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ObjectivesWe applied social network analyses to determine how hospitals within Orange County, California, are interconnected by patient sharing, a system which may have numerous public health implications.MethodsOur analyses considered 2 general patient-sharing networks: uninterrupted patient sharing (UPS; i.e., direct interhospital transfers) and total patient sharing (TPS; i.e., all interhospital patient sharing, including patients with intervening nonhospital stays). We considered these networks at 3 thresholds of patient sharing: at least 1, at least 10, and at least 100 patients shared.ResultsGeographically proximate hospitals were somewhat more likely to share patients, but many hospitals shared patients with distant hospitals. Number of patient admissions and percentage of cancer patients were associated with greater connectivity across the system. The TPS network revealed numerous connections not seen in the UPS network, meaning that direct transfers only accounted for a fraction of total patient sharing.ConclusionsOur analysis demonstrated that Orange County's 32 hospitals were highly and heterogeneously interconnected by patient sharing. Different hospital populations had different levels of influence over the patient-sharing network.

Defensins are highly basic cationic peptides that are important components of the innate and adaptive immune response pathways. In addition, these peptides are involved in CD8+ T cell response to HIV-1, increased pulmonary infection risk among cystic fibrosis patients, upregulated levels of HNP-5 for patients with ulcerative colitis and Crohn's disease, and monitoring HNP-3 levels as a tumor classification scheme for cutaneous T cell lymphomas, and have promise in the pharmaceutical field as a new class of antibiotics. Here we present a parallel assay for the ct (HNP1-3) and [beta] (HBD1-2) classes of defensins in saliva that are naturally observed in the concentration range of 1 ng/mL to 10/[micro]g/mL. The method utilizes solid phase extraction of saliva samples combined with liquid chromatography-tandem mass spectrometry to identify and quantitate defensin targets. The approach involves limited sample manipulation and is easily amenable to automation. The saliva samples analyzed are derived from a large cohort study focused on examining the role of polymorphisms in genes of innate and adaptive immunity in modulating the response to vaccination for two gastrointestinal tract infections: typhoid and cholera. The [alpha]-defensin levels observed range from 1 to 10 [micro]g/ mL and correlate well with known active concentrations against a wide variety of pathogens. The observed concentration range for [beta]-defensins was between the detection limit and 33 ng/mL and had a sensitivity level that was comparable to immunoassay-based detection. This method is easily adapted for use in a clinical immunology setting and can be modified for other biological matrixes. This assay will facilitate examination of the production, secretion, and regulation of defensin peptides in a direct fashion to coordinate levels of these compounds with gender, age, response to vaccination, gene copy number, and oral health.

This review assesses differences and similarities of the states in planning for pandemic influenza. We reviewed the recently posted plans of 49 states for vaccination, early epidemic surveillance and detection, [...]

Our study quantifies the impact of achieving specific Healthy People 2010 targets and of eliminating racial/ethnic health disparities on summary measures of health. We used life table methods to calculate gains in life expectancy and healthy life expectancy that would result from achievement of Healthy People 2010 objectives or of current mortality rates in the Asian/Pacific Islander (API) population. Attainment of Healthy People 2010 mortality targets would increase life expectancy by 2.8 years, and reduction of populationwide mortality rates to current API rates would add 4.1 years. Healthy life expectancy would increase by 5.8 years if Healthy People 2010 mortality and assumed morbidity targets were attained and by 8.1 years if API mortality and activity limitation rates were attained. Achievement of specific Healthy People 2010 targets would produce significant increases in longevity and health, and elimination of racial/ethnic health disparities could result in even larger gains. (Am J Public Health. 2004;94:378-383)

Objectives. This study examined whether more highly educated women were at greater risk of dying of breast cancer during 1989 through 1993. Methods. Breast cancer mortality rates were calculated through death certificates and Current Population Survey data. Results. Breast cancer mortality rates were highest among women with 12 and with 16 or more years of education. Non-Hispanic Black women had the highest mortality rates and Asian women the lowest. Positive relationships between mortality and education were found for Hispanic Black and Asian women. Conclusions. The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women. (Am J Public Health. 1997; 87: 1218-1222)

Temporal trends in breast cancer mortality among US women were examined for 1969 through 1989 by age, race, and county-level socio-economic status (SES). The mortality ratio for high- relative to low-SES counties declined significantly among women 25 to 44, 45 to 64, and more than 65 years of age, respectively, from 1.13 to 0.96, 1.32 to 1.19, and 1.48 to 1.26. The narrowing of mortality occurred among Whites and, to a lesser event, Blacks. A relative increase in either breast cancer incidence among women in lower SES counties or improved survival among women in higher SES counties (reflecting greater use of screening and treatment) could account for this relative worsening of breast cancer mortality among lower SES women in lower SES counties. (Am J Public Health. 1994;84:1003-1006), The gap between white women and black women for deaths from breast cancer narrowed between 1969 through 1989, but this was because deaths among black women increased, more nearly approaching rates among white women. Breast cancer is the exception to most other causes of death in that mortality rates are higher among white women than black women. County economic data were obtained from census data for 1970 and 1980 and analyzed with county mortality data for whites and blacks from 1968 through 1989. Among black women, mortality rose 21% for women age 25 to 44, 38% for women 45 to 64, and 54% for women older than 64. In contrast, mortality among white women fell 14% among women age 25 to 44, 5% for women 45 to 64, and increased 15% among women older than 65. This trend may reflect a rising incidence of breast cancer in poorer regions, greater survival among higher-income women, or poorer survival among low-income women.

Injuries appear to occur more frequently among whites than among blacks, but the latter are more likely to die as a consequence of those injuries. The injury rates are higher in younger age groups, and working adults have lower injury rates than those who do not work. Using data obtained from the National Health Interview Survey (NHIS) of the years 1983 through 1987, the patterns of injuries to currently working adults 18 to 64 years old were examined. Injury episodes were identified as any accidental or nonaccidental violence requiring medical attention, involving at least one half day of restricted activity or loss of work time. For the period of the study 209,576 interviews were conducted. Only 2,016 injuries were reported to have occurred in the prior two weeks, yielding an annual weighted estimate of 27,382,000 injuries in the US working population. Selected determinations based on differing demographic characteristics were estimated, and are reported. In all group comparisons, except the 45- to 64-year-old group, blacks had fewer injuries than whites. Injuries to currently working adults are common in the US, and affect approximately 25 percent of them annually. Injuries happened more often to poor and younger workers. Overall blacks had fewer injuries than whites among blue collar and service workers. Possible confounding of demographic factors other than age and ethnicity could not account for the outcomes observed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Correct analysis of trends in diseases and mortality requires careful work. Sometimes, the apparent increase in a disease might reflect improvements in its recognition and diagnosis, rather than a real increase in incidence. However, this does not appear to be the case for the increase in deaths due to asthma, which occurred during the 1980s. Almost 10 million Americans are affected by asthma; children, blacks, and the poor are disproportionately affected. (The rate of asthma among blacks is twice that of whites.) An analysis of the US Vital Records from 1968 through 1987 revealed a 7.8 percent annual decline in asthma-related mortality in children and young adults during the 1970s. This decline was more rapid among women and nonwhites. However, the 1980s witnessed a reversal of this trend when asthma deaths increased at a rate of 6.2 percent per year. Children seemed to suffer the most; the mortality rate for those under 15 years of age rose more rapidly than for patients between 15 and 34. The increased mortality rates seem to be similar for whites and nonwhites. However, the distribution of the increase in mortality is not geographically uniform. Much of the nation's asthma mortality can be accounted for by increases in New York City and Cook County, Illinois (the Chicago area). The mortality rate for asthma in New York City was 10.1 per million population between 1982 and 1985, almost three times that of the nation as a whole. Only mortality data was included in this study; it is not known if other health problems related to asthma have shown a similar increase over the past decade. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cholera is endemic to many countries. Recent major outbreaks of cholera have prompted World Health Organization to recommend oral cholera vaccination as a public-health strategy. Variation in percentage of seroconversion upon cholera vaccination has been recorded across populations. Vaccine-induced responses are influenced by host genetic differences. We have investigated association between single-nucleotide polymorphic (SNP) loci in and around 296 immunologically relevant genes and total anti-lipopolysaccharide (LPS) antibody response to a killed whole-cell vaccine, comprising LPS from multiple strains of Vibrio cholerae. Titers derived from standard vibriocidal assays were also analyzed to gain further insights on validated SNP associations. Vaccination was administered to 1000 individuals drawn from India. Data on two independent random subsets, each comprising ∼500 vaccinees, were used for discovery of genomic associations and validation, respectively. Significant associations of four SNPs and haplotypes in three genes (MARCO, TNFAIP3 and CXCL12) with AR were discovered and validated, of which two in TNFAIP3 and CXCL12 were also significantly associated with immunity (fourfold increase in vibriocidal titers). CXCL12 is a neutrophil and lymphocyte chemoattractant that is upregulated in response to V. cholerae infection. LPS in the vaccine possibly provides signals that mimic those of the live bacterium. TNFAIP3 promotes intestinal epithelial barrier integrity and provides tight junction protein regulation; possible requirements for adequate response to the vaccine. LPS is a potent activator of innate immune responses and a ligand of MARCO. Variants in this gene have been found to be associated with LPS response, but not with high vibriocidal titer level. [ABSTRACT FROM AUTHOR]