Poultry exposure is associated with a quinupristin-dalfopristin resistance gene and inducible quinupristin-dalfopristin resistance in human fecal E. faecium. The continued use of virginiamycin may increase the potential for streptogramin-resistant E. faecium infection in humans.

Objective: In this study, health event capture is broadly defined as the degree to which a group of people use a particular provider network as their primary source of health care services. The Marshfield Epidemiologic Study Area (MESA) is a valuable resource for population-based health research, but the completeness of health event capture has not been validated in recent years. Our objective was to determine the current level of outpatient and inpatient health event capture by Marshfield Clinic (MC) facilities and affiliated hospitals for people living within MESA.Design: A stratified sample survey with strata defined by MESA region (Central or North) and age group (<18 years or ≥18 years). Methods: A health care utilization survey was mailed to a random sample stratified by age group and MESA region. Telephone interviews were attempted for nonrespondents. The survey requested information on sources of outpatient care and overnight hospital admissions. Population proportions representing health event capture metrics and corresponding 95% confidence intervals (CI) were estimated with analytic weights applied to account for the survey design.Results: Among those with an outpatient visit during the past 24 months, the most recent visit of an estimated 93% (95% CI, 91% -94%) was at a MC facility. The most recent admission of an estimated 93% (95% CI, 90% -96%) of those hospitalized in the past 24 months was at a hospital affiliated with MC. The proportion admitted to MC affiliated hospitals was higher for residents of MESA Central (97%) compared to MESA North (83%). Conclusion

To determine whether poultry contact/consumption predicts colonization with antimicrobial-resistant Escherichia coli, 567 newly hospitalized patients and 100 vegetarians were assessed microbiologically and epidemiologically. Multivariable analysis showed that poultry contact/consumption, other dietary habits, and antimicrobial use did not significantly predict resistance. In contrast, foreign travel significantly predicted both trimethoprim-sulfamethoxazole resistance (prevalence ratio, 2.7 [95% confidence interval, 1.3-5.6]) and "any resistance" (total population), whereas intensive-care-unit exposure predicted any resistance (hospital patients). Thus, most of the individual-level exposures-including poultry contact/consumption-that had been expected to be significant risk factors for infection with antimicrobial-resistant E. coli did not prove to be such. Other exposures, including household-, community-, and population-level effects, may be more important.

Irr itable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by recurrent episodes of abdominal pain or discomfort along with changes in frequency or consistency of the stool in the absence of an organic etiology. The condition is heterogeneous, exhibiting variability in the frequency of symptoms reported within and between males and females. 1 The pathophysiological mechanisms of IBS are not completely understood. Alterations in gut motility, visceral perception, and central processing of pain and motor function due to abnormalities in the enteric and central nervous system are believed to account for symptoms of IBS. 2 The brain-gut axis and biopsychosocial model have been used to explain how intrinsic and extrinsic stimuli modulate disease expression. 3,4 It is unknown whether IBS is primarily a disorder of abnormal perception to a normal stimulus, or a disorder of normal perception to an abnormal physiologic sensory stimulus. Since no structural abnormalities or biochemical markers characterize IBS, diagnosis is based on the presence of clinical symptoms. 2 Symptom-based diagnostic criteria have been established to create uniformity in reporting and enhance diagnostic accuracy. Objective: The quality of documentation of signs and symptoms and validation of the diagnosis of irritable bowel syndrome (IBS) according to case definition criteria of Manning, Rome I and Rome II in an office setting has not been previously described.We sought to identify and validate cases of IBS based on the Manning, Rome I and Rome II diagnostic criteria in a rural practice setting. Original Research Conclusions:Only a small percentage of IBS cases with assigned diagnostic codes met case definition criteria for IBS.There were low concordance rates among the three diagnostic criteria applied.

Methods of ascertaining and defining asthma in epidemiologic research vary, and the extent of agreement between such measures is not clearly understood. Within a broader investigation of early-life farm exposures and risk of childhood asthma and other atopic conditions, the authors sought to generate and compare population-based estimates of asthma prevalence among farm children using several definitions, based on both parental report and medical chart review. The Marshfield Epidemiologic Study Area (MESA) is a geographically defined, population-based cohort that receives nearly all health care from Marshfield Clinic and affiliated institutions. The region includes about 2200 farms, and over 9500 children aged 5 to 17 years who were born in the region served as the study population. A stratified random sample of 1000 overselecting for likely farm resident children was drawn. Parents of 553 children completed the survey and gave permission to review medical records. Informative records were available for 531 (96%). A weighted analysis provided estimates for the full study population. Asthma ascertainment included parental reports of past asthma diagnosis, history of wheezing, and asthma medication use, as well as documentation of asthma diagnoses and medication use in the medical chart. Prevalence of asthma among farm children using a broad composite definition was 24.8%. Prevalence based on parental reports of a specific asthma diagnosis was 11.2%, whereas medical chart documentation of a past asthma diagnosis was found for 10.1% of farm children. Seventy-one percent of parental reports were validated in the charts, and 80% of chart-confirmed diagnoses were reported by the parent. Basing asthma prevalence for farm children on a history of asthma medication use gave a higher estimate than did history of a diagnosis. Of farm children, 19.2% reported wheezing or respiratory whistling, with 8.1% occurring in the past year. Observational research on asthma can be substantially influenced by ascertainment methods and case definitions. Although prevalence estimates based on a past asthma diagnosis were quantitatively similar for parental reports and chart confirmation, agreement on specific cases between the two sources was less than expected. Care should be taken to clearly describe asthma case definitions when reporting results of observational asthma research.