Endemic tuberculosis, the homeless, and public transportation: A merging of geographical information systems surveillance and the Houston Tuberculosis Initiative Surveillance project

To reach the goals established by the Institute of Medicine (IOM) and the Centers for Disease Control's (CDC) STOP TB USA, measures must be taken to curtail a future peak in Tuberculosis (TB) incidence and speed the currently stagnant rate of TB elimination. Both efforts will require, at minimum, the consideration and understanding of the third dimension of TB transmission: the location-based spread of an airborne pathogen among persons known and unknown to each other. This consideration will require an elucidation of the areas within the U.S. that have endemic TB. The Houston Tuberculosis Initiative (HTI) was a population-based active surveillance of confirmed Houston/Harris County TB cases from 1995–2004. Strengths in this dataset include the molecular characterization of laboratory confirmed cases, the collection of geographic locations (including home addresses) frequented by cases, and the HTI time period that parallels a decline in TB incidence in the United States (U.S.). The HTI dataset was used in this secondary data analysis to implement a GIS analysis of TB cases, the locations frequented by cases, and their association with risk factors associated with TB transmission. ^ This study reports, for the first time, the incidence of TB among the homeless in Houston, Texas. The homeless are an at-risk population for TB disease, yet they are also a population whose TB incidence has been unknown and unreported due to their non-enumeration. The first section of this dissertation identifies local areas in Houston with endemic TB disease. Many Houston TB cases who reported living in these endemic areas also share the TB risk factor of current or recent homelessness. Merging the 2004–2005 Houston enumeration of the homeless with historical HTI surveillance data of TB cases in Houston enabled this first-time report of TB risk among the homeless in Houston. The homeless were more likely to be US-born, belong to a genotypic cluster, and belong to a cluster of a larger size. The calculated average incidence among homeless persons was 411/100,000, compared to 9.5/100,000 among housed. These alarming rates are not driven by a co-infection but by social determinants. The unsheltered persons were hospitalized more days and required more follow-up time by staff than those who reported a steady housing situation. The homeless are a specific example of the increased targeting of prevention dollars that could occur if TB rates were reported for specific areas with known health disparities rather than as a generalized rate normalized over a diverse population. ^ It has been estimated that 27% of Houstonians use public transportation. The city layout allows bus routes to run like veins connecting even the most diverse of populations within the metropolitan area. Secondary data analysis of frequent bus use (defined as riding a route weekly) among TB cases was assessed for its relationship with known TB risk factors. The spatial distribution of genotypic clusters associated with bus use was assessed, along with the reported routes and epidemiologic-links among cases belonging to the identified clusters. ^ TB cases who reported frequent bus use were more likely to have demographic and social risk factors associated with poverty, immune suppression and health disparities. An equal proportion of bus riders and non-bus riders were cultured for Mycobacterium tuberculosis, yet 75% of bus riders were genotypically clustered, indicating recent transmission, compared to 56% of non-bus riders (OR=2.4, 95%CI(2.0, 2.8), p<0.001). Bus riders had a mean cluster size of 50.14 vs. 28.9 (p<0.001). Second order spatial analysis of clustered fingerprint 2 (n=122), a Beijing family cluster, revealed geographic clustering among cases based on their report of bus use. Univariate and multivariate analysis of routes reported by cases belonging to these clusters found that 10 of the 14 clusters were associated with use. Individual Metro routes, including one route servicing the local hospitals, were found to be risk factors for belonging to a cluster shown to be endemic in Houston. The routes themselves geographically connect the census tracts previously identified as having endemic TB. 78% (15/23) of Houston Metro routes investigated had one or more print groups reporting frequent use for every HTI study year. We present data on three specific but clonally related print groups and show that bus-use is clustered in time by route and is the only known link between cases in one of the three prints: print 22. (Abstract shortened by UMI.)^

Project development for older adults : Orientation's contribution

This paper systematizes the work developed during the first year of the initiation scholarship for the research project entitled 'Orientation within the new Active Aging Model: educational, work-related, personal and social choices (1)'. This project articulates the Active Aging Model and the Theoretical Operative Model in Orientation, in order to learn how new projects are developed by older adults who used to be part of the formal system of labor and by those who were out of it, and to design programmatic proposals for educational, work-related, personal and social Orientation choices for such population. The sample is made up by seventy people between 64 and 74 years of age, residing in La Plata. The first conclusions evidence the importance that older adults place on project development at this stage of their life cycle, giving special importance to educational, personal and social projects; as well as on the identification of economic factors, health state, family needs for care and social support, among other things, as conditioning the fulfillment of such projects. The differences found in terms of the labor system they used to belong to can be especially observed in the type of project developed.

Project development for older adults : Orientation's contribution

This paper systematizes the work developed during the first year of the initiation scholarship for the research project entitled 'Orientation within the new Active Aging Model: educational, work-related, personal and social choices (1)'. This project articulates the Active Aging Model and the Theoretical Operative Model in Orientation, in order to learn how new projects are developed by older adults who used to be part of the formal system of labor and by those who were out of it, and to design programmatic proposals for educational, work-related, personal and social Orientation choices for such population. The sample is made up by seventy people between 64 and 74 years of age, residing in La Plata. The first conclusions evidence the importance that older adults place on project development at this stage of their life cycle, giving special importance to educational, personal and social projects; as well as on the identification of economic factors, health state, family needs for care and social support, among other things, as conditioning the fulfillment of such projects. The differences found in terms of the labor system they used to belong to can be especially observed in the type of project developed.

Project development for older adults : Orientation's contribution

This paper systematizes the work developed during the first year of the initiation scholarship for the research project entitled 'Orientation within the new Active Aging Model: educational, work-related, personal and social choices (1)'. This project articulates the Active Aging Model and the Theoretical Operative Model in Orientation, in order to learn how new projects are developed by older adults who used to be part of the formal system of labor and by those who were out of it, and to design programmatic proposals for educational, work-related, personal and social Orientation choices for such population. The sample is made up by seventy people between 64 and 74 years of age, residing in La Plata. The first conclusions evidence the importance that older adults place on project development at this stage of their life cycle, giving special importance to educational, personal and social projects; as well as on the identification of economic factors, health state, family needs for care and social support, among other things, as conditioning the fulfillment of such projects. The differences found in terms of the labor system they used to belong to can be especially observed in the type of project developed.

PREDIRCAM eHealth platform for individualized telemedical assistance for lifestyle modification in the treatment of obesity, diabetes, and cardiometabolic risk prevention: a pilot study (PREDIRCAM 1)

Background: Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention. Methods: PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform. Results: The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible. Conclusions: The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake.

Monitoring and Prevention the Smart Cities

Nowadays, the intensive use of Technology Information (TI) provide solutions to problems of the high population density, energy conservation and cities management. This produces a newest concept of the city, Smart City. But the inclusion of TI in the city brings associated new problems, specifically the generation of electromagnetic fields from the available and new technological infrastructures installed in the city that did not exist before. This new scenario produces a negative effect on a particular group of the society, as are the group of persons with electromagnetic hypersensitivity pathology. In this work we propose a system that would allow you to detect and prevent the continuous exposure to such electromagnetic fields, without the need to include more devices or infrastructure which would only worsen these effects. Through the use of the architecture itself and Smart City services, it is possible to infer the necessary knowledge to know the situation of the EMF radiation and thus allow users to avoid the areas of greatest conflict. This knowledge, not only allows us to get EMF current map of the city, but also allows you to generate predictions and detect future risk situations.

Smart Sentinel: Monitoring and Prevention System in the Smart Cities

Today, faced with the constant rise of the Smart cities around the world, there is an exponential increase of the use and deployment of information technologies in the cities. The intensive use of Information Technology (IT) in these ecosystems facilitates and improves the quality of life of citizens, but in these digital communities coexist individuals whose health is affected developing or increasing diseases such as electromagnetic hypersensitivity. In this paper we present a monitoring, detection and prevention system to help this group, through which it is reported the rates of electromagnetic radiation in certain areas, based on the information that the own Smart City gives us. This work provides a perfect platform for the generation of predictive models for detection of future states of risk for humans.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

Efficiency of a conductive cement-based anodic system for the application of cathodic protection, cathodic prevention and electrochemical chloride extraction to control corrosion in reinforced concrete structures

This article describes the research carried out regarding the application of cathodic protection (CP) and cathodic prevention (CPrev), in some cases with a pre-treatment of electrochemical chloride extraction (ECE), on representative specimens of reinforced concrete structures, using an anodic system consisting of a graphite-cement paste applied as a coating on the surface. The aim of this research is to find out the competence of this anode for the aforementioned electrochemical treatments. The efficiency of this anode has been clearly demonstrated, as well as its capability to apply a combined process of ECE and after CP.

The drinking driver and traffic safety project. Annual report. Volume I of two volumes.

National Highway Safety Bureau, Washington, D.C.

HIV/AIDS prevention and control and population/family planning : the potential for integration of programs and activities in sub-Saharan Africa /

"Report No. 91-146-141."

Community-based AIDS prevention : studies of intravenous drug users and their sex partners : proceedings of the First Annual NADR National Meeting.

Mode of access: Internet.

Ashland Flood Control Project : Village of Ashland, Cass County Illinois : Division of Water Resources, small projects program.

"DOWR/SPR/95-002."

Ashland Flood Control Project : Village of Ashland, IL, Cass County /

"May 2009."

Buffalo Creek Tributary A flood control project in Palatine Township, Cook County, Illinois : executive summary /

Description of a project to replace box culverts with bridges and to widen the channel bottom of Tributary A of Buffalo Creek.