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Krueger W.S.,Oak Ridge Institute for Science and Education | Krueger W.S.,Research Triangle ParkNC | Hilborn E.D.,U.S. Environmental Protection Agency | Dufour A.P.,U.S. Environmental Protection Agency | And 2 more authors.
Zoonoses and Public Health | Year: 2016

To understand the etiological burden of disease associated with acute health symptoms [e.g. gastrointestinal (GI), respiratory, dermatological], it is important to understand how common exposures influence these symptoms. Exposures to familiar and unfamiliar animals can result in a variety of health symptoms related to infection, irritation and allergy; however, few studies have examined this association in a large-scale cohort setting. Cross-sectional data collected from 50 507 participants in the United States enrolled from 2003 to 2009 were used to examine associations between animal contact and acute health symptoms during a 10-12 day period. Fixed-effects multivariable logistic regression estimated adjusted odds ratios (AORs) and 95% confident intervals (CI) for associations between animal exposures and outcomes of GI illness, respiratory illness and skin/eye symptoms. Two-thirds of the study population (63.2%) reported direct contact with animals, of which 7.7% had contact with at least one unfamiliar animal. Participants exposed to unfamiliar animals had significantly higher odds of self-reporting all three acute health symptoms, when compared to non-animal-exposed participants (GI: AOR = 1.4, CI = 1.2-1.7; respiratory: AOR = 1.5, CI = 1.2-1.8; and skin/eye: AOR = 1.9, CI = 1.6-2.3), as well as when compared to participants who only had contact with familiar animals. Specific contact with dogs, cats or pet birds was also significantly associated with at least one acute health symptom; AORs ranged from 1.1 to 1.5, when compared to participants not exposed to each animal. These results indicate that contact with animals, especially unfamiliar animals, was significantly associated with GI, respiratory and skin/eye symptoms. Such associations could be attributable to zoonotic infections and allergic reactions. Etiological models for acute health symptoms should consider contact with companion animals, particularly exposure to unfamiliar animals. Prevention of pet-associated zoonotic diseases includes commonsense measures such as hand-washing, but are often overlooked by pet owners and non-pet owners alike. © 2016 Blackwell Verlag GmbH.

Mukerjee S.,U.S. Environmental Protection Agency | Smith L.,Alion Science and Technology Corporation | Brantley H.,U.S. Environmental Protection Agency | Brantley H.,Research Triangle ParkNC | And 4 more authors.
Atmospheric Pollution Research | Year: 2015

Modeled traffic data were used to develop traffic exposure zones (TEZs) such as traffic delay, high volume, and transit routes in the Research Triangle area of North Carolina (USA). On–road air pollution measurements of nitrogen dioxide (NO2), carbon monoxide (CO), carbon dioxide (CO2), black carbon (BC), coarse (PM2.5–10), fine (PM2.5) particulate matter and ultrafine particles (UFPs) were made on routes that encountered these TEZs. Results indicated overall greater traffic pollutant levels in high volume and delay road sections than bus routes or areas of higher signal light density. The combination of delineating roadways into TEZs with highly time resolved on–road measurements demonstrated how pollutant levels can vary within roadways. © Author(s) 2015.

Dalal A.A.,Glaxosmithkline | Patel J.,Amgen Inc. | D'Souza A.,Xcenda | Farrelly E.,Xcenda | And 2 more authors.
Journal of Managed Care Pharmacy | Year: 2015

BACKGROUND: There is scarce information on chronic obstructive pulmonary disease (COPD) outcomes and costs for patients with differing levels of COPD exacerbations. OBJECTIVE: To examine COPD-related and all-cause health care resource use and costs in subsequent years for frequently and infrequently exacerbating COPD patients. METHODS: Patients with a diagnosis of COPD (ICD-9-CM codes 491.xx, 492.xx, and 496.xx) were identified (1 hospitalization or 1 emergency department visit or at least 2 outpatient visits) using administrative claims data in 2007. Patients were classified in 2008 as frequent (at least 2 exacerbations/ year), infrequent (1 exacerbation/year) and nonexacerbators. Outcomes were computed during a subsequent 2-year period (2009 and 2010). Average per person estimates and total sample-level estimates were calculated. A logistic regression model estimated the predictors of having 2 or more exacerbations per year during the follow-up period. RESULTS: 61,750 COPD patients met the study criteria (mean age 67 years). Of these, 6% (n = 3,852) were frequent exacerbators; 14% were infrequent exacerbators (n = 8,416); and 80% were nonexacerbators (n = 49,482). At baseline, average all-cause health care costs per patient for frequent exacerbators were highest followed by infrequent and nonexacerbators ($12,837, $10,480, and $7,756, respectively). On average, 60% of frequent and 40% of infrequent exacerbators had at least 1 exacerbation per year in follow-up. Average annual per patient COPD-related costs for frequent exacerbators ($3,565 in 2009 and $3,528 in 2010) were more than 3 times (P < 0.05) and infrequent exacerbators ($2,264 in 2009 and $2,265 in 2010) were more than 2 times (P < 0.05) higher compared with nonexacerbators ($1,007 in 2009 and $1,027 in 2010). On a total sample-level, infrequent exacerbators were similar if not more burdensome compared with frequent exacerbators in the proportion accounted by these cohorts for total COPD-related costs (23% vs. 18%, respectively) and total number of COPD exacerbations per year (26% vs. 26%). Compared with nonexacerbators, infrequent exacerbators were 3 times (OR = 2.8, P < 0.001) significantly more likely to have 2 or more exacerbations per year in follow-up, and frequent exacerbators were 7 times (OR = 6.76, P < 0.001) significantly more likely to have 2 or more exacerbations per year in follow-up. CONCLUSIONS: Infrequent exacerbators have an increased risk for future exacerbations compared with nonexacerbators and, on a total sample-level, incur greater costs compared with frequent exacerbators, demonstrating a significant economic burden. © 2015, Academy of Managed Care Pharmacy.

Chopra I.,Duquesne University | Kamal K.M.,Duquesne University | Candrilli S.D.,Research Triangle ParkNC | Kanyongo G.,Duquesne University
Postgraduate Medicine | Year: 2014

Background: Obesity is associated with cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes mellitus, as well as cardiovascular diseases. Objectives: To evaluate demographic, diagnostic, and treatment characteristics of patients with concomitant hypertension and dyslipidemia, stratified by body mass index and the attainment of blood pressure (BP) and lipid targets in obese versus nonobese patients. Methods: This retrospective study used data from GE Centricity Electronic Medical Records database (2004–2011) of a primary care physician group. Patients aged $ 18 years and having concomitant hypertension and dyslipidemia were categorized based on their body mass index: normal weight (# 24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese ($ 30.0 kg/m2). Blood pressure and lipid goal attainments were based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and National Cholesterol Education Program Adult Treatment Panel III guidelines, respectively. Results: A total of 9086 patients with concomitant hypertension and dyslipidemia were identified and categorized as normal weight (n = 1256), overweight (n = 3058) and obese (n = 4772). Patients who were obese were younger (, 65 years); were more likely to have diabetes mellitus (P , 0.001); had higher baseline BP and triglyceride levels and lower levels of high-density lipoprotein cholesterol (P , 0.05); and were more likely to be prescribed antihypertensives and antilipemic agents (P , 0.001). In multivariate analyses, obese patients were significantly more likely to fail to attain BP (odds ratio = 1.562, P , 0.001) and dual BP and low-density lipoprotein cholesterol (odds ratio = 1.193, P = 0.023) goals. Conclusions: Obesity appears to be an independent risk factor for the failure to attain BP and dual BP and low-density lipoprotein cholesterol goals in patients with concomitant hypertension and dyslipidemia. These findings suggest that future research is needed to determine the underlying link between obesity and failure to attain these goals. © Postgraduate Medicine

Wurst K.E.,Research Triangle ParkNC | Kelly-Reif K.,University of North Carolina at Chapel Hill | Bushnell G.A.,University of North Carolina at Chapel Hill | Pascoe S.,Research Triangle ParkNC | And 2 more authors.
Respiratory Medicine | Year: 2016

Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a loosely-defined clinical entity referring to patients who exhibit characteristics of both asthma and chronic obstructive pulmonary disease (COPD). Clinical definitions and classifications for ACOS vary widely, which impacts our understanding of prevalence, diagnosis and treatment of the condition. This literature review was therefore conducted to characterize the prevalence of ACOS and the effect of different disease definitions on these estimates, as this has not previously been explored. From an analysis of English language literature published from 2000 to 2014, the estimated prevalence of ACOS ranges from 12.1% to 55.2% among patients with COPD and 13.3%-61.0% among patients with asthma alone. This variability is linked to differences in COPD and asthma diagnostic criteria, disease ascertainment methods (spirometry-based versus clinical or symptom-based diagnoses and claims data), and population characteristics including age, gender and smoking. Understanding the reasons for differences in prevalence estimates of ACOS across the literature may help guide decision making on the most appropriate criteria for defining ACOS and aid investigators in designing future ACOS clinical studies aimed at effective treatment. © 2015 Elsevier Ltd. All rights reserved.

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