Pesticide exports from U.S. ports, 2001-2003

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class 1a and 1b pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

The export of pesticides: shipments from U.S. ports, 1995-1996.

In 1995-96, 21 million pounds of pesticides that were forbidden to be used in the United States were exported from U.S. ports. This total, which includes domestically-banned and never-registered products, is on average 14 tons per day. In addition, more than 48 million pounds (24,000 tons) of extremely toxic pesticides were exported. Most of these pesticides were shipped to developing countries, despite extensive evidence of the need to restrict the export of hazardous pesticides from the United States to these countries to protect their workers' health and their environments. The National Environmental Protection Act presents a sensible and manageable policy that, if followed, could considerably alleviate the problem. Specifics are provided.     

Pesticide Exports from U.S. Ports, 2001–2003

Abstract

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class la and Ib pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Vaccination practices in U.S. emergency departments, 1992-2000

To determine how frequently emergency department (ED) patients are vaccinated against influenza and pneumococcus, we analyzed all adult ED vaccinations in the combined databases of the annual National Hospital Ambulatory Medical Care Surveys, 1992-2000. During this period, EDs gave 27,738,000 vaccinations (95%CI: 25,878,000-29,598,000). Of these, 93% (87-100%) were against tetanus. The count of pneumococcal or influenza vaccinations was too small to permit estimation of a national total. Large-scale vaccination of ED patients appears feasible, given the tetanus experience, but ED patients are rarely vaccinated against influenza or pneumococcus. Reasons for this disconnect between burden of disease and preventive practices are discussed.     

Generational differences in U.S. public spending, 1980-2000

The balance between spending on children and spending on the elderly is important in evaluating the allocation of public welfare spending. We examine trends in public spending on social welfare programs for children and the elderly during 1980-2000. For both groups, social welfare spending as a percentage of gross domestic product changed little, even during the economic expansions of the 1990s. In constant dollars, the gap in per capita social welfare spending between children and the elderly grew 20 percent. Unlike spending for programs for the elderly, spending for children's programs suffered during recessions. Public discussion about the current imbalance in public spending is needed.     

Changes in incidence of diabetes in U.S. adults, 1997-2003

BACKGROUND: The incidence of self-reported diagnosed diabetes may be increasing because of recent changes in the diagnostic criteria for diabetes, enhanced case detection, and a true increase in disease incidence. These factors may also be changing the characteristics of newly diagnosed cases. Therefore, we examined recent trends in the incidence of diagnosed diabetes, changes to the characteristics of incident cases, and factors associated with incidence. METHODS: First, National Health Interview Survey data for 1997 to 2003 were used to examine 7-year trends in the incidence of diagnosed diabetes among U.S. adults aged 18 to 79 years. Second, among 1997-1998 and 2002-2003 incident cases, differences in sociodemographic characteristics, risk factors, and indicators of health status were examined. Lastly, multivariate-adjusted incidence from multiple logistic regression of 2001-2003 survey data were derived. RESULTS: From 1997 to 2003, the incidence of diagnosed diabetes increased 41% from 4.9 to 6.9 per 1,000 population (p <0.01). Incidence increased among men and women, non-Hispanic whites, persons with at least a high school education, nonsmokers, active and inactive persons, and among obese persons (p <0.05). Obesity was more prevalent (p <0.01) and physical limitation was less prevalent (p =0.03) in 2002-2003 versus 1997-1998 incident cases. Multivariate-adjusted incidence increased with age and BMI category, and decreased with education level (p <0.05). CONCLUSIONS: Obesity was a major factor in the recent increase of newly diagnosed diabetes. Lifestyle interventions that reduce or prevent the prevalence of obesity among persons at risk for diabetes are needed to halt the increasing incidence of diabetes.     

Pertussis--United States, 1997-2000

Pertussis was a major cause of morbidity and mortality among infants and children in the United States during the prevaccine era (i.e., before the mid-1940s). Following the introduction and widespread use of whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids (DTP) among infants and children in the late 1940s, the incidence of reported pertussis declined to a historic low of 1,010 cases in 1976 (Figure 1). However, since the early 1980s, reported pertussis incidence has increased cyclically with peaks occurring every 3-4 years. In 1996, less reactogenic acellular pertussis vaccines (DTaP) were licensed and recommended for routine use among infants. This report summarizes national surveillance data for pertussis during 1997-2000 and assesses the effectiveness of pertussis vaccination in the United States during this period. The findings indicate that pertussis incidence continues to increase in infants too young to receive 3 doses of pertussis-containing vaccine and in adolescents and adults. Prevention efforts should be directed at maintaining high vaccination rates and managing pertussis cases and outbreaks.     

Infant health among Puerto Ricans--Puerto Rico and U.S. mainland, 1989-2000

Although the overall U.S. infant mortality rate (IMR) declined dramatically during the 1900s, striking racial/ethnic disparities in infant mortality remain. Infant health disparities associated with maternal place of birth also exist within some racial/ethnic populations. Eliminating disparities in infant health is crucial to achieving the 2010 national health objective of reducing the infant death rate to 4.5 per 1,000 live births (objective 16-1c). Hispanics comprise the largest racial/ethnic minority population in the United States. Among U.S. Hispanics, considerable heterogeneity exists in infant health, with the poorest outcomes reported among Puerto Rican infants. This report compares trends during the previous decade in IMRs and major determinants of these rates such as low birthweight (LBW), preterm delivery (PTD), and selected maternal characteristics among infants born to Puerto Rican women on the U.S. mainland (50 states and the District of Columbia) with corresponding trends among infants born in Puerto Rico. The findings indicate that despite having lower prevalence of selected maternal risk factors, Puerto Rico-born infants are at greater risk for LBW, PTD, and infant death than mainland-born Puerto Rican infants. This report also highlights a persistent disparity in IMRs and an emerging disparity in LBW and PTD rates between Puerto Rico-born infants and mainland-born Puerto Rican infants. Future research should focus on identifying factors responsible for these disparities to improve infant health in Puerto Rico.     

The U.S. economy and changes in health insurance coverage, 2000-2006

The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. In the first four years of the decade, during a period of economic recession, the number increased by 6.0 million. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults. Employer coverage declined most for self-employed or small-firm workers, in the South, and among noncitizens.     

Trends in hospitalizations with antibiotic-resistant infections: U.S., 1997-2006

Objectives

Antibiotic resistance is a significant global problem, but the trends in prevalence and impact of antibiotic resistance in hospitalizations in the United States are unclear. We evaluated the trends in hospitalizations associated with antibiotic-resistant infections in U.S. hospitals from 1997 to 2006.

Methods

We analyzed the National Hospital Discharge Survey (NHDS) during 1997–2006 (unweighted n=3.3 million hospitalizations; weighted n=370.3 million hospitalizations) and examined trends in prevalence of hospitalizations with antibiotic-resistant infections, length of stay, and discharge status.

Results

The number of infection-related hospitalizations with antibiotic resistance increased 359% during the 10-year period, from 37,005 in 1997 to 169,985 in 2006. The steepest rise was seen among individuals <18 years of age. The mean age of individuals with infection-related hospitalizations that had antibiotic-resistant infections decreased substantially, from 65.7 years (standard error [SE] = 2.01) in 1997 to 44.2 years (SE=1.47) in 2006. As the proportion of patients with antibiotic-resistant infections who did not have insurance increased, the length of stay for those hospitalizations had a corresponding decrease (r=0.91, p<0.01).

Conclusions

Antibiotic-resistant infections are becoming increasingly commonplace in hospitalizations in the U.S., with a steady upward trend between 1997 and 2006. Antibiotic-resistant infections are increasingly being seen in younger patients and those without health insurance.Despite the clear benefits of antibiotic therapy for a variety of infectious diseases, the widespread use of these agents has facilitated the emergence of a variety of antibiotic-resistant pathogens.¹ Because of the significant impact antibiotic resistance has on morbidity and mortality, it is considered a threat to U.S. public health and national security by the Institute of Medicine and the Infectious Diseases Society of America.^2,3Since the 1990s in the United States, the prevalence of antibiotic resistance has increased for a variety of pathogens. Increased resistance has been found for Neisseria gonorrhoeae, Salmonella ser Typhi, Escherichia coli, and Mycobacterium tuberculosis.^4–7 In particular, the emergence of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) has raised serious questions about the ability to treat some of these new resistant pathogens.^8,9 At first, many of these resistant organisms were confined to hospitalized populations; however, in recent years the emergence of community-associated infections with these resistant organisms has become more common.^10,11 Community-associated MRSA is particularly important because it is not simply an extension of hospital-associated MRSA into the community, but rather a different strain.The purpose of this study was to describe the trends in hospitalizations and deaths associated with antibiotic-resistant infections in U.S. hospitals from 1997 to 2006.     

Prevalence and trends in obesity among aged and disabled U.S. Medicare beneficiaries, 1997-2002

Given Medicare's recent national coverage decision on bariatric surgery, as well as potential coverage expansions for other obesity-related treatments, data on obesity in the Medicare population have great relevance. Using nationally representative data, we estimate that between 1997 and 2002, the prevalence of obesity in the Medicare population increased by 5.6 percentage points, or about 2.7 million beneficiaries. By 2002, 21.4 percent of aged beneficiaries and 39.3 percent of disabled beneficiaries were obese, compared with 16.4 percent and 32.5 percent, respectively, in 1997. Using 2002 data, we estimate that three million beneficiaries would be eligible for bariatric surgery coverage under current Medicare policy.     

Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004

As emergency department (ED) patient volumes increase throughout the United States, are patients waiting longer to see an ED physician? We evaluated the change in wait time to see an ED physician from 1997 to 2004 for all adult ED patients, patients diagnosed with acute myocardial infarction (AMI), and patients whom triage personnel designated as needing "emergent" attention. Increases in wait times of 4.1 percent per year occurred for all patients but were especially pronounced for patients with AMI, for whom waits increased 11.2 percent per year. Blacks, Hispanics, women, and patients seen in urban EDs waited longer than other patients did.     

Urinary phytoestrogen concentrations in the U.S. population (1999-2000)

We report population-based urinary concentrations of phytoestrogens stratified by age, sex, and composite racial/ethnic variables. We measured the isoflavones - genistein, daidzein, equol, and O-desmethylangolensin (O-DMA) - and the lignans - enterolactone and enterodiol - in approximately 2500 urine samples from individuals aged 6 years and older who participated in the National Health and Nutrition Examination Survey (NHANES) in 1999 and 2000. We detected all phytoestrogens in over 70% of the samples analyzed; enterolactone was detected in the highest concentrations, and daidzein was detected with the highest frequency. The geometric means for each phytoestrogen were as follows: genistein, 22.3 microg/g; daidzein, 68.6 microg/g; equol, 7.65 microg/g; O-DMA, 3.95 microg/g; enterolactone, 217 microg/g; and enterodiol, 24.3 microg/g creatinine. The 95th percentiles for each phytoestrogen were as follows: genistein, 380 microg/g; daidzein, 944 microg/g; equol, 50.3 microg/g; O-DMA, 217 microg/g; enterolactone, 2240 microg/g; and enterodiol, 240 microg/g creatinine. Multivariate analyses showed statistically significant differences among many of the demographic subgroups. Adolescents had higher concentrations of genistein and equol than adults. Non-Hispanic whites had higher concentrations of enterodiol and equol than Mexican Americans or non-Hispanic blacks. Non-Hispanic whites also had higher concentrations of enterolactone and O-DMA than Mexican Americans. Mexican Americans had higher concentrations of genistein than non-Hispanic blacks; however, the opposite was found for O-DMA. Determination of phytoestrogen exposure in the US population will help us to better understand phytoestrogen consumption in the US and will assist us in elucidating the potential role of phytoestrogens in protecting against cancer and heart disease.     

Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000

OBJECTIVE: To examine trends in walking among adults in 31 states. METHODS: Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4-5.2), from 26.2% (95% CI=25.1-25.3) in 1987 to 30.1% (95% CI=29.4-30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4-7.8), from 40.4% (95% CI=-39.4-41.1) to 46.9% (95% CI=46.2-47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2-14.2) in Hispanic women, 8.5% (95% CI=4.4-12.6) non-Hispanic black women, and 7.0% (95% CI=2.3-11.7) in non-Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for > or =30 minutes per session). CONCLUSIONS: Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.