direct interventions., (© 2013 Wiley Periodicals, Inc.)

Objectives: We examined the association between housing type and household emergency preparedness among households in Oakland County, Michigan., Methods: We used interview data on household emergency preparedness from a cluster design survey in Oakland County, Michigan, in 2012. We compared survey-weighted frequencies of household demographics, medical conditions, and preparedness measures in single-detached homes versus multi-unit dwellings, and determined the unadjusted odds ratios (OR) and the income-level adjusted OR for each preparedness measure., Results: Households had similar demographics and medical conditions between housing types. Unadjusted ORs were statistically significant for single detached homes having a generator (11.1), back-up heat source (10.9), way to cook without utilities (5.8), carbon monoxide (CO) detector (3.8), copies of important documents (3.4), evacuation routes (3.1), and 3-day supply of water (2.5). Income level adjusted ORs remained statistically significant except for owning a CO detector., Conclusions: Households in multi-unit dwellings were less likely to have certain recommended emergency plans and supplies compared to those in single detached homes. Further research is required to explore the feasibility, barriers, and alternatives for households in multi-unit dwellings in terms of complying with these measures.

Rapid changes to the United States public health system challenge the current strategic approach to surveillance. During 2011, the Council of State and Territorial Epidemiologists convened national experts to reassess public health surveillance in the United States and update surveillance strategies that were published in a 1996 report and endorsed by the Council of State and Territorial Epidemiologists. Although surveillance goals, historical influences, and most methods have not changed, surveillance is being transformed by 3 influences: public health information and preparedness as national security issues; new information technologies; and health care reform. Each offers opportunities for surveillance, but each also presents challenges that public health epidemiologists can best meet by rigorously applying surveillance evaluation concepts, engaging in national standardization activities driven by electronic technologies and health care reform, and ensuring an adequately trained epidemiology workforce.

Public health surveillance and epidemiology are the foundations for disease prevention because they provide the factual basis from which agencies can set priorities, plan programs, and take actions to protect the public's health. Surveillance for noninfectious diseases associated with exposure to agents in the environment like lead and pesticides has been a function of state health departments for more than 3 decades, but many state programs do not have adequate funding or staff for this function. Following the efforts to identify core public health epidemiology functions in chronic diseases, injury, and occupational health and safety, a workgroup of public health environmental epidemiologists operating within the organizational structure of the Council of State and Territorial Epidemiologists has defined the essential core functions of noninfectious disease environmental epidemiology that should be present in every state health department and additional functions of a comprehensive program. These functions are described in terms of the "10 Essential Environmental Public Health Services" and their associated performance standards. Application of these consensus core and expanded functions should help state and large metropolitan health departments allocate resources and prioritize activities of their environmental epidemiologists, thus improving the delivery of environmental health services to the public.

Objectives: Methamphetamine (meth) is a highly addictive drug of abuse that can easily be made in small illegal laboratories from household chemicals that are highly toxic and dangerous. Meth labs have been found in locations such as homes, outbuildings, motels, and cars. Its production endangers the "cook," neighbors, responders, and the environment. This article describes surveillance data used to examine the emergence and public health impacts of illicit clandestine meth labs, as well as two states' efforts to thwart lab operations and prevent responder injuries., Methods: We analyzed data collected from 2001 to 2008 by 18 states participating in the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) Program to examine the occurrence and public health impacts of clandestine meth production., Results: HSEES data indicate that the majority of clandestine meth lab events occurred in residential areas. About 15% of meth lab events required evacuation. Nearly one-fourth of these events resulted in injuries, with 902 reported victims. Most victims (61%) were official responders, and one-third were members of the general public. Since 2004, with the implementation of local and federal laws and prevention activities, the number of meth lab events has declined. Increased education and training of first responders has led to decreased injuries among police officers, firefighters, and emergency medical personnel., Conclusions: HSEES data provided a good data source for monitoring the emergence of domestic clandestine meth production, the associated public health effects, and the results of state and federal efforts to promote actions to address the problem.

Background: Prior assessments of public health readiness had identified gaps in radiation preparedness. In recent years, preparedness planning has involved an "all-hazards" approach. Current assessment of the national status related to radiation public health emergency preparedness capabilities at the state and local health department levels was needed., Methods: A survey of state health departments related to radiation readiness was undertaken in 2010 by the Council of State and Territorial Epidemiologists (CSTE). States with nuclear power plants were instructed to consider their responses exclusive of capabilities and resources related to the plants given that the emergency response plans for nuclear power plants are specific and unique., Results: Thirty-eight (76%) state health departments responded to the survey, including 26 of the 31 states with nuclear power plants. Specific strengths noted at the state level included that the majority of states had a written radiation response plan and most plans include a detailed section for communications issues during a radiation emergency. In addition, more than half of the states indicated that their relationship with federal partners is sufficient to provide resources for radiation emergencies, indicating the importance states placed on federal resources and expertise. Specific weaknesses are discussed and include that most states had completed little to no planning for public health surveillance to assess potential human health impacts of a radiation event; less than half had written plans to address exposure assessment, environmental sampling, human specimen collection and analysis, and human health assessment. Few reported having sufficient resources to do public health surveillance, radiation exposure assessment, laboratory functions and other capabilities., Discussion: Levels of planning, resources and partnerships varied among states, those with nuclear power plants were better prepared. Gaps were evident in all states; however and additional training and resources are needed to ensure adequate levels of preparedness., Conclusion: Overall results of this assessment indicate that in most measures of public health capacity and capability, states are poorly prepared to adequately respond to a major radiation emergency event. Specific recommendations are noted in the discussion.

Background: Despite epidemiologic, experimental and observational data on the association of environmental tobacco smoke (ETS) and adverse health effects, bar and restaurant workers remain exposed to ETS in the majority of states and countries., Methods: Three public health surveillance systems were used to identify and conduct a follow-up investigation of a reported acute asthma death of a young waitress in a bar., Results: The waitress collapsed at the bar where she worked and was declared dead shortly thereafter. Evaluation of the circumstances of her death and her medical history concluded that her death was from acute asthma due to environmental tobacco smoke at work., Conclusions: This is the first reported acute asthma death associated with work-related ETS. Recent studies of asthma among bar and restaurant workers before and after smoking bans support this association. This death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke.

Background: Hepatitis C virus (HCV) infection in Australia is predominantly transmitted through injecting drug use. A reduction in the heroin supply in Australia in late 2000 and early 2001 may have impacted the number of injecting drug users (IDUs) and consequently the number of new hepatitis C infections in Australia. This paper updates estimates of HCV incidence and prevalence between 1960 and 2005., Methods: Simple mathematical models were used to estimate HCV incidence among IDUs, migrants to Australia from high HCV-prevalence countries, and other HCV exposure groups. Recent trends in numbers of IDUs were based on indicators of injecting drug use. A natural history of HCV model was applied to estimate the prevalence of HCV in the population., Results: The modelled best estimate of past HCV incidence showed a consistent increasing rate of HCV infections to a peak of 14,000 new seroconversions in 1999, followed by a decline in 2001-2002 coincident with the decline in heroin availability. HCV incidence was estimated to be 9700 (lower and upper limits of 6600 and 13,200) in 2005. Of these, 88.7% were estimated to be through injecting drug use, 7.2% among migrants and 4.1% through other transmission routes. An estimated 264,000 (lower and upper limits of 206,000 and 318,000) people were HCV antibody positive in 2005., Conclusions: Mathematical models suggest that HCV incidence in Australia decreased from a peak of 14,000 new infections in 1999 to 9700 new infections in 2005, largely attributable to a reduction in injecting drug use. The numbers of people living with HCV in Australia is, however, estimated to continue to increase.

Context: Pesticides continue to be used on school property, and some schools are at risk of pesticide drift exposure from neighboring farms, which leads to pesticide exposure among students and school employees. However, information on the magnitude of illnesses and risk factors associated with these pesticide exposures is not available., Objective: To estimate the magnitude of and associated risk factors for pesticide-related illnesses at schools., Design, Setting, and Participants: Analysis of surveillance data from 1998 to 2002 of 2593 persons with acute pesticide-related illnesses associated with exposure at schools. Nationwide information on pesticide-related illnesses is routinely collected by 3 national pesticide surveillance systems: the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program, the California Department of Pesticide Regulation, and the Toxic Exposure Surveillance System., Main Outcome Measures: Incidence rates and severity of acute pesticide-related illnesses., Results: Incidence rates for 1998-2002 were 7.4 cases per million children and 27.3 cases per million school employee full-time equivalents. The incidence rates among children increased significantly from 1998 to 2002. Illness of high severity was found in 3 cases (0.1%), moderate severity in 275 cases (11%), and low severity in 2315 cases (89%). Most illnesses were associated with insecticides (n = 895, 35%), disinfectants (n = 830, 32%), repellents (n = 335, 13%), or herbicides (n = 279, 11%). Among 406 cases with detailed information on the source of pesticide exposure, 281 (69%) were associated with pesticides used at schools and 125 (31%) were associated with pesticide drift exposure from farmland., Conclusions: Pesticide exposure at schools produces acute illnesses among school employees and students. To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended.

Background: Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan., Methods: Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997., Results: Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment., Conclusions: In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed., (Copyright 2003 Wiley-Liss, Inc.)

Background: Despite a reported decline in mortality and hospitalizations associated with silicosis [U.S. Department of Health and Human Services, 1999], this decline may be artifactual, stemming in part from underdiagnosis by physicians., Methods: This study estimates, through radiological confirmation, the prevalence of unrecognized silicosis in a group of silica-exposed New Jersey decedents whose cause of death was chronic obstructive pulmonary disease (COPD), tuberculosis, or cor pulmonale. Two expert readers re-evaluated the chest X-rays of this group to determine the presence or absence of silicosis. The study population was considered to be presumptively exposed to silica dust by virtue of their usual industry of employment as listed on the death certificate., Results: Radiographic evidence of silicosis was found in 8.5% of this population, and evidence of asbestosis was found in another 10.7%, for a total of 19.2%., Conclusions: The existence of previously unrecognized silicosis and asbestosis in 19.2% of this study group suggests that occupational lung disease is under-recognized and, hence, undercounted., (Copyright 2003 Wiley-Liss, Inc.)

Two key methodological issues underlying different methods for calculating estimates of the number of alcohol-caused deaths are identified and recommendations suggested for future work. 1. How to adjust alcohol aetiologic fractions across time and place to reflect different levels of risky drinking. A common approach is outlined for both acute and chronic alcohol-related conditions. In the absence of consistent, reliable and regionally specific measures of the prevalence of risky alcohol consumption from national surveys, the use of per capita consumption data as a means of adjusting alcohol population aetiologic fractions over time and across regions is recommended. 2. Whether abstainers or low-risk drinkers should be used as the reference group when assessing the impact of alcohol consumption and how the resulting information is best presented. It is recommended that when abstainers are used as the reference group, the costs and benefits for both 'low-risk' and 'risky/high-risk' drinking should be identified. Using this approach, it was estimated that for Australia in 1998 there was a net benefit of 5,100 lives saved due to low-risk drinking, while there was a net loss of 2,737 lives due to risky/high-risk drinking. On its own, the figure of a net saving of 2,363 lives per year is a simplistic and potentially misleading picture of alcohol as a net benefit to public health and safety. For public health communications, there is still value in providing estimates using the low-risk drinking contrast, of the number of lives saved if risky/high-risk drinkers all became low-risk drinkers (n = 3,292 in 1998). The use of the abstinence contrast, however, allows the more complex picture of alcohol's impact on public health to be apparent, e.g. including the estimated 1,505 deaths associated with low-risk drinking (mostly from cancer).

Problem/condition: Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. WRA includes new-onset asthma caused by workplace exposure to sensitizers or irritants and preexisting asthma exacerbated by workplace exposures., Reporting Period: This report reviews cases of WRA identified by state health departments from January 1, 1993, through December 31, 1995, as well as follow-up investigations of cases and associated workplaces conducted through June 30, 1998. DESCRIPTION OF THE SYSTEMS: State-based surveillance and intervention programs for WRA are conducted in California, Massachusetts, Michigan, and New Jersey as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR) cooperative agreement program, initiated by CDC's National Institute for Occupational Safety and Health (NIOSH)., Results: From 1993 through 1995, a total of 1,101 cases of WRA were identified by SENSOR surveillance staff members in California, Massachusetts, Michigan, and New Jersey. Of these 1,101 cases, 19.1% were classified as work-aggravated asthma, and 80.9% were classified as new-onset asthma. Objective evidence substantiating asthma work-relatedness was documented in the medical records of 3.4% of WRA cases identified in the two states (Michigan and New Jersey) where medical records are routinely reviewed for this information. Indoor air pollutants, dusts, cleaning materials, lubricants (e.g., metalworking fluids), and diisocyanates were among the most frequently reported causes of WRA. In addition, a well-recognized cause of occupational asthma - natural rubber latex - was identified in a new setting, the healthcare industry. The most common industries associated with WRA cases included transportation equipment manufacturing (19.3%), health services (14.2%), and educational services (8.7%). Air sampling for agents known to induce occupational asthma was performed in Michigan for comparison with established federal time-weighted average exposure limits. Sixteen (13.4%) of 119 workplaces tested had airborne concentrations exceeding NIOSH recommended exposure limits (RELs); 11 (9.1%) of 121 workplaces had concentrations exceeding permissible exposure limits (PELs) of the Michigan Occupational Safety and Health Act (MIOSHA) program., Interpretation: The surveillance data findings confirm well-recognized causes of asthma and have identified new putative causes (e.g., cleaning materials and metalworking fluids). Because the surveillance program depends on physicians' recognizing asthma work-relatedness and reporting diagnosed cases, the data are considered an underestimate of the magnitude of the WRA problem. The data also indicate that physicians are not commonly performing objective physiologic tests to substantiate a WRA diagnosis. Workplace findings suggest a need to evaluate existing exposure standards for specific agents known to induce occupational asthma (e.g., diisocyanates). Case-based surveillance can help improve the recognition, control, and prevention of WRA. The SENSOR model also provides a mechanism for workers and physicians to request workplace investigations aimed at primary prevention for other workers., Public Health Action: NIOSH and state health department representatives are working to establish a long-term agenda for state-based surveillance of work-related conditions and hazards. The results from the SENSOR WRA programs described in this report support inclusion of WRA as a priority condition warranting surveillance at the state level.

In the first 11 full years of operation (January 1, 1986, through December 31, 1996) of an adult lead registry in New Jersey, 23,456 reports of occupational lead toxicity (blood lead level > or = 1.21 mumol/L) in 4,011 workers, involving 496 workplaces, were received. The majority of the reports and workers were from the manufacturing and construction industries. Over the 11 years, the annual numbers of reports and workers declined, although the annual numbers of involved workplaces remained stable, as did the number of newly identified workers and workplaces. The decline occurred primarily in the manufacturing industry; the construction industry experienced an increase in reports and reported workers. For all years combined, 36% of reported workers had at least one blood lead level equal to or greater than 1.93 mumol/L, although in the most recent years the percentage dropped overall and in both the manufacturing and construction industries.